Mental health reform in Australia

Mental illness is a serious issue for public health policy in Australia. Currently mental illness accounts for some 13.3% of the disease population of Australia, yet a mere 7.8% of the overall health budget is expended on mental health. In many ways mental illness is a hidden illness, in that the illness and suffering may not be as visible as in physical illness. However the impact of mental illness on the lives of individuals and families is profound, not to mention the economic and social impact. I want to suggest here some public policy initiatives to deal with this.

At the outset I want to suggest that we need to have a greater public commitment to mental health, in order to rectify the above imbalance. I suspect that this will mean an additional 3-4 billion dollars per year for mental health. Some would argue that now is not the time to be advocating greater public expenditure in this area. However even from an economic perspective, mental illness has such an impact upon our society in terms of crime, social dislocation and educational problems, that it makes economic sense to commit to this arena.

Further to the above, it is important that we make beds available when needed. We do need some return to the idea of institutional treatment of those with mental illness. I am not talking about reviving the asylums of the past, which were often cruel and abusive places, although we do need some centres for the 3-5% of those patients requiring chronic and residual care. Or for those who may present with extreme symptoms, such as florid psychosis. At the moment we have people who need institutional care, and the beds are simply not available. This is not good for the community and not good for those suffering mental illness.

Clearly rehabilitation is the key to dealing with those with mental illness, and here so much can be done which currently is not being done. One cost-effective initiative would be to make a greater public commitment to the multi-disciplinary treatment of mental health problems. For instance, a person can only access a psychologist under the Medicare system after a referral from a GP. This is wasteful, and also adds an additional burden on GPs. It makes sense to extend bulk-billing services to psychologists, and indeed to other allied health care professionals. With allied health care professionals included in Medicare, this would also facilitate having more multi-disciplinary clinics and centres.

One creative way of extending Medicare to allied health professionals would be to ration Provider Numbers, to encourage a professional commitment to working in regional, rural and remote Australia. We know that at the moment the indicators for mental health problems in regional, rural and remote Australia are often higher than in urban areas. There are complex reasons for this, often simply related to isolation and lack of facilities. Extending Provider Numbers could provide an opportunity to offer these on a condition that a professional works in areas where health care professionals are in fact most urgently needed.

One area of concern regarding the extension of Medicare to allied health professionals is the professional oversight of such professionals. At the present time, state registration is being replaced by national registration. However here too there are areas of concern. For instance, within the professional registration of psychologists, it is important the registration to based upon the whole of prior learning and experience, and not just upon academic standards only. The registration process itself needs to be well-resourced and professional.

Finally, I would suggest that mental health reform in Australia requires a cultural change, that would undergird policy initiatives. Put simply, we need a cultural change where we see that we are all inter-related, and mental health is a concern for us all. And it follows from this that having an effective national mental health policy is of benefit to us all. There are some positive signs that this cultural change has been taking place over recent years, with initiatives such as Beyond Blue and numerous other advocacy groups for those with mental illness. Ultimately mental health reform is about encouraging a more compassionate and inclusive Australia, something which should concern us all and something which will ultimately benefit us all.