Mr Hunt’s community mental health approach a welcome start
The pledge by the new Health Minister Greg Hunt to focus on the national crisis of suicide should raise our hopes that we might at last see an effective national strategy to counter this tragedy.
Suicide claims more than 3,000 deaths in Australia each year. That’s more than the death toll due to breast cancer. Yet we still struggle to develop a vigorous national plan to counter this heart-breakingly avoidable loss of life.
We welcome Mr Hunt’s ambition to foster more community-based initiatives to comprehensively address the factors that propel people to end their lives.
Experience with the plethora of poorly coordinated state and federal schemes of the past indicates that real success in reducing rates of illness and suicide will only come when we have an effective set of people focused on mainstream community health arrangements as a backbone to our overall health and social care system. Reform to specialised mental health services on its own is not enough, as better access to mainstream services is not enough. Mainstream services need to have their capacity to identify and respond to people with a lived experience of mental illness built up.
After all, people with mental illness and those at risk of suicide live as members of the wider Australian community. Increasing their access to overall services is going to make a difference to the extent that we can intervene earlier and get them path to recovery.
In his recent ABC 7.30 interview, Mr Hunt emphasised the importance of front line workers and of finding the right responses for each community.
Mr Hunt is rolling out 16 community-focused suicide prevention trial sites to be led by Primary Health Networks. That is an encouraging start to what we hope will become nationwide arrangements providing integrated primary care that includes as a matter of course localised, evidence-based mental health and suicide prevention services and support developed with local consumers, carers and health professionals.
In Australia we need to move more decisively towards wrap-around health and social services that recognise that so much of our wellbeing is dependent on social and economic factors, like family support, education and employment.
In the United Kingdom and the United States there are developments which are demonstrating that helping people deal with social challenges can deliver health and economic dividends. In the UK there are a variety of schemes known as “social prescribing” in which GPs, nurses and other health professionals can refer people to a range of local, non-clinical services to help them take greater control of their own health. This is a promising foray into consumer centred care that integrates health and other services.
The UK health charity, the King’s Fund, says social prescribing can include a range of activities typically provided by community organisations like arts activities, social networking, group learning, gardening, cooking, healthy eating and sports.
In Houston, Texas, in a program aimed at reducing expensive hospital visits by high “frequent flyer” patients, paramedics reach out to parks and neighbourhoods to encourage vulnerable people to enroll in volunteer programs which support and encourage them to get the right medical help from GPs and specialists. Kaiser Health News reported that the results of this program can be “stunning” in health improvement and reducing medical care costs by as much as 83 per cent and hospital visits by up to 70 per cent.
Of course these outcomes are set in health systems very different from that which operate in Australia. But what the results nevertheless highlight is that health outcomes that are good for the patient and the community involve more than merely health care.
If there is one thing we hope Mr Hunt will gain from his early and admirable drive to confront suicide and mental illness, it is that we need community-based and community-wide responses to our health challenges. And Mr Hunt has the good fortune to have at hand, albeit underfunded, two developments that have great potential to bring better, local health responses: the Primary Health Networks which are established to commission health services needed locally; and the Health Care Home initiative starting in July to reinvigorate Medicare with the aim of delivering more consumer-centred, integrated health and social care.