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Issue #1682      April 29, 2015

Mental health crisis

Lack of funding key contributor

The federal government’s review of mental health, the National Mental Health Commission’s Review of Mental Health Programs and Services, has revealed a grim picture. Nearly half the population is likely to experience mental health problems during their lifetime. Mental health problems are most evident within rural and regional areas, where services are far less accessible than in the cities.

Unemployed, imprisoned or poorly educated people are more likely than others to be affected, yet less than half are likely to receive treatment. Young people, struggling farmers and their families, and Aboriginal people are worst affected. Only one in ten young persons with mental health problems received professional care last year, and often only after having committed self harm or attempted suicide.

Approximately 65,000 Australians attempt suicide each year, and the review sets a target of halving the nation’s current suicide rate of 2,500 per annum. Young people are at greatest risk, with a particularly high rate among Aboriginal youth in country areas.

Mental health now gets about 5 percent of national health funding, even though it accounts for nearly 15 percent of the health care burden.

However, the Abbott government reduced overall health funding by $3 billion and, according to a Fairfax report of the NSW government’s decision to allow local health services to allocate funding, has resulted in health administrators cutting mental health services, rather than closing hospital beds.

In a recent survey of half the state’s psychiatrists, 50 percent described resources as inadequate, and a further 33 percent as grossly inadequate. More than half said the problem had become worse in the last year, and a quarter now say they’re considering leaving government employment.

Labor health spokesman Walt Secord commented: “They are deeply troubled, as they are powerless to help. Local health districts – particularly rural and regional ones – are [achieving savings] by failing to fill positions, or are replacing mental health workers with less qualified practitioners. … sadly, mental health services are the easiest to cut.”

The review

The federal review expresses deep concern about “vulnerable people left to navigate a complex and fragmented system”, with inefficiencies, overlapping government services and lack of service for rural and regional areas.

The Abbott government refused to release the review after it was finalised five months ago, but the summary of its findings was leaked last week. The government has now referred its recommendations to expert committees for further advice.

If implemented, the review’s recommendations for better planned and coordinated services, clearly defined roles and targets, early diagnosis and preventative care would undoubtedly assist in reducing the incidence of mental health problems.

But in other respects the review arouses concern, not least because of its recommendation that $1 billion of mental health acute care funding for state and territory hospitals should be transferred to community care from 2017.

Alarmed health professionals have warned that implementing this recommendation could lead to a repetition of the disastrous “deinstitutionalisation” of earlier decades, under which patients were moved from mental health institutions, supposedly into small community facilities but often into boarding houses without proper care.

Govt reaction and responsibility

Mental Health Australia (MHA), peak body of the mental health sector, wants the government to release the review and discuss mental health with the states at the next meeting of the Council of Australian Governments (COAG), as well as with health professionals and organisations, with a view to complete reform of the nation’s mental health system.

The government says it will not cut funding for acute care in hospitals. However, it seems intent on getting the states and territories to raise their own finances for their areas of government services, and funding cuts are exactly what it’s looking for. At the COAG meeting it is entirely possible that the government will seek to cut acute care funding, but minimise any increase in funding for community health care.

The incidence of mental health is also affected by policy decisions that increase the economic burden, and thus the stress level, for average Australians.

Examples include the extra tax burden imposed on them by the government’s unwillingness to force super rich tax individuals and major corporations to pay tax in proportion to their earnings, as well as its “direct action” policy which requires taxpayers to foot the bill for polluting industries to clean up their act, and the crippling costs involved in putting students through tertiary education.

Other government policies contribute directly to the nation’s mental health burden.

Asylum seekers trapped in detention centres in Nauru or Manus Island commit self harm, attempt suicide, or become withdrawn, but receive a level of mental health care far below what is required.

The government’s practice of unquestioning military support for the US in its never-ending wars in the Middle East and elsewhere has resulted in often catastrophically damaging post-traumatic stress disorder (PTSD) for military personnel and their families.

Official military estimates say PTSD affects 4 percent of combatants, but this is a gross underestimate (see editorial Guardian #1681). Soldiers often cover up the symptoms rather than risking their careers by seeking treatment. Michael Burge, director of the Australian College of Trauma Treatment, says “Usually with war veterans it’s consistently around 30 percent”.

Soldiers can wait years for their claims for compensation and treatment to be heard. Yet the government allocated $325 million for the recent centenary of the Gallipoli invasion, and the bill is likely to reach $400 million.

Journalist Mike Saunokonoko, who interviewed Burge and many others, believes that because of the cumulative impact of Australia’s repeated incursions into the Middle East the nation is sitting on a mental health time bomb. Burge agrees. He says “The psychosocial and community implications are just horrible”.

But the Abbott government’s lack of action to date has demonstrated that they’re in parliament to look after the big corporations, not the those in need, including the mentally ill. At the coming COAG meeting the government is certain to do its utmost to avoid taking decisive and effective leadership or provide extra funding for mental health.

The most effective action the Australian people can take to improve the situation is to dump the Abbott government as soon as possible.

Next article – Burning traditions are being reignited

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