Today Crikey publishes in full the National Mental Health Commission’s review of mental health programs and services. The report was received by the government five months ago but has not yet been released. And we now know why — it’s a damning document, as Bernard Keane explains.

“The system is driven by supply (what providers provide), rather than by demand (what people want and need),” the review states.

It’s a familiar refrain in health reform.

There are potentially big gains to be made in both efficiency and health outcomes from focusing on patient needs and choice, rather than making them fit in with government-ordained structures of primary, community and acute care. A similar understanding has driven recent changes in the aged care sector.

Only now, with the NMHC’s report, has similar thinking been applied to mental health. The report proposes a shift of resourcing from the sharp end of mental health care — in hospitals, frequently after an incident involving self-harm or a threat to others — “upstream” to primary care, community care and family and community environments.

The problem for the Abbott government is that it has already slashed hospitals funding and is engaged in a ferocious war with the states over the issue. A proposal to shift more resources out of hospitals at the moment is the last thing it needs. Yet it simply cannot allow the current patchwork system to continue — it is not efficient, and nor is it good for health outcomes.