Opinion Politics — 03 May 2017

The mental health sector is plagued with ineffective programs that should lose funding, according to a leading expert.

Ian Hickie, a commissioner on the National Mental Health Commission, said services suffered from poor co-ordination and did not address the needs of users and their families.

Professor Ian Hickie said mental health services are poorly co-ordinated, and has called for the defunding of ineffective programs. Photo: Steven Siewert

Professor Ian Hickie said mental health services are poorly co-ordinated, and has called for the defunding of ineffective programs. Photo: Steven Siewert

“Increased funding for expanded mental health services is crucial, but unless we overhaul the system and have the courage to defund ineffective programs, we will be throwing good money after bad,” he said.

Writing in the latest edition of the Sax Institute’s Public Health Research and Practice journal, Professor Hickie said there was a lack of oversight of mental health services.

“For too long we have been pumping scarce resources into a dysfunctional system riddled by silos and an absence of independent monitoring and evaluation of effectiveness,” he said.

Professor Hickie, who is also co-director of health and policy at the University of Sydney’s Brain and Mind Centre, expressed frustration with suicide prevention programs that were divorced from clinical services “as if suicidal people don’t have mental health problems”.

He said there had been a proliferation of awareness campaigns for suicide prevention or mental health, with different “brands” competing for space in the media and public funding.

“Australia is the most mental health literate country on earth by miles,” he told Fairfax Media. “The problem is not awareness. The problem is not being able to get a service.”

In contrast, Professor Hickie said, “if you get run over in the street we’ve got an emergency system of care that doesn’t ask you how old you are or what other problems you have. It deals with the problem.”

Fellow NHMC commissioner Jackie Crowe said people with mental health difficulties have to “fit in” to a fragmented mental health system of care.

“This is at a time when a person is unwell, may have multiple health, psychological or social needs, or be contemplating suicide and while their families are desperately worried,” she said.

Ms Crowe said the system of care was “ineffective, inefficient and unfair” and led to increased costs, uneven quality, human rights abuses and rising suicide rates.

“There is no way of knowing if you are accessing a quality and effective service or receiving optimum treatment from a service provider,” she said.

“Finding services to assist you and meet your need is a trial and error process that can take years.”

She said many people in the mental health sector were resistant to change.

“There is an issue with practitioners, service providers and government entities being either blind to or cherry-picking only the parts that suit them in key mental health policies and legislation,” she said.

Professor Hickie said the Turnbull government had embarked on the most ambitious attempt to reshape mental health services since the deinstitutionalisation era of the late 1980s.

The National Disability Insurance Scheme will also play a major role in the mental health sector.

However, he lamented the government’s rejection of a key element of the NHMC’s 2014 review of mental health programs and services to reallocate at least $1 billion in Commonwealth hospital funding to community-based services.

Professor Hickie likened the mental health sector to a malfunctioning shower.

“You keep pumping more water in at the top, you have lots of little holes where the water goes out,” he said. “The danger is a whole lot of people don’t get wet.”

“There are more gaps between the services than there are integrated service pathways. And our response is to put more in.”

Professor Hickie, who resigned from national youth mental health service Headspace in 2012 to join the NMHC, has previously questioned whether it was reaching the vulnerable young people it was set up to help.

He said the best way to deliver higher-quality mental health care was through multidisciplinary teams.

“In many cases, however, these are resisted by professional organisations that prioritise fee-for-service, solo-practitioner or single-professional group styles of practice,” he said.

“We also continue to prioritise funding into institutional settings when we know that community-based psychosocial, primary and community health services can have the most impact.”

This piece was originally published on ‘The Sydney Morning Herald’ April 28, 2017.

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