Australian of the Year Professor Patrick McGorry and his colleagues recently have invested much hard work in a carefully crafted campaign aimed at achieving some political movement on mental health.
Given the history of neglect of the mentally ill — by governments, health services and indeed the broader community — it’s difficult to begrudge the mental health lobby some celebratory moments. Their campaign finally seems to be paying off.
The federal government has clearly been caught out, and deservedly so. It has earnt every bit of political headway that Tony Abbott makes on mental health.
Mental health — together with other under-served areas, such as dental health and primary care — should have been front-and-centre of the government’s health reform push, rather than something that could be tacked on later.
The government’s inertia on mental health has been unfathomable, no matter which way you look at it — whether from the perspective of a politician, policy wonk, or ordinary, decent human being.
Abbott’s plans include the establishment of 20 early psychosis intervention centres, 800 mental health beds, and 60 additional youth headspace sites. These will be funded by scrapping the government’s reform agenda plans for an Independent Hospital Pricing Authority and the primary health care organisations known as Medicare Locals, as well as cuts to e-health and infrastructure funding to general practice, specifically GP super clinics.
Abbott has won some positive headlines, but I’m not rushing to celebrate just yet, despite my sympathies for the mental health sector. There are too many unsettling questions.
Is this really the best way to make health policy — in order to reap political gain? Will the new services be allocated according to population needs or according to which communities and service providers have the most political clout?
And what about the other under-served areas? Don’t people with mental health problems also have difficulty accessing affordable dental care, never mind all the other (physical) health services they often miss out on?
Won’t the cuts to primary care and e-health also have a negative impact on people with mental health problems? Aren’t they actually one group with much to gain from a stronger, more integrated primary care system that makes better use of e-health?
Could Australia develop the maturity to move towards planning and funding health services based on the population’s actual health needs, rather than upon the lobbying of particular professional, disease or service groups?
Could — gasp — we even go so far as to develop a bipartisan approach to these issues? While the political hardheads may fall about laughing at this suggestion, it is possible.
Just yesterday I was chatting with Dr Jim Primrose, the chief adviser in primary health care to the NZ Health Ministry, who is in Darwin to speak at the Primary Health Care Research Conference.
He said NZ had achieved significant health gains from the implementation of a primary health care strategy that had received bipartisan support.
The strategy is based upon population-based capitation payments (in contrast to our dominant model of fee-for-service), with district health boards being accountable for the health services of a defined population, and patients being enrolled in primary care practices.
He said this approach had resulted in increased use of primary care services by high-need groups, who previously had been missing out on health care. Many health indicators had improved and there had been an improved focus on chronic conditions.
“At a national level we can show that over the last 20 years our improvement in life expectancy, based on OECD data, has been significantly ahead of the OECD average, and has been ahead of Australia’s,” he said. “While Australia’s average life expectancy exceeds NZ’s, our improvement over the last 20 years has been better than Australia’s.”
While health services are unlikely to be responsible for all of these gains, Primrose’s presentation does suggest that substantial benefits can flow from a population-based approach to health policy that emphasises primary care. (And there is also plenty of evidence of this from other countries, too).
Primrose says it wasn’t too difficult to get bipartisan support for the policy because the professions and broader community were supportive.
Perhaps we in the Australian community, including the health professions, should be setting our goals much higher, and asking our political leaders for a more rational and productive approach to health policy.