A Swing … and a Miss
I’m disappointed. I’m not surprised, but I’m disappointed. I’m disappointed that in a “mental health package” of 2.2 billion over five years, there is almost nothing aimed at those most in need. In fact I’ll go further: there is absolutely nothing aimed at those most in need, and I’m more than disappointed; while I am remaining calm (because of the lack of surprise, primarily), my feelings about this are pretty much unprintable.
So I’d better stick with my thoughts.
The main thought is quite simple: this will not help. This will not help the most severely ill. This will not help those who do not fall within a particular age band. Thus will not help those who do not have a particular type of disorder.
The bulk of the money (at least of that going into actual clinical service) as I understand is earmarked for the creation of more Headspace, and Early Psychosis Prevention and Intervention Centres (EPPIC). As I have remarked on previously, these services serve only a narrow age band, and the majority of the psychiatrically ill thereby miss out on any increase in resources. Headspace is expressly not set up to treat serious psychiatric illness, so even young people will not be helped by that money if they have a serious illness. EPPIC are aimed, as the name suggests, at psychotic disorders. So young people with a serious but non-psychotic psychiatric illness will not be helped by this extra money.
An abiding characteristic of boutique services like Headspace, and (I admit this is an assumption) EPPIC, is that they are not geared up to treat really acute illness. If someone requires daily input, if they have strong thoughts of suicide or harm to themselves – or others – they will be referred to the acute service of the general mental health service.
People like me.
Working in teams that are chronically under-funded and under-resourced.
Teams that see people of any age, with any disorder, when they are most severely and acutely ill.
Teams that don’t have the luxury of saying no on the basis of age, lack of psychosis – or simply being too sick or too “risky”.
Teams that will see not a red cent from this budget.
Professor Alan Rosen from the Brain Mind Research Institute at Sydney University has written criticising the allocation of this extra funding. He has made similar points, but more gently, and without calling anyone an idiot. So I shall do that:
This. Is. Complete. Idiocy.
There was mention of not putting more money into old systems – that are not working. Fair enough on the face of it. However, allow me to illustrate some of what I face every day. I work in one of the largest and fastest-growing Local Government Areas in the country. It has large amounts of poverty, of alcohol and other drug abuse, and of disability – both medical and psychiatric. Our outpatient psychiatric services however, at half the national average, receive the lowest level of resources, in terms both of dollars and staffing, in the country. If you do that to a service, I can guarantee that no matter your model of service, it will not function well.
We are the ambulance at the bottom of the cliff. And indeed we are the ambulance, despite a huge throng of people milling around at the top and falling off. So unsurprisingly we don’t do as well as we need to. These services like Headspace and EPPIC will contend they are like a fence at the top of the cliff; build a proper fence and you won’t need more ambulances.
Admirable, but bollocks. Actually they just pick out a few of the people farthest away from the cliff and make them a really swish fence – but if they start to get too close to the cliff’s edge, will just tell them to be sure to look for the ambulance at the bottom.
Maybe they’ll call to give the ambulance a heads-up, but that’s about it.
Now I realize that people far more eminent than I (Professor Ian Hickie and Professor Patrick McGorry) have spoken lovingly about this budget and the wondrous things it will do for mental health care in this country. Well … they would, wouldn’t they? Headspace is Prof Hickie’s baby, and EPPIC Prof McGorry’s. Colour me cynical, but I don’t think that’s coincidental.
Severe and Debilitating
Ok, there’s something in the budget for those with severe and debilitating illness. Not acute care though. Look, I don’t take issue with enhancing the recovery care we provide. In fact that’s the whole damn point, but the first step in recovery for many is acute treatment of terrible illness. If you don’t do that right, the rest is most unlikely to succeed; at best it will provide less benefit than it could have.
The stuff about “increasing economic and social participation for people with mental illness” is the same: excellent and necessary, but needs to be able to build on the results of good acute care of serious psychiatric illness. That acute care is under-resources and poorly structured, and this budget will do nothing to change that.
I agree that simply pouring money in is unlikely to give great results. I also agree with Professor Rosen when he notes that:
“… provision of well tested 7 day and night mobile mental health teams, with adaptations for regional populations, has not yet been tried consistently and equitably across this country. One state, Victoria, is an exception, and even the resourcing there is now fraying.
These teams only don’t work where they have never been tried. Or when their resources are withdrawn due to managerial expediency or loss of a clinically informed culture. However, there is little encouragement for public mental health services in this budget, except a pious hope that at the next CoAG meeting, the Commonwealth will be able to convince the states to match this investment.”
The evidence is there, for Assertive Community Treatment teams, for acute care home-based treatment teams, for models of care that would make a very real difference to the lives of those with severe psychiatric illness. This budget commitment is idiotic and superficial, and will do damn-all for the people who really needed more.
Disappointed. Frustrated. Angry.
And really sad.