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Mental health package welcomed but acute services must not be weakened

November 2015

The Federal Government’s person-centred and regionalised reform package for Australia’s mental health services is welcome, but acute services must not find themselves weakened as the system shifts towards an emphasis on early intervention and prevention, according to Australia’s largest non-government provider of public hospitals.

St Vincent’s Health Australia – which offers acute care as well as integrated out-patient clinics and community mental health support through its public hospitals in Sydney and Melbourne – said while it supported the overall direction of the government’s package it would be watching closely its impact on acute mental health care.

“SVHA supports the direction of the government’s reforms. Early intervention and community-based support for people with mental health disorders is enormously important,” said SVHA’s CEO, Toby Hall.

“We agree the current system doesn’t do enough in prevention. We need more resources to help people with mental illness before they reach crisis.

“But in the gradual shift of the mental health system towards community-based care and prevention, we must be careful not to weaken the acute system and services that are already under stress.

“Some of the commentary I’ve heard in the past about acute mental health care doesn’t describe the services I’ve seen hospitals provide.

“Public hospitals provide far more than acute in-patient care. At St Vincent’s hospitals, we deliver integrated out-patient clinics and community mental health teams that provide care in people’s homes.

“We’re the ones that chase up people who don’t engage, who are reluctant to receive care and who don’t voluntarily attend appointments and come in for follow-ups.

“For example, among homeless people – who experience very high rates of mental illness – while we look to collaborate with community providers wherever possible, we’re often the first port of call for support and intervention.

“We welcome the fact that both the federal government and opposition have given guarantees not to redirect $1bn out of acute care during the mental health system’s transition.

“We’ll also be looking to federal and state/territory governments as they negotiate the 5th National Mental Health Plan to provide security and certainty to the acute care system.

“In terms of other aspects of the package, it’s very pleasing to see a focus on employment and mental illness.

“We’ve had employment specialists embedded in the mental health services at our Melbourne hospital since 2006. Participant-led employment support is crucial in terms of a person’s recovery.

“The only point we’d raise is the package’s seeming focus on providing employment support only to young people. We believe it’s critical to everyone – whatever age and stage of illness – that they be given the opportunity and support to obtain and retain work.

“We also welcome the package’s ‘local’ emphasis with Primary Health Networks (PHNs) to lead planning and mental health service integration at regional levels.

“Our advice to government and health authorities in the wake of the Mental Health Commission’s report was that making greater use of the PHNs in coordinating funding and services showed significant promise but we needed to allow the networks time to establish relationships with acute care providers and the community sector.

“Let’s remember, they didn’t start until July this year and there’s a great deal of variation among the PHNs in their development and progress.

“So we welcome the government’s recognition that it needs to build the capacity of the PHNs to play this role. Large and well-established hospitals like ours also have a part to play in assisting that process.

“Another area of major interest to St Vincent’s is the use of online technology to address mental health needs.

“At our Sydney hospital, we operate one of Australia’s most successful online therapy programs – This Way Up – which makes a benefit of the fact that 19 out of 20 patients (95%) experiencing anxiety and depression choose, if available, to receive treatment online rather than face-to-face.

“Apart from producing significant, long-lasting patient outcomes, online therapies address the lack of mental health specialists in rural and regional areas; are 10 times more cost-effective; and there are no waiting lists to begin treatment.

“But while we commend the government developing a digital portal to assist people with their mental health needs, there’s a degree of detail missing about how it will work and how government will incorporate the ideas and innovation of those already in this space. We look forward to working with the government to progress its plans in this area.”