Opinion — 23 December 2015

‘Tis the season to be jolly, but it’s also a time of stress and struggle for many people.

Expectations are thrust upon us by popular commercial culture that we will float through Christmas showered with expensive presents and happily exhausted by endless parties on a tinsel tide of love and goodwill. So in many homes and minds where nothing like this will happen, the scene is set for anxiety, stress, disappointment and even despair.

The Victorian government’s frequently useful Better Health website has some tips to reduce the stress. It advises saving throughout the year to provide a nest egg for Christmas expenses (too late now, but good for next year) and organising a group activity for after the Christmas Day lunch: “Family members involved in after-lunch activities such as cricket on the back lawn are less likely to get into arguments.”

As for expectations: “Don’t expect miracles. If you and certain family members bicker all year long, you can be sure there’ll be tension at Christmas gatherings.”

Families dealing with the acute challenge of mental illness, whether right now, at some point in the year, or all year round, may have been heartened by the federal government’s mental health reforms revealed in November.

The calls for change have grown increasingly urgent, through 32 reports and inquiries into mental health between 2006 and 2012. The most recent, the National Mental Health Commission’s review led by Professor Allan Fels, provided the recommendations on which the latest reforms are based.

But the four million Australians every year who experience some form of mental health problem and their families know better than to expect miracles. This crucial area of growing need costs the economy an estimated $40 billion a year, to say nothing of the associated pain and grief.

People with lived experience of mental illness know that disparate, disconnected mental health services run by state and federal governments and NGOs won’t suddenly start providing seamlessly co-ordinated, timely packages of care which can head off crises before they occur and provide the best treatment possible when they do.

But that’s what these rational and hopeful reforms intend.

A stepped approach is meant to provide alternatives to the mental health consumer beyond the GP’s surgery, the psychologist’s rooms or the hospital emergency department.

A “digital mental health gateway” with a single telephone number and website will direct people promptly to the services they most need, whether crisis support, clinical and specialist services or online self-help information and education.

Rather than sending everyone off to ten subsidised sessions with a psychologist or a psychiatrist under the burgeoning Better Access program, people with less complex problems will be expected to access evidence-based mental health services and therapies online as a first step.

Crisis response is a priority but the system’s overall focus shifts to catching people before they fall: it emphasises community-based services for primary health care, prevention and early intervention.

Importantly, the reforms also recognise the desirability of integrating clinical and social support services for seriously ill people, to provide help not just with their illness/es but with the housing, employment and life skills they need if they are to transition to productive, enjoyable and sustainable lives.

All this will be co-ordinated through Primary Health Networks which are tasked with planning and commissioning the right mix of services for their regions to respond to all the problems a person with mental illness might have.

The true test of the reforms lies in the implementation. We can’t know yet whether the Primary Health Networks which replaced Medicare Locals during the Abbott era are up to the job. There is risk that, with limited funds and limited expertise, the services they commission may simply replicate the limitations of the services available now, as has turned out to be the case under similar arrangements in the United Kingdom and New Zealand.

There’s no new money, even though the system is underfunded, accounting for about 13 per cent of the disease burden but receiving only 6 per cent of the total health budget. And success depends on the so-far elusive integration of the federally-funded primary health care system with the state-based acute mental health services.

It will require leadership, focus and determination to implement these complex and comprehensive reforms. We should not expect miracles, but we should expect things to be sufficiently different from and better than the past, so that future mental health services can justifiably be called a system.

This editorial first appeared on ‘Sydney Morning Herald’ on 18 December 2015.

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