Budget’s mental health pledges rely on deals with states and workers that don’t exist, experts warn
Mental health promises in the federal budget are contingent on deals with the states and territories that have not yet been negotiated and on a boosted workforce that does not yet exist, raising doubts that the extra funding will fix systemic problems.
Tuesday’s budget included a $2.3bn mental health package which is being touted by the federal government as “the largest single mental health and suicide prevention” plan in budget history. It will see $278m spent on 10 new Headspace clinics for youth, while $298m allocated to suicide prevention will include a new National Suicide Prevention Office.
Dr Sebastian Rosenberg, a senior lecturer at the University of Sydney’s Brain and Mind Centre, said the suicide prevention spend included funding for an aftercare service to follow up people after their discharge from hospital to ensure they remained well and were accessing community support. “This kind of service is not groundbreaking in any means, it is something which has been tried and tested in pilot programs, and it is about making sure there’s a network of care that extends beyond the hospital,” Rosenberg said.
“But that will require a connection to the states who run the hospitals from which the suicide attempts are discharged, and then the workforce in those states who can follow them up.
“Structural reform and real change to the experience of care for people with mental illness will require connections between systems including federally funded systems like Medicare and state-funded systems like hospitals. And at the moment, those connections are largely missing.”
Rosenberg said he was concerned that despite the significant spend, “we have been in this territory before” when the Gillard government promised $2.2bn investment over five years in the 2011-12 budget. But a decade later the system was struggling, he said, though
he acknowledged Medicare-subsidised psychology sessions funded as part of the Gillard budget had been significant.
Even so, he said a Brain and Mind Centre analysis published in September had found that for mental health to begin to gather the resources required to address demand, about $1bn was required each year for several years.
“This budget provides around half this,” he said, adding it was “an improvement on recent more meagre years”. Rosenberg said he was also concerned that funding to extend telehealth measures, including for mental health, ran out on 31 December.
“What happens after that?” he said. “Telehealth has been an absolute cracker for mental health, especially for those living in non-urban areas.”
Jo Robinson, an associate professor at Orygen, the National Centre of Excellence in Youth Mental Health, said a large and welcome amount of funding had been allocated to suicide prevention and mental health overall.
Robinson, who leads Orygen’s suicide prevention research and works with self-harm patients in emergency departments, said there was uncertainty about how the money would benefit people using the services.
“A lot of the money that’s been promised looks like it will be quite conditional on the relationships and negotiations that happen at state and territory levels, and I think that’s where actual people that are using the services and their families stand to benefit the most,” she said.
A spokesperson for the Youth Health Forum, Roxxanne MacDonald, said the investment was largely around strengthening current models of care, especially for young people, rather than the reform touted by the government.
“We know that Headspace is a great doorway to mental health care, but it’s only meeting the needs of a handful of young people, with many of the most vulnerable falling through the gaps,” she said. “For the young people who fall into the ‘missing middle’ we often talk about, this budget is more of the same.”
She said the government had failed to invest in more sophisticated solutions to address the complexities of rising youth mental ill-health rates.
“Once again, the focus remains on clinical care with little attention paid to social determinants of health,” she said. “We know how important financial stability and a sense of belonging are in preventing and treating mental illness in communities. These things must be at the centre of mental health care for young people if we are to achieve our goals for mental health system reform.”
The final report of the Productivity Commission’s inquiry into improving mental health to support economic participation was made public in November 2020 and recommended measures such as greater support for families and carers, better support for younger people, greater support for people in the justice system and a strengthened workforce. The budget does include Medicare-subsidised sessions for carers of those with mental illness.
But the government responded to the inquiry by announcing a select committee to inquire into mental health and suicide prevention, which is due to deliver its findings in November. A new national agreement on mental health and suicide prevention is being negotiated between the federal, state and territory governments and is due by the end of November.
A psychiatrist and former national mental health commissioner, Prof Ian Hickie, said with the national agreement still under negotiation, the budget presented “so many unknowns”.
“It means the large commitments in this budget may never get spent effectively,” he said. “It is all contingent on state deals that don’t exist and can’t be done – no workforce or capacity to do them.”
In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, Mental Health America is available on 800-273-8255