A plan to improve mental health

AT last year's federal election Julia Gillard made a clear commitment that mental health would be a key focus in the next term of a re-elected Labor government.

Mental health had been shelved yet again by the lopsided Council of Australian Governments health reform package constructed by her predecessor, prompting unprecedented nationwide disappointment and anger among the 4.4 million Australians affected by mental ill-health and the resignation of the government's chief adviser on mental health, John Mendoza. Mental health was in deep crisis.

Since then both houses of parliament have passed non-binding motions supporting substantial reform and investment in 21st-century mental health care, an international survey has shown Australians now rate it as a top concern for the nation, alongside the economy and climate change, well ahead of any other country, and tragically, more than 1000 Australians have died from suicide, mostly preventable if mental health were taken seriously as a national health and social priority.

While this was happening, energetic new Minister for Mental Health and Ageing Mark Butler was assembling all the ingredients for a sustained program of reform and investment, we trust as a prelude to a key announcement in the May budget.

Already this year the Gillard government has restructured the flawed 2010 health reform package, finally paving the way for mental health to be taken seriously this year. The spate of natural disasters has tragically underlined the need for universal access to timely and high-quality mental health care.

Mental health reform is achievable, popular and will save not just lives and futures but a great deal of money. Mental ill-health, affecting as it does those in the prime productive years of life, weakens the social fabric of our society in so many ways and, critically, the economy as well. This is why experts at Access Economics and the London School of Economics agree it is an absolute best buy in health reform, why there is tripartisan political agreement in parliament and why there is now virtually complete health sector agreement on the focus and direction for investment and reform. What are those directions?

An independent mental health reform group led by David Cappo and including me, Ian Hickie and several key advisers has captured and condensed them into a blueprint that, at a total cost of about $3.5 billion over four years, provides ready solutions to Australia's mental health crisis, and will begin to transform the way mental ill-health is responded to in this country. We currently spend 7 per cent of the health budget on mental health care while it causes 14 per cent of the burden of disease. An extra $3.5bn over four years would be a modest and overdue step which would move it up to 8 per cent.

The overarching strategy is one of full social inclusion. This means all Australians with mental ill-health will have a secure place to live, a home, the chance to participate economically and socially in everyday life, their families will receive real support, their voices will be heard, and discrimination and prejudice will no longer be tolerated.

Creating integrated models of community-based care, especially for those with established and persistent mental ill-health, in which expert specialist mental health care sits within holistic programs that fill the yawning gap opened by the demise of the asylum, is achievable and will cost an estimated $1.5bn during the next four years.

Second, mental ill-health emerges early in life, with 75 per cent of disorders emerging before age 25. This is the opposite pattern to physical illness and consequently the impact on society is much more serious.

At the same time, if we focus on prevention and early intervention for children and young people, we can substantially reduce the human cost and the economic burden on society. To stem the flow of new cases of mental disorder in this critical stage of life $1.1bn will be needed during the next four years.

In the 21st century, new technologies, especially e-health services, can increase access to care and empower self-care strategies. Similarly, research and development will be crucial to driving improvements in mental health care. We need to invest much more strongly in mental health research, which has been severely disadvantaged within mainstream medical research, where investment has been even more lopsided than in the clinical-care arena; $600 million is required to address these two aspects.

Finally, a new and independent national mental health commission should be established by an act of parliament to provide a more effective mechanism to deliver accountability for the care provided to the mentally ill and their families.

Working in close collaboration with state governments, the commission would track the performance of our mental health system.

We need to invest $250m in creating a new culture of accountability, social inclusion and consumer engagement.

This is the national opportunity and imperative that beckons to this government, the chance to transform the lives of millions of Australians, to strengthen the nation in a way not previously envisioned. It is so simple, so practically achievable and so vitally important.

In recent weeks our group has been part of an inspiring national, whole-of-government planning process, led by Mark Butler, to position the federal government to drive home this reform. State governments are lining up to play their part. I have met several premiers, chief ministers and health ministers in recent months and am convinced they are keen to play their part to the extent that they can.

However, the federal government's vision and investment is the key to success. It is critical that the government ensures that the Prime Minister is able to honour the commitment she made to the Australian people last year, so that the next COAG meeting, which is to consider mental health reform, can take the next step.

Mental health was a key area where the Rudd government lost its way. Four million Australians are counting on the Gillard government to find the way back.

This article originally appeared in The Australian of March 11th.