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Mental health and the federal budget

Below is some reaction to mental health elements of the federal budget

Mental Health Takes the Night Off – Budget 2012

By Sebastian Rosenberg, Senior Lecturer, Brain and Mind Research Institute, University of Sydney

From a mental health perspective, the budget was an alarmingly quiet affair, with the Government content to rest on its $2.2bn laurels from last year.  A ‘control F’ search of Budget Paper 2 for the word ‘mental’ yields only 2 results. Slim pickings.

It was not our turn.  It was aged care’s turn, with the Budget delivering $3.7bn package over the next five years.  In health specifically over the next four years, the Budget also promised $0.5bn for dental care, $233m for ehealth and $50m for bowel cancer.  This is in addition to the Federal Government’s $1bn investment in the National Disability Insurance Scheme.  Not our turn.

In such a tight fiscal environment, it was perhaps not surprising that the hard copies of the health budget package didn’t even make it to the Treasury lock-up where I spent many happy hours this evening.

There were still some points to note.

Funding for the Mental Health Nurse Incentive Program has been maintained but capped, with $17.6m provided over the next two years. Based on the increased numbers of people receiving care in 2010-11, the Australian College of Mental Health Nurses estimate around 30,000 people with severe mental illness will miss out on care due to this capping.

The Government will provide $21.0 million to fund additional allied mental health services for patients under the Better Access initiative. Under current arrangements, patients can access up to ten subsidised mental health services through the Medicare Benefits Schedule (MBS). These funds will allow access to a further six MBS-subsidised mental health services for some patients up until December 2012.  This was the compromise change forced on the Government by the Greens. However, the funding is not new, with the Government reducing the Flexible Care Packages Program by $16.3m and the Better Access Training Initiative by $4.7m.

Perhaps the only exception to the general silence on mental health in the Budget was $115m over five years directed towards better mental health care for veterans.

While the National Disability Insurance Scheme is clearly a worthy headline, the extent to which it will cover people with a mental illness is unclear. This is clearly an issue of real significance for people with severe illnesses such as schizophrenia.

Previously announced changes to the Disability Support Pension kick in from 1 July and the impact these will have on people with a mental illness needs careful scrutiny.  There are some measures in the Budget designed to assist the unemployed find work.

While there was an almost complete absence of mental health-related activity, the Budget still offers some gems of information.

New spending of $9.1m will permit the Australian Bureau of Statistics to conduct its Survey of Disability every three years, rather than every six years, from 2014‑15. The ABS Survey into Mental Health and Wellbeing of course occurs only every decade. These types of surveys give us unparalleled understanding of issues and the paucity of this kind of data in mental health explains why we are currently ‘outcome blind’.

A budget Press Release by Minister Brendan O’Connor re-affirms the 2008 commitment made by Labor to halve the rate of homelessness by 2020 and makes the striking claim that the Government has already spent $5bn on this cause. A large chunk of this funding was for 20,000 social housing places. Again, without baseline data it is not possible to understand the impact such key initiatives are having on people with a mental illness who require housing support. Funding is required to procure this information.

Last but not least is the statement made in the Budget that Commonwealth outlays on health have now reached $61bn. This represents a 37% increase on 2007-08 levels.  Though last year’s funding for mental health was welcome (the $2.2bn was over 5 years), this year there is practically nothing while the rate of increase to the overall health budget continues largely unabated.  Mental health’s share of the overall health budget is in decline.

In announcing the Commonwealth’s commitment to the $5.5bn 2006-11 National Action Plan on Mental Health, then Prime Minister Howard recognised that mental health required more than one-off attention.  It needed the ongoing political and financial support of governments, to build the community service infrastructure not built following the closure of Australia’s asylums.  While some important steps have been taken since 2006, there is no new CoAG National Action Plan and there is a long, long way to go.

Wait your turn.

***

Still waiting from last year’s budget

By Professor Pat McGorry 

While there is relief in some quarters that mental health has at first glance does not appear to have been cut in this budget, there are three areas of concern.

Firstly, the long term structure of Better Access remains uncertain beyond 2012 as far as one can tell. Furthermore a much needed  ”stage 2″ program with enhanced multidisciplinary skills, for the subset of people with more complex and persistent disorders who run out of Better Access credits yet have no hope of access or tenure in the heavily constrained State public mental health system, is not even in prospect.

Secondly, there is concern about the capping of the mental health nursing initiative, one of the most valuable of the recent reforms.

Thirdly, there are in fact latent cuts to projected mental health expenditure arising from the fact that several major programs announced last year have yet to surface.  For example, the largest single program of 2011, “Partners in Recovery”  for severe and enduring mental illness, had not been designed when announced in the budget and has had a consequently long gestation, while the upscaling of EPPIC has been delayed despite committed and genuine efforts by the Minister and senior DoHA officials, solely due to the requirement under the NPA mechanism to deal with State health departments rather than directly with major providers.

This has meant that despite the best of intentions, nationwide policy support from all jurisdictions and desperate community need, no new services have yet been opened.  I believe the global solution is a much stronger role for the Commonwealth in the design, funding, integration and national standardisation of community mental health services in close association with enhanced primary care, allowing the States to focus on their heartland of hospital care.

Finally we must remember that our 10 year goal is equal access and quality for mental and physical health for all Australians, which means progressive real increases in mental health investment as a share of the health budget.

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  • 1
    John Mendoza
    Posted May 9, 2012 at 4:33 pm | Permalink

    Well we now know the meaning of a “second term priority” when it comes to mental health. Not a lot of evidence as the writer points out last night. Seems that was an aberration last year and the circus has moved on ….

    Those of us involved in mental health reform well remember being told at the 2005 Senate MH Inquiry “that progress would be slow” by well paid consultants engaged by the DOHA for the last decade.

    “Glacial pace” is no longer an apt description for the pace of mental health initiatives. Consider these facts: 1) not one sod of soil has been turned on the early psychosis program allocated $25.5m in 2010 and a further $225m in 2011; 2) not a single package of care for people with severe and persistent mental illness has been provided from the initial announcement of $58.5m in 2010 and massively increased to a total of $550m in 2011; 3) no report card; 4) no roadmap; 5) no sign of expanded ATAPS and other mental health programs etc etc .

    At this pace the world’s glaciers will be long gone before we see mental health reform.

  • 2
    rhonda.wilson
    Posted May 10, 2012 at 10:34 am | Permalink

    ‘not our turn’…. in rural Australia, and in regard to mental health – especially young people’s mental health…. It never seems to be ‘our turn’. The picking are slim on a ‘good’ year. Yet, the outlook for young people with emergent mental health problems in rural areas continues to be grim. Quite simply, it seems that young rural people are not prioritized, and as a result they are perpetually disadvantaged.

    I am out in the field collecting data about this problem at the moment – the real life stories of parents and young people are both heart breaking , and frequently their reports to me raise some basic human rights issues. I will bring the research to fruition – and tell their stories, but…. it seems that help is never on the way and when it is – it is fly in – fly out and too little too late.

    Hopefully next year will be a better budget for young rural peoples mental health – but, it is hard to remain hopeful, when the track record has been just that – a dusty dirt track seldom traveled by the budget bandwagon.

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    johnny
    Posted May 10, 2012 at 2:03 pm | Permalink

    Get with the program John,1/ the early psychosis was stopped because the “people” us, worked out psychiatry and mental health don’t have a “crystal ball”, nor should they be poisoning little kids and baby’s because they’ve imagined their might be a mental illness in the future somewhere,sometime.2/ There “is” plenty of care for of people with severe and persistent mental illness, and all you’ve got to do to see that keeps happening is, take out of the equation those being severely and brutally treated to the point they are persistently handicapped and made languid on debilitating poisons being forced into their bodies, without any fair test to show that that is what they are doing to them. 3/ A Report card is being developed at the moment, but its not going to do anything if it doesn’t listen to the cries of its victims,that it asks to respond to and help put the report together with, and it hasn’t up until now, so i doubt there is any change in the gale force wind blowing the life and hope out of its victims in the near future anyway. 4/ The road map is a map that allows mental health to keep force drugging its victims, until that stops, its a road to despair for its victims, to its victims, remember them, the client/patient, by an oppressive aggressive arrogant poisoning organisation. Laced with caring well meaning lingo that aims to make itself look humane whilst it continues to poison and oppress, and not lift up the lives and outlook of its victims cognitively, with love and guidance. 5/ ATAPS- What and take away psychiatric dollars- no way were not going to let that happen, all those years we studied why we need to poison people, forget it. its just not happening.

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    jillian Horton
    Posted May 11, 2012 at 2:21 pm | Permalink

    The May budget not only did nothing further for mental health is has actually reduced the prospects that people in the community will get the help they need. The cuts to Better Access, which get worse in January 2013, means that people will be cut off from care after having only 10 hours of psychotherapy. Specialist psychologists are already seeing that people are either not getting the care they need. Some private specialist psychologists are closing or reducing their their private practices, which means there will be even less treatment otpions in the private sector – not a good outcome. We must all move away from the ridiculous concept that proper psychological care and treatment can be undertaken in 10 hours. Sometimes it takes this long to build trust and rapport, investigate the issues, form a diagnosis and just start interventions. Especially with children and adolescents where there are many layers to examine. There is no future for proper treatment of people with psychological disorders with these restrictions – ulness you just want drug management.

    Jillian Horton
    Clinical Psychologist
    President of the Australian College of Specialist Psychologists

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