A ten year plan to fix mental health

Feature story by Frank Quinlan, CEO Mental Health Australia

As those in the sector would know, the National Mental Health Commission’s Review of Mental Health Services and Programmes is currently underway. This isn’t the first government review of mental health – far from it. There have been many reviews before, and many have failed. In reality, we still have a fundamentally flawed system where too many people are not getting the support they need.

Once this current review is over, we have the opportunity to foster a period of action and change. We can’t afford to see yet another review into mental health ending up in the bottom drawer; the too-hard basket.

This is why Mental Health Australia developed its Seven Point Plan for Mental Health. Developed in consultation with the sector, our plan lays the foundations for reform and provides tangible steps on where to go from here. The plan identifies the key areas where agreement and action is needed to reshape the way we address mental illness in Australia.

We know what the issues are in our broken system, and this plan shows us the practical action we need to take to fix it.

A high performing system needs to promote recovery, and support people through seamless integration of mental health services with other areas of health, disability, employment, housing and other systems. Services need to be accessible, effective and efficient, with consumers and carers truly engaged at all levels.

There is a pervasive myth that the mental health sector is divided on how to move forward. This is false – the sector is united on most of what we need to do. Their agreement on our Seven Point Plan and subsequent Blueprint for Mental Health Reform is an example of this solidarity.

This isn’t simply a call for more funding to the sector, but coordination and integration, and a redistribution of existing resources based on evidence and, crucially, input from those in the sector. In many areas the change we suggest will be cost positive.

The first point of the plan is that we need to agree on what we want to achieve between the sector and the government. While work already completed shows the sector is largely in agreement on what the targets and indicators are for good mental health, we need to bring governments to the table and implement them. A high-performing mental health system would maximise consumer and carer participation, prioritise mental health promotion, prevention and early intervention, and be recovery-oriented. It would facilitate timely and equitable access to the right services matched to individual needs.

To achieve this we need to address the many factors which enable people to live contributing lives, such as social and economic participation, accommodation, physical health and safety, and freedom from prejudice and discrimination.

Secondly, we need to be clear on who is responsible for what. Commonwealth, state, and territory governments must clarify their respective roles, and how they will work with each other and the mental health sector. Acute clinical services are necessary, but are only one part of the picture. Roles need to be defined for the other systems that people with mental illness encounter, like employment and housing, and which can help reduce the demand for expensive crisis services.

By properly defining roles and responsibilities, including for governments, non-government organisations and clinicians, we can ensure that there is ‘no wrong door’ regardless of how someone seeks help.

We also need to increase consumer and carer participation and choice. Consumers and carers must guide the services work for them. Meaningful involvement of people with lived experience should be at the heart of service design, delivery and evaluation. Consumers and carers must be involved in decisions that affect them – from the services available locally to the development of national policy.

Our future systems must match services to need. For the mental health system to respond with effective, timely and evidence-based interventions, we need to ensure service providers, clinicians and other professionals have the knowledge, skills and resources to connect people to the right help at the right time.

We need to ensure that clinical services are linked with the right community services, psychosocial supports and opportunities for self-help, and that those services are available across the full spectrum of need. The challenges of integration are large but not insurmountable if worked through systematically with those effected.

The way governments fund service providers also needs major reform. We must get the incentives right to drive better outcomes. Services delivered in the community are far cheaper and often more effective than treating people in hospital. Our entire system of funding mental health services – from existing arrangements like Medicare, the PBS and block grants to innovative models like individualised funding – should work to reduce fragmentation rather than create it.

Financial arrangements should promote best practice service delivery and collaboration between services. Rewarding activity with no link to improved outcomes risks both jeopardising life outcomes for those who experience mental illness and the misallocation of scarce resources.

We must invest at the right time to achieve the greatest benefit. Improving mental health outcomes will increase national productivity and participation, reaping major economic dividends. We need to invest in mental health promotion and prevention and early intervention in mental illness to encourage help-seeking, challenge prejudice and discrimination, and avoid crisis wherever possible. Where appropriate, empowering consumers and carers to help themselves through new technology will yield high returns on investment and free up clinicians and others to help those with the highest needs.

Finally, governments and services must be accountable. At the moment we don’t have a complete picture of how much governments spend on services for people with mental illness or how effective that spending is. We must support an independent mechanism to provide timely reports on what governments are investing in and whether those investments are assisting consumers and carers to lead full and meaningful lives.

We are now in a period of waiting. While it’s up to the government to respond to the review, it’s our mission in the sector to continue to make our case for change heard.

Following the extensive media coverage around World Mental Health Day and particularly the ABC’s ‘MentalAs’ campaign, the nation is again talking seriously about mental health. However, this discussion is an ongoing task. Only through sustained effort will we see a commitment to the long-term systemic and fundamental reform of the mental health system – a commitment that is funded outside the usual short-term electoral and budgetary cycles.

This is our goal for governments and the broader mental health sector, and we encourage those who have an interest to join us in our efforts to influence the mental health system of the future.


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