Ian Hickie: Is the government up to the task?
The 2021 federal budget has been heralded as the point at which the Morrison government will respond, at scale, to the many failings of the mental health system. We spend only $10.6bn a year providing mental health services to over 4 million people. Importantly, there is an increasing divide between the federal government’s reporting and the independent accounting of what monies are spent on mental health. The responsible ministers claim that federal spending has already substantially increased, up from $3.5bn five years ago to $5.9bn in 2020-21.
By contrast, the Australian Institute of Health and Welfare reports that the commonwealth only expends $3.6bn, with an increase of only 2.1% per annum. AIHW also notes that all governments only increased their spend by 1.5% per capita between 2014-15 and 2018-19 and that the proportion of total health expenditure spent on mental health actually decreased by 1.1%. It remains at 7.5%, and this is largely unchanged since 1992.
If we only see very limited new investments in this budget, then we must stop and ask “why”? Common answers include stigma and structural discrimination. Others note the lack of simple “announceables”. After all there is no simple “social vaccine”. Governments are now working on new federal-state agreements and “whole of government” responses. So it is likely that real action is postponed (once again) till after the next election.
Australia is not alone in its attempts to build an effective mental health system. Unlike many other countries, however, we have had substantial positive movements in community attitudes. We have also seen real innovations in early intervention, youth mental health, use of new technologies and Medicare support for psychological therapies.
Sadly we have not yet seen the combination of those factors that can transition a crisis-driven response to a stable and responsive system. They are: investments at scale; genuine structural reform; infrastructure and technical support for regional implementation; and, a focus on delivering real outcomes. Is our national government, or our new national cabinet, up to the task?
Prof Ian Hickie is the co-director of health and policy at the Brain and Mind Centre, University of Sydney
Hazel Dalton: A huge workforce shortage in rural mental health
Numerous recent inquiries and reports into the Australian mental health system have pointed to systemic challenges, underinvestment relative to need, workforce shortages and barriers to accessing services.
My wishlist for the 2021 budget for rural mental health is action- and investment-oriented. First, we should adopt a strategic approach of five to 10-year goals, not proceeding 12 months at a time.
Government must recognise the diversity of rural areas. As the saying goes “when you’ve seen one rural town … you’ve seen one rural town”. To best serve rural communities, an evidence-informed community-based planning approach is needed.
To deliver our services effectively, governments must invest in better data about mental health services and the health of those who use them. The data should be collected regularly and reported publicly at a meaningful scale such as the local government level.
Investments should strengthen general practitioner and community-based services. There is a huge workforce shortage in rural mental health services. Government should increase the numbers of GPs, nurses and allied health professionals. They should invest in peer workers, that is trained non-clinicians who have a personal experience of mental health problems. It is vital that the workforce is supported through training, local and clinical supervision so that they can serve most effectively.
Telehealth investments including specialist consultations, support and supervision for rural health practitioners, can be used to strengthen local services. Digital mental health investments contribute by providing free self-help and clinician-guided care as well as advice about the promotion of good mental health. This and other investments to promote rural wellbeing, such as well-funded mental health and wellbeing campaigns, and activities to ensure timely access to mental health are needed.
Lastly, governments must work together to promote community wellbeing, to support community activities and infrastructure to foster mental and physical health and strong social connections.
Dr Hazel Dalton is the research leader at the University of Newcastle’s Centre for Rural and Remote Mental Health based in Orange, NSW
Tegan Carrison: People under stress need certainty
In this year’s federal budget we expect significant and necessary investment in mental health. Even though a recent extension of telehealth has been announced, we are calling on the government to make this a permanent and universal option. People under stress need certainty when it comes to getting help.
The government must raise the Medicare rebate to $150 per session. Due to a historic legislative mistake, the Medicare system currently divides psychologists into two different rebate categories: clinical or non-clinical. Currently, Australians can only access a higher rebate when seeing a small pool of psychologists labelled “clinical psychologists”.
As a result, 70% of psychologists in Australia are currently placed on a lower Medicare rebate, despite research showing that patients receive the same high level of treatment regardless of whether their psychologist has a “clinical” label.
Raising the Medicare rebate to $150 per session will mean more bulk-billed psychologists, more Australians able to afford to stay in treatment for longer, and it will also retain more psychologists in the profession that has increasingly become financially unviable.
It is time for the government to implement the Productivity Commission’s recommendation to provide up to 40 rebated psychology sessions per year. The current annual cap for psychology sessions sits at 10 sessions (20 sessions are available until June 2022 due to Covid). For serious or severe psychological conditions, 10 sessions is severely inadequate.
For many, 40 sessions would help patients exit treatment and engage fully and productively in the community. Adequate and consistent treatment will also reduce the pressure on emergency departments and mental health wards of hospitals.
An affordable option for government-funded mental health support would be to utilise the 5,500 provisional psychologists available in Australia through a “provisional psychologist” Medicare rebate. Provisional psychologists are four or five-year trained psychologists, embarking on a final period of supervised practice. We have these mental health professionals at our fingertips; we need to support and use them.
Australia needs to start flattening the mental health curve urgently. We simply cannot afford another national crisis and the long-term, far-reaching effects on our health, economy, society and education.
Tegan Carrison is the executive director of the Australian Association of Psychologists Inc (AAPi)