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Mental health system needs reform

27 April 2017
Patients and families should be at the centre of care

“More funding for mental health services is crucial but unless we overhaul the current system and defund ineffective programs, we will be throwing good money after bad," says Professor Ian Hickie.

“For too long we have been pumping scarce resources into a dysfunctional system riddled by silos and an absence of independent monitoring and evaluation of effectiveness,” says Professor Hickie in an editorial published today in the Sax Institute’s journal Public Health Research & Practice.

“Many parts of the system continue to put practitioners and policy makers, not patients, at the centre. It is incumbent on all of us in the sector to acknowledge and address these systemic problems, instead of hiding under the doona.”

Professor Hickie AM, who is Co-Director of the University of Sydney's Brain and Mind Centre, said the time was right to address these issues, as Australia had recently embarked on the most radical attempt to reshape mental health services in the past 30 years and the National Disability Insurance Scheme was set to play a major role in the mental health sector.

We need a system that puts patients and their families at the heart not just of care, but of the wider decision making process.
Professor Ian Hickie AM, University of Sydney

“We know from Australian and international experience that the best way to deliver higher-quality mental health care is through multidisciplinary teams. In many cases, however, these are resisted by professional organisations that prioritise fee-for-service, solo-practitioner or single-professional group styles of practice.

We also continue to prioritise funding into institutional settings when we know that community-based psychosocial, primary and community health services can have the most impact.

“We also need a system that puts patients and their families at the heart not just of care, but of the wider decision making process. Although the era of hierarchies and the ‘doctor knows best’ mentality is over, many have not caught up to this reality. 

“Finally, we need independent, national evaluation of programs. This will create a true picture of what is working and what isn’t, meaning we can direct resources accordingly. Where services can show their effectiveness, they should be supported with increased resources. But services that are not having an impact should not be supported forever.”

Professor Hickie said the latest issue of Public Health Research & Practice focussed on how to overhaul and improve the mental health sector, with papers from consumers and systems thinkers, and examples of innovative programs that are already being rolled out.

“It should be required reading for everyone in the sector,” he said.

Dan Gaffney

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