The resignation of John Mendoza as chair of the federal government’s National Advisory Council on Mental Health would not have come as a surprise to readers of Crikey‘s health blog Croakey. Last month, in the wake of the government’s hospital funding agreement with the states, Mendoza wrote a scathing critique of the Rudd government’s approach to mental health …

The prime minister and minister for health and ageing claim the reforms agreed to by COAG constitute “a comprehensive health care reform package”.

Since the COAG announcement there has been a chorus of criticism from health reform experts and advisors — many of whom have been handpicked to provide advice to the government which it duly has ignored. In essence the critique is that the PM has delivered little more than a refinancing package for our public hospital system.

There is precious little in relation to mental health, indigenous health, dental health, primary care, community health and most aspects of prevention, and indeed the entire private hospital sector. The government’s narrative is that these areas will improve simply because we have thrown more resources at our ‘over-stretched hospital sector’.

In mental health, the COAG package provides just $115 million in new funds over four years. There is a return of some of the previously reduced funding for mental health nurses (just $13 million) and a further $57 million of redirected funds from the Better Access program to tally up to the headline figure of $174 million.

And yes there is a commitment to build and fund on a recurrent basis some 1,300 sub-acute beds across a range of areas — palliative, aged, respite, mental health and others. Even if every one of these went to mental health, and had an appropriate model of step-up step down care, we would still be a 1,000 short of the number of sub-acute beds that existed in the mid-1990s and we would again be putting another patch on a broken system.

The only aspect of the announcement which deserves praise is the commitment of a further $20 million in funding to headspace, the national network of youth friendly mental health services.

However, even here the government’s numbers look dodgy. The government claims an extraordinary number of young people will benefit (20,000) and up to 30 new sites will be established, extra findings for the existing 30 sites and even telephone and other services. Some of the existing sites are already struggling to remain open given the government’s failure last year to fully fund the expanding network.

To paraphrase another PM’s rhetoric from another era: ‘never before has so much health care been achieved for so little’.  To realise these claims more of the headspace services would have to rely on fee-for-service arrangements or other sources of funding — hardly the way to encourage young people to seek help.

The other aspects of the COAG announcements on mental health are more of the same as we have seen time and time again when it comes to mental health — “a recognition that more needs to be done”; “[an intention] to take a greater policy and funding role for mental health services over time”; “providing a foundation for better coordinated care for people with mental health disorders into the future” — on and on it goes.

These are the same statements in some cases and the same hollow promises that have been spruiked by successive governments (federal and state/territory) for the past two decades since we began the national mental health reform strategy in 1992.

While the quantum of funding for mental health in these announcements beggars belief, what funding is there is largely misdirected. Take the $57 million over four years for “up to 25,000 people with severe mental illness living in the community”. Anyone working in the mental health sector would have choked on their Weeties reading that line in the morning newspaper!

That’s just $2,280 per person. It compares with a $10,000 package per person under another existing Commonwealth program and between $30-70,000 packages provided by several state governments for people with severe mental illness or high levels of disability as is often the phrase.

Further nonsense is the plan to send those people with “common disorders such as anxiety and depression” off to primary care services funded by the federal government and all those with other mental illnesses off to the states/territories.

So do we have a sign post for these people at the state-run community mental health service saying “no stalkers with depression or anxiety allowed here”? Where do those with treatment resistant depression, co-morbid but common conditions or moderate anxiety disorders and phobias go?

Bring back John Cleese and co — there’s new material here for them to work with!

In mental health we know what madness is like, and this is simply mad policy that will simply result in more preventable deaths every day of Australians unable to access the mental health care they and their working and non-working families and friends desperately need.

It will result in thousands more Australians every day being turned away from EDs and hospitals looking for mental health care services for which they have a fundamental human right. It will result in more lost productivity, family trauma and separation, child abuse and neglect every day because people cannot get access to effective care when and where they need it.

The prime minister said on December 7, 2009 that “a lack of early identification and intervention forces people suffering from acute mental illness to turn to hospitals … as their only option for help”. He was correct in identifying that systemic problem.

He went on to ask: “Why is it that mental health problems are so often picked up by police and drug workers, not our health services? This is the problem today, but it will become a greater problem in the future.”

And under the reform package he is right on that point as well.

Peter Fray

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