Introduction by Croakey: The Productivity Commission this week begins a series of hearings across Australia, seeking responses to its draft report of its inquiry into mental health released late last month.
See Croakey managing editor Melissa Sweet’s comprehensive wrap of the 1,238 page, two volume report, in which she urges those concerned with health equity to respond at public hearings or via written submissions (which close 23 January 2020), ahead of the Commission’s final report which is due by the end of May 2020.
Public hearings begin in Canberra on Friday (15 November) and will follow in Melbourne (18-19 November), Geraldton (20 November), Perth (21 November), Sydney (25-26 November), Broken Hill (28 November), Rockhampton (2 December), Brisbane (3 December), and Launceston (9 December). Dates and locations for South Australia and the Northern Territory are yet to be announced.
Mental health stakeholders have to date generally welcomed the draft report, saying it provides a comprehensive consolidation of issues that have long needed urgent attention and recognised the role of broader social determinants like housing and justice systems, and is prompting new thinking on funding and institutional reform.
But there are concerns, in particular from key consumer groups and individuals who believe their voices have not been fully heard, and disappointment from the Australian Council of Social Service (ACOSS) that it did not recommend an immediate increase to Newstart and investment in new social housing units.
There are also early signs of professional concerns, including from the Australian Medical Association, which has said it will be “seeking assurances” on the future of current private sector models, especially specialist psychiatric care, and to be sure that appropriate non-GP specialist referrals are “not a casualty of reform.
Below are some of the key responses to the draft report, and links to more detailed statements. More responses and analysis can be found in Associate Professor Lesley Russell’s latest Health Wrap.
CHF applauds agenda for change
Leanne Wells, CEO of the Consumers Health Forum of Australia said the Productivity Commission’s wide-sweeping report is detailed and thoughtful, with recommendations that compel urgent government action in the near and longer-term and require significant “time, resources and effort to achieve cultural shifts for health service funders, providers and the general community”.
In a statement, Wells said the call for more responsive, person-centred and better coordinated systems of care for people with mental ill-health is resounding and long over-due and that reform cannot be just for the mental health system, but also in aged care and primary health care.
CHF welcomed the report’s focus on social determinants such as housing, justice and employment, and its thinking on funding and institutional reform, particularly for the role of Primary Health Networks or some other regional commissioning authority.
It welcomed the report’s emphasis on consumer and carer experience and co-design, its spotlight on prevention, early detection and intervention and strong focus on young people.
National Consumer Peak Alliance concerned
The recently formed National Consumer Peak Alliance said it welcomed the recommendations of the draft report and agreed an urgent generational shift is required but its members were concerned there is “no single statement to say that Consumers will be an integral part of future directions”.
“The Alliance believe that it is critically important to ensure the inclusion of consumers in decision making processes that directly affect their lives. It said:
We know that the system is broken and we believe that it is not a matter of fixing the system so that it looks similar, we are talking about creating a system that meets consumers’ needs.
“We know this happens when consumers lead.”
The members of the Alliance include: Victorian Mental Illness Awareness Council (VMIAC), BEING (NSW), Consumer of Mental Health WA (CoMWA), ACT Mental Health Consumer Network, Lived Experience Leadership and Advocacy Network (SA), Flourish Tasmania.
See also this interview with VMIAC incoming chair Tricia Szirom (which also discusses the pending draft report from the Royal Commission into Victoria’s Mental Health System, due later this month).
Szirom welcomes the Productivity Commission’s recognition that consumers should be involved in the design and delivery of services but says there is “a significant difference between being central and (being) involved”.
Read also a detailed critique at the bottom of this post to Croakey from consumer peer worker Tim Heffernan, Deputy Commissioner at the Mental Health Commission NSW.
Mental Health Australia welcomes push for national agreement
Mental Health Australia said the draft report has the potential to be “a defining moment for systemic mental health and suicide prevention reform” and that it shows the Productivity Commission clearly understands the scale and breadth of the challenge.
Acting CEO Melanie Cantwell said at the core of the draft report is the push for a new national agreement for mental health, which has also been at the heart of Mental Health Australia’s Charter 2020: Time To Fix Mental Health, now co-signed by more than 110 mental health and suicide prevention groups.
RANZCP calls for immediate action
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has called on the Federal Government to act on key Productivity Commission recommendations “without delay”.
‘We acknowledge this report is part of a longer-term, once-in-a generation opportunity to undertake wide-ranging reform of the mental health sector, but we also know there are things we can do right now,’ said RANZCP President Associate Professor John Allan.
In its first statement, the RANZCP welcomed the inquiry’s focus on shortages of psychiatrists, particularly in regional, rural and remote Australia and in certain subspecialties, such as child and adolescent psychiatry.
It also highlighted the report’s recognition of the lack of access to services in acute and subacute settings, particularly lack of suitable housing options for people in their recovery from mental illness.
In a second statement, Allan highlighted the difficulties that people in rural, regional and remote communities experience in finding and accessing suitable mental health treatment and support, particularly a lack of addiction specialists to manage the underlying problems of ice addiction and its related harms.
AMA says report a “welcome catalyst” but assurances needed
AMA President Dr Tony Bartone said the report was “a welcome catalyst for much-needed political, sectoral, and community debate and discussion to urgently reshape our mental health system to better meet growing and more complex demand”.
“One of the key findings is the need for better coordination between psychosocial supports, housing services, the justice system, workplaces, and social security,” he said in a statement.
However the AMA said further detail was required to ensure any solutions are appropriately and clearly resourced and do not add to “burdensome bureaucratic processes”.
Bartone said it would also be “seeking assurances” there are no plans or recommendations to move away from current private sector models, especially specialist psychiatric care, and that appropriate non-GP specialist referrals are “not a casualty of any reform”.
ACOSS says report charts new way, but more needed on housing, income
ACOSS said the Commission had heeded the calls from community and mental health experts for a much greater focus on prevention and early intervention and on the role of affordable, secure, stable housing and of financial stressors in mental ill health.
“This is a clarion call to governments to do things very differently,” it said.
ACOSS welcomed recommendations to prevent discharges from hospital into homelessness and address persistent homelessness, as well as the recognition of the need to improve the employment services system, where it says engaging with Centrelink and JobActive is “toxic (and debilitating)”.
But it said efforts to address homelessness need to be coupled with significant investment in social and affordable housing (including a minimum 20,000 dwellings), and the inquiry also needs to address “one of the biggest contributors to poverty in Australia – the inadequacy of the Newstart and Youth Allowance payments”.
- strong recommendations for how mental health services are funded and commissioned, including longer funding cycles for community mental health services
- acknowledgment that consumers and carers should be included in all mental health program development and
- the proposal that Aboriginal and Torres Strait Islander community controlled organisations are given preference in funding decisions for Aboriginal and Torres Strait Islander peoples and communities.
Black Dog Institute says business as usual “not an option”
The Black Dog Institute statement said it joined the rest of the mental health community in hoping the report represents a key moment in the journey towards a world-leading mental health system.
“We know that addressing our country’s mental health concerns will come at great costs to government, the mental health sector, and those on the front line in our local communities,” said Black Dog Institute’s Director and Chief Scientist, Scientia Professor Helen Christensen.
“However, given the Productivity Commission’s finding that mental illness and suicide is now costing Australia $500 million a day, continuing to do the same things is no longer an option.
Christensen said the Black Dog Institute had been looking at innovative e-mental health apps and digital technologies to deliver evidence-based mental health resources and tools at scale, regardless of geographic boundaries, and via its Future Proofing trial, which aims to use smartphones to deliver prevention interventions at scale.
Tim Heffernan, Deputy Commissioner at the Mental Health Commission NSW
Consumer peer worker Tim Heffernan welcomed the draft report, including its focus on expanding the mental health peer workforce and the need for a national peer worker voice, although he was concerned the Commission “does not yet have a fully developed understanding of the mental health peer workforce”.
“This reflects the lack of a strong consumer voice in the document and this is the main issue I have with the report,” he told Croakey, saying he will be feeding this back in further consultations and public meetings in the lead-up to the development of the final report.
“I feel the Commission could learn from what is going on in New South Wales where there is a strong focus on putting people at the centre of care. Too often we focus on systems and services and forget the people and the voice of people living with mental health concerns is not heard.
“More broadly, I am concerned that the report is still very much based on ‘the illness model’ of mental health. The recommendations are framed in terms of the need to ‘fix’ people with mental health conditions and focus too much on what has to be ‘done’ to people, rather than how they can be supported to maximise their mental and physical well-being.”
Heffernan said it was significant that the report doesn’t make recommendations around numbers of required inpatient beds.
“From our point of view, people who are ‘not compliant’ with in-patient treatment often want to avoid hospitals because that type of care has negative consequences for them.
“What we should be doing is evaluating whether this type of care is working, rather than focussing on how to get more people into the hospital setting.
“The worst thing we can do is to try to push everyone into types of care that hinder rather than help.
Despite being very comprehensive, Heffernan said much of the content of the Report involves “summing up recommendations from previous reports in this area”.
“It’s not the visionary shift that we need to really make a difference,” he said.
“For example, in the section on the mental health of children and young people, the Report acknowledges the need to do more to support students’ mental health but the recommendations centre around more psychological intervention for students already struggling with mental health issues.
“I would like to see more recommendations focusing on how to make schools places where all students can thrive and learn and none miss out on the developmental milestones they need.
“The report seems to accept that the system is designed a certain way rather than suggesting how it could be changed to promote better mental health outcomes.
“This contrasts with work being done internationally on mental health, and the position of global leaders, such as UN Special Rapporteur on the Right to Health, Dainus Puras. He has spoken out on the problems with the dominance of the bio-medical model and the rights of people to adequate mental health care.”