It’s just over a year since the PM reached deep into his pocket and pledged an extra $1.9 billion to help the mentally ill, and the NSW Premier put his hand on his heart and said sorry, on behalf of all Australian governments, for the years of underfunding, haphazard policy and “endless excuses and evasions”.

And it is almost a year since the untimely death from cancer of Dr Grace Groom, who did so much to push mental health onto the political agenda while CEO of the Mental Health Council of Australia.

All these anniversaries will be marked this Thursday when prominent psychiatrist Professor Ian Hickie gives the inaugural Grace Groom Memorial Lecture at the National Press Club.

Hickie’s talk is tentatively titled No Silver Bullet — in recognition of the complexity of translating the extra funding into better care and outcomes for the mentally ill. But it is a sure bet that he will be firing plenty of bullets himself.

Hickie will be asking a deceptively simple question: whether the billions of extra dollars committed by federal and state governments through COAG over the next five years will make a real difference to peoples’ lives?

At this stage, it’s looking like the answer might be “who knows”. COAG’s National Action Plan on Mental Health reveals only very general, motherhood-style goals, not the specific targets that Hickie and others would like to see established, and then measured.

As he and colleagues argue in the latest issue of the Medical Journal of Australia, the extra investment may fail rural and remote communities, in particular. One reason is that much of the money is being ploughed into fee-for-service models of care, which don’t have a proud history of ensuring that the needy get the treatment they need.

Hickie is scathing that independent, prospective evaluation is not being built into the roll-out of programs.

“It just means they will do the usual post-hoc look at how much services were used and were the stakeholders happy,” he says.

“The psychologists and doctors will be happy they got paid more but whether the system is better and whether peoples’ experiences of care are better are in danger of never being measured.”

By contrast, when the Canadian province of Ontario committed big bucks to mental health reform in Canada, the bureaucrats brought in academics to evaluate the impact, with upfront agreement the results would be published in peer-reviewed journals. This not only gives confidence in the credibility of the evaluation but helps share knowledge about what works and, just as importantly, what doesn’t.

You can see why politicians and bureaucrats might want to run a million miles from such an arrangement. The political hit they might sustain this week from a few of Hickie’s bullets would be nothing compared with credible studies showing that a multi-billion dollar investment hasn’t translated into a meaningful “sorry”. Besides, the fashion in government these days seems to put more weight on being seen to fix problems, rather than actually fixing them.

Declaration: Melissa Sweet was commissioned by the Canadian Health Services Research Foundation to write a report on evidence-based policy, which included as a case study the Ontario evaluation of mental health reform.

Tomorrow: Why governments should stop good health from being a privilege

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Peter Fray
Peter Fray
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