House debates
Monday, 18 October 2010
Adjournment
Mental Health
9:24 pm
Joanna Gash (Gilmore, Liberal Party) Share this | Hansard source
On the weekend marking International Mental Health Day, 10 October, the Weekend Australian, in its Inquirer section, ran two interesting articles on mental health in Australia. Authors Patrick McGorry and John Mendoza know what they are talking about and when they say that more needs to be done then that is what has to be done.
Back in 2006 the coalition government saw the under-delivery of mental health services by state governments and injected a massive $1.9 billion in an attempt to bring things back on track. Four years later not much seems to have changed, hence the comments by professors McGorry and Mendoza. The problem is that the further you go away from cities, the scarcer the service availability and access, and not just in mental health. Everyone is fighting over the same small bucket of money and it certainly does not help to have an organisational system—if I can call it that—which encourages internal competition for scarce funds. The net effect is a dissipation of energy and a much reduced delivery of effective service.
The problem for me is getting a handle on what is actually available and how it is delivered. Recently I was approached by representatives from the mental health support community in the Shoalhaven. They wanted virtually the same things that professors McGorry and Mendoza were advocating. Let me itemise what the Shoalhaven group is seeking and perhaps that will provide a hint as to why I suspect the way we deliver mental health services needs to be reappraised. To improve things for their mental health clients they need more community mental health workers; mental health units and beds at our local hospitals; more access to psychiatrists; more community based supported accommodation; better cooperation and coordination with alcohol and other drug services; and, transport services to and from the nearest mental health unit. I am sure the government is more than aware of these needs.
The temptation to simply throw more money at the problem is not the answer, but it certainly could be part of the solution. But we also need to change the way things are done. For as long as I can remember, the lack of effective delivery of mental health services has been a constant source of frustration for all concerned. With all the direct and indirect sources of funding currently available, it is reasonable to ask whether these needs have evolved as a result of the inadequacy of funding that has been given or through inefficiency of delivery. For instance, how much is being burnt up in administrative costs and how much is actually left to help the clients? And is it a fair apportionment?
What I think is needed is a model that service providers can follow. At the moment there is a mix of government agencies, nongovernment agencies and volunteer groups all trying their hardest, all well intentioned and all struggling to remain viable. I suspect there is also some territorial competition between the providers burning up money.
Can we do it better and what sort of assistance has the government to provide? I fail to see the point in introducing new programs side by side with existing programs which, on the surface, seem to replicate the same approaches. It is like giving an old car a new paint job and telling everyone how its performance is going to be improved. Yes, we need funding and we need it now. But first let us decide on a plan and a structure to deliver a measurable outcome. And then let us put into place an effective management system. We need a method that is outcome oriented rather than process oriented, an effective program that can be guaranteed to make significant inroads to addressing mental health. Then we need to comprehensively fund it.
I do not know what the answer is, but I want to know it and so do a lot of other people who live with this constant frustration of trying to do a lot with very little. Whether it is money or organisation, the government is obliged to make sure the right mix is reached. I applaud our local providers for doing the best they can under extreme difficulties. The recent community forum they held, which many of our local community attended to discuss the services, was a great plus in their favour. And I certainly applaud organisations like Beyondblue. All sides of politics have a lot to answer for, certainly here in Gilmore.
Melissa Raven
Posted on 21 Oct 2010 5:40 pm
Actually, Professor McGorry and Adjunct (honorary) Professor Mendoza don't always know what they are talking about. They both get their facts wrong, and unfortunately they mislead a lot of people, including the public, the media, and politicians. See Raven & Jureidini: Misleading claims in the mental health reform debate: http://www.onlineopinion.com.au/view.asp?article=10793.
Prof. McGorry claims that there is a hidden 'waiting list of 750,000 young Australians currently locked out of the mental health care they and their families desperately need'. But this is a gross over-estimate of treatment need that misrepresents the finding in the 2007 National Survey of Mental Health and Wellbeing that 750,000 young Australians had a lifetime diagnosis of a mental disorder and symptoms at some time in the previous year (not continuously throughout the year). Leading psychiatric epidemiologists in Australia and the US, including the Vice-Chair of the task force developing the DSM-V (the 'bible' of psychiatric diagnosis), emphasise that it is nonsense to assume that all people who meet diagnostic criteria in a population survey need treatment, because most mental disorders are mild and transient. Many so-called mental disorders in young people are mild cases of harmful alcohol use, particularly in young men, who would flatly refuse treatment. Fortunately there is a high rate of so-called spontaneous remission, and alcohol problems are best tackled by continuing harm reduction strategies such as licensing restrictions and random breath testing. Most of the 750,000 young people with untreated mental disorders do not desperately need treatment. Most choose not to access, and often that choice is appropriate, because their disorders are mild and transient. The vast majority are not suffering from untreated psychosis or severe depression or bipolar disorder or some other disorder that will blight their life if it is not treated (as McGorry claims). And they certainly do not need treatment at one of McGorry's Early Psychosis Prevention and Intervention Centres (EPPIC).
Adjunct Prof. Mendoza claims that more than a third of Australians who kill themselves have been discharged too early or without care from hospitals. This claim has been publicised by GetUp. But it is wrong by a factor of 30 or more. The NSW Government's 2005 'Tracking Tragedy' report concluded that suicide on discharge from hospital is a rare event. Between 1999-2003, there were approximately 750 suicides annually in NSW. The 20-odd people discharged within 28 days prior to suicide annually constituted only 2.7% of them. The report concluded that only one quarter to one third of suicide deaths following discharge could reasonably have been prevented (less than 1% of all suicide deaths). Unquestionably there is a need to improve discharge planning and follow-up for many reasons, not just because of the risk of suicide. However, this is not relevant to the majority of suicide cases.