By Ian Hickie
Launching the Coalition’s policy for Efficient Mental Health Research and Services late last week, Tony Abbott said he wished all his policy statements attracted such media attention.
Given the Australian community’s demonstrated engagement with mental health, it’s more surprising that we’ve heard so little about it in this election campaign.
Abbott’s commitment is modest; it matches the Rudd government’s announcement late on Thursday to expand the number of new headspace services from 90 to 100 sites nationally. Headspace is targeted at engaging people aged between 12 and 25 years, with emerging mental health problems.
But Abbott went further, promising A$18m for a new national centre for excellence in youth health and A$5m for a comprehensive e-mental health platform in partnership with the Young & Well Cooperative Research Centre. Australia has been a world leader in developing tools to help self-manage mental health problems with the internet.
Abbott also explicitly said there would be no subsequent cuts to mental health funding.
The Greens have the only mental health policy with substantial financial investment, with a total of A$1.1 billion in new commitments. The money is split between rural mental health initiatives (A$552.6m) and broader investments (A$547.4m) in mental health nurses, research, psychological care, and suicide prevention.
But why have the two major parties missed the opportunity to impress the Australian electorate with decent investment in mental health? An international survey by King’s College in 2010 showed Australians were most concerned by four big issues – the economy, climate change, mental health and ageing.
What happened before
In contrast with the last few weeks, the 2010 election campaign saw considerable emphasis on mental health. Back then, Tony Abbott led the charge, promising to spend A$1.5 billion on a comprehensive program of early intervention specialist services for young Australians.
Former prime minister Julia Gillard nominated mental health as a second-term priority for her government and appointed Mark Butler to represent both mental health and ageing (later upgrading the position to cabinet).
The Gillard government also established the National Mental Health Commission and had COAG consider developing national targets and a ten-year road map for reform. Most importantly, it committed A$2.2 billion over five years to a new suite of service initiatives, focusing both on people with established illness and enhancing early intervention services for young people.
But after protracted Commonwealth-state negotiations, no new early psychosis intervention centre has yet opened.
Ongoing divided responsibilities and arguments about who should foot the bill for reform lie at the heart of our current difficulties.
The capacity of headspace youth services to build sustainable service platforms that are effectively linked with state-based emergency and specialist services is yet to be demonstrated.
Indeed, headspace services remain desperately short of professional, peer- and family-based workforces. And of the suite of funding mechanisms needed to deliver appropriate medical, psychological, specialist and vocational services.
E-mental health remains a cottage industry, despite its capacity to reach many people who choose to not engage with traditional services. Specialist mental health services delivered in the community by state governments are likely to suffer further as new activity-based funding mechanisms push most new cash back into hospitals from 2014/15.
What needs to happen
While mental health enjoys bipartisan support at the highest political levels, it is running the risk of once again being seriously neglected.
By contrast, other areas of health are attracting new funding commitments. During this election campaign, think Labor’s promise of a hospital rebuild in Western Sydney and new cancer care initiatives, and the Liberal Party’s investment of A$200m for dementia research and enhanced support for access to medicines.
It appears that both parties have now ticked off mental health for this election without feeling any great need to invest new funds.
At least, the Coalition’s announcement contains the hint that it may be interested in a more radical overhaul of existing arrangements. This is an area where the first Rudd government really dropped the ball. Specifically, during the 2010 health reform negotiations, it failed to take the opportunity to fund community mental health.
Tony Abbott has suggested the National Mental Health Commission be asked to review the effectiveness of existing programs. This follows calls from across the sector for a productivity commission-style investigation of the divided funding and service provision arrangements between the commonwealth, states, and the community sector, which result in many people receiving either duplicated services or no services at all!
The challenge for the next government is to get beyond the simplistic belief that goodwill alone can deliver mental health reform or effective suicide prevention.
There are solutions but they will require redirection of existing funds and new monies; early intervention can be transformative and e-health has great possibilities. But change will require commonwealth-state cooperation and coordination, and annual independent reporting of outcomes.
Most importantly, a commitment to expand community-based, rather than hospital-based, services is fundamental.
Over the next three years, the performance of our next government should be judged not on the basis of the lean promises of this election campaign but on its capacity to implement genuine reform in this key area of health, economic and social policy.
Ian Hickie is a NHMRC Senior Principal Research Fellow. His work has been funded by a variety of research councils, philanthropic support and investigator-led research studies funded by the pharmaceutical companies. He is Executive Director of the Brain & Mind Research Institute (BMRI), University of Sydney. The BMRI operates two Headspace Centres in Central Sydney and Campbelltown, NSW and is a member of the Young and Well CRC. He is also a Commissioner in the Australian National Mental Health Commission.