The Productivity Commission recently released their biggest report ever – over 1600 pages – all about mental health. With Australians contributing 1244 submissions and 488 comments it is a clear demonstration of how important mental health is to the nation.
The Final Report highlights the important role housing, employment and physical health play when we are supporting a person’s mental health. However it also highlighted the massive gap in psychosocial support outside of the NDIS with many of our member organisations referenced for their work.
There is a strong recognition in the Report that clinical mental health services are not enough and they recommend a whole of government approach and an architecture for the Commonwealth, states and territories to work together.
As economists the authors outlined the costs and proposed investment to reduce some of the impacts of mental ill health. I would note that the Productivity Commission Commissioner Stephen King has clearly stated that this reform needs to be done as a whole and that there are considerable risks in just implementing parts of the plan.
It is impossible to summarise this report and so the following is not an attempt to do that. What this article aims to do is identify some highlights that relate to key issues our organisation, sector and stakeholders have a strong interest in.
The Report proposes national mechanisms and structures but there are areas that are clearly within the ambit of state and territory governments.
There is much in the Report that can inform and strengthen our current work, particularly in relation to our work with the SA Government such as the implementation of the SA Mental Health Services Plan and the work of Wellbeing SA.
Human rights not just mental health
The Report advocates for a whole of government approach as critical to getting results and this requires action beyond just health departments. The Report authors are critical of the Fifth National Mental Health Plan as being too health-centric.
While the Report highlights the importance of social determinants of health it notes solutions to issues like income support as ‘beyond scope’ of the current inquiry. The report does, however, focus on some areas beyond health such as housing, employment, income support and justice and in this way is more similar to the Fourth National Mental Health Plan.
So while the Report highlights the importance of a human rights centred approach, it will require leadership within our state to make progress on this. Here in South Australia the SA Mental Health Services Plan has a strong focus on improving our human rights approach and we are looking forward to working with the Department and Government on this. There is growing recognition that even as we improve our mental health services and systems, the lack of support and access to resources across other departments and agencies can become the limiting factor.
On Human Rights Day, with the Rights Resources Network and colleagues in other welfare and social services sectors, we discussed what value a human rights framework could bring to our state. A human rights framework in SA would underpin a better context for building capacity to deliver holistic support across departments and agencies. In health and mental health settings, for example, it could provide a consistent driver to consider a person’s holistic needs not just their immediate medical needs.
The Gap in Psychosocial Support
The Productivity Commission quantified the psychosocial support gap nationally between supply and demand. Essentially across the country 690,000 people would benefit from psychosocial support including 290,000 people with ‘severe and persistent mental illness in most need of support’. Across NDIS (64,000) and all funded Commonwealth, states and territories funded mental health services (72000), there are places for only 136,000 (22% of the 690,000 total). This means that there are no places for the 80% of people who need psychosocial support, including an estimated 154,000 from the ‘severe and persistent’ group. This gap is huge however it is consistent with our advocacy and the experience of individuals and families who struggle to find the help they need.
Psychosocial supports help people to manage their mental illness in the community, solve difficult problems and get help from services and supports beyond health and mental health.
It is urgent that the State and the Commonwealth work together to reduce this enormous gap as soon as possible. The benefits will be that people are able to build better lives in the community and reduce their reliance on crisis and acute care services. This will also fill the gap identified by the Commission of more support for carers and families. Here the human rights focus is also a challenge as we need to ensure our models have the right balance of delivering system efficiency (eg reducing hospitalisation) and supporting people to build a better life in the community. International approaches such as citizenship can help extend our current achievements and understandings developed through a recovery approach.
Our state has some excellent psychosocial support services already but more investment is needed to support more people to recover and for our system to deliver more human rights outcomes. The Actions 17.1-17.3 on pp.38-39 highlight the need to invest more to reduce this gap but as a ‘start later’ priority. The MHCSA argues that the scale of unmet demand justifies this action to be upgraded to the ‘start now’ category.
Finally, improvements to data collection and reporting as well as consumer and carer experience of care are also prioritised by the Report.
Person–Centric – lived experience at all levels
It was a welcome surprise that the Productivity Commission quickly understood how important the lived experience voice is to understanding the problems and limitations of our current approaches. There was also a strong message that co-design is essential to provide solutions. However investing in training and capacity building will be necessary to support organisations and individuals to lead and contribute to processes of governance, advocacy and co-design within our state.
Once again, having a strong human rights framework will create a more person-centric environment for this work.
Social Determinants – Housing, Justice, Employment and Income Support
The Report highlighted the importance of social determinants of health to mental health including housing, justice, employment and income support. The PC recommendations and actions in these areas are welcome although many of the social determinants were considered ‘out of scope’.
To use one example that the Report dealt with, housing, this is a high priority area as for many people in our mental health system there is a lack of both support and access to housing.
The Report noted that around 30% of hospital beds were occupied by people who could be discharged if they had the support and/or housing. This represents an enormous financial cost to our health system as well as to the individual.
The Report’s call for an accurate estimation of the shortfall is welcome and will help advocacy to address this via their suggested mechanism of the next National Housing and Homelessness Agreement.
Workforce and Industry Development
The Report included attention to workforce development generally but did not specifically address the requirements for an increased lived experience workforce and increased psychosocial workforce.
The MHCSA has developed a range of tools and supports for non-government psychosocial rehabilitation providers to build skills and capability around lived experience workforce. A specific focus will be required to ensure supply of qualified lived experience and psychosocial support workers. Support for service providers to implement a stronger human rights focus will also assist with rapid adjustment to deliver on citizenship outcomes.
There is a long way to go and many twists and turns to implement as much as we can of this grand vision. But a human rights lens and a focus on citizenship would be an invaluable compass in making sure that we go in the right direction and help resist being channelled back to a narrow medical path.
As the Productivity Commission puts it – they want to make sure that the money is spent on delivering outcomes that consumers and carers value.
Submissions will be received up to 4th February 2021.
Geoff Harris, Executive Director, MHCSA