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Mental health system ‘broken’


The nation’s mental health system is “fundamentally broken” and in need of a decade-long overhaul to boost prevention and early intervention and ensure the mentally ill get the care they need, a major health group has said.

In a scathing assessment of current arrangements, peak body The Mental Health Council of Australia has detailed basic flaws in the conception, management and delivery of mental health services that compromise treatment and undermine attempts to improve care.

“There is no such thing in Australia as a mental health ‘system’ per se,” the Council said in a submission to the National Mental Health Commission’s Review of Mental Health Services and Programs.

“Instead, the mental health system is shorthand for the many systems and services that consumers and carers may encounter over a lifetime. For the most part, these services and systems are poorly integrated, overseen by different parts of government, based on widely differing organising principles, and not working towards a common goal for improved outcomes,” the Council’s submission said.

As the Federal Government ponders its role in the delivery of mental health services in the context of a fundamental re-think of Commonwealth-State relations, the Council has argued that there is a role for all levels of government.

While the principle of subsidiarity (that policies and services are conceived and delivered by the level of government closest to consumers, as far as is practicable) has guided the Commission of Audit’s view that mental health be fundamentally a State responsibility, the MHCA has taken a more cautious view.

It said that there was “a very strong case” for continued Commonwealth involvement, proposing that it “provide national leadership and hold responsibility for areas…in which national consistency is critical,” such as setting and monitoring service delivery standards, workforce accreditation and data specifications.

Alongside questions about the division of responsibilities between different levels of Government, the Commonwealth is also considering what services need to be publicly provided, and which needs can be best met through the operation of market forces.

In its submission, the MHCA argued that mental health care has been characterised by market failure, and people with mental illness are among those who truly need Government protection and assistance.

“Governments must think carefully before using market mechanisms to coordinate and deliver mental health services of one kind or another,” the Council said. “The mental health arena has, over time, been characterised by market failure, underinvestment and a chronic absence of services.”

It said the solution was not necessarily more money.

“After years of substantial spending by the Commonwealth and states, and increased rates of help seeking, mental health outcomes are not improving at the pace they should be,” the Council said. “Structural reforms would not necessarily involve major new spending by Government – in fact, significant progress can be made on a number of important fronts at little cost.”

What was needed, it said, was a shared, decade-long commitment to sustained reform that had as its goals improved consumer and career outcomes, priority for mental health promotion and prevention, matching needs with services, and the seamless integration and coordination of programs, policies and services.

“Major gains can be made by ensuring that the right governance conditions are in place, improving coordination within and across governments and service providers, and addressing gaps in services,” the MHCA said. “If we can take these steps, we will truly be able to say we have a cohesive ‘system’ which meets the needs of consumers and carers.”

“By contrast,” it warned, “if governments only tinker with the present system, but have no vision for a better system in the future or the path to reform, then improvements in outcomes will inevitably be piecemeal and fortuitous rather than far-reaching and deliberate.”

The National Mental Health Commission Review, led by Professor Alan Fels, is seen as major opportunity to substantially improve mental health care, and it has so far attracted more than 1800 submissions.

But the Federal Government has been criticised for its handling of the Review. It is yet to release an interim report provided to it by the Commission in February, and is set to receive another interim report early this month.

Shadow Minister for Mental Health Jan McLucas said the review process needed to be honest, transparent and inclusive, and this necessitated disclosing submissions and sharing interim findings.

The Commission is due to deliver its final report in November.

Adrian Rollins