Contributing lives, thriving communities Report of the National Review of Mental Health Programmes and Services Summary 30 November 2014 just want to emphasise that people with mental health issues are a part of the community and that our lives matter. Not only that, but by denying people like me the chance to have a stable life, with stable housing and a reduction in poverty related stress, you are also denying our kids and loved ones relief from those stresses.? Person with lived experience, Victoria About this Review This document provides a summary and list of recommendations of the four-volume report of the National Review of Mental Health Programmes and Services. All volumes can be downloaded from A complete list of the Commission?s publications is available from our website. A number of electronic fact sheets for the Review are available on our website. The quotes in this publication come from people and organisations in Australia who participated in the Commission?s Call for Submission process. ISSN 2201-3032 ISBN 978-0-9874449-6-7 Suggested citation National Mental Health Commission, 2014: The National Review of Mental Health Programmes and Services. Sydney: NMHC Published by: National Mental Health Commission, Sydney. (cm National Mental Health Commission 2014 This product, excluding the Commission logo, Commonwealth Coat of Arms and material owned by a third party or protected by a trademark, has been released under a Creative Commons BY 3.0 (CC BY 3.0) licence. The excluded material owned by a third party includes data, images, accounts of personal experiences and artwork sourced from third parties, including private individuals. With the exception of the excluded material (but see note below with respect to data provided by the Australian Bureau of Statistics (ABS) and the Australian Institute of Health and Welfare you may distribute, remix and build upon this work. However, you must attribute the National Mental Health Commission as the copyright holder of the work in compliance with our attribution policy. The full terms and conditions of this licence are available at Requests and enquiries concerning reproduction and copyrights should be directed to: Note: Material provided by: 1. the Australian Bureau of Statistics is covered under a Creative Commons Attribution 2.5 Australia licence and must be attributed in accordance with their requirements for attributing ABS material as outlined at 2. the Australian Institute of Health and Welfare is covered by Creative Commons BY 3.0 (CC BY 3.0) and must be attributed to the AIHW in accordance with their attribution policy at Contents Executive Summary Background This Review Setting the scene System reform Overview of mental illness in our community Economic and social costs to Australia Commonwealth expenditure Financial risk Where we are now Stigma persists A system that responds too late Where we want to be Widespread public knowledge and understanding Access in the right place at the right time Future approaches and funding priorities A person-centred approach System architecture Shifting funding to rebalance the system Strategic directions and recommendations 1. Set clear roles and accountabilities to shape a person-centred mental health system 2. Agree and implement national targets and local organisational performance measures 3. Shift funding priorities from hospitals and income support to community and primary health care services 4. Empower and support self-care and implement a new model of stepped care across Australia 5. Promote the wellbeing and mental health of the Australian community, beginning with a healthy start to life 6. Expand dedicated mental health and social and emotional wellbeing teams for Aboriginal and Torres Strait Islander people 7. Reduce suicides and suicide attempts by 50 per cent over the next decade 8. Build workforce and research capacity to support systems change 9. Improve access to services and support through innovative technologies Conclusion Where can I get further information? References National Review of Mental Health Programmes and Services Summary I think having two bureaucracies (federal and state) isn?t working The money needs to go into one very efficient and competently run system, not be fragmented across NGOs, GP-referred groups and a lot of semi-trained/unregistered service providers. It should be a one-stop-shop where people tell their story once and an appropriate referral for follow-up is made.? Member of the public, New South Wales National Review of Mental Health Programmes and Services Summary system has fundamental structural shortcomings. This same conclusion has been reached by numerous other The overall impact of a poorly planned and badly lives are being improved as a result. funding. take advantage of this unique opportunity to reform Australia and Australians. Summary • based and controlled services. programmes and overall investment and spending • Greater community understanding of mental There have been considerable changes in mental • the system to focus on the needs of users rather than providers • • • • • involvement of people and their families and other support people in planning and making decisions about their care and support. • The development of the community mental health • • • funds spent on the small percentage of the mental health dollar to purchase integrated • reform reduce the burden on the system but also can Summary Mild-moderate Severe episodic/ severe and persistent (anxiety, depression etc) 3 million people complex and chronic illness disorders, severe depression etc) 625,000 people Severe and persistent/ psychosocial disability Whole of 65,000 people Spectrum of mental ill-health in Australia health The mental health needs of Aboriginal and Torres Less than Suicide is the leading cause of prevalence in the community. Summary in direct and indirect costs overall cost of mental health to developed countries is In burden. individuals and their families and other support . • • • • • • • • programmes • • • year provided to the states and territories under the • Summary consume more of the types of income supports and Those risks also fall back on state and territory crisis for hospital care. together to achieve the best outcomes for individuals must be on these programmes. • $9.6 billion expended • 12.5% spent on all other 48.8% 10.7% $9.6 billion 10.4% 9.5% 8.0% 12.5% Summary Disability Support Pension (DSP) $4,676.3 million 36.8% since 2008–09 (est MH share of Commonwealth hospital funding) $1,024.9 million 13.1% since 2008–09 Carer Payment and Allowance $999.1 million 52.5% since 2008–09 $907.9 million 21.3% since 2008–09 $768.1 million 7.6% decrease since 2008–09 $1.2 billion • • • • capacity and poor economies of scale Distressed individuals having to provide the same • • fragmented service system A myriad of siloed funding streams and programmes focused on providers • • • Limited choice • and the outcomes achieved • them • • People being discharged from hospital and treatment discharge planning • • and circumstances may deteriorate and become more • persistent mental health problems • mental illness and their support people • • The greatest level of funding goes into high cost areas • Summary • • • • integrated services and economies of scale • • around support for the individual and their families • Families recognised and included as vital members of the care team safety and quality standards • • • • Specialists reaching out into the community • • health or drug and alcohol related treatment services • • recovery • • • • • Summary to be the fundamental principle guiding its themselves around the system. from those closest to them are the most important resources they have to build and sustain good transferred from one team to another but remain support people. Lo ng mo Me l he nt a m ter tiv e s Family C accommodation rw o n s e r vic e s Local plo ym s or ke r Co r re c Pe e S CH NGO vt Em AC Welfare s rc h e hu or t A m bu lanc e n Go s es alth nur pp on su da s Os ng & Social Clu b s ice en rv p re v e s id e uic om or en t R ac c eh s tatio Ho NG usin g& Hea lth He lp li ab i Self Crisis team vices e Nurses Allied ac c H ser r s, P unity C BUILDING BLOCKS GP mm Individual s s Co Frie n ED lac e M ity un Wo r k p m s o ol Co ea lth re h Sc Police P rim ar y h m m Fa Specia list ds Performance targets, indicators & data Planning & governance iders rov P te ng iva nseli cou Pr ily ls ca eMental Health & es v ic Sp Workforce training, r Se H o s p it a rs are • Private: PHI, self funded, commercial & social investments Os Funding models: Summary High-Very High Needs packages of Very high of need High of need Low-Moderate Needs Moderate Low people Need for and Majority Summary all • fundamental elements of the stepped care approach • • decisions based on meaningful data. at higher risk or have special needs. It is supported those countries that focus on specialist and acute care. and support for recovery that is not just measured in across Australia provides the ideal opportunity to The realignment of system architecture as recommended regional basis. • level of need. • provide for a seamless journey through the mental health system. • • reducing risk factors • • readmissions and income support payments. A stepped care approach can also support people • • appropriate services and supports. support they need. community as much as possible and other acute services • managing the handover from hospital back into • Summary Current cost curve Proposed cost curve Integrated Care Pathways for Mental Health Self help, PBS MBS costs of acute care and crisis management. Summary supports. community. Reinvest and Save Hospitals Reduce costs and reinvest Child and Adolescent Mental Health Services Psychosocial supports, including housing, Primary Mental Health Care Proposed Primary and Mental Health Networks Community Mental Health Services Recovery focused sub-acute care Reduced need for DSP and Carer Payment Summary and that they should be based on formal analyses of in high levels of unmet mental health need. A picture opportunity to reform our mental health system for some areas and considerable unmet need in others. are targeted at reform of individual programmes and services; others are focused on leveraging change at the system level to ensure that system and funds and services currently did not meet the needs of and irrelevant to the people they are designed for. Programmes for Aboriginal and Torres Strait Islander funded across Australia means that meaningful help to crisis point. This is either because no mental health this makes neither economic nor humanitarian sense. that services and programmes should be designed in Summary mental health care. and community mental health services. Urgently clarify the eligibility criteria for access to the key regional architecture for equitable planning and ensure the provision of current funding into community supports. Improve service equity for rural and remote health. system. Strengthen the central role of GPs in mental health and payment arrangements and a more equitable members of the mental health care team. Summary Improve research capacity and impact by doubling community needs. mental health nurses and the mental health peer impacted by childhood trauma. treatment. Improve emergency access to the right telephone Strait Islander specialist mental health services. provide direct clinical support strategies or enhance Summary It is clear that our current mental health system contribute to poor social and economic outcomes for centred system that achieves desired outcomes and submissions received from the community have of the mental health reform agenda set by Government. This is a summary of a report to Government in received in the generous public response to the call years. agenda. Summary Australian Aboriginal and Torres Strait ABS. Australian Aboriginal and Torres Strait to reduce the impact of mental illness in the ABS. ABS. Summary This page has been left blank intentionally 23 National Review of Mental Health Programmes and Services Summary Services need to be more family oriented to support the family unit as a whole. It is the carers/families/support people who are the one family needs to be included, listened to and informed and and not be looked on as part of the problem. The family is very important in supporting consumers to lead better quality of lives. We need more understanding, less sh'gman'sation, more education, and support.? Support person, Australian Capital Territory Australian Government National Mental Health Commission