According to government statistics, around 4 million Australians suffer some form of mental health issue each year, making it the third largest chronic disease in the country, only behind cancer and cardiovascular disease.
The recent Mental Health Review noted that there is significant spending on mental health – but that a one size fits all approach is simply not working.
In response, the federal government has released a reform package, to be delivered over a three year period, that focusses on the following actions:
- Contestable mental health services will be commissioned, not delivered, through the recently established Primary Health Networks (PHNs);
- Coordinated packages of care will be created for people with severe and complex needs and flexible support for mild and moderate needs;
- A new Digital Mental Health Gateway will optimise the use of digital mental health services;
- A new approach to suicide prevention, co-ordinated by PHNs.
In more detail, the reforms aim to deliver a ‘stepped care’ model so that Australians can receive varying levels of primary care treatment and support depending on their level of need as determined by a health professional. For the first time, Australians with a severe and complex mental illness will also have access to an integrated care package tailored to their individual needs, which may include:
- comprehensive assessment and care-coordination support;
- psychological services; mental health nursing;
- drug and alcohol services; vocational assistance; and
- peer support.
The government will also undertake a landmark shift in service delivery from Canberra to local communities through the 31 Primary Health Networks across the country, with the PHNs put in charge of commissioning the mental health services they consider necessary and appropriate.
Some industry response to the reform package is summarised below.
The Consumers Health Forum has welcomes the reforms, saying that they provide welcome recognition of the need to meet the individual needs of patients with care that is comprehensive and provided locally.
“We strongly support the direction of this package. It is people-centred and moves to place mental health services firmly within the scope of primary care in the community,” said the Chief Executive Officer of CHF, Leanne Wells.
“The recognition of the primacy of the primary health care setting in treatment will ensure service planning is done on the ground by clinicians and consumers close to where people live and will take into account existing services and opportunities to integrate with state services.”
Chairman of beyondblue Jeff Kennett said today’s announcement by the Turnbull Government is a defining moment for mental health care in Australia.
“It’s about time someone had the guts and foresight to overhaul the system to focus on the needs of people rather than providers. We need to get the maximum bang for our buck by spending taxpayers’ dollars where they have the greatest impact,” said Mr Kennett.
“This is exactly the kind of leadership we need to help the three million people who at any one time have depression or anxiety, and the hundreds of people who attempt to take their lives or the seven who die by suicide every day in Australia – and their families.
“Today’s theme of national leadership with a focus on regional planning and delivery is broadly what individuals and families have been demanding, and what the National Mental Health Commission has recommended.”
The National Mental Health Commission also welcomed the Federal Government’s announcement on mental health reform as a major step forward in enabling people to lead more contributing lives and for Australia to grow thriving communities.
“The Government’s response represents a ringing endorsement of the strategic directions outlined in the Commission’s National Review of Mental Health Programmes and Services – Contributing Lives, Thriving Communities,” Commission Chair, Professor Allan Fels, said.
“The focus now must be on effective and efficient implementation, as well as on change management, to ensure the community reaps the full benefits of the reform package. It is critical that implementation actively engages key stakeholder groups across the mental health sector, and places individuals, families, carers and other support people at the centre.
“It also is critical to recognise that mental health and wellbeing is much broader than the health system and that to be fully successful we must adopt a whole of government, whole of person, whole of life approach.”
Joining the praise, the Australian Healthcare & Hospitals Association (AHHA) said that the government’s reform signals a positive move towards better integrated, patient-centred, regionally responsive care, with the potential to improve health outcomes, and ensure a more holistic approach to care.
“This must be complemented by a commitment from the Commonwealth, state and territory, and local governments to empower PHNs with the authority to effectively carry out these roles and ensure they are appropriately funded for long-term investment in their communities,” said AHHA Chief Executive Alison Verhoeven.
“We recognise that reform will not be achieved in an instant, as the task to redesign long-standing approaches to care is complex. The reforms will need to be monitored and evaluated as they progress through trials to national implementation.”
The Butterfly Foundation called the reform package a necessary step for proper treatment of approximately 1 million Australian’s currently suffering from an eating disorder.
“This overhaul of Australia’s mental health system includes a commitment to direct funding through Primary Health Networks, favouring a regionalised approach to meet local needs. As quantified in Butterfly’s “Investing In Need” report, every dollar invested in early identification and proper treatment of an eating disorder delivers over five dollars in benefits. The economic and social rationale for individual care is compelling” said Butterfly Foundation Chair David Murray AO.
Catholic Health Australia (CHA) said it is pleased to see the Commonwealth government taking a leadership role and acting on the Commission’s recommendation to move away from the current fragmented and provider-focussed system.
“I am particularly pleased to see that those who have complex care needs will soon be able to access a package of integrated care services, including comprehensive assessment and care co-ordination support, psychological services, mental health nursing, drug and alcohol services, vocational assistance and peer support,” said Suzanne Greenwood, CEO of Catholic Health Australia.
“There will no doubt be significant challenges ahead for the Government and our members who provide mental health services in moving to a new framework for the funding and delivery of mental health services,” Mrs Greenwood said.
Mental Health Australia CEO, Frank Quinlan, said that reform starts today, with the government providing a workable framework for systemic change.
“Realising this vision will now depend on the contribution of all players, not governments alone,” said Mr Quinlan.
“The mental health sector stands ready to play its role as we start the reform journey.”
Black Dog Institute clinicians and researchers have welcomed the new National Mental Health Plan.
“We are very pleased the Government has acknowledged the very powerful evidence that clearly demonstrates mental health programs need to be fully integrated into day to day life,’ said Prof Helen Christensen, Director of Black Dog Institute and Chair of NHMRC Centre for Research Excellence in Suicide Prevention.
“Like any serious public health issue, mental health can’t be something we only worry about when it turns bad. We need a whole systems approach that incorporates education, prevention, early intervention, access to quality treatment and ongoing support where required.
“Research shows that many cases of mental illness, and nearly all cases of suicide, could be prevented with the appropriate systems in place. With this plan finally completed, I hope we can now work with the government, community and health systems to significantly reduce the rates of mental illness and suicide in Australia.”
Perhaps one of the least-congratulatory voices was that of the AMA, with AMA President, Professor Brian Owler, warning that GPs must remain at the centre of care.
“GPs are usually the first point of call in the health system for patients with mental illness, with BEACH data estimating that around 13 per cent of GP encounters are mental health-related,” said Prof Owler.
“GPs play a key role in treating patients with mental illness, and refer to other services where appropriate. Patients who have concerns about their mental health should talk to their usual GP, who is well placed to help them.”
COTA also sounded a note of caution, saying that the reforms provide a welcome shift to a more person-centered, streamlined and localized approach but fail to address the unique issues faced by older Australians.
“The reality is that the mental health needs of older people are frequently not given priority, or are indeed ignored, often being incorrectly discounted as just a normal part of getting old, “said COTA Australia CE Ian Yates.
The Australian Psychological Society (APS) said the reforms were much-needed and that the regionalised approach will lead to better care for people with mental health issues.
“The proposed changes, including increased access to online mental health interventions and tailored packages of care for people with severe, chronic and complex conditions through Primary Health Networks (PHNs) across Australia, will lead to a more integrated and coordinated approach to their mental health care,” said Executive Director of the APS Professor Lyn Littlefield.
The APS also welcomed the focus on children and young people and making Aboriginal and Torres Strait Islander mental health a priority.
The Government’s full response is available on the front page of the Department of Health website: www.health.gov.au