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  1. 1

    Dr Ben Mullings

    The article above makes some excellent points about the need to lift the scale of investment in mental health care and support. However, criticisms leveled at Medicare support for psychological care (i.e., Better Access) are out of place.

    There is an enormous amount of evidence that Australia needs to provide more support for psychological care, not less (see Adjustments to the program based on the evidence lean in the direction of expansion, not reduction of the program. Taking aim at Medicare to make the case for more funding in other areas of mental health care, is reminiscent of suggestions that we should fund the NDIS by cuts to welfare (see Both are cases of “robbing Peter to pay Paul”.

  2. 2

    John Mendoza

    As the author states there is no reasonable basis for more funding for hospital based acute mental health care. Indeed our analysis, with colleagues at University of Sydney, Brain and Mind Centre, shows that the number of acute care hospital beds in a number of PHN regions in Brisbane, Sydney, Melbourne and Perth, is equal to or greater than the same service in almost every other region in European examined using the same methodology.

    In Brisbane North, its not too far from the reality, that the only public mental health services are acute care beds or a mobile non-acute clinical team. Not much bang form $160m of state government spending. As Seb Rosenberg points out, less than 2% of the population get access to these services.

    Furthermore, these analyses show the lack of alternatives to hospital – there are too few of the out of hospital services to support recovery and prevent re-admission to acute care. In particular there are almost no specialist rehab programs – veterans can access some specialist PTSD programs but not much else – and there are almost no specialist employment support programs. We have ample information and awareness programs and an oversupply of assessment and referral type service, But if you actually need a residential facility with psycho-social and possibly access to out of hospital clinical services, then good luck. Homeless service providers too can provide assessment, a hot meal, some access to crisis accommodation and not much else.

    As many consumers say – “I want something to do, something to look forward to and something or someone to love” – if we get real mental health reform and not more of the same as we have for the past 25 years (since so-called reform commenced), then that desire could be satisfied. Given the state of the nation’s finances, that will require moving funding from acute care, and to a lesser extent, awareness programs.

    1. 2.1

      Dr Ben Mullings

      I agree with all of those points John. We should be clear though that Medicare-supported psychological care is not hospital-based acute mental health care. The Better Access program allows people to access psychological support in their own community. Programs of this kind help an enormous number of people in our society remain functional and recover from distress, so that they can avoid hospital. To improve the system we need to strengthen those parts which are working well and expand our investment to cover more areas.


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