Mental health groups have heralded wide-ranging changes to the sector as a new era in the delivery of services, but have warned there is a “real risk” patients who use existing services will fall through the cracks in the transition process.
The federal health minister, Sussan Ley, on Thursday announced reforms to the sector that aim for a more personalised approach to managing mental illness.
Under the changes, $350m a year that is currently set aside for commonwealth programs will be redirected to primary health networks. Those 31 nationwide networks would then use the money to commission services specific to the needs of their communities.
The funding falls short of what was recommended by the National Mental Health Commission, which had wanted a further $1bn over five years taken from the hospital system and put into primary care.
Ley praised the government’s response to the commission’s report, saying it reflected a shift from a Canberra-centric “one-size-fits all” mentality.
“This is real structural reform. This is concrete actions,” Ley said. “This is something that will make a difference to people who wake up and want help and can’t find it.”
Mental health groups have described the initiatives as an “important blueprint”.
“We’re pleased at last that we have a really, focused, structural approach to tackling these issues,” the chief executive officer of Mental Health Australia, Frank Quinlan, said.
The changes will see the creation of a new “stepped” or tiered system that separates people into four categories: at risk, mild, moderate and severe mental illness. A healthcare professional will ascertain what category a person falls into, and therefore what level of care they need.
But Quinlan warned that there would still be people living with mental illness who fell through the cracks, particularly if primary health networks chose to axe existing programs in their communities.
“There’s no doubt that some people will be better served by these measures than others,” he said. “It is a real risk. As you start to do new things, you have to stop doing old things, and so I think how that implementation is scheduled is very important.
“I think the last thing any of us would want is for those gaps to open up. We don’t want to be closing down old systems until we know that new systems are up and running and are effective.”
The changes aim to offer “wrap-around” services to people living with complex mental illness, including psychiatric services, community support and drug and alcohol rehabilitation.
But with an estimated 690,000 people living with severe mental illness, it is still unclear whether the funding – slated to rise from $350m to $380m over three years – will go far enough.
“Today what we’ve done is laid the framework. But I’m quite certain that we’ll be likely to head back to government to request further investments that make sense within the framework that might be effective,” Quinlan said.
The chair of the National Mental Health Commission, Allan Fels, said the option to take $1bn out of the hospital system was not off the table, but that the proposal was subject to negotiation with state and territory governments.
“At that time the federal government was not particularly keen on saying, ‘Fine, we’ll take that $1bn out,’ but I read the question as not being off the agenda, just how it’s to be done,” Fels said. “I think they were a bit cautious [in negotiations].”
Ley said money for mental health could still be taken out of public hospitals, but “only with the agreement of the states”.
The commission was asked to provide a framework for reform within the existing funding envelope. The $350m a year is taken from funding for commonwealth-funded programs such as Mental Health Nurse Incentive program and Headspace centres.
The Better Access system – which allows patients to claim 10 Medicare-subsidised psychology sessions annually, something that costs $750m a year – will remain in place for existing users.
The system has been criticised for not adequately supporting the needs of rural and regional Australians.
The opposition leader, Bill Shorten, said: “We think that regional Australia doesn’t get its fair share of resources and propose that 12 centres or 12 projects would receive increases to mental health funding.”
“We think Aboriginal and Torres Strait Islanders get forgotten a lot in the mental health discussion so that is a priority.”
The reforms including specific funding for Indigenous mental health programs of $85m over three years included in the $350m a year figure.
Reforms to the mental health sector announced on Thursday will create more incentives for counsellors and mental health professionals to operate in rural and remote regions, co-author of the commission’s report, Ian Hickie, argued.
But Quinlan admitted that support in those areas, particularly for services like drug and alcohol rehabilitation, simply did not exist yet. Enforcing wrap-around support for mental illness which includes elements like rehabilitation services will simply add to the waiting list, he warned.
“The concern is that if there’s not enough to go around, that people will miss out,” he said. “It’s my prediction that we absolutely will see shortages. Currently, in order of about two-thirds of people who could benefit from appropriate mental health treatment don’t seek it out.”
He said that the reforms announced on Thursday would provide a “strong foundation” for increasing funding in areas that are lacking.
“There will come a time when we’re taking argument to government on investing appropriately in services that we know will be effective and efficient,” Quinlan said.
Quinlan and the acting director of ReachOut Australia, Deepika Ratnaike, welcomed the government’s creation of a “digital mental health gateway” and the consolidation of a number of existing telephone helplines into one service.
Ratnaike said that offering online help is “the way of the future” and that many young people already seek support in this way.
The changes will be phased in from next year.
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