Federal claim of mental health agreement ‘first’ raises eyebrows

By Melissa Coade

Monday November 8, 2021

Scott Morrison
PM Scott Morrison. (AAP Image/Bianca De Marchi)

Experts have spoken up about a federal government announcement for a new intergovernmental agreement on mental health, correcting the so-called ‘first’ as, in fact, the sixth such national mental health strategy, and proposing a set of guidelines to ensure it will succeed.

In a statement shared with The Mandarin, two academics from the University of Sydney’s Brain and Mind Centre dismissed the federal government’s assertion that an intergovernmental agreement to be signed next year was significant because it was the first of its kind. 

Brain and Mind Centre director Professor Ian Hickie and senior lecturer Dr Sebastian Rosenberg suggested that it was perhaps more accurate to say that the anticipated 2022 agreement was part of 30 years of ‘frustrating’ and failed attempts to reform Australia’s mental health system. 

“This is not Year Zero. Mental health has a long history from which it can learn and design a better future. There is no more time to waste,” the academics said.

“Initial progress in 1992 was clear. Additional funding and clear goals under the first plan were specifically designed to reduce Australia’s dependence on long-term institutional care, in favour of more ‘mainstream’ mental health care in public hospitals. The extent to which even this was successful is moot, given Australia still spends almost $600 million on 2,000 beds in psychiatric hospitals each year.”

On Friday, Hickie and Rosenberg said department of health officials had just briefed the mental health sector that following a $2.3 billion investment towards mental health in the 2021 federal budget, a new intergovernmental agreement on mental health would be developed.

“The officials made the point that such an agreement would be the first under the new National Cabinet arrangements, as opposed to previous agreements struck by the Australian Health Ministers’ Council or the Council of Australian Governments (now both defunct). But this is not Year Zero […]. We are not starting again.” 

“The fact is that despite five national plans, two national policies, one action plan, one road map, several visions and countless reports, inquiries and other reviews, consumers, carers, professionals, providers and others in the mental health sector have lost faith in the national mental health planning process.”

Given the acute strain the COVID-19 pandemic and associated health orders had put on the Australian community since 2020, they said the overwhelmed mental health system was ‘already broken’, and that the government could not afford to take no action. The experts also pointed to a recent Productivity Commission assessment that Australia’s failure to drive improvements in mental health had come at ‘colossal cost’ to the wellbeing of individuals, communities and the national economy. 

“We cannot afford the sixth national mental health agreement to be just business as usual, a continuation of the same lowest common denominator planning that permits the governments to make an agreement that does nothing,” they said. 

Hickie and Rosenberg called for the sixth national plan to be clear in its goal. Part of this clarity required an understanding about which parts of the plan should comply with national standards, and which parts are better managed regionally to reflect local needs. 

The experts also said the plan should focus on how to engage those most invested in its implementation — not officials, but patients, their families, health professionals, service providers and local planners. 

“Experience tells us that an agreement run by senior officials from head office fails to drive local implementation.

“There is genuine confusion about how to organise the mental health system. Recent reports and recommendations have referred to stepped care, integrated care, individualised care, resource formulas and other service planning frameworks. 

“The next agreement should make it clear what we are aiming to achieve,” they said.

They recommended that the plan should follow seven guiding principles — mostly to adopt the recommendations of a recent select committee inquiry into mental health and suicide prevention, the Productivity Commission, the Victorian Royal Commission, and the 2014 ‘Contributing lives, thriving communities’ review — which also included acting on a children’s mental health and wellbeing strategy, accepting the advice on suicide prevention from the national mental health commissioner, and the forthcoming royal commission into defence personnel suicide (due in 2023).

“Mental health stands out as a conspicuous failure in a health system of which Australia can otherwise be proud,” they said. 

“The next agreement must prioritise workforce design, to not only build the mental health workforce of the future but also help it become better organised to deliver the collaborative care often  necessary to meet people’s needs. 

“This is about professional training and getting the payment mechanisms right to enable teamwork to flourish.”

Hickie and Rosenberg also warned against rhetorical commitments, which were a feature in the fifth national mental health plan. A promise in that plan that primary health networks would cooperate with state-funded local health districts had failed to drive effective mental health planning on a local level, they said.

“At the heart of the next agreement is the federal government’s appetite for leadership. There is strong evidence that the shape and quality of the mental health care available to Australians, often poor and sometimes catastrophic, varies depending on where they live. Is this patchiness acceptable?,” they asked.

Other ways the sixth plan could learn from mistakes of the past were to integrate social determinants of health including the links between mental health, employment, housing, education and social engagement. Hickie and Rosenberg said they wanted the new plan to deliver mechanisms that encouraged collaborative governance structures between departments and agencies and overcame the challenge of ‘siloes’.

One obvious way to improve on the last plan was to ensure that all goals, targets and outcomes were measured and monitored for progress. The experts noted that technology and digital services could also be used to great effect assessing direct care and consumer reported outcomes. 

“There is no agreed process for systemic quality improvement in mental health. Without accountability, we are outcome blind. It is not good enough anymore to just measure activity – budgets and bed numbers,” the experts said.


Mental health spending rising but strategy and evaluation now key, expert says

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