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Launching the Coalition’s policy for Efficient Mental Health Research and Services late last week, Tony Abbott said he wished all his policy statements attracted such media attention.

Given the Australian community’s demonstrated engagement with mental health, it’s more surprising that we’ve heard so little about it in this election campaign.

Abbott’s commitment is modest; it matches the Rudd government’s announcement late on Thursday to expand the number of new headspace services from 90 to 100 sites nationally. Headspace is targeted at engaging people aged between 12 and 25 years, with emerging mental health problems.

But Abbott went further, promising A$18m for a new national centre for excellence in youth health and A$5m for a comprehensive e-mental health platform in partnership with the Young & Well Cooperative Research Centre. Australia has been a world leader in developing tools to help self-manage mental health problems with the internet.Abbott also explicitly said there would be no subsequent cuts to mental health funding.

The Rudd government announced funds of A$34m for more headspace centres; A$9m to expand LifeLine’s services and A$40m for workplace mental health initiatives.

The Greens have the only mental health policy with substantial financial investment, with a total of A$1.1 billion in new commitments. The money is split between rural mental health initiatives (A$552.6m) and broader investments (A$547.4m) in mental health nurses, research, psychological care, and suicide prevention.

But why have the two major parties missed the opportunity to impress the Australian electorate with decent investment in mental health? An international survey by King’s College in 2010 showed Australians were most concerned by four big issues – the economy, climate change, mental health and ageing.
What happened before

In contrast with the last few weeks, the 2010 election campaign saw considerable emphasis on mental health. Back then, Tony Abbott led the charge, promising to spend A$1.5 billion on a comprehensive program of early intervention specialist services for young Australians.

Former prime minister Julia Gillard nominated mental health as a second-term priority for her government and appointed Mark Butler to represent both mental health and ageing (later upgrading the position to cabinet).

The Gillard government also established the National Mental Health Commission and had COAG consider developing national targets and a ten-year road map for reform. Most importantly, it committed A$2.2 billion over five years to a new suite of service initiatives, focusing both on people with established illness and enhancing early intervention services for young people.

But after protracted Commonwealth-state negotiations, no new early psychosis intervention centre has yet opened.

The challenge for the next government is to get beyond the simplistic belief that goodwill alone can deliver mental health reform or effective suicide prevention. Sunghwan Yoon

Ongoing divided responsibilities and arguments about who should foot the bill for reform lie at the heart of our current difficulties.

The capacity of headspace youth services to build sustainable service platforms that are effectively linked with state-based emergency and specialist services is yet to be demonstrated.

Indeed, headspace services remain desperately short of professional, peer- and family-based workforces. And of the suite of funding mechanisms needed to deliver appropriate medical, psychological, specialist and vocational services.

E-mental health remains a cottage industry, despite its capacity to reach many people who choose to not engage with traditional services. Specialist mental health services delivered in the community by state governments are likely to suffer further as new activity-based funding mechanisms push most new cash back into hospitals from 2014/15.
What needs to happen

While mental health enjoys bipartisan support at the highest political levels, it is running the risk of once again being seriously neglected.

By contrast, other areas of health are attracting new funding commitments. During this election campaign, think Labor’s promise of a hospital rebuild in Western Sydney and new cancer care initiatives, and the Liberal Party’s investment of A$200m for dementia research and enhanced support for access to medicines.

It appears that both parties have now ticked off mental health for this election without feeling any great need to invest new funds.

At least, the Coalition’s announcement contains the hint that it may be interested in a more radical overhaul of existing arrangements. This is an area where the first Rudd government really dropped the ball. Specifically, during the 2010 health reform negotiations, it failed to take the opportunity to fund community mental health.

Tony Abbott has suggested the National Mental Health Commission be asked to review the effectiveness of existing programs. This follows calls from across the sector for a productivity commission-style investigation of the divided funding and service provision arrangements between the commonwealth, states, and the community sector, which result in many people receiving either duplicated services or no services at all!

The challenge for the next government is to get beyond the simplistic belief that goodwill alone can deliver mental health reform or effective suicide prevention.

There are solutions but they will require redirection of existing funds and new monies; early intervention can be transformative and e-health has great possibilities. But change will require commonwealth-state cooperation and coordination, and annual independent reporting of outcomes.

Most importantly, a commitment to expand community-based, rather than hospital-based, services is fundamental.

Over the next three years, the performance of our next government should be judged not on the basis of the lean promises of this election campaign but on its capacity to implement genuine reform in this key area of health, economic and social policy.

Author
Ian Hickie

Professor of Psychiatry at University of Sydney

Disclosure Statement

Ian Hickie is a NHMRC Senior Principal Research Fellow. His work has been funded by a variety of research councils, philanthropic support and investigator-led research studies funded by the pharmaceutical companies. He is Executive Director of the Brain & Mind Research Institute (BMRI), University of Sydney. The BMRI operates two Headspace Centres in Central Sydney and Campbelltown, NSW and is a member of the Young and Well CRC. He is also a Commissioner in the Australian National Mental Health Commission.

Victoria's shameful child abuse farce

The worst-affected area was Loddon-Mallee with 58 files closed between January 2008 and March 2010 reopened within three months after abuse allegations were proved. Source: The Australian

MORE than 400 vulnerable children were exposed to further sexual or physical abuse within three months of their cases being closed by bungling child protection bureaucrats.

In a shocking revelation, Freedom of Information documents show Department of Human Services management is putting children at risk of further violence as over-stretched staff battle to juggle a growing workload.

Documents seen by the Herald Sun show 408 cases in the past two years where child protection workers closed files on children as nothing could be substantiated - only to reopen them within 90 days after abuse or neglect claims were confirmed.

The worst-affected area was Loddon-Mallee with 58 files closed between January 2008 and March 2010 reopened within three months after abuse allegations were proved.

The public service union, which represents child protection staff, has consistently maintained DHS management is obsessed with closing files to meet internal targets.

"Without more resources and caps on caseloads, child protection workers are being forced to choose one neglected or abused child over another," union assistant secretary Jim Walton said.

The revelation comes after a radical call from former Victorian ombudsman Norman Geschke for parents with a history of child abuse to have forced sterilisations.

Opposition community services spokeswoman Mary Wooldridge said the FoI data confirmed Victoria's child protection system was in crisis.

"Children who have been reported to the government have been left in abusive homes instead of getting the care and protection they need from the incompetent Brumby Government," she said.

The revelation is the latest in a long list of bungles overseen by Community Services Minister Lisa Neville.

Ms Neville said child protection workers took action as soon as new allegations or new evidence was available.

"Child protection is an extremely challenging and complex area of work and allegations are often difficult to substantiate for a raft of reasons," she said.

Mental health a second-term priority, says Gillard

Prime Minister Julia Gillard says she will make mental health a second-term priority for a re-elected Labor Government, promising an immediate boost of $277 million for suicide prevention measures.

The announcement is an effort to heal a sore spot for Labor, which has been criticised by mental health experts, including Australian of the Year Patrick McGorry, for a lack of spending in the area.

Ms Gillard said the package of suicide prevention measures would include more for frontline services, crisis prevention, services targeting men and services targeting young people.

Former NSW opposition leader John Brogden and Prime Minister Julia Gillard in Brisbane today. Photo: Andrew Meares

''A first-class health system means dignity and it means peace of mind,'' she told an economic conference in Brisbane this morning.

''Mental illness is a place where quality services can make a real difference to people's lives, indeed it can save lives.''

The plan would include psychological counselling services for 12,500 people who have attempted suicide or are at risk of suicide, 20,000 specialist psychiatry sessions for people with severe mental illness and funding to provide a respite for careers of mentally ill people.

Other measures include making calls from mobiles to Lifeline free and shoring up safety measures at notorious suicide spots like The Gap in Sydney.

Ms Gillard said if re-elected she would also make mental health a ''second-term priority' including more funding for youth mental health services and developing long-term plans for the sector.

The coalition recently promised $1.5 billion towards mental health services.

The prime minister said she had been made acutely aware of mental-health issues by her father, a psychiatric nurse, who had taught her illness of the mind was as tough as illness of the lungs and the heart.

Ms Gillard also used the speech to criticise opposition leader Tony Abbott's record as health minister in the Howard government saying he had invested his energy in shifting blame to state health services instead of investing in new services himself.

She was joined at the announcement by Health Minister Nicola Roxon and former NSW Liberal leader John Brogden, who attempted sucide in 2005 and is now a board member of Lifeline.

After a tough few days on the campaign trail, Ms Gillard has returned to safe ground for Labor by promoting health policy.

It is the second day of health promises from Labor after Ms Gillard yesterday pledged $96 million for emergency medicine.

Ms Gillard will campaign in Queensland for most of the day.

She has already announced $742 million in funding for a new Moreton Bay train line servicing the marginal electorate of Petrie, which Labor holds by 4.2 per cent.

New Membership Categorisation for the Australian Counselling Association

Extract from the ACA Website,

Thank you for your interest in joining the association, the following explains the mission and criteria of the association. Please do not hesitate to phone us if there are any points that need clarifying or do not fully explain to your satisfaction what is required.

The Australian Counselling Association (ACA) fulfils a critical role within the counselling industry - as will your involvement in the Association. The primary aims and functions of the Australian Counselling Association are: -

To provide a single unified voice for the counselling industry.
To provide a consistent Code of Ethics and set of Practitioner Standards for counsellors.
To establish a national complaints tribunal.
To assess, review and approve counsellor education courses.
To maintain a national register of practicing counsellors.
To lobby on behalf of its membership to government and industry for the betterment of the profession.
To make the general public at large more aware of the counselling profession and the availability of reputable counsellors.
To create employment opportunities for our members wherever possible.

Level One
Has graduated from an ACA Accredited Course of study at minimum Diploma Level.

Completes 25 Points of ACA approved Ongoing Professional Development per annum.

Completes 10 hours Professional Supervision per annum.

Level Two

Has graduated from an ACA Accredited Course of study at minimum Diploma Level and has a minimum of 2 years post-Diploma professional experience; or 1 year post-Diploma plus Vocational Graduate professional experience; and has completed a minimum of 50 hours Professional Supervision.

OR,

Has graduated from an ACA Accredited Course of study at minimum Degree Level.

AND,

Completes 10 hours Professional Supervision per annum.

Completes 25 Points of ACA approved Ongoing Professional Development per annum.

Level Three

Has graduated from an ACA Accredited Course of study at minimum Degree Level.

Has a minimum 3 years post qualification counselling experience, including minimum 750 client contact hours.

Has completed a minimum of 75 hours Professional Supervision and completes 10 hours Professional Supervision per annum.

Completes 25 Points of ACA approved Ongoing Professional Development per annum.

Level Four

Has graduated from an ACA Accredited Course of study at minimum Degree Level.

Has a minimum of 6 years post qualification counselling experience, including minimum 1,000 client contact hours.

Has completed a minimum of 100 hours Professional Supervision and completes 10 hours Professional Supervision per annum.

Completes 25 Points of ACA approved Ongoing Professional Development per annum.

Student

Student Membership is for persons undertaking an ACA Accredited Course of study at a minimum Diploma level. Student Members should not practice counselling except under the auspice of an ACA Accredited Course of training.

Associate

Associate members are members who have an interest in counselling, however do not practice therapy. Any non practicing individual may apply for this category.

Social workers fear for mentally ill clients

SOCIAL workers are outraged at a federal government decision to cease Medicare payments for mentally ill people who see them, claiming it will prevent vulnerable clients from accessing care.

The decision, announced in last week's budget, will affect mainly low-income people who can't afford to see psychologists.

Under sweeping changes announced by the Howard government in 2006, people with mental illnesses could for the first time receive payments from Medicare for seeing psychologists and social workers.

But more than 1100 social workers who were accredited under the program will be excluded from July. The social workers provided 121,540 sessions in 2008-09 at a cost of $9 million.

The government says it is redirecting funding to GP networks to co-ordinate care for people with severe mental illness.

But social workers have been left reeling by the cancellation of what they say is a successful early-intervention program set up to ease pressure on the mental health system.

Peter Keil in 2007 set up the only bulk billing counselling practice in Bendigo and with two colleagues now provides about 150 sessions for 80 clients each month.

His clients, who see him for an average of six sessions, have conditions including anxiety, depression, post-traumatic stress disorder, and anger management problems linked to substance abuse.

Mr Keil, who has 20 years' experience as a social worker, said the Better Access program was designed for people who couldn't normally afford mental health interventions and there was ''no evidence that need has dissipated''.

He said the only other option for his clients would be to see a psychologist, paying $100 to $160 a session before claiming some of the money back from Medicare, usually leaving them anywhere from $20 to $60 out of pocket.

''People struggle to put petrol in the car to come and see me. If I were to ask them for $20 a time they just wouldn't come,'' he said.

Mr Keil said social workers at his practice were able to see clients within about a week - but the waiting list for publicly funded counselling in Bendigo was about eight weeks, which would only worsen once Medicare rebates were cancelled for his service.

''Shifting to the GP sector simply means that people who have major and highly disabling mental health problems will be able to go to the GP and get some help,'' Mr Keil said.

''But that's the whole point. What happened to preventative mental health?''

St Kilda social worker Danielle Elisha, who works with a GP in a small medical clinic, said: ''I can't think of a client who doesn't also have a social issue like drug and alcohol addiction, homelessness, financial problems or domestic violence.''

''There's no one out there to deal with these issues, as well as the mental illness.''

Health Minister Nicola Roxon said redirecting funding to provide care for people with severe mental illness would ''deliver co-ordinated mental health care to those most in need in our community, rather than treatment on an ad hoc basis.

''The services social workers provide to the community are valued.

''This measure is about using and funding those services in a different way.''

Abused children face long wait for counselling

Traumatised young children who have been sexually abused are in some cases waiting up to five months for counselling because of a funding shortage for these specialised services.

The Age is aware of a girl, 6, sexually abused by a relative, who has been on a waiting list for counselling at the Children's Protection Society since November. The organisation says she will have to wait for one more month.

Three other children - all aged three - have been waiting for three months.

Children's Protection Society chief executive Bernadette Burchell says that for children under 12, the waiting list for sexual abuse counselling at the organisation is on average 159 days. Fifteen children are on the waiting list.

Only a handful of organisations provide state government-funded counselling for sexually abused children under 12, and waiting times differ. The Children's Protection Society provides services for the north-eastern region, including the cities of Yarra, Darebin, Whittlesea, Nillumbik and Banyule.

Ms Burchell said in the case of the six-year-old, the wait for help had exacerbated her symptoms. ''She's had things like bed-wetting, anxiety, nightmares, separation anxiety from her mother, all these sorts of symptoms that are getting in the way of her getting on with primary school and life,'' she said.

''We've made a couple of phone calls to mum to see how things are going but nothing really more than that. The symptoms haven't abated.''

It is another sign of a system under pressure and under-resourced. Last year, the organisation had to close its books for a time to new referrals needing family support services.

The most recent figures from the Australian Institute of Health and Welfare indicate that in 2008-09, about 450 proven cases of child abuse in Victoria involved sexual abuse.

But Ms Burchell said it was still a very hidden problem and the number of children affected was likely to be much higher. When children had to wait for help, their symptoms became entrenched.

''Everything becomes larger and harder to deal with,'' she said. ''Childhood abuse and sexual abuse are writ very large as contributing to the sort of trauma that leads to later-life issues.''

A spokeswoman for Community Services Minister Lisa Neville said the average waiting time across Victoria was 28 days for children up to 17, and younger children were given priority.

She said other agencies in the region of the Children's Protection Society had waiting times of up to five days and could see young children.

Anyone concerned that they were waiting too long should contact the department, which would put them in touch with another agency.

At the Royal Children's Hospital's Gatehouse Centre for the Assessment and Treatment of Child Abuse, children can wait up to 12 weeks, depending on urgency.

A spokeswoman said the hospital provided acute crisis care and longer-term counselling. All children who might have been sexually assaulted were assessed, and all urgent cases were seen immediately.

''Patients who have been assessed as not requiring crisis care are placed on a priority wait list and could be seen the next day,'' she said. ''Other patients are seen within 12 weeks. We do everything we can to ensure that children are seen as soon as possible.''

The Australian Childhood Foundation, which provides counselling for sexually abused children in the eastern suburbs, had a waiting time of 12 to 14 weeks late last year and has reduced this to about one month since recently receiving more funding from the state government. The foundation's chief executive, Joe Tucci, said children should not wait longer than a month.

''Anything that goes longer than four weeks you're really starting to extend the impacts of the trauma,'' he said.

South Eastern Centre Against Sexual Assault also has a waiting time of four weeks for children under 12.

www.psyence.com.au