Patchwork system
costs everyone

Imagine a business where only 20 percent of staff time was spent servicing customers.

Or a business where up to 30% of your limited and expensive resources are needlessly exhausted.

Or indeed a business that turns away a large proportion of potential customers and sends them somewhere else.

Not a good business model - yet it’s one Australian taxpayers are paying for, and it’s costing $550-600 million every day.

All these are features of Australia’s current mental health system, outlined in stark and disappointing detail in the Productivity Commission’s report into mental health.

It’s a system that’s not meeting many people’s needs – not people living with mental health challenges, alcohol and drug problems, nor those experiencing suicidal crisis. It’s not meeting the needs of the community, clinicians and workers, and it’s not meeting the needs of governments.

Why is this so?

Because federal and state governments own and fund different patches of the system, each struggling to meet demand and needing the other to invest more, which means the system largely operates by shifting people from one patch to another.

The federal government funds the primary mental health system of GPs, private psychologists and psychiatrists through the MBS, the NDIS and some non-government services.

The state funds public community and hospital services and some non-government services for people that don’t qualify for the NDIS.

The primary care end supports people with mild-to-moderate conditions who can afford the gap, while the public hospital system treats people with acute and severe mental illness.

But there is a group in-between – it’s called ‘the missing middle’.

They’re the biggest losers in a patchwork system, because their mental health challenges can exclude them from the primary health system because they’re too complex, but not complex enough for the state system.

They regularly fall through the gaps in the patchwork of services.

State-based public mental health services end up being the default catch-all, with emergency departments the de-facto front door.

This additional pressure is exacerbated by the fact Queensland has the lowest per capita spending of any state on mental health.

Now take a system already stretched pre-COVID and overlay a pandemic-driven demand increase right across the service spectrum.

Wait times have blown out, people are struggling to access services, and when they do, often it’s too late and their mental health is far worse – putting additional pressure on the public mental health system.

So what is the answer?

Commonwealth investment is especially necessary to build a diverse range of community-based services, including for the missing middle.

The Commonwealth provided $2.3 billion last budget for mental health and suicide prevention including Head to Health community mental health centres and a temporary increase in MBS-funded private mental health sessions from 10 to 20 a year.

While this is a great start, it’s plainly insufficient when spread across eight states and territories.

In fact, funding 10-20 mental health sessions a year has actually exacerbated workforce pressures, because it hasn’t increased the number of clinicians – it’s just divided their time among fewer people, increasing wait times and frustrations for people needing support.

We need to free up clinicians and workers so they can spend more time meeting the needs of clients, rather than the needs of the system.

Most of all, we need genuine collaboration, shared responsibility and accountability between federal and state governments to address end-to-end system pressures and gaps - rather than a piecemeal approach that serves few, least of all the taxpayers and the millions of Australians let down daily by the current patchwork of services we call a system.