There’s a better model of care for the ACT

This article was originally published in The Canberra Times on 27 October 2022.

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As Mental Health Month 2022 draws to a close, it is worth reflecting that this year marks 30 years since the First National Mental Health Plan in Australia. This plan set Australia on its course to shut the old psychiatric institutions and, at the time, was regarded as world-leading policy reform, partially because it put the person at the heart of the mental health solution.

The plan prioritised the need to ‘expand community-based mental health services’, with community-based prevention and intervention services to be integrated with local psychiatric in-patient units in hospitals. The intention was to reform the mental health sector so that consumers, carers, medical practitioners, non-government mental health organisations and other non-health services (such as housing, disability services, social security and employment) would work together to help people with mental ill health.

This significant development undoubtedly resulted in a radical shift to Australia’s mental health treatment landscape.

Yet three decades and four plans later, our current approach to mental health in Australia is failing to keep people well. The mental health of Australia’s population hasn’t noticeably improved over the past three decades—on many indicators, we seem to be going backwards. Our mental health system is underfunded, overstretched and crisis-driven; service access is inequitable; integration is lacking and holistic care hard to find; dignity is often disregarded; and families and carers miss out.

The personal pain and suffering caused by these failures is profound. The social and economic costs are equally immense.

Perhaps one of the most significant and urgent challenges is establishing a vibrant community-based mental health system. There continues to be a heavy reliance on a medical model and hospital-based crisis care. The community-managed mental health sector, which supports people with mental health conditions to live well in our community, is typically forgotten and ignored by governments at all levels when Budget time comes around.

This sector provides services and programs to help prevent people from spiralling into mental health crisis, and picks them up after they have been in acute situations to help them along their recovery journey.

Since that 1992 plan, the importance of our sector—and the need for greater investment—has been raised repeatedly in inquiries, royal commissions, and numerous studies and reports on improving mental health in Australia. According to one recent study, there have been no less than 55 high-profile public inquiries relevant to mental health over the last 30 years, involving more than 55,000 public submissions and 9,000 witnesses.

In 2020, the Federal Government’s own Productivity Commission Inquiry into Mental Health once more called for generational reform to create a person-centred mental health system.

In that report, the Productivity Commission called for the expansion of the community-managed mental health sector as a priority, as it is “a crucial linchpin in supporting the recovery of people with mental illness and their capacity to remain active, connected and contributing within their family and community.”

Yet governments still don’t seem to be listening.

Instead of funding the proven model of preventing mental health issues from escalating into crisis that the community-managed mental health sector provides, they pump money into the hospital sector that people need to be in crisis already to access. They ignore the demonstrated fact that keeping people with mental health challenges out of our over-stretched hospital system is clearly the most cost-effective and humane approach to treatment and care.

Where there is additional funding for community-managed services, it tends to be sporadic, piecemeal and time-limited, contributing to a community-based service system that is fragmented and chronically under-resourced.

More concrete proof that the First National Plan’s vision has failed is in data collection, or the lack thereof. The plan included a focus on increased data collection to understand mental health in Australia. Yet still, in 2022, there is no systemic data collection at either the Federal or ACT Government level of the community-managed sector. Psychologists and psychiatrists are counted, so why aren’t we?

Perhaps if they don’t count us, they don’t need to acknowledge the dire straits our sector is in.

Community-managed mental health services across Canberra—and Australia—are experiencing intense and unsustainable pressures from increasing demand, complexity in people’s mental health needs, and chronic under-resourcing and understaffing.

That means that too many Canberrans with mental health issues are missing out on the care and support they need to stay well in the community.

We want to see a mental health system where Canberrans can access support when and where they need it, without their mental health having to deteriorate to a crisis point before they get care. To achieve this, we need increased investment in the vital community programs provided by our sector.

But it can’t just stop there.

We also need to address the drivers of mental ill health, like housing insecurity and poverty, and consider what collective action we can take to address those issues.

Although some might describe mental health as a ‘wicked problem’, the solutions are well known. They’ve just been ignored for far too long.

It is time to re-assert the vision originally described in 1992: a shared goal to enable people with mental ill health to live with dignity in our communities, wherever possible.

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Media contact: Angel Hellyer, Communications and Events Manager, 0493 388 756 | communications@mhccact.org.au

MHCC ACT is the peak body for community-managed mental health services in the ACT. Find out more about MHCC ACT at www.mhccact.org.au.