National mental health plan ‘fundamentally flawed’

The Productivity Commission has released a dire warning about Australia’s mental health care future, saying the current system is not only ‘fundamentally flawed’, but inaccessible, unaffordable, and fragmented.
 
It’s a scathing assessment backed by GPs, with one expert saying general practice must urgently be equipped with the tools needed to offer best-practice care within an overhauled system.
 
This week, the Commission released its interim review of the National Mental Health and Suicide Prevention Agreement – a plan that aims to have the federal, state and territory governments working together to improve the mental health of all Australians and reduce the rate of suicide.
 
However, the Commission’s damning review found a long list of areas where the agreement is ‘falling short’, saying the system is ‘fragmented and out of reach for many people’.
 
According to Commissioner Selwyn Button, the current agreement ‘cannot deliver the systemic, coordinated change it promises’.
 
‘The agreement comprises a raft of outputs and initiatives that aren’t connected to each other or to an overarching strategy,’ he said.
 
‘The consumers, carers and service providers we spoke with told us of ongoing challenges accessing and affording care and of uncoordinated services that do not respond to need.
 
‘Our consultation shows that people involved in the system know what needs to change. The new agreement needs to be delivered with them, not just for them.’
 
It comes after an RACGP submission to the review called for the agreement to better recognise the significant role general practice plays in mental health care provision, saying its lack of recognition and support for GPs across several key areas is a concern.

The Commission found the actions in the agreement do not advance system reform, resulting in services which are unaffordable, difficult to access, and unable to respond to people’s needs.
 
It said key commitments in the agreement have not been delivered and should be completed as a priority, including National Disability Insurance Scheme (NDIS) service gaps affecting around 500,000 people.
 
The Commission also pointed to a lack of ‘meaningful change’, saying that although the agreement emphasises the need to incorporate the voices of people with lived and living experience in the system, it does little to achieve this.
 
‘To fulfil its purpose, the next agreement needs focused objectives and tangible commitments to achieve them,’ Commissioner Button said.
 
‘It must make governments accountable for delivering specific and measurable outcomes.’
 
Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine, agreed with the Commissioner’s findings, labelling the agreement ‘ineffective’.
 
‘There is too much fragmentation in the system, and the system changes that are needed for a cohesive, Australia-wide policy have not occurred,’ she told newsGP.
 
‘The despair that leads people to suicide needs a holistic approach and timely access to services.
 
‘This means multidisciplinary physical and psychological health services as well as social services and supports, including NDIS and housing issues.’
 
In response to the agreement, consumers reported several obstacles to care, including inadequate availability and accessibility of some essential services, long waiting times, high costs for using services, and experiences of discrimination.
 
‘Inadequate acute care (hospitals) and shortages of primary and specialist providers (GPs, psychiatrists, psychologists) prevent many people from receiving quality treatment and support,’ the review found.
 
It has called for increase in the supply, quality and capacity of workers to provide mental health and suicide prevention services, including GPs receiving greater mental health care training.
 
Many consumers also recommended improving wages, working conditions and career pathways.
 
One person called for ‘more GPs in regions and rural, train GPs with mental health skills and make sure they know what services are available locally’.
 
Dr Andronis added that the professionals working in this ‘challenging crisis system’, including GPs, are often left frustrated by the lack of follow-up services for participants.
 
‘GPs see some of these patients either before or immediately after crisis care, often in the local emergency department, but often struggle to connect them to services that can support a person through a critical period of their lives and provide the individualised care that the person needs,’ she said.
 
‘This might be psychological counselling, it might be emergency housing, or it might be quick access to Centrelink payments – it these services are difficult to link to in a hurry.
 
‘This is demoralising for the GP as well as the patient and their families who are feeling desperate. It’s hard to offer hope in these circumstances.’
 
Federal Health and Ageing Minister Mark Butler welcomed the report, acknowledging there is ‘significant unmet need in the community’ for those living with poor mental health.
 
‘There’s 230,000 Australians, we’re told, with severe psychiatric disability who are receiving essentially no supports – that must be a focus of the work of health ministers and mental health ministers,’ he said.
 
‘Both in terms of how we negotiate a new mental health agreement with states and territories, but also, it is a piece of work for foundational supports.
 
‘We know that those Australians without support are bumping in and out of emergency departments, in contact with justice and police systems, are vastly overrepresented in our homeless population and, frankly, deserve better.’
 
The agreement was signed in 2022 and is being reviewed ahead of its expiration in 2026.
 
However, the Commission is now calling for the current agreement be extended to 2027 to allow time for the new agreement to be co-designed with consumers, carers and service providers, as it has made ‘little progress’ towards achieving its goals.
 
It says this extension will allow for ‘new policy architecture’, including a long-term strategy for reform, a five-year national agreement to tackle key priorities, and bilateral schedules to direct funding of services that respond to local needs.
 
It is also calling for new, separate schedules on services to support the social and emotional wellbeing of Aboriginal and Torres Strait Islander people and suicide prevention.
 
Dr Andronis says GPs must be given urgent access to better education and support for managing mental health crises.
 
‘But we also need to be supported by our colleagues in peer reflective practice and supervision groups regardless of our levels of experience and expertise,’ she said.
 
‘This could be more enabled by governments, so that we don’t have to pay to get the support that we need to practice safely while trying to keep our patients safe.’
 
The Productivity Commission is now calling for submissions to inform the final report of the review, which will be handed to Government in October this year.
 
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