Mental health is one of the most important and most vexing areas of health policy and service development. The effects of mental ill-health can be profound and wide-reaching for individuals, families, communities and economy.
Right now, the mental health system is under scrutiny by the National Mental Health Commission. I understand the Commission has lodged its final report with the Federal Health Minister and that it may be published soon. Locally, here in the ACT, the Government is consulting on a whole-of-government Mental Health and Wellbeing Framework 2015-2025.
ACTML has made submissions to both these reviews. Our messages are clear. To the Commission we said that Australia must have strong, evidence-based mental health care services and programs delivered at the primary care level. The common and often most disabling conditions long-term such as depression and anxiety are best managed in a primary health care setting by general practice working in teams with specialist mental health services and supported by relevant community services to provide integrated, coordinated, ‘wrap-around’ care. This is the model of care we should invest in, not more beds.
We urged the Commission to promote the lead role that regionalised primary health care organisations (PHCOs) can play. Medicare Locals, and before them, the divisions of general practice established, coordinated and integrated new services such as the Access to Allied Psychological Services Program (ATAPS) and headspace with the rest of the system. Primary Health Networks (PHNs) will have the same, if not greater, promise. As regional commissioning organisations, they will have the capacity to make federalism work at least at the point where Commonwealth and State/Territory responsibility in primary health care intersects. Their promise in this space should be supported through pooling of funding and ‘alliance commissioning’ approaches especially if we want to see real flexibility, integration, responsiveness and innovation in primary health care. Primary Health Networks will replace Medicare Locals as Australia’s regional system of primary health care organisations from 1 July this year.
We suggested three practical steps for change:
- a joined-up approach between Local Hospital Networks and Medicare Locals/PHNs to whole-of-system planning, design and development of localised mental health services that span the full spectrum of care.
- aggregate and devolve all funding for primary mental health care programs in a single flexible mental health fund to commission services in the configurations and mix that best match local need. This will go a long way to fostering services that are focused on the whole person and to commissioning services with the whole system in mind.
- the development and implementation of a full suite of localised mental health pathways through co-design by appropriate primary care and specialist clinical leaders and embed them in HealthPathways where this initiative exists in local health systems.
Closer to the ground, to the ACT Government we said that ACTML strongly supports the development of whole-of-government Mental Health and Wellbeing Framework 2015-2025. However, we risk this Framework being a missed opportunity unless it takes a “different not more” approach. This should involve steps such as:
- a governance approach to the Framework’s development and implementation oversight that commits relevant ACT Government Directorates to action and mirrors that taken with the development of the ACT Human Services Blueprint. This process saw Directorates and community sector leaders coming together in a single taskforce to co-design the Blueprint. Consumer and carer involvement in co-creating the framework is a must
- a boost in strategies and shift in investment to expand early intervention and primary and community-based mental health care services
- building in and continuing to invest in promising, results-oriented early intervention models of care such as the beyondblue and ACTML supported NewAccess low-intensity psychological service and positive parenting programs, another area where the evidence is extremely strong
- the introduction of a shared care model to improve integration and transition between primary, secondary and tertiary services, improve consumer experience (particularly to better support the management of physical and mental health comorbidity) and reduce costs associated with re-referring and mistakes in system navigation.
Mental ill-health will continue as a major challenge for policy makers, clinicians, NGOs and communities. It is time for brave new policy at both Federal and State levels and one that recognises that investment in primary mental health care will be the lynchpin to a stronger and more responsive system of care overall.