National Mental Health Reform 2011-12
Foreword
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Australia has long been a leader in treating and caring for people with mental illness. But all too often, this nation’s mental health system fails the people who need the most help and frustrates the professionals who work in the system and the families and carers who work hard to support them.
Around one in three Australians experience mental illness at some stage in their life. Mental illness accounts for 13 per cent of the total burden of disease in Australia, and is the largest single cause of disability, comprising 24 per cent of the burden of nonfatal disease. And mental illness, unlike any other chronic disease, affects people of all ages, with a significant impact on many young people: 25 percent of people with a mental disorder experience their first episode before the age of twelve – half a million children – and 64 per cent by age 21. Yet treatment rates for our young people are low: only 25 per cent for those aged 15 to 24 receive treatment, for example.
Despite significant gains in primary mental health care, more broadly, too many Australians with mental illness are still not seeking or receiving treatment – only around 46 per cent, compared to more than 80 per cent for comparably disabling physical ailments. And those most severely affected by mental illness are dying at rates second only to Indigenous Australians.
People with mental and behavioural conditions have very low workforce participation rates of around 42 per cent compared to more than 80 per cent for people without disability.
Over the last five years, all levels of government have been increasing their investment in mental health. The Commonwealth’s Better Access, Access to Allied Psychological Services and Mental Health Services in Rural and Remote Australia programs have brought treatment to many who previously have missed out. The
significant increase in community mental health services, including the Personal Helpers and Mentors program and respite services for mental health carers has also been widely welcomed by consumers and their families. There have been further emphases on increasing youth-friendly services, tackling suicide and world-leading telephone and web based treatment. Many jurisdictions have been trying out different models of care to see what works best.
Despite these successes, the system is still too crisis-driven, with many people only receiving help when they are at their most vulnerable, instead of help to stay well. There are a number of highly effective services, but they are often patchy and not connected and, for reasons of program design or funding, struggle to deliver a truly integrated service response based around the individual’s needs. This fragmentation of services also creates gaps, which prevent people receiving the full range of services that provide an optimal path to recovery.
Not enough is done to prevent mental illness, or detect it early, so that treatment and support can be provided to prevent worsening health, social isolation, disadvantages such as homelessness, and tragedy such as suicide. This is particularly important for Australia’s young people – our kids and teenagers - and those most vulnerable in our community – people affected with severe mental illness.
More needs to be done to help Australians who have a mental illness get the care they need, when and where they need it and to support their families and carers.
And the Australian Government (‘the Government’) is responding. The Prime Minister has declared mental health to be a priority, and appointed this country’s first federal Mental Health Minister. We have backed this with action, with substantial investment in foundational health system reform, together with targeted mental health funding, in both the last Budget and through our election commitment doubling investment in suicide prevention.
Now we are putting in place a further major boost to services for people with a mental illness – both health and community services – plus a structure to continue reform over the long term.
We need to end the fragmentation in the system and address the service and support gaps. We need to ensure that Australians with mental illness are receiving the right care and support to manage their illness. We need to ensure they stay connected with family and friends and with the other cornerstones of a productive life, such as education, secure housing and employment. We know the changes Australia needs will not happen overnight. We need a long-term sustainable reform plan.
The package outlined in the 2011-12 Budget follows a period of extensive engagement with the sector – with experts, service providers and, most importantly, with consumers and their carers. This Budget lays down the foundations for a new systematic approach to support people with mental illness. Coupled with a longerterm roadmap, the Government will commit a massive $1.5 billion in investments over the next five years to build a better mental health system – a system that will work better for patients, their families, carers and health practitioners alike. This new system will support people to get well and stay well.
The longer-term roadmap will signpost a vision for the system, ground our investments in the advice of experts and stakeholders – those who know what works best – and commit the Government to ongoing action. Future reform will be guided by evaluation of these new measures.
When combined with our 2010 Budget and election commitments, which deliver $624.0 million in funding for services over the same five year period, the Government will be providing $2.2 billion over five years for mental health services. The Government already provides significant mental health program funding. On top of this, the Government also supports people with mental illness through Medicare and the Pharmaceutical Benefits Schemes. In 2009-10, the Government provided $754.8 million to assist individuals access GPs, psychiatrists and psychologists through Medicare.
In line with the Government’s fiscal rules and strategy, all of these new investments are offset by genuine savings. These include a redirection of $580.5 million from the Better Access program.
The focus of our immediate reforms is both delivering early intervention services that have the best chance of improving lives and putting people on a productive and positive path to recovery – and on the priority groups who need additional services. Many of those most severely affected by mental illness, and their families and carers, will be assisted to access the full range of services they need to stay well and out of hospital – together with a single point of contact for information and support to access services. Services will be responsive to the needs of the individual, rather than leaving people to find their own way through a system that is disconnected and hard to understand.
More services will be provided for our children, including a universal voluntary health check for three-year-olds that, for the first time, will include markers of social and emotional development and wellbeing. There will be an increased focus on supporting families and children early. We will create national coverage of services for young people, through models that we know work well: ‘headspace’ and Early Psychosis Prevention and Intervention Centres, and expand Family Mental Health Support services for families and young people at risk.
Treatment options will be expanded, including for hard to reach groups, so that more of the Australians who do not currently get treatment can receive it – particularly in primary health care.
At the same time, we will maintain the essential aspects of the support available through Medicare and the Pharmaceutical Benefits Scheme.
As important as clinical treatment is, other services and support in the community are also critical for the recovery of people with mental illness - to participate in social and community life, get and keep a job, improve relationships with family and friends and help managing the tasks of everyday life. The Budget includes substantial additional funding for community based mental health support including Personal Helpers and Mentors and essential respite support.
The Government is taking the lead role in reform – but we cannot achieve full reform alone. We recognise that non-government organisations, the private sector and state and territory governments (‘states’) – and activities that cross health and non- health sectors – have a vital role to play in a better mental health system. States in particular provide a range of specialist services and support to people with severe and debilitating mental illness. But the range and type of services vary, creating major service gaps. People with the same illness and needs should be provided with the same opportunity for treatment and support, regardless of their location.
Using a competitive process the Government will offer a new National Partnership agreement on mental health to the states. This will help them to fill known gaps, for example, by providing more accommodation support, particularly to help tackle the high levels of homelessness for people with mental illness, or improving presentation, admission and discharge planning in emergency departments. This will occur through performance based funding that promotes and rewards action and results for those requiring support and assistance. The Government’s reforms will take pressure off hospitals, which are currently the default providers of treatment for many.
Knowing what reforms are working well will help us to make investment decisions in the future under the ten year reform roadmap. That is why the Government will continue to fund vital research and data collection. In addition, the Government will establish Australia’s first National Mental Health Commission. Positioned in the Prime Minister’s portfolio, the Commission will have a truly whole of government mandate, will provide authoritative advice to the Government and ensure a more transparent and accountable system so that we know we are getting value for our investments. We will also fund the creation of a new national mental health consumer representative body, to harness the experience of consumers across Australia and to reinforce that their voices should be, and will be, a key driver of policy and program development.
It is the start of a journey – a journey that will make a real, practical difference to the lives of Australians who suffer from mental illness, and the families, carers, friends and professionals who support them.