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Targeted Mental Health Service Delivery

Estimates & Committees
Penny Wright 20 Feb 2012

Community Affairs Committee
Wednesday 15 February 2012

Senator WRIGHT: Can you tell me what types of mental illness, if any, have been identified for targeted service delivery and, if so, how were they identified?

Mr Singh: In essence, the budget package responded to our identification of people with particular needs, particularly those who have severe illness, severe persistent mental illness, including those with complex care needs. There was substantial investment in the budget through the Partners in Recovery Initiative and through the expansion of the Day to Day Living Program and the expanding of PHaMs, as well as a recognition of those people who have high-prevalence mental illness but whose symptoms are not as severe or as persistent and who therefore can benefit, for example, from expansion in the ATAPS program.

At the same time there was reflection that we need to do more to actually prevent mental illness and to intervene early. That particularly is applicable to young people, since the majority of people with mental illness develop symptoms at an early age. Again that was the focus of measures such as the additional EPPICs and the expansion to headspace.

Senator WRIGHT: In terms of the answer to that question, I was interested in whether there has been an identification of types of particular conditions or illnesses and how they can be targeted, as opposed to the need requirements, the care requirements. Coming back to my question: in terms of specific mental illnesses, shall we say, perhaps psychotic illnesses generally or even getting down to things like schizophrenia, schizoaffective disorder, bipolar disorder, personality disorders or depression et cetera, has there been an identification of meeting the needs of specific types of conditions or illnesses in that way?

Mr Singh: Given that the budget package was very much aimed at a system-wide response, I think in general we did not target individual clinical diagnoses. But it is generally true that some diagnoses tend to correspond with more severe mental illness such as psychosis and schizophrenia, for example, and depression and anxiety tend to be in the less severe end of the spectrum. But it is absolutely true that major depression and anxiety are also a very debilitating and severe mental illness. So those individuals would be able to benefit from the initial investments of budget.

Ms Huxtable: If I could add to that: when we were doing a lot of the policy development work there were probably two things to note. One is the importance of a life-span approach, starting from early childhood. You would be aware that in the package there are some early childhood measures. Mr Singh has already mentioned the importance of addressing the markers for future issues early in life, including for adolescence, and clearly the early psychosis and headspace measures are focused on providing mental health services to that group.

The second thing is this: recognising that, even though people may have what are called high-prevalence disorders and less severe ones, I think the very clear feedback we got from the sector was that people will move in and out of severity. There will be times in the course of their illness where they have very acute needs, regardless of whether they have a depressive illness or a psychotic episode. Really we were focusing on putting in place the system characteristics to enable responses regardless of the cause of that condition so that people would not be excluded from service because they were diagnosed with a particular condition, but rather the service would be able to meet their needs, which would vary in terms of level of acuity, effectively.

Senator WRIGHT: That makes sense to me. The reason I am asking is that we also know that there are some organisations devoted particularly to a particular condition or illness that receive funding. I am interested in what the thinking is or what the policy is behind deciding how those funds are allocated, because that is not just looking at particular services but at particular conditions.

Ms Huxtable: In the case of the mental health reform package, probably the only example of that that I can think of is the early psychosis intervention. That was very much based on the evidence that intervening early in that process can be effective in the longer term. That particularly focused on young people. We certainly had evidence—I do not have it in my head anymore—at the time we were doing the early development work that the markers of mental illness are being seen in adolescents definitely. If you can actually put in place a coordinated service—and with the EPPIC services you are looking at a service that is beyond a health service that also links into education and employment services and provides a service for the whole family—that can be effective in enabling them to manage their illness and recover. Clearly there will be evaluations that will be part of the EPPIC model. I do not think there is any other example of that within this particular package. That is not to say that there is not funding provided to organisations outside of that package.

Senator WRIGHT: That is my point really. I am not just focusing on the reform package; I am actually focusing on what has occurred historically and what the ongoing situation is in terms of decisions about funding particular organisations in relation to particular conditions, as opposed to services that meet perhaps a more generic need. That is what I am interested in.

Ms Halton: If I can make an observation here about the broader health-funding sector, if I can mix my descriptions of it: if you look at the history of how we have funded a number of areas—take dementia, or I could note several other areas—

Senator WRIGHT: Sorry, could you speak up a bit?

Ms Halton: You could take dementia as an example where we have both funded the specific organisation and funded the system more broadly. As Ms Huxtable says, what we really tried to do here—and I would draw a very clear parallel with what we are doing in relation to Indigenous health—is work on a philosophy that says that if you can make a material difference to the longer term outcome, particularly for younger people, you are going to have a potentially whole-of-life consequence, which is by definition a good thing. In this particular case, that is expressed in the kind of service type that Ms Huxtable has been outlining to you, but at the same time strengthening the whole system, because essentially you have people on a life course with a clinical history with a set of social circumstances—we could go on—and so you need to basically tackle both areas.

You can see this philosophy in a number of things we are doing in relation to health outcomes, investing both in the current but also in some prevention, we hope. Those are important philosophies. That does not mean that over a period, in common with the other parts of the health system, we will not necessarily target at a particular time schizophrenia or target at a particular time people with a personality disorder, whatever it might be. The thing that we really try to do here—acknowledging, of course, that the history and the challenge with mental health services and policy are to create a more integrated framework—now is create that framework and create that service delivery system. It is not easy.

Senator WRIGHT: No, it certainly is not easy. We would probably all agree with that. That segues into my next question quite well.

 

In the Supplementary Budget Estimates week, Penny Wright asked the Department of Health and Aging questions relating to the following mental health issues. Click on the links below to read the transcripts.

10 Year Roadmap for Mental Health Reform

Better Access

Targeted Mental Health Service Delivery

High Risk Groups

Mental Health Services for Regional, Rural and Remote Areas

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