Mental health and person-centred care: how two Commissions reach the same verdict
CHF’s Consumer Commission report whose key recommendations included a focus on mental health, came out just days after the release of the Productivity Commission’s final report on mental health.
The two reports produce broadly similar findings about the widespread dearth of services and pressing need for reform and much more investment --- further persuasive and considered evidence of the need for extensive change to the underpinning policies and services in mental health.
Of pivotal significance is a point that both reports highlight, the need for individually-focused care. As the Productivity Commission (PC) stated: “Put simply, Australia’s mental health system is not person-centred. It should be.”
The PC found many Australians do not receive the treatment and support they need. As a result, too many people experience preventable physical and mental distress, disruptions in education and employment, relationship breakdown, stigma, and loss of life satisfaction and opportunities. And reform of the mental health system would produce large benefits in people’s quality of life — valued at up to $18 billion annually.
The Consumer Commission (CC) diagnoses growing rates of anxiety, loneliness and distress and escalating demand for mental health and suicide prevention services in a system struggling to cope. It observes that more than ever services like social housing and a secure income have a significant impact on mental health and wellbeing outcomes. Personal and community wellbeing has been highlighted as fundamental to resilience and coping in times of crisis.
The onset of COVID-19 and measures designed to reduce its spread have seen widespread changes to the usual psychological state across the Australian community, with mild to moderate incidences of depression and anxiety significantly higher during the lockdown period.
The CC calls for a shift towards a more holistic approach to mental health and wellbeing that recognises the interdependency of physical and mental health across all government systems. Policy development needs to recognise that all aspects of a person’s life, including physical, mental, emotional and social factors, influence their state of wellbeing.
Reforms should start with a permanent increase to income support payments and a significant investment in additional social housing stock to provide stable, supportive environments for people to live healthy lives.
Greater investment is needed in mental health, suicide prevention and psychosocial support services based on a targeted understanding of gaps and in a way that complements existing supports. While investment is needed at all levels, a recovery and wellbeing focussed approach requires shifting investment towards community-based services. Coordination is needed between mental health, suicide prevention and other sectors including child and family services, education, youth and justice.
The CC report also calls for greater recognition of allied health and psychosocial supports within mental health and a more integrated approach to holistic care planning.
There is a need to enhance the role of peer support across the mental health and suicide prevention systems as peer workers are currently sporadically utilised and poorly supported. The Fifth National Mental Health and Suicide Prevention Plan recognises that peer workers play an important role in building recovery-oriented approaches to care, providing meaningful support to people and modelling positive outcomes from service experiences.
Both peer workers and community organisations should have a central role in the development and delivery of social prescribing programs as they have a key role in delivering services that support health behaviours and psychosocial care. Social prescribing is the delivery of non-clinical services to improve health and wellbeing outcomes and address the underlying causes of poor health, loneliness and social isolation
The recommendations of the CC Report included:
- For all levels of government to increase investment in mental health and suicide prevention services, organisations supporting wellbeing and specialist services providing psychosocial care with a focus on early intervention in the community. The Commonwealth should lead this process given its responsibility for primary care, and should start by implementing all recommendations from the Productivity Commission inquiry into mental health
- Governments and providers should expand the role of peer support investing in training and embedding peer workers into workforce structures
- Governments should pool funding to develop a set of accountability indicators for mental health, suicide prevention and psychosocial support services that are clear, evidence-based and measurable and relate to both clinical outcomes and quality of life. The indicators should be developed in partnership with consumers and carers and publicly reported on
The PC report contains a comprehensive factsheet for consumers and carers which states mental health services and supports have not kept pace with demand for services. To build a person-centred mental health system, it recommends changes to shift the focus of services and supports so that they become centred around the needs, preferences and aspirations of people.
Its key recommendations for action on this aspect go into some detail and examples include:
• Reducing the gap between the low-intensity healthcare services that are needed by individuals, and what is currently available; that requires consistent assessment and referral processes accessible either through a GP or directly by individuals; Increased access to online treatment that is supported by clinicians, and to group therapy and telehealth, where these are preferred by the consumer.
• Reducing the ‘missing middle’ gap between mental healthcare services needed by people with moderate to high needs, and what is currently available; to that end, evaluating MBS-rebated psychological therapy (the ‘Better Access’ program) to assess its effectiveness and to trial an increase in sessions available.
- Providing a formal coordination service to link up care services for people with severe and complex mental illness,and implementing single care plans for people with moderate to severe mental illness who receive services from multiple providers.
- Publishing information about the shortfall in funding for non-hospital mental healthcare services and increasing the funding over time to meet this shortfall and expand access.
The PC Report says mental health is important to everyone. “Although it means different things to different people at different points in their life, the capacity to enjoy life, cope with and be resilient in response to stress, set and fulfil goals, and build and maintain relationships are key aspects of being mentally healthy and participating in the community.”
Leanne Wells is CEO of the Consumers Health Forum of Australia.