Prevention is better than cure: AHHA Chief Executive Alison Verhoeven sits down with Mental Health Australia CEO Frank Quinlan to discuss what needs to be done in mental health

Tuesday, October 4, 2016

F or this special partnership edition of The Health Advocate, AHHA Chief Executive Alison Verhoeven and Mental Health Australia CEO Frank Quinlan sat down together to discuss mental health in Australia and what needs to be done to improve it.

Frank Quinlan: Mental health providers have for decades recognised the need for significant reform across the sector. The services provided to consumers are not as responsive as they should be. The good news is that now, governments have come to a position of similar recognition, and are pursuing that reform. Part of that process is driven by the National Disability Insurance Scheme (NDIS), and also by the Commonwealth response to the National Review of Mental Health Programmes and Services (conducted by the National Mental Health Commission (NMHC)). This is an era of unprecedented reform, which is a reason for caution. We don’t want to resist the reform processes, but we must ensure reform is orderly and sustainable, and we don’t have people falling through the cracks of a redesigned mental health system. For example, we can’t have services discontinued without replacement services in place. This is one of the major issues — there is no centralised responsibility for the overarching picture of mental health and mental health reform.

Alison Verhoeven: Ongoing reforms across the sector, such as the processes underway in aged care, chronic disease and in primary care with the trial of Health Care Homes, will impact on mental health as well. And the tight funding situation for public hospitals impacts their ability to allocate resources to acute mental health services. Better integration across all sectors is needed, including better resource allocation and sharing of patient records. Each reform process on its own is quite commendable, but will be affected by disparate governance and funding.

FQ: The NMHC found a disproportionately high amount of funding had gone towards acute care in mental health, compared to a disproportionately low amount in community care. We have to re-orient this so the ratio is inverted. We saw in this Budget that less per capita is being spent in community care programs, despite reforms. According to Department of Health data, 680,000 Australians are diagnosed with severe mental illness each year. Of these, 250,000 to 300,000 people require individual support. There are 58,000 places available in the NDIS, so we can only offer places to one-twelfth of the people who experience mental illness each year. The responsibility for the care of the majority of people falls outside the NDIS, in community care.

AV: This is made more complex by the inherently different funding mechanisms, with individuals as fund holders in the NDIS and aged care, and providers as fund holders in the health sector. People suffering mental illness can be among the most disempowered in society, and are more likely to be on lower incomes. With less access to resources and sometimes lower health literacy, it can be difficult for them to navigate the funding structures. Government support is vital in ensuring they can access the right services.

FQ: We would welcome any shift towards greater individual control of healthcare, but we must also recognise there needs to be a sustainable framework for service providers to offer services, otherwise it’s a false freedom. We must set up funding that offers individual choice and control for people, while protecting service providers.

AV: Governments do face a challenge regarding how much funding they can allocate to the health sector. More sophisticated budgetary thinking is needed on supply, demand and need. We now have a situation where spending in one area of health is paid for by cuts in another area of health, and it has to be re-thought.

FQ: Mental health spending provides the clearest possible example of the “invest to save” model. In the medium term, it makes sense to invest more, as the costs of mental illness to the community are huge. Investments in mental health could kick big goals in GPD and macroeconomic reform — more so by far than other tax reforms. The Australian economist and Chair of the NMHC Professor Allan Fels AO has said that if the mental health sector was 10% more effective, it would lead to a 1% bump in the GDP. 

AV: Politically, health spending is always looked at as nothing more than a cost to the taxpayer, but health is also one of the fastest growing sections of our economy.

FQ: Additionally, the approach now seems to be that maintaining the status quo has no cost, when it absolutely does. We have to change that view.

AV: If you had a magic wand, what would you change about the mental health sector?

FQ: I think the sector is very coherent as it is. It’s been absolutely clear regarding its overall direction, and consistent in pushing for greater investment in community services and programs. The question is making sure we have the will to achieve those goals. We need to ensure there is a clear and visible overarching responsibility – nowhere in Australia, at the moment, is mental health considered in a unified way. We have a mix of forums between states and territories, the Commonwealth Government and separate Departments. The forthcoming Fifth National Mental Health Plan is an opportunity to establish that responsibility. The other issue is about political will. The Prime Minister and the Opposition Leader both made strong statements about mental health during the election. If we had political leaders willing to take the issue on and drive that widereaching reform, we could make progress. Otherwise, we are just tinkering around the edges.

AV: I would say on a practical level, the Plan can provide the architecture of what must be done, but nationally resources must be commensurate to the needs of Australians — we must move past the notion of health as a burden on the taxpayer.

FQ: Mental health causes 14-15% of morbidity costs, and takes up 7-8% of the health budget. Essentially we’re investing half of what we should be. And many things we would seek to address at an early intervention level — relating to diet, sleep, social inclusion, community resilience — will also bring improved health benefits across the board.

AV: It’s a very strong message that health leaders perennially communicate, the need for governments to invest in prevention and to see it as an investment in society. It’s a real area for them to demonstrate bipartisanship.

This article appeared in the October 2016 edition of The Health Advocate. To access current and previous editions, click here.