The current state of mental health reform

Josh Fear

November 2016

What did the National Mental Health Commission’s Review find?

• …‘fundamental structural shortcomings’ across ‘a

poorly planned and badly integrated system.’

• …‘a hit-and-miss arrangement of services and

programmes around the country, seemingly based

on no discernible strategy, creating duplication in

some areas and considerable unmet need in others.’

• ... ‘a massive drain on people’s wellbeing and

participation in the community.’

What did the Federation Taskforce find?

• “Mental health is a compelling example of the

challenges associated with assigning roles and

responsibilities…”

• “The Commonwealth and the States and Territories both

have roles [which] have evolved in piecemeal fashion

and have usually not been defined with respect to an

overarching vision…”

• “No level of government ‘owns’ mental health, which in

turn has made it difficult to ensure accountability...”

Unprecedented reform

• State and Commonwealth programs

transitioning to NDIS

• Commonwealth commissioning via PHN

flexible pool

• Introduction of ‘Stepped Care’

• New Digital Mental Health Gateway

Unprecedented reform

• Integrated whole of childhood mental health pathways

• Integrated youth mental health services

• Integrated Aboriginal & Torres Strait Islander wellbeing

services

(MH, AOD, Wellbeing)

• Suicide prevention – integrated prevention trials &

follow-up services

• Better care coordination for severe and complex mental

health

Unprecedented reform

• Better care coordination for severe and

complex mental health

• National leadership - including 5th Plan

• All reform within the spending envelope

Failed Commonwealth spending

2014 Federal Budget allocations for community mental health

versus actual expenditure/revised forecasts ($m)

Declining Commonwealth spending

Per capita expenditure on community mental health ($)

Where do we need to go?

• Setting clear targets and indicators to

measure the progress of mental health

reforms

• Fund greater consumer and carer

participation in service co-design,

service delivery and evaluation

• Agree on a comprehensive 5th Plan for

Mental Health & Suicide Prevention with

state and territory governments

Where do we need to go?

• Increase investment in early intervention

and prevention

• Support the National Mental Health

Commission to ensure accountability

across various areas of current reform

• Strengthen the community mental health

sector during the transition to the NDIS

and PHN commissioning

The current state of mental health reform

Josh Fear

November 2016