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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