The political spin and confusion around the issue of mental health policy in Australia just seems never-ending. For a while now, the federal Government has been celebrating that they are spending more than they ever have on mental health services, but yet at the same time, the general public are being told to accept that psychological treatment for depression and other common conditions is going to be cut below minimum treatment guidelines accepted worldwide. To make any sense of these apparent contradictions, one needs to appreciate the illusory nature of what we are being told. Much like the Penrose triangle pictured here, the mental health reforms coming from people in charge right now can only be properly understood when we realise that the structure they have in mind lacks substance. That is, while the recent reforms give the appearance of each component connecting with the other, the reality is that the system is fragmented and disconnected, placing impossible demands on distressed people in the community to rush themselves through treatment.
Last week Senator Penny Wright posted her questions about mental health programs from the Senate Estimates meeting on 15 February 2012. Penny asked a very important question: “What programs are currently being progressed to fill the likely need for services that will be caused by the changes that will come into effect on 1 January 2013”. This is an excellent question, given that the Government has promised that the psychological treatment they have cut from the system will be replaced by other programs. The response she received however, indicates that most of the programs which the Government have in mind will not actually deliver psychological treatment services. The progams they were talking about included the ‘Partners in Care’ initiative, the ‘Personal Helpers and Mentors’ program, and the ‘Support for Day to Day Living’ activity program. As I will explain below, none of these programs deliver psychological treatment services and the other alternatives programs (e.g., the ATAPS program, Headspace, and EPPIC) are simply not up to the job.
Partners in Care initiative
The way that the Partners in Care initiative operates is that a ‘Care Facilitator’ is appointed to link a person to services and programs in the community, when that person is identified as having ‘severe and persistent mental illness’. This ‘Care Facilitator’ is an employee of an an agency or group that wins a tender to deliver services within the new ‘Medicare Local’ regions. They will have access to a flexible pool of funds “to help fill service gaps”, but the majority of services will come from existing programs run by the Commonwealth and states. The Government is making this initiative accessible to only 24,000 people across Australia. This program will help people connect with programs that already exist in the community, but unfortunately, if those programs which provide psychological treatment are limited to ten sessions or so, then vulnerable and distressed people are left in exactly the same position as everybody else affected by the cuts to the Better Access program. The program simply doesn’t offer treatment full stop.
Personal Helpers and Mentors program
In this program (aka PHaMs), people with severe functional limitations that are the result of severe mental illness will be able to access a personal helper or mentor to assist with practical tasks, such as housekeeping, shopping, keeping appointments, and linking to other services and support networks. These helpers/mentors will be provided by NGOs (non-government organisations), with a minimum of 5 helpers/mentors being provided by each NGO.The program is a useful one, no doubt, but once again, it does not provide psychological treatment services.
‘Support for Day to Day Living’ activity program
This activity program (aka ‘D2DL’) aims to deliver social, recreational and educational activities in 49 pre-identified locations around Australia delivered through NGOs delivered to people with severe and persistent mental illness. There are some great ideas in this program such as helping people develop new skills, establishing social networks, participating in the community, and accomplishing goals. It isn’t hard to see how such a program would be of great benefit to people who are marginalised or estranged from their connections with the community, however once again, the program does not deliver much needed psychological treatment for people who have a recognised mental health condition.
Do these programs “fill the need for services”?
The short answer is “no, they dont”. The Better Access program delivered a reasonable length of psychological treatment to people with an identified mental health disorder through the Medicare system. It meant that for the first time, people who had never accessed services due to the prohibitive cost and stigma associated with reaching out for help, were able to receive proper care for their condition. The Headspace and EPPIC programs where the Government is focusing the bulk of funding, are only able to provide services to young people. Anybody that has a mental health condition who is over 25 will be left on their own to face their predicament, which is quite concerning when you consider the prevalence of conditions like depression across the lifespan and the fact that the highest suicide rate in Australia is actually for middle aged men (26 deaths per 100,000 males aged 40-44).
More to the point here, you might have noticed the rhetoric spanning all of these programs mentioned above, that mental health services should be made accessible only to the most severe cases. What happened to early intervention in this plan? It doesn’t take a genius to appreciate that when we don’t offer any treatment to people who are struggling and asking for psychological help, then in many instances, they will become even more distressed. It seems self-defeating to let a person struggle without support until their situation becomes so severe that they require care facilitators, personal helpers, and structured activity programs in order to recover.
In addition to this, the statements at the senate estimates meeting once again directly contradict the claims of Government Ministers who have insisted that the ATAPS program provides services for people with more severe and complex needs. In the words of one of the spokespeople at the meeting, “both Better Access and ATAPS have the same client group”. If that is the case, then the rationale to cut the number of sessions available to people who utilise the Better Access program, is based on false pretenses. The fact is, we know that the Better Access program was always intended to reach people with a genuine need for psychological treatment, including those who have complex and severe mental health disorders.
In all of this spin, what we are most concerned about is that treatment services are being cut overall. The situation is exactly the way that the AMA described it earlier on, “robbing Peter to pay Paul”, except that reallocation of funding has resulted in less psychological services, not more. There is no amount of spin or praise given to the new innovations in service delivery that can hide that depressing point.
Want to help?
Oppose the cuts to psychological services by signing our petition at at CommunityRun and Change.org. You can also join in discusison about this important issue on our Facebook Group.
If you would like to email your concerns to a politician, you might start by taking this directly to Prime Minister Julia Gillard: http://www.pm.gov.au/contact-your-pm/. You can also send an eail to the Mark Butler, the Minister for Mental Health, or Concetta Fierravanti-Wells, the Shadow Minister for Mental Health, or Senator Penny Wright, senator for The Greens on Mental Health. Make your message loud and clear – ten sessions is not enough. Every voice makes a difference!
Your comments are welcome below