Prime Minister John Howard's announcement of a $1.8 billion mental health package last week is hopefully the first in a series of giant steps towards a genuine process of national mental health reform. The fact that the prime minister has become personally involved in this important social and health issue is recognition of the depth of the national crisis and the significance of the issue for the country's future health and welfare. Now the state premiers must step forward. To date (April 6), only New South Wales' Morris Iemma has recognised the extent of the problem.
There are striking deficits across the spectrum of mental health care. They are apparent from the most basic interaction with your general practitioner, through the acute hospital setting and onto the medium-term hospital and longer-term community care settings.
In this package, the Howard Government recognises the need to develop new teams of professionals who can work in close association with general practice and other primary care practitioners. It has also attached priority to working more closely with non-government organisations that have a long-term commitment to the welfare of those with mental illness.
The most obvious example of new systems is the extension of federal funding to clinical psychologists. This is a long overdue reform of the Medicare system. But the government will need to ensure that clinical psychology does not go the way of other medical specialties. The move should lead to a much wider range of psychological treatment options being open to people with common problems such as anxiety, depression, and alcohol and substance abuse.
But distinct dangers remain. Services could be clustered in the better-off areas of Sydney and Melbourne. Those with psychotic or more complex conditions may not gain ready access. Psychologists could be drawn away from their public sector health roles. Large out-of-pocket expenses could easily result for the individual patient.
Fortunately, the government proposes placing additional emphasis on teamwork and the introduction of new schemes for employing mental health nurses, youth workers and psychologists under specific programs that focus on new services in rural and regional Australia. As with many of the proposed reforms, we will need to see the detail to gauge whether the value of these reforms outweighs the potential risks. The government has not moved to challenge the work practices of private psychiatrists or the ways in which private health insurance packages may undermine utilisation of the private hospital sector.
The government recognises the critical role played by families and carers. It proposes access to respite care and other family supports, but this needs to be backed by a more holistic approach to accommodation support. Another particular need arises as people with mental illness grow older. The combination of behavioural and other health problems often leads to admission to aged care services. This is a key area where the federal and state governments need to develop shared processes for providing ongoing care.
The package does emphasise providing better health services to younger persons. This comes on the back of the establishment of the National Youth Mental Health Foundation by the Howard Government. The related alcohol and drug issues that afflict young persons with mental health problems are also recognised. We need new and innovative services developed to treat significant mental health problems as soon as they arise in high school or early adult life. This is an area where close co-operation is required with state-based initiatives and a high priority should be placed on community-based treatments that can prevent acute hospitalisation.
Other problem areas include the acute hospital and medium-term care sectors, long-term accommodation and community support. We need real investment in return-to-work programs, particularly for those with chronic illnesses. The infrastructure and work-force investments required in these areas are large. We are faced with putting right decades of neglect.
Hopefully, the state governments will recognise their responsibilities in this area and, like the Howard Government, set about making new financial and innovative service commitments.
We need not only new monies but also new systems of care and new ways of reporting back to the community about the rate and extent of that process. The recent senate report and the federal government recognise the potential expanded role of the Mental Health Council, the need to increase dramatically support for service innovation and medical research, and the need to demand new forms of accountability. Simply investing new monies in old and failed systems will not deliver the new and seamless system of federal and state-funded care that is urgently required.
First published in The Australian on April 6, 2006.
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