Cautious welcome for new integrated mental health care plan

Doug Hendrie

15/08/2019 2:44:43 PM

Advocates have praised the Government’s plan to better integrate Australia’s mental health system, but RACGP President Dr Harry Nespolon feels questions remain.

Greg Hunt
Federal Health Minister Greg Hunt addresses the National Press Club in Canberra. (Image: Lukas Coch)

Federal Health Minister Greg Hunt this week announced plans to better coordinate state and federal mental health services in a ‘single, simple, unified’ system.
‘We will work over the next two years to establish a new partnership with the states for an integrated mental health system from the Alpha to the Omega, from prevention to recovery. And with understood and agreed responsibilities,’ he said.
‘It starts with prevention, which is a shared responsibility but a Commonwealth lead.
‘We then move to early diagnosis and treatment, where the GPs take the lead and the Commonwealth takes responsibility.
‘We move then to the mild to moderate treatment phase. And this is a shared responsibility but a Commonwealth lead.’ 
Minister Hunt called on his state and territory counterparts to boost the number of youth mental health units to tackle acute treatment.
‘Many have identified the missing middle as being the gap between the GP and the hospital,’ he said.
In response, Minister Hunt announced that existing plans for eight new walk-in adult mental health centres would be followed by a ‘much broader and deeper’ network of centres.
RACGP President Dr Harry Nespolon welcomed the broad scope of the plan, but questioned whether the new walk-in centres are the right solution.
‘It’s good that there’s a 10-year plan not tied to the electoral cycle. Minister Hunt is taking a 10-year view, which is an excellent idea,’ he told newsGP.
But Dr Nespolon has concerns over whether the new adult walk-in centres will lead to more silos in healthcare.
‘The idea of the missing middle is nothing new – that’s what these walk-in centres are meant to fill,’ he said. ‘But I’m not sure they will adequately fill it, and if they do, it will only be for a small group of people.
‘At the end of the day, the detail really matters. If the Government underfunds any of these, they’re doomed to fail from the beginning. These are ideas of merit, but the real question is how much the Government is willing to put into it.
‘The concern is that this has to be integrated, so we don’t produce more silos. You can’t take care of mental health without considering physical health.
‘Developing these walk-in centres for adults seems to be very expensive for what it’s likely to produce. It’s also concerning they haven’t built the first lot, but they’re already considering the second.’

RACGP President Dr Harry Nespolon welcomed the broad scope of the plan, but questioned whether the new walk-in centres are the right solution.

Speaking at the National Press Club in Canberra, Minister Hunt also announced a new ‘Children’s Mental Health Strategy’ to tackle mental health for children up to 12.
‘We know that half of all symptoms of mental illness begin before the age of 14, and that neuropsychiatric conditions are the leading cause of disability in young people,’ he said.
‘If untreated, these conditions severely influence how children develop, and how they do at school and in life.’
Minister Hunt described mental health as ‘our great national challenge’, with around four million Australians experiencing poor mental health in any given year.
‘It’s your story and it’s my story. And it’s my mother’s story, who had her battle with bipolar. But it’s a story that every Australian is touched by at some stage,’ he said.
Minister Hunt said that self-stigma remains high and is now the primary obstacle to seeking help.
‘Enormous progress has been made on destigmatisation, but self-stigma – people’s self-consciousness about their own mental health concerns – remains high. It is the main barrier to people seeking help,’ he said.
The new announcements came as part of Minister Hunt’s launch of the Government’s Long Term National Health Plan in a bid to build the world’s best healthcare system.
As of 2017, Australia’s health system was ranked second of 11 high-income countries by the Commonwealth Fund, following the UK.  
The Long Term National Health Plan pulls together the 2030 mental health vision, the 10-year Primary Health Care Plan, the 10-year National Preventive Health Strategy, the 10-year Medical Research Future Fund, and changes to private health insurance.
Prime Minister Scott Morrison recently declared mental health his number one priority.
Former Prime Minister and current Beyond Blue Chair Julia Gillard recently called for unity across the mental health sector and backed the push for a universal system of mental health treatment.
‘We must stop this revolving door of acute mental health and suicide presentations at hospital emergency departments by valuing and investing more in community-based supports,’ she said in a speech to Suicide Prevention Australia’s national conference.
The 10-year plans will also draw on data from a new three-year $90 million Intergenerational Health and Mental Health Study of 60,000 Australians.
The funding for the survey came after the Government chose not to conduct the National Survey of Mental Health and Wellbeing in 2017, having previously conducted it in 1997 and 2007.
The news sparked calls for better data to inform the mental health sector.
Other new announcements from Minister Hunt:

  • Lung cancer is likely to be the next national cancer screening target, with Cancer Australia to lead a review of its potential to save lives
  • Communities with comparatively low levels of vaccination will be targeted in a bid to lift five-year-old vaccination coverage from 94.7% to the 95% required for herd immunity
  • A new target to bring smoking rates down to below 10% of the population within six years, down from almost 14% in 2017–18 
  • A new focus on reducing avoidable hospital admissions and re-admissions
  • A commitment to a zero-suicide target for the nation
The mental health announcements were welcomed by the organisations such as the Butterfly Foundation, the National Mental Health Commission, Consumers Health Forum and by Labor’s Shadow Health Minister Chris Bowen.

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Dr Kalyanie Kuruppuarachchi   18/08/2019 8:53:10 PM

My suggestion as a GP is to organise walk in centres within primary care centres, as there is a high self-stigma rate among patients. They may not be willing to attend labelled centres.
It would be beneficial to allow more than the current 10 visits per patient to see practitioners every year.
High level screening programs to screen primary school and high school students for early diagnosis and treatment is substantial. This can be extended to university level .