Professor Alan Rosen, a psychiatrist who has been a longstanding advocate for better community-based mental health care, has turned to the Western genre for help in interpreting the warring policies and factions in mental health.
“If we were replaying how the wild west was won, community mental health services could be in the role of the bison, quietly becoming almost extinct as the invading frontiersmen and the incumbents shoot it out.
Self-annointed Tin-star Tony Abbott and his health spokesman side-kick Dead-eye Dutton partially got the message, and have usefully targeted the mental health needs of young people.
But they continue to ignore the disabling state of mental health services for other phases of mental illness and other age-groups.
They picked off an imagined demand for 800 more “early intervention” hospital beds, though early intervention is mainly a community-centred endeavour. While we need dedicated inpatient beds for young people, we actually need many more community based respite and subacute residential places for all age-groups.
However, they didn’t even graze the crying need for the complete revamp of 24 hour mobile community mental health services. Yet these might provide humane alternatives to constantly playing the last line of defence by piling up people in emergency departments and in fortress hospitals.
In the meantime, Galloping Gillard, the yodelling cowgirl, could have earned her spurs in the prime ministerial saddle when she intoned in her launch of Labor’s mental health policy mark II on July 27th: “The solutions are as complex and multi-faced as these problems. But I have also learnt that mental illness is a place where quality services can make a difference in people’s lives. Indeed, better mental health services can save lives.”
The words were moving, but the music and actions, although worthy in themselves, were discordant, as they were so fragmentary and accompanied by such piddling funds.
She also said: “I learnt from my dad, a psychiatric nurse, that illness of the mind is as debilitating as illness of the heart… and no less important or deserving of our understanding and care”. She could have also credited her close schoolgirl friendship with a distinguished psychiatric family for her decision to do law, and from there her political career took off, as she told her biographer, Jacqueline Kent.
So Julia, we know you know better, and can do better than this. So why aren’t you committing your government to a strategy that will make any practical and enduring difference to mental health services, at a whole population level?
Can’t the real Julia come up with a real mental health plan for the nation, which is both timely and comprehensive? Yes, you can!
There is a certain dismal consistency between our leaders’ stands on mental health and their other key policies.
Firstly, when PM Gillard says: “I want to be absolutely clear – mental health will be a second term priority for this Government” while only committing to spending peanuts on it over that 2nd term, this just sounds like code for indecision, inaction and delay.
Like climate change, both government and opposition appear to be just putting comprehensive mental health service reform off indefinitely.
They are priming the mental health community to keep fighting over the crumbs we get from the health budget table. We are being set up to argue over what ‘s worth doing for most of the the next term. We might even get a randomly chosen citizen’s assembly or a facilitated bun-fight on mental health.
After fuelling needless dissention, born in continuing resource starvation and premeditated fragmentation of services, Labor seems to imply that only then, if there is substantial agreement, Labor might get around to doing something about it in a third term, if they get one, and who knows with the Coalition?
Secondly, getting mental health services right appears to be such a discomforting task for both Federal Labor and Coalition, that like their dealings with asylum seekers, we would not be surprised if they came up with an “offshore solution” to make us all just magically go away! Those who have seen the recent excoriating Scorsese movie, Shutter Island, already have a fair idea what this would be like.
Health Minister Calamity Nicola’s advice hasn’t been much help either. She keeps teasing the mental health community to the tune of: “you can’t agree among yourselves, so you’re not ready yet, and anyway to give more to mental health means we would have to take away from some other worthy health cause ”.
She wouldn’t dare to sing that lament to the physicians and surgeons, to delay funding their priorities. Yet, similarly to the rest of health and science, the main disagreement that arises is between psychiatric professors protecting their academic turf, and debating the subtleties of evidence.
When this spills over into the public arena it doesn’t look pretty, and it can confuse the pollies and the public.
This is NOT the main game however. There IS broad consensus between most professional and stakeholder networks about what is worth doing in bread and butter services, to re-tool services to a contemporary recovery-oriented standard across the nation. This includes a one-stop-shop approach for each age-group of mental health services, starting with the pioneering work of Headspace and Early Intervention teams, Aboriginal Community Controlled health centres, 24 hour mobile assertive community teams, and specific e-health initiatives, but not stopping there.
The next government of whatever complexion needs to commit before the election to :
• a short and sharp widely consultative task force, arriving at a consensus inside 4 months, about priorities for a national mental health reform program for the next 6 years, integrating public, non-government and private sectors.
• a National Mental Health Program, overriding the ineffectual, diluted and downgraded revamps of the National Mental Health Policy, Plan and Standards, with implementation commencing squarely in this coming term. So far, only the Greens have come up with the seeds of a comprehensive national program that resets the balance of services towards systematic community care, but both major parties are capable of coming on board with this.
• A National Mental Health Commission, like New Zealand, Canada, and now Western Australia, which promotes the resourcing and monitors the implementation of the reform agenda at arm’s length from government, while constantly consulting with all stakeholder groups, and reporting on an all-of-government scorecard basis to the Prime Minister and parliament.
• We need government to find new resources to bring the mental health proportion of health budget, currently sinking to 6%, up to 13%, close to the proportion of health burden due to mental ill-health, as most other developed countries have done.
We don’t need yet another policy shoot-out to entertain the political punters.
We need a consistent commitment to integrated collaborative mental health care for the whole Australian community.”
(Photograph reproduced courtesy of Southern Methodist University, Central University Libraries, DeGolyer Library)
• Alan Rosen is Professorial Fellow, School Public Health, University of Wollongong, Clinical Associate Professor, Brain & Mind Research Institute, University of Sydney, and Secretary, Comprehensive Area Service Psychiatrists Network