This post continues a Croakey discussion about the new primary health care organisations to be known as Medicare Locals, and explores the question: what are their implications for mental health care and mental health reform?

Sebastian Rosenberg, Director, ConNetica Consulting Pty Ltd, and a Senior Lecturer, Brain and Mind Research Institute, Sydney Medical School, writes:

The relationship between mental health and Medicare Locals is unclear and partly explains why mental health is on the CoAG agenda in 2011.

Many advocates for mental health reform focus on the need to invest in new models of community-based mental health care and service.  Some of this would be clinical and some would be the sort of non-clinical, psycho-social rehabilitation that is now demonstrated in the literature to be effective in keeping people out of hospital and well living in the community.

These services represent a small but precious element of the total mental health service spectrum (around 8% of total funding Australia-wide, with Victoria allocating around 12% of its mental health budget, NSW 4%) and their growth is critical to ongoing reform.

It is very unclear how Medicare Locals will drive this growth.

Organisations like MIND, the Richmond Fellowship and the Mental Illness Fellowship, to name but a few, have now built up 30 years of expertise in the delivery of recovery-focused psycho-social rehabilitation.

Any successful engagement by a Medicare Local in community mental health will probably be based on strong links to this type of organisation.

At one stage, it was rumoured that the Commonwealth would jumpstart the involvement of Medicare Locals in this area by transferring responsibility to them for all extant federally-funded community mental health programs, Personal Helpers and Mentors, Respite Care, Activities of Daily Living and some other programs worth around $600m over the life of the CoAG National Action Plan on Mental Health 2006-11.

Most state governments are resisting this.  Whether this proceeds or not, the main challenge for Medicare Locals will be to ensure that the community can continue to see growth in the psycho-social rehabilitation sector and to ensure balance in the services available in the future.

Access to services from a bio-medical paradigm alone will be insufficient to meet the needs of people with a mental illness to live well in the community.

Medicare Locals have been characterised by some as Divisions of General Practice on steroids.  What exactly is the model of primary and secondary mental health care we are attempting to implement and what is the evidence to support its application to people with a mental illness?

I know there are many general practitioners with misgivings about the new arrangements. Are Medicare Locals merely part of the scenery of the pantomime called National Health and Hospital Reform presided over by Kevin Rudd and Nicola Roxon?

Apart from perhaps visiting Pat McGorry’s EPPIC service and a headspace service, I am not sure either of them actually visited a psychiatric hospital ward or other mental health service.  It is perhaps not surprising that it is so unclear what role Medicare Locals are supposed to play with regards to community mental health.

Mental health reform is at a critical juncture as the new Minister Mark Butler takes over.

The 2nd CoAG Progress Report showed how funding for mental health across Australia remains heavily skewed towards acute and hospital-based clinical care.  More and more funds are being spent here but, as also shown in the Report, there is no commensurate increase in the number of people with a mental illness receiving care, particularly in the state health system.

We risk simply pouring new money into failed systems.

Apart from the Commonwealth’s Better Access Program, there are few resources provided under CoAG for other and new models of care and service in mental health.  CoAG in 2006 stated that the $4bn investment made then was the first down-payment in a long term investment by all governments in properly funding mental health in Australia.

The creation of Medicare Locals cannot be permitted to stall this process of reform in mental health, a process predicated on the establishment of new clinical and non-clinical services, particularly early intervention services, to be available in or from a person’s home.

While Australia’s mental health accountability framework is very weak, with the rate of access to services unchanged over the past decade, the critical factor in reform now must be to demonstrate the delivery of new services for new clients.

This applies to Medicare Locals as much as it does to all other areas of the mental health ‘system’.

A new approach to accountability was promised as part of health reforms. We must watch carefully to see what it will measure.

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Previous posts in this discussion:

Scott White
http://blogs.crikey.com.au/croakey/2010/10/12/crowdsourcing-ideas-for-how-medicare-locals-can-engage-their-communities/

Helen Keleher
http://blogs.crikey.com.au/croakey/2010/10/12/a-call-for-healthy-action-beyond-medicare-locals/

Carol Bennett
http://blogs.crikey.com.au/croakey/2010/10/13/community-engagement-is-not-just-about-ticking-boxes-a-caution-to-medicare-locals/

Mark Harris
http://blogs.crikey.com.au/croakey/2010/10/13/plenty-of-challenges-ahead-for-medicare-locals/

Michael Moore
http://blogs.crikey.com.au/croakey/2010/10/13/and-some-more-questions-about-medicare-locals/

Jennifer Doggett
http://blogs.crikey.com.au/croakey/2010/10/15/engaging-consumers-in-health-policy-and-programs-what-does-the-evidence-say/

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