The adage that the devil is in the detail is never more true than at budget time. This year the details of the health budget reveal that the big loser is mental health.
Despite the huge burdens of cost and disability that mental illness imposes on society, despite a raft of reports that cogently argue for doing and spending more, and despite election commitments to make mental health a priority, the budget details reveal spending cuts of $290 million in mental health programs over the next four years.
There are some new commitments in mental health. A total of $76.3 million will be spent on a national plan for peri-natal depression and more post-graduate and masters degree scholarships for mental health professionals, and $2.4 million will be provided from within existing Department of Health and Ageing resources to establish a National Advisory Council on Mental Health. But even these new measures are short on funding and long-term commitment.
The budget provides $41.3million over four years to tackle pre- and post-natal depression. This is a valuable new initiative to address a problem that affects almost one in five new mothers.
However, this funding represents a significant retreat from the $85 million promised during the election and in the media release accompanying the budget papers.
There is $35 million over four years to expand the current program that provides post-graduate education assistance for mental health nurses and psychologists.
This builds on the Howard government's 2006 funding of $103.5 million to provide training support for a total of 1400 additional mental health nurses and 700 additional clinical psychologists by the end of 2011.
The current budget states that the additional $35 million will provide scholarships for 1070 mental health nurses and 222 scholarships for psychologists in rural and remote areas. When compared to 2006, this package seems to be significantly underfunded.
And finally, the willingness to fund the new national advisory council to provide independent expert advice to the Government apparently only extends for three years.
This new spending is more than offset by the cuts in mental health programs. The rationale provided for these cuts is that the programs have historically been under-spent, and that if demand does increase in the future, then more funds will become available.
Most of the affected programs are part of the Howard government's mental health package funded in the 2006-07 budget, so there is no long history to support the argument about the reduction in funds reflecting the historical spending pattern.
Lack of leadership and strategic policy from the previous government meant that these programs never really got up and running.
There is no commitment from the Rudd Government to examine the value of these programs, to understand why uptake rates have been less than predicted, and to invest the budget savings in innovative approaches to the delivery of mental health services.
All new programs are currently constrained by severe workforce shortages, and access to services is particularly limited for people who live outside metropolitan areas.
So it is particularly problematic to see $15.5 million in reduced funding for mental health services in rural and remote areas, and $219.7 million cut from mental health workforce and training programs with no apparent effort to address the reasons for low and slow uptake.
The scholarship programs to train more mental health nurses and psychologists will not deliver more mental health workers for three to five years, and action to deliver more and better services cannot wait that long.
It seems that good health policy has lost out to the budget razor gang. It seems that the needs of the mentally ill have lost out to a short-sighted Government commitment to responsible economic management.
Dr Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, University of Sydney/Australian National University.
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