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Mental health funding ‘locked down in dysfunctional hospital system’ – Ian Hickie

Australia’s national mental health commissioner says money is needed most in community services

Government funding for mental health is “locked down in the dysfunctional hospital system” rather than being invested in community mental health services where it is most needed, the national mental health commissioner, Ian Hickie, says.

Hickie made the comments in response to new data from the Australian Institute for Health and Welfare released on Thursday, which found spending on mental health-related services increased to $8.5bn in 2014–15, a $911m increase compared with 2010–11.

“Spending increased in real terms from $343 per person in 2010–11 to $361 per person in 2014–15,” said a spokesman for the institute, Matthew James. State and territory governments funded 59% of the total spend, compared with 36% by the federal government and 5% by private health insurance funds.

But Hickie said it was not how much was being invested that mattered but where the money was being directed. He said he was yet to see preferential funding given to mental health services compared with investment in other sectors, such as cancer care.

“The trouble is so much of the money is locked down in our dysfunctional hospital system when the challenges for mental health in the 21st century are out in the community,” Hickie said. “What we need is a health minister for the 21st century that will progress the mental health system out of the 20th century.”

The new health minister, Greg Hunt, who replaced Sussan Ley after her resignation last month, marked his appointment by declaring mental health to be a key area he wanted to focus on.

Hickie said he had spoken with Hunt in recent days and believed the minister understood the need to invest in mental health services in the community, such as outreach teams and social services, to prevent those with mental health problems from reaching an acute stage and entering hospital wards.

“It’s rare to have both the health minister and the prime minister both seriously committed to mental health,” Hickie said.

“We need to stop purely investing in late intervention and ongoing chronic care and instead we must invest to address the problems of poorly coordinated care, and the new minister seems absolutely aware of that.”

The director of the Orygen youth mental health research organisation, Prof Patrick McGorry, met with Hunt on Wednesday morning. The fact that Hunt had met with mental health leaders in his first weeks in the job showed he was committed to better investing in mental health, McGorry said.

He agreed with Hickie that state and territory governments had placed too much of mental health spending into hospitals and acute care. His service was struggling to provide community care for patients in Melbourne, he added.

“Our organisation looks after teens and young adults and suicide, violence and aggression are the big issues for those with mental health issues in that group, yet we have a lack of ability to meet demand to help them,” McGorry said.

“Young patients are becoming so unwell they’re posing a risk to society. In the past seven years we’ve seen six homicides at the hands of these patients who are our clients, who are not dangerous if they’re treated in a timely way.

“When a family is concerned about someone not being well, you need to have outreach teams trained to go to them and help them. But we just don’t have the funding to do that kind of work any more.”

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Peter King
Peter is the CEO of the Centre for Mental Health Education specialising in educating mental health professionals in effective approaches when managing extreme emotion dysregulation, borderline personality disorder and PTSD using approaches such as Dialectical Behaviour Therapy and Somatic Trauma Therapy.