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04 Jun 2019

The AMA made a detailed submission to the Productivity Commission (PC) inquiry into the role of mental health in supporting economic participation, enhancing productivity and economic growth.

Briefly, the submission noted that the AMA represents tens of thousands of medical practitioners who interact with the mental health system in myriad ways. The submission attempted to capture the general views of the AMA; however, there was an acknowledgement that there are other valid views from AMA members that may not have been included in one submission.

The submission stressed the inconsistencies in responsibilities for mental health services. Despite previous attempts, overlap, duplication and gaps are experienced at a Commonwealth-State/Territory level, between public and private, acute and community-managed and regional-metropolitan. These structural and financial divides and divisions are historic and require a massive overhaul of how mental health services are understood, planned, funded and delivered. A national Royal Commission, which is similar to that currently underway in Victoria, may deliver systemic changes.

This PC inquiry will differ from past reviews by considering how reforms outside of healthcare – such as in workplaces, education, justice systems, housing and social services – can improve mental health, and hence social and economic participation. The social context underpinning mental health is very important; that is, housing, employment, education, finance, locations and access to services, race and ethnicity, language skills and other ‘determinants’ of health.

The failure of governments to collaborate in reducing gaps and delivering effective services is an ongoing frustration to the AMA. Multi-disciplinary, multi-agency team approaches to mental health care operate in some jurisdictions and overseas, and the PC should examine how these operate and their outcomes. A major obstacle is the way government portfolios operate in silos. The PC faces an enormous challenge here. There must be an understanding that even though mental illness is an individual condition, collaborations by different agencies and disciplines (and including factors such as housing, employment, relationships, domestic violence, disability, drug and alcohol, migrant/CALD and Aboriginal and Torres Strait Islander) are important to reduce duplication in services and ‘fill the gaps’.

The submission called on the PC to start by examining whether the current Australian payment and funding system is adequate and adaptable to treat and manage episodic mental illness. The AMA believes that the current appropriations and allocation of funding for mental health services, treatments and workforce, by both the Commonwealth and State/Territory governments, need to be overhauled and realigned.

A consistent message from the AMA is that funding is not properly weighted between community-based mental health services, acute care and advocacy requirements, and there appears to be no effective and evidence-based approach to the overall mental health architecture. Current funding mechanisms stifle the sector and inhibit proper mental health care. At the community-based end, block, flexible and/or innovative funding is essential to maintain and build services and supports. Block and/or flexible funding can make it easier to maintain a stable workforce and allow for long-term planning and delivery.

The under-resourcing of acute care has been well-documented. It has been the practice of successive federal and state governments to fund ‘attractive’ components of the mental health system, such as awareness-raising campaigns, at the expense of frontline treatment and care. Funding for psychological care and non-medical providers has been at the expense of acute mental health services for more severe illnesses, clinically appropriate and humane physical infrastructure, and community-based psychiatric mental health programs and services. Consequently, many psychiatric mental health service providers struggle to provide a continuous, stable service, retain qualified staff with corporate knowledge, and provide proper outreach services. The consequence has been a loss of senior psychiatrists and psychiatric leadership from many publicly funded psychiatric mental health services and a fragmentation of the public psychiatric workforce.

Others have called for a more multi-disciplinary team approach to provide coordinated care based on national standards implemented with regional mechanisms. Mental health for many patients is best delivered in a coordinated manner, with agencies working together to meet individual and community needs.

There is ample data available to the Commission indicating that the commonest cause of premature death for people with mental illness is physical illness. The life span of a person with mental illness is shortened by at least a decade. Physical health is too often ignored in these patients.

 

The AMA submission can be found at: https://ama.com.au/submission/ama-submission-productivity-commission-inquiry-mental-health-0


Published: 04 Jun 2019