Mental health

Budget Review 2017–18 Index

Anna Dunkley

The Australian Government has been making changes to implement a ‘regional approach to [health] service planning and integration, and better matching of services to individual needs’, and the ‘Prioritising Mental Health’ measures in the 2017–18 Budget are intended to contribute to this process.[1] The proposed changes have been welcomed by stakeholders, though some have also argued ‘mental health remains chronically underfunded’.[2]

It is unlikely the measures will require separate legislation, though the telehealth measure will require a disallowable legislative instrument to change the Medicare Benefits Schedule. (See the Budget Review article ‘Indigenous Affairs: Health and Wellbeing’ for more information on the ‘Prioritising Mental Health’ measures, and the article ‘Veterans’ Affairs’ for details of veterans’ mental health measures.)[3]

Psychosocial Support Services—funding

‘Psychosocial disability’ describes the ‘disability experience of people with impairments and participation restrictions related to mental health conditions’.[4] State and territory governments have primary responsibility for funding psychosocial support services (community mental health services), but the Australian Government also provides funding.[5] Some government funding is transferring to the National Disability Insurance Scheme (NDIS) as it is gradually implemented across Australia.[6] However, not all people with psychosocial disabilities have conditions that fulfil the severity and permanency criteria for accessing NDIS Individually Funded Packages (an impairment condition may be considered permanent even if it varies in intensity or is episodic).[7] In 2019–20 approximately 64,000 NDIS participants are expected to have a significant and enduring primary psychosocial disability, fewer than the estimated ‘230,000 Australians with severe mental illness [who] have a need for some form of social support’.[8] Australian governments have committed to providing continuity of support for people who currently receive services and who will be ineligible for the NDIS.[9] Nevertheless, stakeholders expressed concern at a lack of clarity about these arrangements.[10]

To address these concerns, the 2017–18 Budget allocates $80.0 million over four years from 2017–18 to fund psychosocial support services for people ‘with severe mental illness resulting in psychosocial disability’ who are not eligible for the NDIS but are ‘existing clients of Commonwealth-funded psychosocial services’, such as the Partners in Recovery, Day to Day Living Program and Personal Helpers and Mentors programs.[11] The funding is to be delivered through regional Primary Health Networks (PHNs), which have previously been barred from commissioning psychosocial support services.[12] Services are to be provided using a ‘stepped-care approach’, through which ‘Australians receive varying levels of primary care treatment and support depending on their level of need as determined by a health professional’.[13] The Department of Health states that ‘Commonwealth investment will be delivered once an agreement has been reached’ with state and territory governments confirming their ‘appropriate’ contributions.[14] Arrangements for the transition period are unclear, as is what will happen if state and territory governments do not agree to provide this funding.

This measure has been positively received, and Mental Health Australia described it as starting ‘to address one of mental health’s most critical issues’.[15]

Improving telehealth for psychological services in regional, rural and remote Australia

Medicare rebates are currently available for mental-health related consultations through the ‘Better Access’ initiative.[16] Evaluations of this initiative have found that it has lower rates of uptake in rural and remote regions, and the Consumers Health Forum of Australia has highlighted that in rural areas ‘rates of untreated illness are significantly above those in urban areas’. [17]

The telehealth measure allocates $9.1 million over four years from 2017–18 to extend the Better Access rebate to videoconferencing consultations provided by psychologists.[18] From November 2017, people living in rural towns and remote locations (Modified Monash Model regions four to seven) will be able to access up to seven of the ten sessions available to them under the rebate via videoconferencing.[19]

Stakeholders, including the National Farmers’ Federation and the National Rural Health Alliance, support this measure.[20]

Suicide prevention support programs

This measure allocates $2.1 million funding over three years from 2017–18 to improve the ‘capacity and reach’ of Lifeline’s crisis line service, and to ‘promote help-seeking messages at [suicide] hotspot locations’.[21] It also contributes $9.0 million to the National Partnership Agreement on suicide prevention to install barriers, lighting or surveillance in these locations.[22]

The measure follows the recent announcement of an expansion to the Suicide Prevention Trial, and has been positively received.[23] 

Research

Many in the mental health sector expressed concerns regarding the 2016 draft of the Fifth National Mental Health Plan, and suggested (among other things) that Government ‘Reorient investment towards early intervention and prevention’.[24] Perhaps in response to such concerns, a research budget measure allocates $10.0 million ‘for further work on prevention and early intervention’ ($5.0 million each to the Thompson Institute and the Black Dog Institute) and $5.0 million to a youth-focused Orygen facility.[25]

The funding has been welcomed, and CEO of the National Mental Health Commission, Peggy Brown, hopes it ‘is a positive sign for the future’.[26]



[1].          B Joyce (Deputy Prime Minister) and F Nash (Minister for Regional Development), Budget 2017-18: Regional Australia—Driving Our Economy, ministerial budget statement, 2017, p. 100.

[2].          R McFadden, ‘Budget is a big win for mental health’, Pro Bono Australia, 10 May 2017; NMHC, 2017-18 Federal Budget: Mental health proves to be a priority, media release, 10 May 2017; S Rosenberg, ‘Mental health funding in the 2017 budget is too little, unfair and lacks a coherent strategy’, The Conversation, 11 May 2017.

[3].          Australian Government, Budget measures: budget paper no. 2: 2017-18, pp. 176-179.

[4].          National Mental Health Consumer and Carer Forum (NMHCCF), Unravelling Psychosocial Disability, A Position Statement by the National Mental Health Consumer & Carer Forum on Psychosocial Disability Associated with Mental Health Conditions, NMHCCF, Canberra, 2011, p. 16.

[5].          Steering Committee for the Review of Government Service Provision, Report on Government Services 2017, ‘Mental health management’, Productivity Commission, Canberra, 2017.

[6].          Senate Community Affairs Committee, Answers to Questions on Notice, Social Services Portfolio, Supplementary Estimates Hearings 2016-17, Question No: SQ16-000402.

[7].          NDIS (Becoming a Participant) Rules 2016 and National Disability Insurance Agency (NDIA), Submission to the Joint Standing Committee on the NDIS, Inquiry into the provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition (Inquiry), 5 August 2016, p. 4.

[8].          NDIA, National Mental Health Sector Reference Group Sector Communiqué – October 2016, ‘Attachment A—Key Data on Psychosocial Disability and the NDIS—at 30th June 2016’, p. 1; Department of Health (DoH) estimate cited in Mental Health Australia, Submission to the Joint Standing Committee on the NDIS, Inquiry, 2017, p. 6.

[9].          NDIA, Submission to the Joint Standing Committee on the NDIS, Inquiry, op. cit., 2017, p. 5.

[10].       This was raised in many submissions to the Joint Standing Committee on the NDIS, and in the media, for example: R Morton, ‘100,000 mentally ill lose NDIS cover’, The Australian, 19 December 2016; N Hermant, ‘Fears life-saving mental health support at risk for thousands of Australians’, ABC news, 23 March 2017.

[11].       DoH, Prioritising Mental Health—Psychosocial Support Services—funding, fact sheet, 2017.

[12].       Australian Government, Portfolio budget statements 2017-18: budget related paper no. 1.10: Health Portfolio, p. 63; DoH, PHN Primary Mental Health Care Flexible Funding Pool Implementation Guidance: Stepped Care, p. 6.

[13].       Portfolio budget statements 2017-18,Health Portfolio, op. cit., p. 63; M Turnbull (Prime Minister) and S Ley (Minister for Health), A new blueprint for mental health services, joint media release, 26 November 2015.

[14].       Portfolio budget statements 2017-18, Health Portfolio, op. cit., p. 63.  

[15].       Mental Health Australia (MHA), Federal Budget invites states to close critical gaps in mental health, media release, 9 May 2017.

[16].       DoH, ‘Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS (Better Access) initiative’, DoH website, December 2015.

[17].       J Pirkis, M Harris, W Hall and M Ftanou, Evaluation of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule Initiative: Summative Evaluation, Centre for Health Policy, Programs and Economics, 2011, pp. 28-9; G Meadows, J Enticott, B Inder, G Russell and R Gurr, ‘Better access to mental health care and the failure of the Medicare principle of universality’, Medical Journal of Australia, 202(4), pp. 190-4; Consumers Health Forum of Australia, Online psychology for bush a much-needed advance, media release, 20 April 2017.

[18].       Budget measures: budget paper no. 2: 2017-18, op. cit., p. 120.

[19].       G Hunt (Minister for Health) and F Nash (Minister for Regional Development), Budget to deliver telehealth boost for rural psychological services, joint media release, 19 April 2017. The DoctorConnect website illustrates the Modified Monash Model.

[20].       National Farmers’ Federation, Medicare rebate for ‘online’ psychological services for regional, rural and remote Australians welcomed, media release, 19 April 2017.

[21].        Budget measures: budget paper no. 2: 2017-18, op. cit., p. 121; DoH, Prioritising Mental Health—suicide prevention support programs, fact sheet, May 2017.

[22].       Suicide prevention support programs, op. cit.; Portfolio budget statements 2017-18,Health Portfolio, op. cit., p. 63; Australian Government, Federal Financial Relations: Budget Paper No. 3: 2017–18, p. 27.

[23].       G Hunt (Minister for Health), Major suicide prevention trial extended to four more regions, media release, 6 February 2017; Suicide Prevention Australia, Encouraging commitment to addressing a complex social public health problem: Suicide Prevention Australia on 2017/18 Budget, media release, 10 May 2017; Lifeline, Federal Government commits $11m to stop suicides at hotspots, media release, 9 May 2017.

[24].       MHA, Mental health sector unites to highlight shortcomings in Fifth National Mental Health Plan, media release, 20 December 2016; DoH, ‘Fifth National Mental Health Plan’, December 2016.

[25].       DoH, Prioritising Mental Health—research, fact sheet, May 2017;  Budget measures: budget paper no. 2: 2017-18, op. cit., p. 121.

[26].       NMHC, 2017-18 Federal Budget: Mental health proves to be a priority, op. cit.

 

All online articles accessed May 2017. 

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