The Budget: What’s in it for mental health …

The 2011 Federal Budget, despite being lauded as making mental health the “centrepiece” of the Gillard Budget, is not as finely targeted as last year’s Budget and does contain some rather extreme psychiatric ideas such as “baby mental illness” evaluations.

The foremost problem is that this year’s budget does not address the Big Issue in mental health – life expectancy. According to early research by the Department of Public Health at the University of Western Australia, people utilizing mental health services have the same life expectancy as indigenous Australians – that is in the 50s. Recent overseas research is indicating that life expectancy for with mental illness is actually decreasing since initial research in the 1990s.

When you live with mental illness this life expectancy issue is up front and central as you virtually see people “drop off the perch” in front of your eyes. Chronic conditions can rapidly become acute, small untended issues become massive and costly hospitalization and even tragedy results. This Budget, while increasing the public perception of mental health as an issue, does not address the urgency of the situation regarding life expectancy. The Budget doesn’t address the life expectancy of indigenous Australians either and this “blind spot” about a glaringly obvious, profoundly tragic issue for both groups just continues – and continues.

The West Australian study indicates that the reduction of life expectancy in the mentally ill is not due to suicide as generally believed, but also because of neglect of simple medical screening procedures and diagnostic tests and failure to receive adequate treatment for routine problems that occur with heart disease.

According to the 2011 Federal Budget there are around 60,000 Australians living with severe, persistent and debilitating mental illness who have complex service needs. This emphasis on those with severe illness as opposed to those who have moderate illness is a good move and the suggested services for this sector, including providing a single assessment process and providing additional funding for Flexible Care Packages to match an individual’s needs are excellent. However if the single point of contact for obtaining these services is to be a local organisation, as suggested in the Budget, then there could be a problem.

In local mental health services, a problem arises in that some of them tend to draw a very firm line on stepping from psychosocial type services to “clinical” or medical type services and they therefore hold back from getting involved in any health issues relating to the consumer. There is a psychosocial/clinical divide in many mental health services. Mental health consumers with serious conditions, need to be transported to the doctor, have someone assist them in communicating with the doctor and sometimes get assistance in carrying out doctors’ orders. If local mental health organisations are not prepared to do this, then problems of increased hospitalizations and early death will continue.

The Government is investing $208 million over five years to provide an additional 425 Personal Helpers and Mentors to provide practical one on one support for people with severe mental illness and PHaMs is an excellent service. However it needs to be established whether or not these workers are going to be able to cross the “psycho-social/clinical divide” consistently and effectively. In order for them to do this training will be required and there does not appear to be any provision for this in this year’s Budget.

Mental health nurses, who are accessed through a referral from a GP and who visit people in their homes, are much more concerned with the clinical aspects and this is why they are more useful in terms of increasing life expectancy. The Budget does indicate that more mental health nurses will be provided but this is not spelled out as a priority.

The real lulu in this Federal Government Budget as far as mental health is concerned is the inclusion of social and emotional wellbeing in the three-year old health check. Yes. I did say three-year old.

In an unreferenced statement explaining this initiative the Government makes the extraordinary claim that 25% of people with a mental disorder experienced their first episode before the age of 12. This is a pretty astounding statement and needs a lot more explanation. Does “first episode” mean that a child gets sad and depressed when their budgie dies? Does it mean that having a childish fit of rage and running away from home is a “first episode”? There doesn’t have to be a link between childish misbehaviour and later serious mental illness and to put that unreferenced statement out there will, in my view, give unnecessary concern to parents of young children.

What is worse is that an “Expert Group will also be established to advise on its (the 3 year old check) implementation”. Naturally an Expert Group in childhood mental illness will have a vested interest in finding the problem that they are expert in, so childhood mental illness would appear to be a growth area.

In a rather ominous 1984 way the blurb continues: “The Government is investing in evidence-based approaches to assist families, early childhood educators and school communities to better understand and recognise risk factors for mental illness and to build resilience in children. “

I am not saying that childhood mental illness does not exist, but it is a mistake to think that childhood problems, even serious depression or anxiety, is a precursor to future mental illness. Children do grow out of emotional and social problems and even children at risk of having serious mental illness are probably not well served by diagnosing it too early. I unfortunately was a bit of a psychotic child. I did see things that weren’t there and I did grow up to be an adult with a serious mental illness. However my psychotic episodes as a child were not problematic because I had good enough parents who provided a good enough environment for me. Could early intervention have prevented my later psychosis? I doubt it because then I would have had to go through my teenager life with the label of mental illness which would have been a serious hindrance rather than a help.

Risk factors for mental illness in children often involve external factors such as child abuse or bullying at school. Rather than raising the prospect of mental illness for the child and teaching them to be “resilient” as advocated in the Budget Overview, isn’t it better just to deal with the problematic external factor?

The area crying out for early diagnosis is in the area of autism, which is not a mental illness but rather a developmental disorder. If the 3 year old check was about autism then it would have some serious value.

The Government’s investment of $197 million over five years in new headspace centres is a good move as young people with mental illness need support. However there needs to be much more public discussion about what actually occurs at headspace. Not wishing to impugn Professor McGorry, who was an Australian of the Year, but mental health services promoted by charismatic people with little community oversight have historically been prone to ideological excess and unintended consequences. If the Federal Government is going to make a McDonald’s out of headspace then we all need to know exactly what is in the programmes.

In one section the Budget refers to “expanding the Early Psychosis Prevention and Intervention Centre model”. This sounds rather Clockwork Orange and I can’t really see how you can do “Early Psychosis Prevention and Intervention”. Are they saying they can prevent psychosis happening before it occurs with drugs? If so, that is a radical approach and needs further explanation.

Buried deep in the Budget is probably news of whether the Medicare Free Dental Scheme has been retained. This scheme, despite being accused of being a rort, not being means tested and experiencing serious budget blow out, is a fantastic scheme for persons with mental illness as this group experiences a disproportionate amount of dental problems. This is often due to the drugs we have to take, teeth grinding due to anxiety and also lack of money.

The scheme which allows $4,250 for dental work and dentures has never been widely promoted and requires the General Practitioner to place the person concerned on a Health Care Plan. I have lost count of the number of people with mental illness with teeth rotting in their heads who have never heard of the programme or who have found accessing it through a GP too difficult.

The lesson of the Free Dental Scheme is that whatever mental health programmes are put in place you have to promote them and also provide assistance to the person with the mental health problem to access it.