People with mental illness deserve better facilities

I recently recommended that people interested in mental health should consider voting for any party that promised a long term strategic plan to invest in mental health reform in Australia.

With only one in three people with mental illness receiving any care, the need for this kind of sustained investment and strategy is obvious.

The recent National Press Club debate between Minister Nicola Roxon and her Liberal counterpart Peter Dutton did nothing to inspire confidence that either party is committing to this type of fundamental reform.

It is true that the Liberals are offering about four times the investment promised by Labor. But in reality, the components of both parties' promises look very similar, with both parties pledging to support investment in the headspace model of youth mental health, the establishment of new early psychosis centres and sub-acute care. It is only the scale of the promises that differs.

The Liberals have promised some part of 800 new mental health beds for sub-acute mental health care while Labor has pledged some part of 1300 new sub-acute beds for mental health, with the total to be shared with other services. Yet neither Roxon nor Dutton clarified the model of care under which these proposed new sub-acute services would operate. This is a significant concern given this is by far the major component of investments promised by both parties and there is scant evidence to merit such spending. The last thing needed in mental health is a massive capital investment in a new set of warehouse wards designed to catch the overflow from our bursting acute psychiatric units.

This would constitute new investment in old and failed services.

The extent to which it is possible to build and establish genuinely therapeutic sub-acute mental health care is largely untested in Australia and an issue deserving of extremely close scrutiny as both parties rush headlong to invest in this area.

But perhaps most frustrating is Roxon's repeated assertion that people with a mental illness want and deserve access to general practitioner care just as much as the general community. She makes this point to highlight Liberal plans to fund their mental health promises by making cuts to funding for super clinics, E-health and so on. However, the Minister would never suggest that people with cancer should choose between access to specialist cancer treatment or access to their general practitioner. She would rightly say that people with cancer deserve and need both. This is not the case with mental illness apparently. Put simply, access to general practitioner services will be of quite limited benefit to many people with persisting mental illness without also providing access to high quality specialist mental health services which are not available now.

The rate of access to mental health care is less than half that of other chronic illnesses. Yet Roxon persists in linking any additional spending on vital new and long overdue mental health services with reductions in spending on other parts of the health system. This is both inappropriate and palpably unfair. People with a mental illness deserve better. They deserve access to a world-class stream of mental health services just as Labor announced a world-class cancer stream in the 09-10 Federal budget with funding of $1.3 billion.

Then mental health got just 2 percent of $7.4 billion at the April 2010 meeting of the Council of Australian Governments.

Even putting aside the funding issue, Roxon seems to miss a fundamental point. Many people with severe and persistent mental illness often do not have or see a general practitioner. For example in Mackay, the city highlighted in a recent ABC Four Corners program on the paucity of mental health care available to the community, it is reported by Queensland Health that 50 percent of clients admitted to acute care or receiving support from the community mental health service have no GP and do not see GPs. It may occur to Roxon that significant numbers of Australians cannot connect to GPs for all sorts of good reasons.

The final point I would make is that the call for robust accountability in mental health has been consistent since 1992 and yielded almost nothing. Roxon made a point during the debate about Labor's commitment to system-wide accountability. However, the focus here will be on process measures or outputs, nonsense items such as waiting lists, the number of beds, the number of occasions of service and other such dud markers as agreed in compromise with state health bureaucracies. With regards to mental health specifically and despite the fact that our mental health system is now worth over $5 billion annually, over the past 18 years neither Labor nor Liberal governments have established the means by which we can assess any of the following key markers: whether a person is alive or dead within three or 12 months of seeing a mental health service; whether we are reducing the rate of suicide; whether our mental health services are impacting on the rates of homelessness among people with a mental illness; whether education and employment rates are improving for people with a mental illness; and, importantly, whether people treated in our mental health system say they were treated with dignity.

In mental health, we are service poor and outcome blind and neither party has outlined any longer term commitment to fix this.

Sebastian Rosenberg is a senior lecturer at the Brain and Mind Research Institute.

Media enquiries: Sarah Stock, 9114 0748, 0419 278 715, sarah.stock@sydney.edu.au