Budget Review 2020–21 Index
Elliott King
In October 2019, the Productivity Commission (PC) released
its draft
report into Mental Health, estimated the cost of mental ill-health and
suicide at $43 to $51 billion per year, plus an addition $130 billion cost
‘associated with diminished health and reduced life expectancy for those living
with mental ill-health’ (p. 2).
Around twelve months later and in the context of the
pandemic, the Minister
for Health highlighted the mental health impact of COVID-19, noting that
since 16 March, there has been a ‘15 per cent increase in the number of
Medicare-subsidised mental health services delivered’ nationally. In Victoria,
between September and October the number of these services accessed rose by 31
per cent, while support services such as Beyond Blue, Lifeline and Kids
Helpline have experienced substantial increases in the use of their services.
The Government has highlighted mental health and suicide
prevention as one of its ‘highest
priorities’
(p. 23), with Health portfolio mental health spending expected to reach $5.7
billion in 2020–21. The Treasurer flagged future announcements in the Budget
Speech (p. 13):
In coming weeks, we will release the Productivity
Commission’s Mental Health final report and the interim report into suicide
prevention commissioned by the Prime Minister.
These reports will guide our future actions, working
together with states and territories to save lives. [emphasis added]
The most significant budget initiatives in terms of funding
or policy change are briefly outlined below. These measures do not appear to
require legislation.
Better Access Initiative
The
Government has announced a doubling of the number of Medicare-funded
psychological services from 10 to 20 through the Better
Access to Psychiatrists, Psychologists and General Practitioners through the
Medicare Benefits Schedule (MBS) initiative (Better Access initiative). This
change to the Better Access initiative will allow patients with an assessed
mental disorder to access up to 20 psychological therapy services per calendar
year. Patients
referred by a GP under a mental health treatment plan, a psychiatrist
assessment and management plan, or a psychiatrist or paediatrician, can claim
Medicare rebates for these sessions.
This measure is the largest mental health expenditure item
announced in Budget
Measures: Budget Paper No. 2: 2020–21 (p. 96), estimated to cost $100.8
million over two years from 2020–21. The measure expands
an earlier initiative that increased the session cap for people in areas affected
by the second wave of COVID-19, by extending
the program to 2022 and removing the impacted area criteria (p.26).
This
measure is a response to the PC’s Mental
Health draft report recommendation 5.4, which recommends trials of up
to 20 sessions of therapy (group or individual) as part of an evaluation of the
effectiveness of MBS-rebated psychological therapy.
COVID-19 and extended measures
The COVID-19
Response Package—Additional Mental Health and Crisis Support for Victoria (p.
93) provides $47.3 million over two years for Victorians experiencing mental
illness and distress due to the pandemic. Over half of this is allocated to
establishing 15 enhanced mental health clinics within six Primary Health
Networks ($26.9 million). The enhanced
clinics will ‘support GPs by providing access to multidisciplinary teams of
mental health workers, including psychologists, mental health nurses, social
workers, and alcohol and drug workers’. The centres are intended to provide a
local referral point for mental health treatment. The remaining funds are split
over:
- digital and telephone support services for vulnerable groups
($5.0 million) and
- outreach and crisis support services for young people administered
by headspace ($5.0 million), Beyond Blue, Lifeline, and Kids Helpline ($7.0
million).
A further $3.4 million has been allocated for an evaluation
of these initiatives and to support the Victorian Mental Health Taskforce.
The Government has also announced its continued support of
the 2019–20 Prioritising
Mental Health measure (p. 139), allocating an
additional $62.1 million over four years from 2020–21 to mental health
services (p. 103). The bulk of this funding ($45.7 million) expands the Youth
Employment Strategy Individual
Placement and Support program by increasing the number of headspace sites that
can provide vocational assistance integrated with clinical mental health and
non-vocational support services. The package also includes support for:
- the Prevention Hub’s (Black Dog Institute and Everymind) research
targeting mental ill-health and suicide ($2.1 million)
- mental health and career information for students ($5.0 million)
- digital mental health services, including Head to Health ($6.9 million) and
- upgrades for the Mount Barker headspace centre in South Australia
($2.3 million).
Other mental health initiatives
Small business owners
The
Government has committed $7.0 million to support
small business owners (p. 17) who are under increased financial and
emotional pressure during the COVID-19 pandemic. The BusinessBalance
program is scheduled to run in 2020–21 and will expand Beyond Blue’s NewAccess
coaching program ($4.3 million) and a free mental health literacy program
operated through Deakin University ($2.2 million) (Budget
Paper No. 2, p. 114). Commencing in early 2021, the NewAccess
service will be accessible through the Australian Small Business and Family
Enterprise Ombudsman’s My Business Health
support portal and provide small business owners with six free telehealth
sessions with mental health coaches. This follows on from other
mental health support initiatives targeted at small business, such as Ahead for Business.
Veterans’ mental health
The Government has announced $101.7
million for veterans’ mental health support and services, the largest
component of which is a ‘one-off
increase to the fees paid’ to the Department of Veterans’ Affairs’ approved
mental health service providers ($94.3 million) (p. 168). This measure is
discussed in the separate Veterans’ Affairs article elsewhere in this Budget
Review.
Stakeholders
Stakeholder groups have expressed mixed responses to the
Budget. The Australian
Healthcare and Hospitals Association argued that the Budget was
‘disappointing’ as the Australian Government had not used the opportunity to
implement the regional community-based mental health services reforms recommended
in the PC’s draft report.
Mental
health consumer advocate, Being, welcomed the
extension of the Prioritising Mental Health and COVID-19 support measures and
the increase in Better Access services, but highlighted issues which may affect
program delivery. Others, such as the Australian
Association of Social Workers and the Victorian
Mental Illness Awareness Council (VMIAC), have welcomed the increase in
Better Access services, with VMIAC highlighting the imminent release of the
PC’s mental health report and the likelihood of further government action as
flagged by the Treasurer. The national Australian
Medical Association (AMA) president, Dr Omar Khorsid, included the Better
Access initiative measure in his praise of the Government’s health response.
Some
commentators have argued that services such as headspace and Beyond Blue are
not suited for those with complex needs. According
to Professor Ian Hickie of the University of Sydney, the doubling of
Medicare-subsidised psychological services through the Better Access initiative
‘does nothing for those who cannot afford the out-of-pocket expenses (often in
excess of $50 per session), or those who live in those outer urban, poorer or
rural and regional areas that are grossly underserviced’. More fundamentally,
Dr Sebastian Rosenberg of the Australian National University and University of
Sydney, argues
that while ‘many people may be helped by these new sessions’, the program
has ‘fundamental design problems’. He further suggests that ‘there is little if
any evidence it has fundamentally improved the mental health of Australians’. Similar
concerns were raised in the
PC’s draft report, with the PC finding that Better Access is ‘poorly
targeted’ and disproportionately used by people in large urban centres, and
that it suffers from an ‘absence of data’ which limits the ability of
government to robustly evaluate the initiative (pp. 20–21; p. 222).
All online articles accessed October 2020
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