Mental health reform can't wait
If the states accept the need for action, they will strengthen our nation.
Australians now understand that mental ill health is one of the nation's greatest challenges. Half of us will experience mental ill health during our lives, with young people bearing the most severe burden. The community and all sides of politics have acknowledged that our mental health system is on its knees and needs major redesign and investment. By 2020 Australians should expect the same access and quality for mental health care as for physical health care.
Next week the COAG meeting of the heads of all Australian governments will consider mental health as its first agenda item. The Commonwealth has thrown down the gauntlet to the states and territories. The choice facing premiers and chief ministers is to seize this opportunity for reform or to condemn our beleaguered mental health services and their consumers to another decade of neglect and decline.
In the light of a series of media pieces in which misleading statements have been made, including false allegations of a conflict of interest on my part, I need to state that I have no conflict of interest relating to these developments. Neither Ian Hickie nor I have any commercial interests in these programs and my personal remuneration is in no way affected by increased government investment in them. The beneficiaries of the early intervention and youth mental health reforms are the young Australians and their families who will gain better access to holistic and stigma-free care.
My own organisation, Orygen Youth Health Research Centre, has financially supported my advocacy on behalf of all Australians. Further, the Orygen Youth Health clinical service is facing the threat of service cuts this financial year through its governance within the financially stressed acute hospital system.
Australians will understandably be puzzled why an urgent, popular and evidence-based reform such as improving mental health care for young Australians should provoke such misrepresentation and fierce opposition from a minority of professionals. All reforms involve an implicit threat to the status quo. The reformers say the current approach is just not good enough. Naturally the status quo doesn't give up without a fight and these reforms have been resisted here and overseas by a small group of professionals who are defending their turf. People with mental ill health and their families are noticeably absent in this defence.
Evidence is never perfect so we have to act on serious problems on the basis of the best available evidence. Early intervention and the models of care supported by the new reforms are among the most evidence-based best buys available in mental health. The federal government has already nailed its colours to the mast on mental health reform, with $1.5 billion of new investment pledged to the initial reform building blocks. Next week it is up to state and territory governments to display similar leadership and purpose. State and territory governments are currently responsible for acute and community mental health services, which continue to be eroded, overstretched and at risk of funding cuts.
In all parts of Australia we have seen great pressure on emergency departments and acute inpatient care. With the governance of the state mental health systems sitting within financially stressed hospital systems, community mental health services, never built to scale anyway, have been undermined and eroded, and have developed maladaptive work practices to cope with this.
The task facing state and territory governments is to:
■ Immediately ring-fence mental health budgets to address the imminent resourcing threats undermining state-funded mental health services.
■ Provide matching funding for the federal government's $1.5 billion reform investment to ensure that early psychosis prevention and intervention services are widely available; provide decent housing for people with mental illness; reduce pressures on emergency departments; and create a system that guarantees the growth and regeneration of community-based mental health care over the next five years.
■ Commit to a 10-year reform goal that Australians should have the same access to quality care for mental ill health and physical ill health.
This will be an exercise in nation building. If state and federal governments commit to genuine reform, they will greatly strengthen our nation socially and economically.