Not so much a roadmap, more a dead-end pass
NSW Premier Barry O'Farrell and Prime Minister Julia Gillard at last week's COAG meeting at Parliament House. Photo: Alex Ellinghausen
The apotheosis of political decision making in Australia is the Council of Australian Governments (COAG). Like New York, if you can make it there, you can make it anywhere. Last Friday, COAG issued its Roadmap for National Mental Health Reform 2012-2022, fully 2½ years after the Prime Minister, Julia Gillard, vowed to make mental health ''a second-term priority'' for her government.
The trouble with this roadmap is that it leads us somewhere we have already been, not somewhere new. Since 1992 Australia has had four national mental health plans, two national policies, one national action plan, a national report card and now a national roadmap. There are also plans and policies in areas such as suicide, alcohol and drugs, homelessness, indigenous health, promotion, prevention etc. You then need to multiply all this by nine to ensure each state and territory has its own version of the national document.
Rather than end this bureaucratic pantomime of activity, the new mental health roadmap demands more, signalling a fifth national mental health plan will succeed the fourth when it lapses in 2014.
The roadmap describes a journey that is productively engaging with many players, including national and state governments, non-government organisations and others in the effective delivery and development of Australia's complex and modern mental health system.
In fact, most families affected by mental illness would struggle to identify any system of care at all. Over the past 20 years Australia has largely failed to lift the rate of access to care for people with a mental illness, and key groups continue to miss out. Of young men with a mental illness for example, only 13 per cent receive any care. Overall community rates of access remain stubbornly low, with only about one third of people receiving any care, a rate far below other illnesses such as diabetes. Increasingly, the only place to go for care is to an expensive and often traumatic hospital emergency department. The community knows Australia's mental health system is in crisis. We know about the scourge of suicide. We do not need yet another parliamentary inquiry; the politicians have a keen appreciation of the scale of the problem and its impact on the Australian economy and community.
The roadmap takes us back to familiar ground and here is what that place looks like. It contains no new funding for mental health. The government has milked its $1.5 billion injection of ''new'' funds in the 2011 budget long enough. To be spent over five years, this funding outcome condemned mental health to continue the slow decline in its share of the ever growing health budget. Instead of arresting this decline, the roadmap continually refers to the need to ensure existing funds are appropriately targeted.
The roadmap lists only a preliminary group of performance indicators and sets no targets. No funding is provided to ensure these indicators will be collected. Australia knows remarkably little about such a ubiquitous health problem. We don't know whether people with a mental illness are employed or not, homeless or even whether they are alive or dead after receiving care. This roadmap commits to three-yearly reporting once the data items have been agreed by the end of next year, meaning the first report on progress could be reasonably expected by 2017. The roadmap leaves us outcome blind, despite commitments for genuine accountability in mental health going back 20 years. The lack of targets is a clear statement of our ambition.
Crucially, the roadmap leaves the states and territories completely autonomous in how they manage their mental health systems, what services they choose to invest in and by when. In this sense, the roadmap looks like the last time COAG tried to deal with mental health in 2006. The National Action Plan it created had four key funding areas and there was no nationally agreed plan on spending; each state and territory did as it pleased - meaning, for example, that while Victoria spent about 15 per cent of its COAG funding on prevention, Queensland reported spending less than 2 per cent. The 2006 COAG plan, in fact, had a fifth key area entitled ''Governments Working Together'', though no funding was provided as they clearly do this naturally.
This roadmap leaves responsibility for mental health care impaled on the Commonwealth/state divide. The type and quality of mental healthcare varies wildly depending where a person lives, to an extent deemed unacceptable in other domains of health care.
The roadmap pays lip service to the need for specific attention to the indigenous community, with clearly marked boxes highlighting vague commitments to involve people more. People with severe mental illness face limited life expectancy akin to the aboriginal community. This roadmap offers no closing the gap strategy for people with schizophrenia, nor is there concerted effort directed towards younger people - even though 75 per cent of mental illness manifests by age 25.
The final familiar landmark on this roadmap is the standard issue national working group, this time to be made up of three government representatives from every jurisdiction, one from ''first minister's departments'', one from health and one to represent the other interested portfolios from each government. Given the total autonomy offered to each jurisdiction by the roadmap, this new Gang of 27 look about as likely to oversee or drive national mental health reform as the committees it will succeed.
The roadmap takes us back to familiar, depressing sights. It offers a gestural national vision, and then makes it clear everybody can go back to normal, doing things to their own timeframes and priorities. It offers no new incentives or sanctions to do things differently in mental health yet the last thing we can afford is more of the same. Too many lives lost, lives wasted.
The roadmap is vacuous at best and, at worst, might represent a 10-year year prison sentence from which mental health may struggle to free itself, particularly in the light of other issues which now assert themselves as higher governmental priorities, such as David Gonski's school funding review, dental health and the national disability insurance scheme.
Sebastian Rosenberg is a senior lecturer at the brain and mind research institute, University of Sydney.