Much of the recent debate about Australia’s parlous mental health system has revolved around its lack of funding.
It’s been estimated that an extra $2.5 billion over four years – and $3.5 billion over five – is required to address the demand for mental health care across Australia.
But all the money in the world won’t make a difference if the system doesn’t work.
Don’t get me wrong, a significant injection of funds is absolutely essential if we’re going to get on top of the mental health crisis in this country. But it will be good money after bad if our overall approach to the problem doesn’t undergo a sea-change.
Put simply our mental health system must move from delivering pills to delivering practical support and care built around fundamental needs such as employment and housing.
The problem as it stands is that clinical intervention comes first and the support and care required to help mentally ill people participate fully in our community comes a distant second.
That’s because, at present, the medical profession sits at the heart of delivering mental health outcomes. This has to end.
Through my membership of the
Mental Health Expert Working Group – set up by Mark Butler to advise the government on mental health – I have come to believe that of the numerous blueprints and strategies for change, past and present, all of them fall short because they are almost exclusively health-based responses.
Most give no consideration to employment, housing and social participation, opportunities most of us take for granted but which are a constant struggle for the majority of Australians dealing with mental illness, and when they do it’s as an under-researched afterthought.
The medical experts behind these proposals, while well-meaning, are trained to fix health issues not provide guidance on housing, skills training, accessing employment or enrolling in education.
The solution is to put care ahead of medical treatment.
This needs a radical shift of understanding by governments, and by our society as a whole, in terms of addressing mental illness.
It will also involve a massive re-direction of funding to organisations that can provide holistic support and care to those with mental health problems and intellectual disabilities and their families.
I’m aware the cynics will interpret this as Mission Australia’s CEO making a play for more funding. But I’d sign away any opportunity for my organisation to receive a red cent if it meant we were able to change our current approach.
How would it work? Well it happens in our services every day of the week.
Take Michael, a young man I met recently, as an example.
Beset by severe mental health problems Michael, now aged in his early 30s, spent much of his 20s homeless, including several periods sleeping rough.
This time in Michael’s life was characterised by a merry-go-round of hospital admissions and discharges, at great cost to the community, but with limited or no benefit in terms of quality of life.
But by giving Michael personalised, non-clinical care – providing him with the support he needed to maintain independent accommodation and navigate daily life – he now lives in his own unit and hasn’t been in hospital for five years.
Michael’s clinical treatment is almost identical to what he received previously, but his quality of life has vastly improved.
It costs government around $900 per night to keep a homeless person with a mental illness in a hospital bed. In fact, there are estimates it can cost NSW Health up to $60,000 a year to provide emergency medical care to a homeless person with a mental illness.
It costs organisations like us a fraction of that amount to give someone the support they need – and our approach is infinitely more successful.
It’s also holistic care. Employment, housing and treatment all rolled into the one package.
We see literally thousands of Michaels in our services every year.
Talk to them and their families and they quickly tell you that while adequate and reliable medical care is high on their list of needs, their greater desire is to be part of the community. They just need help to achieve it.
In short, they need a society that can care and support the whole person.
If Minister Butler is after a template for reform he need only look at his government’s approach to tackling homelessness.
This was driven by a three-person council who worked brilliantly to assist the government in developing a policy platform for a system that had been broken for decades.
While significant challenges remain it laid a successful foundation for the work ahead.
Unless he takes a similarly focussed approach, and takes the matter out of the hands of special interest groups and the medical establishment, he will not get far.
And until we adjust our thinking around mental health to be one of caring for people rather than treating them, the system will continue to fail.
Toby Hall is the Chief Executive Officer of Mission Australia. Story originally published at ABC's The Drum.
