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Mental health policy
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Mental health: Turnbull can lead change, like Howard and Gillard

15 July 2016
When it comes to mental health reform, Malcolm Turnbull can make a real difference, writes Ian Hickie.

All major parties in this year’s election campaign emphasised suicide prevention, youth mental health and improving services in rural and regional areas. As distinct from many other aspects of the health and hospitals debate, the Prime Minister has the chance to make an immediate impact.

Significantly, in mental health it is more important to implement effective reforms and demonstrate national leadership than it is to spend more money. As highlighted by the National Mental Health Commission, the commonwealth already spends about $10 billion annually, with the states and territories contributing another $20bn or so. Thankfully, so far this government has not made the error of pouring precious new resources into failed or poorly performing and disconnected systems of care.

What has set Australia apart from other developed countries in mental health during the past two decades has been the direct engagement of the highest political office. In that time, two prime ministers really left their mark: John Howard and Julia Gillard.

In the late 1990s, Howard promoted a national focus on suicide prevention.

In 2005, in partnership with NSW premier Morris Iemma, he led the Council of Australian Governments’ response to a damning report by the Human Rights and Equal Opportunity Commission on the woeful state of services. Howard was open to radical changes, including the introduction of Medicare rebates for psychological services, better social support for those with chronic illness, and the establishment of Headspace, to lead early intervention services for young people.

Gillard, ably assisted by her minister for mental health and ageing, Mark Butler, emphasised that mental health needed not only substantial new investments (committing more than $2bn in the 2011-12 budget) but also serious oversight by the new NMHC.

More than any recent PM, Turnbull is acutely aware smart 21st-century digital technologies can transform how we deliver services.
Professor Ian Hickie

Late last year, in response to a review of the NMHC’s commonwealth-funded services, Turnbull set out a clear agenda for mental health reform. As highlighted by NMHC chairman Allan Fels, mental health reform is not just a health issue but also a serious economic challenge. Structural reform could add at least 1 per cent to gross domestic product

At the time, Turnbull also made the key observation that in the 21st century Australia’s most valuable resources were not under the ground but in the brains and minds of its citizens. Consequently, he made a broader commitment to invest in health, social services and innovative technical programs that would increase Australia’s mental “wealth”. More than any recent PM, Turnbull is acutely aware smart 21st-century digital technologies can transform how we deliver services.

New mobile-based systems can bring highly personalised, expert and rapid service responses to those who are acutely suicidal, those who do not want to attend clinics, those who can’t afford the cost, and those who live in rural and regional areas. Consequently, rather than promising to pump more money into our inequitable and poorly distributed Medicare-based fee-for-service systems, the Turnbull government has committed to embark on serious structural reform. Not surprisingly, this approach has already attracted criticism from those who simply argue for more money, those providers of services who benefit most from the existing system and those who simply fear change.

Additionally, the Coalition has promised (with significant new funding) two standout new initiatives. The first is large-scale, regionally based suicide prevention trials. As recommended by the NMHC, these will build on local strengths, respond to local circumstances, use new technologies and be linked to serious research and evaluation. These trials, costing at least $90 million, respond to the diversity across Australia and recognise that suicide rates are often two to three times higher in regional areas undergoing significant economic and social change.

The second big investment is in Project Synergy, a series of focused new service trials using 21st-century digital technologies and costing $30m across three years. This builds on an Abbott government initiative and the outputs of the Young and Well Co-operative Research Centre. This initiative has already attracted wide interest and potential co-investment from US and Canadian partners.

It is exactly the type of transformational approach that is desperately needed. Without direct prime ministerial support it risks the same fate as other technology-based healthcare initiatives: rejection by professionals and organ­isations strongly invested in maintaining the status quo.

If Turnbull really wants to demonstrate his government is seriously committed to improving healthcare, then implementation of the Coalition’s policy platform would be a great way to start.

Professor Ian Hickie is co-director of the Brain and Mind Centre at the University of Sydney. This opinion was originally published in The Australian.

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