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Mental health: PM, Butler get credit — are professions up to implementation?

The psychiatrist Professor Ian Hickie is not one for biting his tongue. Over the years, he’s been unusually generous in dispensing harsh critiques of many politicians and medical colleagues.

This morning, however, he was fairly gushing with praise for the Prime Minister Julia Gillard and her Mental Health Minister, Mark Butler, for their role in the budget’s mental health announcements (outlined at Croakey.

Hickie, a member of Butler’s expert advisory group and executive director of the Brain and Mind Research Institute at the University of Sydney, told Crikey: “My insider view is that it would not have happened without her (the PM’s) direct involvement. It is something where she made the difference. The Rudd government was deaf to the community on these key issues.”

Butler, he said, had been instrumental in pushing the government and Department of Health and Ageing to focus on social equity considerations in its mental heath policies.

This is a reference to the funding cut for the Better Access program (of which Hickie has been a critic from its outset), by reducing the Medicare rebate for GP mental health care plans, and capping the total number of allied psychological consultations available each year at 10 rather than 12.  Instead, funding to the Access to Allied Psychological Services (ATAPS) program will be boosted, which Hickie argues will better reach disadvantaged groups.

Of course, no one with any sense of history (anyone remember the grand expectations around the 2006 COAG “breakthrough” on mental health?) will expect last night’s announcements alone to solve the major problems in mental health, which were outlined in blunt detail in the budget papers.

They should instead be seen as a first step, says Hickie, and one of the next priorities will be to ensure matched funding from the states and territories at the next COAG meeting.

The real challenge will be implementation. We shouldn’t forget that some of the government’s mental health promises in last year’s budget didn’t get turned into action, says Hickie.

But perhaps the biggest issue is whether the professions are up to the task of implementation and innovation.

Hickie may be praising politicians today but his critique of professional interests remains damning.

The AMA’s concerns about cuts to GP rebates for mental health plans are “nonsense”, he says.

We all know that a lot of people have been paid a lot of money for glorified referrals to become a cash spinner rather than a quality product,” he says. “Doctors have only themselves to blame.”

Hickie says it was an act of “bastardry” for the AMA and Australian Psychological Society to persuade the government of the time to set up the fee-for-service model of the Better Access program in the face of arguments from Hickie and others that it would be inequitable compared to other, more integrated models of care.

The doctors pulled out of a much better program in favour of fee-for-service, and it got devalued, and now they’re complaining,” he says.

When it came to scale up after five years work on establishing the principle of integrated care, they chucked it out the window in favour of fee-for-service. It was bastardry, and now they’re paying the price for it five years later, and I don’t think they have the right to complain.

The AMA and APS have got to stop being so professional union focused and get on with the job of professional health policy,” he said. But he added: “(AMA president) Andrew Pesce has done a really good job compared with other presidents.”

Hickie was also scathing about colleagues who have not been prepared to engage in policy and service development. There has been a “deafening silence” from many mental health professionals, he says, and a reluctance to engage with new services and structures.

We are desperate for workforce in headspace and other areas,” he said.  “There’s a great deal of professional complacency.”

While mental health is the obvious budget headline hogger, other noteworthy announcements are in dental care, although these are modest compared with the National Health and Hospitals Reform Commission recommendations.

One of the more significant announcements is of ongoing support for regular, population-based studies of children’s health and well-being (the Australian Early Development Index (AEDI) measuring children’s development by the time they start school, and the Social Engagement and Emotional Development (SEED) survey of children aged 8-14 years).

It is this sort of work that might start to drive policies for the betterment of the community’s health in the broadest sense, rather than for sectoral interests.

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  • 1
    Jenny Haines
    Posted Wednesday, 11 May 2011 at 2:52 pm | Permalink

    Headspace is not the only mental health program that is desperate for staff. They all are pretty much. The shortage of nurses in Australia has hit mental health services hard and there is a lot of reliance on young inexperienced staff to work in roles beyond their level of knowledge and skill. Workforce planning mistakes by past governments, State and Federal, have left the mental health nursing workforce depleted of numbers and of those studying at university in nursing courses, very few aspire to work in mental health. Just as an indicator -I ask my first year nursing tutorials who is going into mental health work. I usually get no-one in the class. By third year if you asked the same class you may get anywhere between 1 and 5 out of up to 30 in the class expressing an interest in mental health. I have been suggesting for some time to anyone who will listen, that there should be an undergraduate bachelors degree in mental health nursing, a direct entry course. This sort of course has worked to improve midwifery numbers. It could work for mental health.

  • 2
    Harribal
    Posted Wednesday, 11 May 2011 at 5:23 pm | Permalink

    ATAPS has provided free (or nearly free) psych sessions for people in vulnerable socio-economic groups for years before Better Access. It Works.
    Why isn’t the money being put into ATAPS? Because the Australian Psychological Society thinks it pays too little.

  • 3
    Scott Grant
    Posted Wednesday, 11 May 2011 at 5:59 pm | Permalink

    I had never heard of ATAPS before now (although it does not affect me directly). My interest in this area is due to a close friend on a disability pension since the mid nineties. For at least a decade, she had pretty much zero access to psychologists and dentists, and gained access for the first time through the “Better Access” program. She now sees a clinical psychologist regularly and gets good dental care. I am somewhat worried as to what the changes will mean for her.

    As for dentistry, forget about the dental hospital. They are so overwhelmed, they don’t do preventive treatment and pretty much take only emergencies, by which time the tooth has to be extracted.

    As for therapy, she has been so damaged by incompetent therapists (both psychiatrists and psychologists, when she still had some money), that I am worried about any changes which might have the potential to deny her access to her current therapist.

    It is ironic that people talk about the shortage of nurses. She was a very experienced clinical nurse with some managerial experience. It is quite possible that, had the mental health system originally given her the support she needed, she would still be employed. The personal cost to her has been immense. But it has also cost society. By not spending adequately on mental health one or two decades ago, society has lost, permanently, at least one very competent nurse.

  • 4
    Sense Seeker
    Posted Wednesday, 11 May 2011 at 10:06 pm | Permalink

    I am afraid that all this spending on mental health programmes is going to achieve damn little. As in so many areas, it is much more worthwhile to target populations rather than individuals. We didn’t reduce smoking rates by counselling smokers.

    What would really help is to reduce differences in wealth and income, so lower taxes in the low brackets and higher for those with a high income. Socio-economic inequality is a root cause of much misery and (mental and physical) ill-health.

    Firm restrictions an gambling would probably also help, as would taxing junk food (and subsidising healthy foods). Hard to get evidence for, though.

  • 5
    alongside
    Posted Thursday, 12 May 2011 at 12:07 pm | Permalink

    Let’s hope that this funding boost prompts an examination of best-practice prevention and treatment models. One remarkable example comes to mind.
    About ten years ago, researchers in the UK decided to ‘get back to basics’ in understanding emotional health. They looked at what new insights the disciplines of neuroscience, sociology, and biology could offer. The search yielded amazing
    results - a series of ‘givens’ or bedrock truths that better explain what it means to be psychologically well, and what to do when things go wrong.

    Reported in a current British Psychological Society journal, this new approach to mental health is proving to be “a highly effective treatment for service users presenting with a variety of problems, particularly anxiety and depression”. A major UK university now offering a masters degree in the approach describes it as “the best organising idea in the mental health field today”.

    Perhaps, the reported ‘quiet revolution in healthcare’ in the UK could offer new insights for professionals here and better hope for sufferers.

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