A better plan for our mental health
Blame and finger pointing won’t help get services to those who need them most, says Connie Digolis
AS Tasmania inevitably moves toward the next state election you will hear even more debate around the Royal Hobart Hospital redevelopment, emergency department wait times and the ever-growing issue of bed numbers and staffing.
These are important concerns that need resolving urgently for Tasmanians and have a rightful place high on the state agenda.
Access to adequate health care should not be a politicised issue; however, it seems unavoidable at this juncture.
The mental health sector has been at the forefront of this debate for some time now with the brunt of criticism being directed at public mental health services and their capacity to admit and treat people presenting at hospital.
The commentary has been largely devoid of providing any solutions to the issues within the sector, apart from simply acknowledging that the current system isn’t working.
We aren’t disagreeing, it isn’t working, but nor can we keep doing the same thing and expect a different result.
With the recent announcement of the inquiry into the acute health system, it would seem something will be done to address present issues across all areas in our hospitals.
Unfortunately, the nature of such inquiries might mean that swift change is not possible until the findings and recommendations of the inquiry are handed down.
From our perspective as the peak body representing community-managed mental health services in this state, simply complaining about the present situation by suggesting more of the same rather than implementing evidence-based immediate and then long-term actions is an insult to Tasmanians who are, quite frankly, fed up.
The road map of how we can solve some of the concerns within the mental health system already exists, some of it is beginning to be put in to practice and we need to maintain this momentum.
The Rethink Mental Health 10-year-plan launched nearly two years ago now by the State Government addresses and provides the evidence for two key solutions to some very real problems.
One of the priorities identified in the plan is to begin shifting the focus from hospital-based care to support in the community and another is to develop an integrated Tasmanian mental health system.
Without action and agreement across all services and levels of government, a plan is nothing more than words on paper.
It needs more than leadership; these actions require a cultural and procedural shift throughout all services from the acute to primary health and right into community-based care.
We need to stop framing the conversation in terms of who gets a bigger or more deserving slice of the pie — clinical services or community services.
It’s not about who gets what but rather what can be achieved collectively. It’s about removing the barriers between each facet of our health system and allowing them to work collaboratively and efficiently.
At the core of reform within our mental health system is putting the individual first and at the centre of their own care.
This shouldn’t be a controversial concept, but it does require a shift in thinking from how services have been managed in the past.
There are numerous examples that demonstrate that these concepts, when implemented properly, really do work and some states are already putting these models into practice. In Victoria, for example, Prevention and Recovery Care (PARC) services have been implemented over a number of
We have the evidence; we have the road map. Let’s not let a little thing like politics get in the way of improving mental health outcomes for all Tasmanians.
years in an effort to provide a viable and sustainable subacute option as part of a stepped model of care.
A recent evaluation of the PARC services in 2016 indicated that, “PARC services aim to provide an alternative to hospital-based inpatient acute mental health care and/ or post-acute support, and a step-down service for consumers leaving inpatient care”.
The fundamental concept underpinning this type of service integration is to implement a “stepped model of care” whereby each person receives an appropriate level of care for every stage of need.
Essentially, it is about having the right service in the right place, at the right time, delivered by the right person.
Community mental health services and clinical services deserve better than to be lumped with the tag of “uncoordinated”.
Simply stating that the problem is that patients are being discharged too early with nowhere for them to be referred to is at best unproductive.
If the argument is that patients are being discharged too early and it will hamper their recovery, this is ignoring the evidence and frankly a narrow view of what is possible. This is the same as saying someone with a broken leg should stay in hospital until they are no longer limping.
It cannot be emphasised enough that the best place for someone to be supported in their ongoing recovery from an episode of mental ill-health is not in hospitals, it is in the community.
According to the Australian Institute of Health and Welfare, Tasmania has the lowest rate of community specialised mental health care service contacts per 1000 population, in the country.
Is this because we are not using community mental health services enough or that they are under resourced?
Or both? Surely, if an integrated approach is being adopted around the country and the world, it warrants consideration for Tasmania.
This should include investment into preventive and early intervention services that will minimise the need for hospital or acute care in the first place.
These issues are not about finger pointing or a turf war but rather looking more broadly at the bigger picture and acknowledging that by working together we can all lift our game.
We have the evidence, we have the road map. Let’s not let a little thing like politics get in the way of improving mental health outcomes for all Tasmanians.
The road map of how we can solve some of the concerns within the mental health system already exists.