Mental Health. Small wins, more needed.
20 October 2019
When I was in Parliament, 4 things happened in quite rapid succession.
I was part of an inquiry into prisons and a Dept of Corrections psychiatrist who attended court to question accused people told the committee that it was much easier to get into Prison than the mental health system and that a large number of people who become homeless because they could not comply with the ‘mutual obligations’ of being unemployed and then stole for food came to the ‘Justice system’ quite inappropriately and at much greater cost that looking after them would have cost.
A psychiatrist, Dr Rachel Falk with whom I had gone through medical school approached me and said that things were very bad since the closure of the mental hospitals at Gladesvillle, Callan Park, Cumberland and Bloomfield in Orange as mentally ill people had nowhere to go.
I ran into a community mental health nurse at a youth homelessness workshop, who I had met some years before and she said that after a long weekend, she did her rounds of the parks and under the bridges to see how many of her homeless patients were still alive.
I went up the North Coast for a weekend on the beach and happened to meet a woman, who hearing I was a politician said that she had a son with schizophrenia who no one would look after and that she was sure that I as a politician would be as useless as all the others and that her son would continue to have no help from the system. She had no personal animosity to me, but she knew that that was how it was and told me pretty bluntly.
I spoke to the community mental health nurse and asked her to write me a summary of what was happening in mental health in NSW. She did so, and the heading of each paragraph became a term of reference of the Mental Health inquiry that I initiated in NSW. I got Dr Brian Pezzuti, an ex-Liberal assistant health minister to chair it, because he was politically savvy, meticulous, was retiring at the next election, and wanted to do something useful while he was still in Parliament.
I had wanted to bring the matter on before the Christmas close down and had approached the Labor Government a few times in the fortnight before, but it was small beer to them and they said that they had overlooked it and would get back to me etc. On the last day before the Christmas recess, 11/12/2001 I said to Ian Macdonald, who was managing Government business, that I was going to bring it on. He said, ‘You cannot, the Government has not taken a position on it.’ I was exasperated. I said, ‘I do not give a stuff what the Government’s position is, I have the numbers’. He looked surprised. Cross benchers do not usually speak to Government leaders like that. The government opposed me bringing it on, lost on the numbers as I had all the cross bench onside and the inquiry went ahead. Dr Brian Pezzuti did a good job and the Report came out in 2002. This added momentum and the Democrats in Federal Parliament managed to get a Select Committee into Mental Health up on 8 March 2005, which reported in 2006. After some negotiations, which were rather cumbersome on behalf of the psychologists, psychologists were put on Medicare in November 2006 under the Better Access Scheme which increased the mental health practitioners on Medicare by about 6 times as there are far more psychologists than psychiatrists. However, to keep costs down, and arguably wasting quite a lot of money, GPs are the gatekeepers and have to write a ‘Mental Health Plan’ to enable people to get to a psychologist for a limited number of visits.
It is interesting to see in the graph below the uptake of psychologists, and InPsych 2017 Vol 39, the journal of the Australian psychologists, it was hailed as great success. But Prof Anthony Jorm, writing in the ANZ Journal of Psychiatry stated last year that the Better Access Scheme had had ‘no discernible impact’, and felt that the number of sessions allowed were not enough. Certainly my experience of patients in General Practice would agree with that- the patients always ask for more. The GP Mental Health Plans are a nuisance to do and do not contribute much, though they do keep the GP informed of what is happening to his/her patients and as such are one of the few parts of the health system reinforcing the role of the GP.
So from the point of view of retired politician, it was a case of a small win, but a lot more needs to be done. Here is a graph of the use of Mental Health Services under Medicare from the Sun Herald 20/10/19, and an article about the efforts to increase mental health services. They are still very bad for psychotic illnesses, particularly due to the shortage of inpatient beds. As far as neuroses, the psychological injuries where reality contact is not lost, one could argue that the increased insecurity of housing and employment is having a far worse effect on the nation’s mental health than any number of psychologist visits could reverse.