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Big questions hang over mental health reforms

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Primary health care networks will be paid by the Commonwealth to provide tailored “integrated care packages” for patients with mental health problems in a major overhaul of the mental health system unveiled by the Federal Government.

In its long-awaited response to the National Mental Health Commission’s review of the system, the Government announced a fundamental shift away from direct funding and program delivery. Instead, it will set up a pool of funds which can be used to pay the nation’s 31 Primary Health Networks (PHN) to plan and commission local services for mental health patients.

“Just like any other chronic disease, mental illness is often complex and requires access to multiple health professionals and support services to address it properly,” Health Minister Sussan Ley said. “Experts recognise many patients with severe or complex mental health needs would benefit from an integrated health care package tailored to their individual needs, and that’s what we’re delivering.”

While patients can still choose to have Medicare-subsidised psychology sessions through GP-designed mental health plans, the Government expects a large proportion will opt instead for care packages provided by PHNs in partnership with Local Hospital Networks.

But AMA President Professor Brian Owler said that although the changes were well-intentioned, much hinged on funding and the capacity of the PHNs.

Professor Owler said the focus on tailoring care to individual need and local service planning and delivery was welcome, but a lack of detail on funding and service delivery left big questions hanging.

“The success of this new direction in mental health service delivery will depend very much on the capacity and capability of PHNs,” the AMA President said.

Professor Owler said the new framework needed to deliver genuine patient-centred care, rather than simply giving PHNs the power to determine what package of care patients can have, based on the services it has chosen to organise.

“It is particularly important that the system neither reduces nor compromises the patient’s choice of health care provider, and their ability to plan and manage their care with their GP,” he said. “It is equally important that the system does not lock people into a package of care provided or commissioned by the PHN with predetermined providers, with limited or no ability to change providers once the package has commenced.”

In addition to questions about the capacity of PHNs to develop and organise tailored care packages, concerns have been raised that the arrangements will add to administrative costs by essentially funnelling funding through an additional layer of bureaucracy.

In addition to commissioning PHNs to deliver tailored care packages, the Government will establish a phone and internet service to act as a single gateway for patients to access the full range of mental health services, and will redesign primary mental health care program to a “stepped care” model to better target services.

National Mental Health Commission Chair Professor Alan Fels said the Government’s plans were a “ringing endorsement” of the Commission’s Contributing Lives, Thriving Communities review, which condemned current arrangements as fragmented and inefficient.

“These reforms have far-reaching potential to improve the lives of millions of Australians,” Professor Fels said. “The focus must now be on effective and efficient implementation.”

But a key recommendation from the Commission that $1 billion be redirected from hospital mental health care services to bolster primary care has been rejected by the Government, underlining concerns about the adequacy of resources to be provided to GPs under the new arrangements.

The overhaul has also raised questions about the general approach the Federal Government is taking to reforms in health care.

Professor Owler said the fact that the new framework entailed Commonwealth withdrawal from funding and program delivery to instead assume a “strategic leadership” role was of concern.

He said the AMA would be watching closely to see whether the Turnbull Government adopted a similar approach in primary care and private health insurance policy, and tried to unload greater responsibilities onto the states and territories and the private sector.

Ms Ley said there would be a trial of the new arrangements this financial year, and they would be phased in over three years from early 2016-17.

Adrian Rollins