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.

Peter Fray

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