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LEADING psychiatrists and mental health professionals fear an exodus of mental health workers if the federal government does not quickly resolve the funding uncertainty affecting many community organisations.
Counselling services, advocacy groups and outreach teams for the mentally ill are among the non-government organisations (NGOs) waiting to hear if they will continue to receive federal funding beyond 30 June.
The government last year resolved to delay its usual funding decisions on mental health, pending the outcomes of the National Mental Health Commission’s review of existing programs. (1)
Although the commission handed the government its report in November, it has not been publicly released and the government has not released its plan for mental health.
Last month, the Department of Social Services threw a lifeline to two programs supporting people with a mental illness and their carers, announcing interim funding extensions to June 2016 for the Personal Helpers and Mentors program and the Mental Health Respite: Carer Support program. (2)
However, a spokesman for Mental Health Australia said they were two of only a handful of programs that had so far received confirmation of funding.
“The majority would still be waiting on confirmation from the federal government”, he told MJA InSight.
In November last year, Mental Health Australia surveyed 87 of its member organisations and found that of the 75 receiving federal funding 80% were uncertain of their funding arrangements past 30 June this year. The survey found 40% had experienced loss of staff due to lack of job security. (3)
Professor Anthony Jorm, who leads the Population Mental Health Group at the University of Melbourne, told MJA InSight the situation was potentially very serious for NGOs, including those funded through the successful National Suicide Prevention Strategy.
“Many could go to the wall if funding was stopped”, he said. “The uncertainty needs to be resolved so that the services can make plans.”
Professor Harvey Whiteford, professor of psychiatry and population mental health at the University of Queensland, said mental health services “have enough trouble attracting and keeping good staff”.
“If we lose people as a result of funding uncertainty that’s a tragedy”, he told MJA InSight.
Their comments come as a Perspectives article published in this week’s MJA argued for an end to the Groundhog day scenario of endless audits and reviews of mental health, and a start to implementing solutions. (4)
The authors wrote that successive government and independent reviews since the landmark 1993 Burdekin Report had raised similar issues with the mental health system, including inadequate access to services, inadequate interagency cooperation and training, and absence of monitoring and surveillance. (5)
“There are typically no accountability mechanisms to ensure that the responsible lead authorities change their practices to deal with the recommendations in these audits”, they wrote.
However, Professor Jorm told MJA InSight there were dangers in monitoring only “inputs” such as quality of services provided and interagency cooperation, rather than “outputs”, such as “whether more people are able to function in society and have fulfilling lives”.
He said he hoped the latest review might pave the way to reducing duplication in mental health, suggesting rationalisation might be possible in e-mental health services and telephone services.
“There are some truly excellent [e-mental health] services [but] how many do we need?” he said.
He also questioned whether states and territories needed to be involved in early psychosis services when the federal government was rolling out the National Youth Mental Health Foundation’s headspace centres.
Professor Jorm also raised concerns that the government might see the commission’s report as an “excuse to cut costs rather than make a long-term plan for improving the situation”.
Professor Whiteford told MJA InSight one of the most pressing reform needed was to give Australians with severe and persistent mental illness with complex multiagency needs a single care plan to help prevent them falling through cracks in the system.
He also agreed there must be clearer delineation of state and federal government responsibilities to reduce duplication and improve accountability.
“Sometimes the left hand doesn’t seem to know what the right hand is doing”, he said.
Despite the frustrations of mental health workers, Professor Whiteford said the system was improving, but the pace was “two steps forward, one step back”.
He cited the National Mental Health Report 2013 which showed that in 2010‒2011 there were 47 community-based mental health workers per 100 000 population, compared with just 19 in 1992‒1993. (6)
The Department of Health had not answered MJA InSight’s questions on how many organisations were awaiting funding confirmation, and when and how they would be notified, at the time of going to press.
1. National Mental Health Commission
2. Assistant Minister for Social Services 2015; Media release, 16 February
3. Mental Health Australia 2014: Funding survey
4. MJA 2015; 202: 172-174
5. Australian Human Rights Commission: Burdekin review
6. Department of Health 2013; National mental health report
(Photo: RapidEye/ iStock)
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Having worked for 40 years in statutory mental health services in Victoria, NSW and Queensland, it is clear to me that there is no consideration at all of best practice in these, and this is also true of NGOs in NSW and Queensland, although in the Victorian NGO sector.
Unfortunately, all psychiatric services I haver seen effectively run as individual fifedoms, according the the preferences and biases of the medical director, under partial constraint by non-clinical managers who generally have no understanding of the disorders of the clients of the services or the specifics of the skills (and emotional labour) required of the clinicians the seek to maange. This is hardly a formula for best practice, or even consistency.
Add to this the reality that 40% of a typical GP’s work load is related to emotional distress and mental health problems, and that about one twentieth of their training is in mental health and it is no wonder that mental health services seem to be lurching from crisis to crisis.
Governments and professional bodies need to put aside issues about who pays for what, and actually focus on what is best practice. Is it more support for GPs, school nurse and perinatal mental health services as early intervention? Is is consistent models for crisis and inpatient services (or as the data suggest – more focus on providing intensive in-home support to keep people out of hospital to achieve better recovery)? Or better training for clinicians at all levels to provide evidence based psychological support, rather than the current militaristic (yes – doctors are still called ‘medical officers’ and nurses called ‘nursing officers’) custodial approaches emphasising compliance with medications?
I say we need a new approach!