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Keynote: Dr Sebastian Rosenberg,

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Keynote presentation by Dr Sebastian Rosenberg, from the Centre for Mental Health Research ANU College of Health and Medicine. presented at the WA Mental Health Conference 2019.

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Keynote: Dr Sebastian Rosenberg,

  1. 1. Dr Sebastian Rosenberg Centre for Mental Health Research ANU College of Health and Medicine
  2. 2. 2 • Provide a picture of mental health in WA • Consider contemporary policy settings • Highlight key recommendations and issues arising from the Productivity Commission Inquiry • Present some key questions which should underpin the next phase of mental health reform This Presentation
  3. 3. 3 Mental Health’s Share of the Health Budget 6.60 6.80 7.00 7.20 7.40 7.60 7.80 8.00
  4. 4. 4 0.00 50.00 100.00 150.00 200.00 250.00 300.00 350.00 400.00 NSW Vic Qld WA SA Tas ACT NT Nat Avg All $ $304 $206 $232 Per Capita State and Territory Spending on Mental Health $356
  5. 5. 5 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% NSW Vic Qld WA SA Tas ACT NT Public psychiatric hospitals Specialised psychiatric units or wards in public acute hospitals Community mental health care services Residential mental health services Grants to non-government organisations Other indirect expenditure Components of Mental Health Spending 2016-17
  6. 6. 6 NGO Share of Total State and Territory MH Spending 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 National WA
  7. 7. 7 • Despite repeated inquiries generally associating the mental health system with the word ‘crisis’, there has been minimal effort to bridge the gap between mental health’s share of the health budget (7.4%) and its contribution to the burden of disease (12%). • This gap does not explain everything. But it explains something. What does this mean?
  8. 8. 8 So what are we getting for the spending?
  9. 9. 9 NSW Vic Qld WA SA Tas ACT NT Aust 1286 1007 1014 1515 1243 1063 1227 1992 1205 Average recurrent costs per inpatient bed day, public hospitals 2016-17
  10. 10. 10 NSW Vic Qld WA SA Tas ACT NT Aust 13.9 13.6 9.9 15.1 10.3 11.4 12.2 14.0 12.7 Average Length of Stay, Public Hospital Acute Units 2016-17
  11. 11. 11 NSW Vic Qld WA SA Tas ACT NT Aust M 13.8 13.2 13.6 15.7 14.0 11.9 13.4 10.3 13.8 F 14.8 16.1 14.4 21.1 17.9 15.4 16.6 14.1 16.1 Readmissions to hospital within 28 days of discharge
  12. 12. 12 • The Australian Capital Territory (34.5%) had the highest proportion of service contacts provided to people with an involuntary mental health legal status, while Western Australia (3.4%) had the lowest.
  13. 13. 13 NSW Vic Qld WA SA Tas ACT NT Aust Average treatment days per episode of ambulatory care 8.1 6.2 7.0 5.1 5.4 5.4 8.3 4.6 6.7 Average cost per treatment day of ambulatory care $ 237.19 458.54 340.73 430.20 325.31 338.34 224.33 447.02 325.04 Ambulatory Treatment and Costs 2016-17
  14. 14. 14 Reg Psych Clin Psych }GP Plans GP Plan Review GP Treatment GP Plans Access to Better Access 2018-19 Australia 5.4m psychology services costing $570m. For WA this means almost 11,000 sessions of psychology costing more than $1.1m WEEKLY (not including OOPs).
  15. 15. 15 Access to Better Access NSW Vic Qld WA SA Tas ACT NT Aust Psychiatrist services 92.3 113.5 113.8 64.8 96.5 97.6 47.7 18.7 98.0 GP mental health specific services 141.9 157.3 146.8 118.3 125.6 111.8 115.3 66.1 141.3 Clinical psychologist services 80.3 96.4 81.6 90.4 113.1 122.9 101.2 19.3 88.7 Other psychologist services 112.6 137.9 124.5 72.2 72.5 86.5 93.7 35.4 112.7 Other allied health services 12.7 22.4 16.3 10.9 19.4 9.1 7.3 2.3 15.9 Mental health care specific MBS items processed Rate per 1000 people 2016-17
  16. 16. 16 • Data for genuine accountability is poor • Focus is on outputs rather than outcomes • Data on issues that matter to many consumers and carers like employment, education, housing, social inclusion generally missing • Across Australia quality and access to mental health care varies enormously depending on where you live • Hard to see any jurisdiction investing in community-based alternatives to hospitalisation • Risk of perpetuating hospital/bed/crisis-focused responses Summary
  17. 17. 17 • High expectations – once in a generation but latest in LONG line • Re-emphasise social determinants – more like 4th Plan than 5th • Some significant recommendations, including: – No discharge to homelessness – New engagement with schools and universities – New activities around early intervention and kids – New structures to promote regional governance – New structures for accountability • Big numbers: cost to the Australian economy of mental ill-health and suicide: $43 to $51 billion per year PLUS $130 billion associated with diminished health and reduced life expectancy for those living with mental ill-health • Draft report only – submissions due in Jan, fin report May 2020 Productivity Commission
  18. 18. 18 • Strangely health and clinically focused • Role of psychosocial support misunderstood or poorly described: Even with the best clinical treatment, episodic or persisting mental illness can result in the need for psychosocial and other supports (Vol 1. p25) • Responsibility for psychosocial support split between Feds for NDIS recipients (64,000) and states for everybody else (around 700,000) • Issues around psychosocial workforce, markets, collaboration etc. poorly described • Support for systemic consumer and carer advocacy missing Productivity Commission
  19. 19. 19 • There is no clear national vision for mental health • [no] collaboration with non-health portfolios • Disconnect between the national vision statement and those developed by individual State and Territory Governments (Vol 2, p.898) • New role for National MH Commission as interjurisdictional monitor of progress – where does that leave state commissions? • Solutions are new agreements and target setting processes with governments that have previously been unable or unwilling to engage in better accountability Productivity Commission – On Governance
  20. 20. 20 • How can stepped care survive without steps or monitoring? • Who owns the ‘missing middle’? • Where is hospital avoidance? • Where is clear articulation of the role of psychosocial support? • What will make new Regional Commissioning Authorities comprised of PHNs and LHDs choose to invest in community mental health services? • If all the PC recommendations were implemented would they make enough of a difference? • PC is just one horse – are we backing the right one? Productivity Commission – Key Questions
  21. 21. 21 • Is it clear where we want people needing mental health care to go (based on evidence, their wishes etc.)? • Is it clear who they should see (issues of role delineation, ehealth etc.)? • Is it clear what they should do next, if their situation improves or worsens? • Is it clear that as a community we wish to preference community care over hospital care (see National MH Commission Review 2014)? • Is it clear that we wish to organise mental health services to clearly respond to the epidemiology of illness i.e. focusing on early intervention among young people? • Is the role to be played by psychosocial care as a partner to clinical care clear – links to social determinants? • Are we serious about consumers and carers driving the system – planning and feedback? Key Reform Questions
  22. 22. 22 No Thank you. sebastian.rosenberg@anu.edu.au

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