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Plan to boost GP mental health role fails to win Govt support

Health Minister Sussan Ley has ruled out a recommendation of a Government-commissioned review of the mental health system to boost the role of GPs and Primary Health Networks in providing mental health care by redirecting $1 billion of Commonwealth funding from public hospitals to primary health providers and community-based mental health services.

A leaked copy of the long-awaited National Mental Health Commission review of mental health care, obtained by the ABC’s 7.30 Report, has urged a shift in funding priorities away from ‘downstream’ services like acute care and the Disability Support Pension income support to prevention and early intervention care provided by GPs and other primary health providers.

“It is clear the mental health system has fundamental structural shortcomings,” the review said. “The overall impact of a poorly planned and badly integrated system is a massive drain on peoples’ wellbeing and participation in the community.”

The Commission has argued that changing to a “stepped care approach” with a major focus on prevention and early intervention would reduce the severity and duration of mental health issues, ultimately slowing demand for expensive acute hospital care and lowering the incidence of long-term disability.

“The Commission believes one of the most fundamental elements of the stepped care approach lies in prioritising delivery of care through general practice and the primary health care sector,” the report said, citing modelling from consultancy KPMG suggesting this would “slow the rate of increase in Disability Support Pension and Carer Payment costs and the costs of acute care and crisis management”.

The Commission report said international evidence showed that strong primary health care made for healthier people and less costly health care than a focus on specialist and acute care, and suggested the creation of Primary Health Networks was an opportunity to “better target mental health resources”.

Commission Chair Professor Alan Fels told ABC’s AM program that, “we believe that over the next couple of years the Commonwealth should get ready to somewhat rebalance its spending away from it all going into hospitals when it would be better spent on services that keep people out of hospitals”.

The Commission found that mental health problems are inflicting enormous costs on the country despite massive Commonwealth spending.

It said that, despite the expenditure of $9.6 billion on mental health care in 2012-13, around 3.6 million Australians experience mental ill-health every year – including 9000 who die prematurely – and the problem costs the country up to $40 billion a year.

“Our ‘mental health system’ is instead a collection of often uncoordinated services introduced on an often ad hoc basis, with no clarity of roles and responsibilities or strategic approach,” the Commission’s report said. “We need system reform to rebalance expenditure away from services which indicate system failure and invest in evidence-based services like prevention and early intervention.”

Professor Fels said the Commission was not arguing for money to be taken out of mental health care, but that the focus of effort be redirected, suggesting the reallocation of “a minimum” of $1 billion of Commonwealth funding from acute hospitals to community-based mental health services from 2017-18.

“There’s a great deal of Commonwealth spending on people, for example, going into the disability support payment scheme because they’re not well and haven’t been treated well. So, we believe there should be better prevention mechanisms, and system needs to be rebalanced in that direction.”

But Ms Ley has poured cold water on the idea, saying the Commonwealth will not make such a change without the full support and co-operation of the states and territories.

“My strong view is we need to be partners with the states if we are to address serious mental health issues in this country long-term,” the Minister told the West Australian. “Our preference, therefore, is to work with the states to deliver better co-ordination of existing roles and funding arrangements, rather than reduce the part they play.”

The Commission’s report was delivered to the Government on 30 November, but it is yet to make a formal response, causing frustration in the mental health sector.

Adrian Rollins