This Blueprint is very timely. It aims to be transformative asking for real (though not enough) amounts of money for improving and enhancing Australia’s mental health services. The authors quite rightly state: “the Blueprint does not make specific recommendations regarding other key services which are currently within state/territory jurisdiction, such as community mental health services, judicial and police services etc” as these are do not come under the Commonwealth jurisdiction. HOWEVER this perpetuates the existing, major, ongoing problems for mental health services in this country. As John Mendoza has said, this is yet another band-aid solution to the problem of providing integrated, comprehensive, innovative and collaborative mental health services in Australia. We must have a national approach that doesn’t set up a parallel system as happened under the Howard government. States and Territories must work with the Commonwealth towards a national system which therefore will include community mental health services and inpatient services and all other state/territory funded mental health services.
The Blueprint is a very good stimulus to begin to transform Australia’s mental health services. The principles of the Blueprint to fund a “four-year $2.5 bn program of strategic investment” are worthwhile however this level of funding is inadequate. The authors’ approach to this Blueprint is quite understandable, BUT we are in need of collaboration and integration of mental health services, programs and projects at national and state/territory levels.
Australia needs a Mental Health Commission to promote resourcing and monitoring of implementation of the reform agenda. It would be at arm’s length from government, while constantly consulting with all stakeholder groups and reporting on all-of-government scorecard basis to the Prime Minister, Health Ministers and parliament.
-Into the future a whole range of new ways of providing services such as e-technologies is highlighted and acknowledged.
-The 8 identified areas and some of the example programs under each are well over due for expansion and enhanced funding.
–Mental Health NGOs (or Community Managed Organisations) deserve an increased share of funding.
–Clinical and functional services need to work closely together to ensure full citizenship of people with lived experience of mental illness, i.e. vocational, housing, and support
–It was good to meet the Minister for Mental Health on his 18 consultations around Australia and have him sit at the table and listen to consumer and carer stakeholders.
–Evidence-based “Best buys” in mental health – what a good idea! Best buys are based on widely agreed need, evidence, lived experience and history.
–A long overdue enhancement of collaborative medical and psychiatric services for the wellbeing of elderly people may be in the pipeline.
–Family services are to be expanded.
Given that the Blueprint is a very good start, what more could we want?
-Recommendations about key services: peer support and consumer-operated services; definite links with State/Territory provided services; rural and remote services; aboriginal; CALD; comorbidity. There needs to be “levers” that can be used between the Commonwealth and States to encourage the States to pick up and enhance the services that are their responsibility.
-For the most part evidence-based “best buys” for people in the middle years (25-65/70) are missing. We need to be careful that national mental health funding and services do not become divided by lifespan – ie younger and older peoples’ services mainly funded via the Commonwealth and services for the “middle years” funded mainly via the States/Territories
-Where are the funded integrative mechanisms and frameworks in the system to ensure that people don’t fall through gaps in services? In many States/Territories public mental health services are not funded adequately. How will these (state/territory) services be enhanced and linked with Commonwealth funded services and programs? Some of these services include: 7 day and night mobile crisis and continuity of care; assertive community treatment and rehabilitation; 24 hour respite households as an alternate to many hospital admissions.
-There is good emphasis on child and youth services but not enough emphasis on early childhood services
-The need for systematic delivery of evidence-based of family interventions has been omitted, e.g. McFarlane, Falloon, Fadden
-Whole population solutions need to be promoted, rather than selecting organisations and programs as examples for funding.
-The process of transformation of services needs to be a more consultative process.
-As well as NGOs, other public community services need urgent enhancement as there have not been real enhancements in funding and services for over 10 years in most states/territories.
-The Blueprint must be transformative and not just about adding more silos of services/programs without linking to the existing services. No more parallel systems between Commonwealth and States/Territories!
-The Blueprint is at last asking for real amounts money. BUT even so, when shared out between states and territories, programs and deserving interests, it will not translate to enough money on the ground. Realistically what is needed is $6.5bil minimum over the next 5 years.
-Certainly there needs to be a large boost in everyday living services such as vocational, housing and support, but the people who provide these programs and services must be well trained not minimally trained as with the current packages for older people.
-A major problem with the workforce development section is that the emphasis is on medical, psychological and nursing workforces. Why are just two groups “most suited to rapid development and support” – nurses and peer-support workers? While these are essential people to have in the mental health workforce, there are a number of professions that are not mentioned, including Occupational Therapy and Social Work. There certainly have been major demarcation disputes but all groups need to be included in negotiations and opportunities. If we are serious about developing the workforce for older people then there are other professional groups who must be included: physiotherapists, music therapists, art therapists, aroma therapists, to name a few. These are not “fringe” groups, they are essential components of services for the wellbeing of older people.
-Clinical training fellowships are needed for the workforce. “Currently, mental health has very few options for recruiting young and gifted clinicians compared with other high-profile health disciplines”. This is the last line of the whole Blueprint but if we are to develop our workforce, we must find better ways of attracting younger people into the mental health workforce. This needs a lot more attention than it has had previously.
Please view the following documents
31Mar 10 FutureCHS AH09741-4 published (Future of Community Health)