Government shows muddled mental health priorities

Despite widespread analysis of the federal budget, measures affecting mental health services have received little attention. But, like other aspects of the budget, there’s serious concern about the lack of a coherent vision or plan behind the government’s actions.

In a largely slashing budget, the government committed funding to a number of new initiatives in mental health, based on its election commitments:

• $18 million over four years for a national centre for excellence in youth mental health, and
• $14.9 million over four years for ten new headspace youth mental health centres.

These are in addition to the $2.5 million for an e-health platform for young people over the next two years.

But, overall, we have a net loss of funding to mental health programs. This is mainly due to $53.8 million being cut from the Partners in Recovery program. This program supports people with severe and persistent mental illness who have complex needs, and it helps their carers.

Sector not consulted

The changes don’t appear to reflect any consultation with the mental health sector including its peak body, the Mental Health Council of Australia, which the government set up in 1997 to represent the sector.

The council made 20 recommendations in its submission to the government on the budget. Some of these had no cost implications, but not one of them appears to have been adopted.

The previous government commissioned a national study of the priorities in mental health research, which included an extensive survey of the views of stakeholders in the sector. The additional funding provided in the budget bears little relationship to the priorities of the sector.

Not spending on areas of need

What’s worse is that the additional expenditure is arguably not in areas where the need is greatest.

Australia already has a Centre of Excellence in Youth Mental Health, also funded by the federal government, located in the headspace national office. And funding for the new centre was allocated to one organisation without any tendering or other competitive process. This is contrary to the usual government procurement rules, which are designed to ensure value for money in use of public funds.

And the National Health and Medical Research Council (NHMRC) was allocated an additional $26.2 million research funds in 2011 for youth mental health.

We already over 60 headspace centres, with more in the pipeline. While it’s possible these are achieving wonderful things for young people’s mental health, we currently have no evidence to support this. They haven’t yet been properly evaluated to see whether they improve mental health any more than generic mental health services funded by Medicare.

A positive component of the government’s budget announcement was funding for such an evaluation. But it would have been better to do this before rolling out an additional ten centres. As more centres get rolled out, any comparison between headspace services and generic services becomes harder.

We also have no need for a new e-mental health platform. The government currently funds ten e-mental health services, including two specifically for young people. This is on top of eheadspace, which provides online and phone mental health support to young people.

And the government already funds mindhealthconnect, which is a single online gateway to trusted mental health resources, support and services.

Losing out

Funding for the new initiatives wouldn’t seem so problematic were it not for the negative effects the cuts will have on those most in need. People with the most to lose are those with severe psychotic illnesses.

The statistics on the lives of this group of Australians are appalling, with 78% unemployed, 63% impaired in their ability to socialise, and 50% having attempted suicide at some point in their life. Their physical health is also poor, with 82% obese, over half having metabolic syndrome, and 20% with diabetes.

What’s more, over 60% are smokers. Not surprisingly, they tend to have drastically shortened lifespans.

Quite apart from the loss of the Partners in Recovery services, which were designed to care for this disadvantaged group, the new co-payment to visit a GP is likely to have a greater impact on these people as they need more physical health care.

Evidence-based reform

The government’s changes to mental health funding so far make no sense. We await the results of the review of existing services it has asked the National Mental Health Commission to carry out. But there’s a genuine fear it will be used as the basis for further cuts.

There is an alternative; a rational evidence-based approach to reform is possible.

The previous government funded a National Mental Health Service Planning Framework, which is nearing completion. It involved a thorough examination of the evidence on what services work and what they cost to implement.

Clearly, we have the tools for a better approach. We just need governments with the good sense to use them.

Anthony Jorm receives funding from NHMRC. He is on the executive of the Alliance for the Prevention of Mental Disorders. He is Chair of the Board of Mental Health First Aid Australia. He was formerly located at Orygen Youth Health Research Centre. He is a former Board Member of the Mental Health Council of Australia.