This post is not going to be filled with political jargon or extravagant terminology, stay with me. If you have been living under a rock or have no political interest whatsoever you may have missed the federal government unveiling their budget for the upcoming year. This year Mental Health has been a focus. About bloody time I say.
This post comes from my clinical background. I understand it is not so black and white and diagnosis is a contentious issue. This is not what this post is about. It is about understanding what this budget and our government is doing for the citizens of this country and for mental health. Whenever I refer to “The Budget” it is in reference to the Australian Government’s 2011-2012 Commonwealth Budget and it can be found here
Mental illness is the leading cause of disability in Australia. The mental health care system can be crisis-driven with many people only receiving help when they are at their most vulnerable, instead of help to stay well. (The Budget, May 2011)
When the government announced the budget, the point that gathered my interest initially was the amount of sessions to be cut for the mental health care plan under the medicare rebate scheme. Then Lana Hirschowitz a.k.a @sharpestpencil wrote another thought provoking piece here.
It’s not that I don’t know about the situation that she has highlighted. It is that I am torn. I totally get that it is necessary for help and services to be available to those who are considered chronic and even those who aren’t but yet experience mental illness as adults. I also understand that life experiences contribute to our mental health so how on earth can this be predicted at 3 years of age. I get that point, but there has been so much research done in the area of prevention that it cannot be overlooked.
As the minister for mental health and aging, Mark Butler points out the key areas of development of mental illness are under 25. What does this mean for those over 25? That they miss out on services that they are “passed it” and its bad luck. Er.. no that doesn’t seem right to me.
Balance is needed but in all honesty the amount that has been pledged or allocated is a drop in the ocean. Even the government has admitted (sorry can’t remember the source) that the medicare rebate scheme for mental health has blown the budget massively since its induction. Therefore it doesn’t surprise me that funding has been cut. Surprised and expected: No. Still needed: very much so.
So what does it all mean. I have summarised the mental health component of the 2011-2012 budget below: The government’s aims are
* expanding services and delivery for people with severe mental illness
* focus on prevention and early intervention for children and young people
* improve access to the primary mental health care system
* establishing a National Mental Health Commission.
* areas of mental health being focused on are suicide prevention and more mental health nurses
* to invest in sub-acute beds through state governments, increasing the amount of beds available to people with mental illness who do not require psychiatric inpatient admission but need some form of clinical care.
* due to significant variation between states, territories and regions across the country the government will take a leadership role.
* this means services will be required to complete outcome measures (which are already in place within most psychiatric departments in hospitals) and key performance indicators. Dollar incentives will then be distributed on measured improvements.
* providing support and incentives for employment services to recruit and retain employees with mental illness. In addition assisting both financially and emotionally those with long-term mental illness return to work and maintain employment.
To break it down further:
Severe Mental Illness-
* funding local organisations (I believe these to be such places as Anglicare, Centacare, The Smith Family and local council run programs.)
* introducing a single assessment for all people with a severe mental illness
* organising and providing Flexible Care Packages so that each individual has services matched to their needs not a certain amount of money allocated per person.
* Additional personal helpers and mentors which helps with one-on-one support and group work for people with severe mental illness teaching self care, cooking, cleaning, shopping and social skills training.
* New respite services for mental health carers (although checking figures it is only 1,100 carers)
Mental Illness and Primary Healthcare Access:
* The amount of sessions available to each person on a mental health plan (Better Access initiative) drops from 12 to 10 sessions
* The GP medicare rebate for mental health has been reduced
* Therefore in basic terms, money from the first two have been redirected into other mental health programs within the budget.
* Money has now been redirected to better help those who weren’t getting assistance through the Better Access initiative such as Indigenous Australians, low socio-economic groups and rural and regional Australians. (“based on independent evaluation” – The budget 2011)
Children and Young People:
The statistics provided in the budget appear appropriate with 1 in 4 children before the age of 12 experiencing issues with their mental health (“mental disorder” was quoted in the budget publication) and over half of young people by the age of 21 (64%) The rationale for this age group to be a focus is that “it will help to prevent a lifetime of disadvantage caused by chronic mental illness”
* Every 3 year old will be recommended to be reviewed voluntarily by their maternal child and health nurse for social and emotional issues. Although it states “voluntarily” I believe it will be strongly suggested that each child be assessed. If not formally, informally it will occur.
* expanding ‘Headspace’ to create 30 new centres to help 12-25 year olds. This is going to help in that it will bring up the number of centres to 90 and help with the current concern of long time delays between onset of symptoms and receiving help which ultimately affects the prognosis and outcome.
*expanding Family Mental Health Support Services (FMHSS) to help better manage the impact of mental illness on young people along with their family and carers.
Tackling problems early reduces the impact of mental illness on individuals, their families and the community. It has been quoted (again sorry I’m can’t find the source – such a great journalist arent I) that Patrick McGorry Australian of the year 2010 was supportive of this federal budget. He has been working on preventative mental health for over a decade and his research is quite clear about the benefits of treating early psychosis in particular. Therefore I think he is a good measure of believing that our federal government is on the right track with their call on early intervention. What must be of note though is that Professor McGorry’s pet project EPPIC (Early Psychosis Prevention and Intervention Centres) is to receive $222 million over 5 years for up to 12 additional youth psychosis sites.
Where I believe the government are getting it right:
# Good work in making a centralised system for clients and family to go to instead of falling between the cracks of services or having to case manage their own care. Lets hope they can implement this pledge effectively.
# The developmental stage between 0-7 is the most important stage of a persons life. It has the most impact and sets social, emotional and learning components into place. Therefore making emotional wellbeing a focus is paramount. Do children have mental illnesses at 3 years old? No, I refuse to reinforce this notion. Are they susceptible to emotional dysregulation, behaviour problems and social and wellbeing issues – most definitely. Children at 3 years of age can show signs of anxiety: social, general and separation; behavioural and parenting issues and austism spectrum disorders.
# Providing money to EPPIC for further sites to treat early psychosis
# Developing a single national e-mental health portal. This is long overdue. Clients presenting in crisis with no idea of their history, medication or even contact people/ next of kin. Those clients who change doctors often or don’t have a regular doctor. This makes so much sense. Just. Do. It.
Still issues for the government:
1. Reducing the amount of sessions available to those on a mental health plan will ultimately put further strain elsewhere such as non government organisations, emergency departments, GP clinics. Although 2 sessions doesn’t seem a lot it is 2 extra sessions of support people are receiving to assist to maintaining positive mental health.
2. The government’s budget document states “rebalancing the number of annual allied health sessions to better align treatment to the needs of people” I am unsure where decreasing the amount of sessions is better aligning treatment.
3. As Lana (sharpest pencil) pointed out, what is happening in relation to more beds for those with psychiatric conditions or places for those to go with chronic psychiatric issues. Yes the government have attempted to address this by mentioning involvement through states and territories but a specific figure has not been set.
4. In addition looking at the numbers provided within all of the statistics throughout the document the pledged amount and figures don’t even touch the sides of those numbers that are affected.
Questions that arise for me:
– Why aren’t nurses already checking emotional, social and psychological health already at the 3-4 year old check
– Will there still be extra sessions available under exceptional circumstances for the Better Outcomes Initiative?
– What happens with those hospitals and more importantly those patients whose regions are not performing as per the key indicators or the hospital is already under pressure and under resourced due to the population and services it is already attempting to provide, do they miss out? The document states they will be using a “competitive process to leverage the states and territories”. I am very cynical.
Although not comforting it is also clear that community focused treatment, intervention and preventative work already achieved since de-institutionlisation has been making inroads into mental illness and its presentation. The fact that people with mental illness are now not locked away and left to sit in a room and treated inhumanely with some of the dated treatments highlights we are making small steps in the right direction. BUT and it is a huge but. It is still not enough.