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Chapter 17 - Recommendations
17.1
This report has demonstrated that there is much work to
do in the area of mental health. There needs to be more money, more effort and
more care given to this neglected part of our health care system. There is not
enough emphasis on prevention and early intervention. There are too many people
ending up in acute care, and not enough is being done to manage their illness
in the community. There are particular groups, and people with particular
illnesses, who are receiving inadequate care. Many of these findings have been
confirmed by other organisations and reports in recent years.
17.2
The tremendous interest in this inquiry indicates that
there may now be a preparedness to fix the problems identified and that this
inquiry is timely. The committee was inundated with submissions not only
drawing attention to the system's failings, but offering constructive
suggestions on how to fix them. As the inquiry was being conducted, widespread
media attention to the issue was matched by regular policy announcements by
governments.
17.3
Most recently
this groundswell of interest has resulted in a commitment by the Council of
Australian Governments (CoAG) to look at mental health reform. Translating
community concern and the opportunity presented by this committee's extensive
inquiry into policy action, CoAG is looking to negotiate the delivery of new
and better services for people with mental illness.
17.4
The committee wholeheartedly endorses steps being taken
by governments in this direction. Much of what the committee has investigated
is relevant to CoAG's deliberations. The committee wanted to ensure that its
findings could help shape proposals that CoAG would consider. As the Chair has
outlined in the Foreword to this report, it decided to do this by delivering this
first report in time for governments to effectively take account of its
recommendations as they worked toward agreement on reform. This concluding
chapter draws together a number of key recommendations, largely focussed on
those things the committee believes should be drawn to CoAG's attention, and
which could be relevant to its deliberations.
17.5
As the Foreword explains, further detailed
recommendations will be included in the committee's second report to be
released in coming weeks.
Seeking CoAG agreement on more community care
Recommendation 1
17.6
The committee recommends that COAG initiates:
-
A substantial overall increase in funding for
mental health services over time, to more closely reflect the disease burden
and to satisfy the very significant unmet need.
Note: evidence
suggests that the mental health budget should, by 2012, reach between 9 and 12
percent of the total health budget and whilst significant investment is
required in mental health in the short to medium term, it is anticipated that early
intervention and community-based care would deliver savings in the long term.
-
From this additional funding, the establishment
of a Better Mental Health in the Community initiative, comprising
a large number of community-based mental health centres, the distribution
primarily determined on the basis of populations and their needs. (Assuming
populations of around 60 000, this would represent 300 to 400 community
based mental health centres nationwide.) The Better Mental
Health in the
Community program should be rolled out over 4-5 years with governments
contributing as follows:
-
States and territories to provide infrastructure
for and ongoing management of mental health centres
-
Commonwealth to establish new direct Medicare
recurrent funded arrangements for employed or contracted mental health staff in
these centres – psychiatrists, psychologists, general practitioners (GPs),
psychiatric nurses and social workers – with the expectation that services
would be provided at times of greatest demand, including after hours and on weekends.
-
The linking of resourcing for mental health to
the two principles of rights to services, and responsiveness to needs of
populations, including:
-
Establishment of defined mental health regions
nationwide and commit to equitable mental health funding to each, basing this
on Health Needs Index weightings.
-
Development of population-specific budgets,
mental health plans and evidence based protocols for children, youth, aged, culturally
and linguistically diverse (CALD) communities and Indigenous people.
-
Definition of benchmark ratios of mental health
professionals to populations, based on analysing numbers needed to meet the
population’s mental health care needs now and in the medium and long term,
recognising the range of health professions relevant to the sector.
-
Designation of an agreed number and distribution
of community based mental health centres for youth 12 to 25 years of age, those
with dual diagnoses and for specialist geriatric and Indigenous mental health,
where appropriate.
-
The Australian Government reform the Better
Outcomes initiative to include a new set of Medicare mental health schedule
fees and rebates for combinations of private consulting psychiatrists, GPs and
psychologists who agree to work together or in conjunction with mental health
centres under integrated, collaborative arrangements in the management of primary
mental health services. Consideration should
be given to the Divisions of General Practice managing the reformed Better
Outcomes, perhaps restructured as Divisions of Primary Health.
Developing mental health strategies
17.7
The above recommendation lies at the heart of the
committee's vision of a mental health care system that is more accessible, more
community centred and better resourced. However, more coordinated and effective
planning should also pay big dividends for mental health, including reforms to
the National Mental Health Strategy, as well
as developing concrete plans in some specific areas of mental health.
Recommendation 2
17.8
The committee recommends that the Australian Health
Ministers agree to:
-
Reform the National Mental
Health Strategy (NMHS) to guarantee the right of people with
mental illness to access services in the least restrictive environment, to be
actively engaged in determining their treatment and to be assisted in social
reintegration and underpin those rights with legislation.
-
Include in the next NMHS Plan specific,
measurable targets and consumer and/or health outcomes that are monitored and
reported on annually.
-
Agree to develop specific national mental health
action plans for addressing child and adolescent, youth, aged, CALD communities
and Indigenous Australians.
-
Ensure that the objectives in the next NMHS Plan
increase emphasis on delivery of community care, prevention and early
intervention, providing a more appropriate balance between these services and
acute and emergency care.
-
Integrate the NMHS, National Drug Strategy,
National Suicide Prevention Strategy and the National Alcohol Strategy and the
delivery of services under these strategies.
-
Agree that building public mental health
services of high quality and high regard is a key to addressing mental health
workforce issues.
Recommendation 3
17.9
The committee recommends that the Australian Health
Ministers agree to establish a timeline and implementation plan for the
National Statement of Principles for Forensic Mental Health
Advocacy, monitoring and research
17.10
The committee heard extensive evidence of the need to
strengthen consumer advocacy, improve mental health research, and create more
rigorous monitoring of the implementation of mental health policy objectives.
It is of the view that a range of organisations can contribute to achieving
these goals. The following recommendation aims to spread a range of tasks
across some existing, and some new, organisations that work on mental health
and human rights.
Recommendation 4
17.11
The committee recommends that Australian Health
Ministers agree to
-
Fund and empower the Mental Health Council of Australia to:
-
report annually on progress under the NMHS
-
conduct annual independent investigation,
monitoring and reporting of services and Commonwealth/state expenditure
-
identify gaps in service provision, training and
performance of the workforce, and
-
report on measurable targets such as suicide
rates, homelessness, use of involuntary treatment orders, medication rates for
high prevalence disorders, incarceration rates, and rates of engagement in
education and the workforce.
-
Establish and fund a National Mental
Health Advisory
Committee made up of consumers, carers and service providers to:
-
advise CoAG on consumer and carer issues
-
be an advocate for mental wellbeing, resilience
and illness prevention
-
promote consumer involvement in service
provision
-
promote the recovery model in mental health
-
promote community and school-based education and
stigma reduction, and
-
promote and manage mental health first aid
programs aiming for 6% of the population to be trained and accredited,
targeting those with the greatest probability of coming in contact with mental
health issues – teachers, police, welfare workers, and family carers.
-
Establish and fund a joint Commonwealth-State Mental Health
Institute to
-
develop a prioritised national framework for
research and pilot programs
-
review evidence-based research on health needs
and cost effectiveness of treatments
-
disseminate best practice service standards, and
-
assist with establishing service targets and
integration of services.
-
Provide recurrent funding to the Human Rights & Equal Opportunity
Commission (HREOC) to:
-
monitor human rights abuses and discrimination
in employment, education and service provision of those with mental disability
-
liaise with state and federal ombudsmen to identify
trends and systemic failures that give rise to complaints, and
-
investigate discrimination against people with
mental illness in Supported Accommodation Assistance Program (SAAP), respite
and private and public rental housing,
17.12
The committee believes other measures should also be
introduced that would strengthen leadership and consumer advocacy in mental
health. Some of these will be outlined in the committee's second report, but
others the committee believes should be considered immediately by governments
Recommendation 5
17.13
The committee recommends that Australian Health
Ministers agree to recognise mental health as a designated ministerial
responsibility in federal, state and territory departments of health
Recommendation 6
17.14
The committee recommends that state and territory
governments agree to harmonise Mental Health
Acts relating to involuntary treatment and admission 'sectioning', and
establish inter-state arrangements for treatment where the strict application of
state and territory responsibility can mean far longer distances must be
travelled to access services than could be the case.
Recommendation 7
17.15
The committee recommends that all governments
establish benchmarks for the employment of consumer and carer consultants in
mental health services, including forensic mental health services, and that all
service providers have formal mechanisms for consumer and carer participation.
17.16
Progress in mental health reform will rely on being
able to assess the changing nature of mental health service provision, and on
boosting the mental health research effort significantly. The committee
believes that better information and research about mental health is something
that could be a useful part of a CoAG package of reforms.
Recommendation 8
17.17
The committee recommends that the Australian
Institute of Health and Welfare should collect comprehensive data on mental
health service provision such as the number of people receiving treatment and
the nature of that treatment, public and private, and on population wide
indicators of mental health and wellbeing.
Recommendation 9
17.18
The committee recommends that the Australian Government
increase funding to the National Health and Medical Research Council (NHMRC),
to enable an increase in research funding on mental health from $15 million,[2007] at least doubling it to $30
million per year.
Other joint government initiatives
17.19
The committee heard about a host of other reforms and
service delivery proposals that could deliver better mental health services.
They have been discussed throughout the chapters of this report and some will
also be addressed in the committee's second report. However the committee
wanted to mention two that it believed would require cooperative action by
governments and could be considered as part of the current CoAG process.
Recommendation 10
17.20
The committee recommends that Australian Health
Ministers consider the creation of a national emergency 1800 telephone
helpline, resourced to provide mental health crisis responses 24 hours a day, 7
days a week and staffed by personnel with expertise in mental health.
Recommendation 11
17.21
The committee recommends that Australian Health Ministers
agree that funding for SAAP be increased overall, and that there be dedicated
resources within that funding for clients with complex needs including dual
diagnosis.
Recommendations for specific governments
In its second report, the committee will make a range of
recommendations about specific issues and programs. Some of these will involve
particular initiatives that look promising and warrant being expanded; others
will involve practices and areas of neglect that need to be remedied. Given the
current discussions going on in CoAG, however, the committee wanted to put some
further recommendations forward that could be considered as all governments
negotiate what the committee hopes will be a new deal for mental health.
Further recommendations for specific
Australian Government action
Recommendation 12
17.22
The committee recommends that the Australian
Government
-
Increase the number of funded places and
financial incentives in accredited medical and allied health training courses
to meet future mental health workforce demands.
-
Substantially increase job support for people
with mental illness, recognising its therapeutic value and provide tax
incentives for businesses employing people with mental illness.
-
Fund public education campaigns and programs for
prevention and reduction in substance abuse.
-
Consider tax incentives, wage replacement
schemes and other financial support for employers to provide more flexible
transitions into work, in hours worked, timing of work and workload and the
provision of mental health services for those employees needing assistance in
the workplace.
Further recommendations for state
and territory government action
Recommendation 13
17.23
The committee recommends that state and territory
governments
-
Establish more respite and step up/step down
accommodation options in conjunction with the federal government Better Mental Health in the Community program.
-
Provide long-stay in-patient facilities with a
focus on rehabilitation for patients with severe and chronic mental disability,
co-located with general hospitals but set in spacious, home-like environments.
-
Ensure safe environments for consumers in acute,
long-stay and emergency settings, including gender and age group separation.
-
Provide specialised mental health and dual
diagnosis spaces or departments (as appropriate) within emergency departments
in general hospitals.
-
Establish more longer term supported, community-based
housing for people with mental illnesses with links to community mental health
centres for clinical support.
-
Increase funding to establish more detoxification
and rehabilitation services for people with drug and alcohol abuse disorders.
-
That there be specialized inpatient facilities
for people with dual diagnosis.
-
Establish specialised programs within designated
community mental health facilities to treat conditions such as eating disorders,
perinatal depression and personality disorders.
-
Transfer responsibility for mental health in
general prisons to the department within each state or territory with portfolio
responsibility for health.
-
Increase levels of consumer involvement in
mental health services, including consumer representation at all levels and
provision of funding to consumer-run mental health services.
17.24
The committee hopes this report will be a step forward
in the process of improving mental health services in Australia.
It looks forward to the adoption of the recommendations included here by CoAG
and by all Australian governments.
Senator Lyn Allison
Chair
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