A nine-day stay in a hospital mental health unit costs the same as community program supporting someone at home for a year.
That is one of the major justifications authors of the National Mental Health Review have used to suggest moving funding from hospitals to community health.
A full copy of the review produced for the Federal Government has been published online.
The report by the National Mental Health Commission recommends a major overhaul of how the Commonwealth funds the sector.
Leaked versions of the document released earlier this week suggested setting a target to reduce suicides by half.
Overall, there would be no reduction in mental health funding.
But one of the report’s key recommendations is that part of the growth in hospital funding, totalling $1 billion, would be redirected to community health programs to keep people out of hospitals.
It notes it costs on average $10,000 for a nine-day stay in hospital, and this amount of money would enable a community health service to support a person for one year.
The report also says there is evidence that “far too many people” suffer worse mental and physical health because of the treatment that they receive “or are condemned to ongoing cycles of avoidable treatment and medications, including avoidable involuntary seclusion and restraint”.
Programs, it notes, are not set up to promote early intervention, and people need to inflict serious physical harm to gain access to support.
Australia is ranked second in OECD for anti-depressant consumption, while use of anti-psychotics had more than doubled.
The review raises concerns about a “missing middle” of people who fall through the gap between GP and hospital care.
Organisations not using money well
The report suggests that the current model favours non-government organisations such as the widely-respected Headspace, but that such groups do not always using the money effectively.
The report calls the current system a “collection of often uncoordinated services that have accumulated spasmodically over time, with no clarity of roles and responsibilities or strategic approach that is reflected in practise.”
It states that Headspace, which provides mental health services for people aged 12 to 25, has become too “overly centralised”, with “rigid management requirements imposed on local services”.
It raises the concern that a “one-size-fits-all, shopfront-oriented approach” doesn’t meet the needs of some communities or people from diverse groups, including those with “more complex or ongoing difficulties”.
The Government has committed to expand to a total of 100 Headspace services by next year, and more than $400 million has been committed to Headspace over the five years from 2013-14.
The Commission recommends that the Commonwealth give power and money to Primary Health Networks to manage the contracts options for non-government organisations, like Headspace, at a local and regional level.
Report not about hospital cuts: Hickie
One of the report’s authors, mental health commissioner Professor Ian Hickie, said the recommendations did not support closing hospital beds or emergency services.
“By contrast, they focus on actions that the Federal Government can enact today to start to build the delivery of effective services for mental illness and suicide prevention in the 60 major regions of Australia,” Professor Hickie said.
“The big winners would be those living in rural and regional Australia who suffer most from the current lack of effective community and professional services in their own local areas.
“The report also challenges health professionals to work in real partnership with communities and those people and families most affected.”
He is urging the Government to respond quickly to the recommendations.
“We do not need to get lost in the intricacies of COAG,” Professor Hickie said.
“What the community expects now, particularly in the area of suicide prevention, is for the Commonwealth to take direct action, particularly in rural and regional Australia.
“People are dying every day in rural and regional Australia due to a lack of coordination of out of hospital services, much of which is under direct Commonwealth control.
“It’s the Commonwealth that funds largely suicide prevention, primary care and all these non-government organisations.
“It’s not an issue for state hospitals. It’s direction within the power of the Commonwealth Minister.
“And that’s why [former Health minister] Minister [Peter] Dutton requested specific advice from the Commission.”
Federal Health Minister Sussan Ley will discuss mental health funding when state and territory health ministers meet.