Mental health policy at a crossroads

Policymakers are coming together and offering ideas to tackle Australia’s growing mental health policy problems, but the government must respond to the call too, Sebastian Rosenberg writes.

While Australia’s overall health system is often lauded as among the world’s best, the same cannot be said for our mental health system, where our performance lags and stories of crisis are common.

Together with the Brain and Mind Centre at the University of Sydney, the Centre for Mental Health Research at The Australian National University recently hosted a two-day forum to consider key priorities for national mental health reform.

The forum brought together around 45 people, including policymakers, professionals, service providers, consumers, carers, researchers, and funders.

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Australia is at a critical juncture in mental health reform. There are several concurrent commissions and inquiries running. There is also a Medicare Benefits Review underway. There is heightened political and community understanding that our current mental health system is not fit for purpose.

The forum was created to influence policy-thinking at this critical time and offer insights into Australia’s mental health policy problems.

Collaborations like these are crucial to solving our policy problems. They emphasise core principles which must remain true as well as outlining central goals for the policy-making process.

People who need mental health care should get it, regardless of where they live or capacity to pay. They must know where to go for help, and providers must know what to do when asked.

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Australians and their families must be confident that the system is backed by evidence, and that their treatment has been tested and modelled before implementation.

The shared aim of funders, providers, consumers, and carers is to make emergency and hospital care a last resort, not the front door for Australian mental health care. Team-based care must be the norm.

Further, policymakers must work with crucial assumptions about the nature of the problem.

Mental health as a policy problem is a ‘complete state’: it captures both medical complexity and the broader social context faced by individuals and their families.

When we compare these goals to our current services, a number of shortcomings become very evident and several questions are raised.

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How can professionals and service providers be trained to work together in the right settings, with the right payment incentives?  What information systems are necessary to support team-based care?

We must also consider how we can sensibly structure the various Australian agencies who split responsibility for mental health awkwardly among themselves.

Policymakers are not short on ideas when it comes to answering these questions. The forum in Sydney recommended urgent and immediate changes governments could consider to begin reforming mental health policy.

One is to consider what is necessary in order to make the Primary Health Network (PHN) experiment work for mental health. Many PHNs are still struggling to really understand and respond to regional mental health needs, and the government needs to further support their capability.

Another is the need for regular benchmarking and accountability in mental health, designed specifically to support systemic quality improvement. Nearly 30 years since Australia’s first national mental health policy, which committed us to national accountability, we are still outcome blind. We cannot explain the impact of the care provided in mental health, the dollars spent, or the lives saved and lost.

Mental health policy is at a crossroads in Australia. The government must listen to the recommendations of policymakers and forge ahead with tackling this difficult issue. Otherwise, its fate will be simply to continue muddling forward, with mental health problems outpacing reform and perpetuating issues for Australians and their families.