Mental Health from the 2024 Budget
By now you will have heard some of the detail about the Budget announcements last Tuesday evening, and perhaps heard or read about some of the detail about mental health initiatives from the Hon Minister Butler, the Health Minister and Assistant Minister McBride.
There is so much hype, expectation, rhetoric, and sometimes disappointment around these processes. This complex process is often one where competing agendas and issues collide, with ‘winners and losers’. For many of us in the community, we pick ourselves up, dust ourselves off, and just get on with it. Reform is such a slow process, after all.
There have been many new initiatives that have come and gone and some which have stayed, with various band-aids planned to help make them better….hopefully.
Rather than provide you only with a list of the various key announced funding measures in the budget, we thought you might appreciate a little of our sense of what it means, where we think it represents some progress and what remains to be addressed.
A National Peer Workforce Association
For LEA, the announcement of funding to establish a National Peer Workforce Association is a joyful standout.
We undertook a significant national mapping project on Professionalisation of the Peer Workforce and literature review in 2018 and 2019 that were seminal in informing the National Peer Workforce Guidelines.
This work and the significant broader advocacy from us, our fellow Lived Experience advocacy organisations and the many allies, was crucial in prompting the 2020 Productivity Commission to strongly recommend the establishment of national peer workforce organisation.
LEA is currently undertaking an international evidence review for the Department of Health on evaluated peer workforce models that will provide the most current evidence for peer work effectiveness and integration, including the many enablers and challenges that remain.
Many of the challenges that this workforce has faced and continues to face include issues like training, supervision, career progression, professional development, staff resources and retention, non-peer service cultures, and so forth. Whilst huge progress has been made, many of these issues have been slow to change across the past 20 years!
With the promised announcement by the Department of Health of further work on the national Consumer and Carer Peaks, and the steps to realise this National Association, the structures to make real progress to overcome these barriers may finally be realised.
It is going to be a significant year ahead.
Low Intensity Services / More Urgent Mental Health Centres etc
The other announced initiatives are likely to be received with uncertainty.
They are aimed at the ‘structures’ in which our mental health services system sits, ie. the scaffolding that influences who goes where and what support they get when they get there, to make sure it suits the need and doesn’t create waste and unequal access. The first thing we note is how profoundly ‘medical’ these initiatives seem.
We also note how reliant they are on people ‘going to’ services to seek help. This is fine for people who can do that, but many of us know that mental health isn’t always like that.
The reforms proposed aim to address inequities that had become apparent in the Medicare Better Access system in which GP’s primary available response was to refer people to a psychologist for therapy, even if not everyone needed this level of care. That step in the mental health system had become ‘all things to all people’ whether they needed this level and type of support or not.
So new initiatives like the proposed Low Intensity CBT digital services will attempt to provide an earlier and different step, complimented with self-directed tools that the person can use at their own pace. That way, people with more severe distress or mental health concerns are the priority for the more specialist mental health services. Early intervention services sound great in theory, the practicality is that only 150,000 people will be able to access this service. This is only 0.5% of the population of Australia.
However, a social determinants lens is missing here, and initiatives that help build strong community relationships between people to help themselves and each other, beyond the medicalised system.
The announced initiative to increase available housing and address homelessness, to provide income and energy bill relief, hold pharmacy prescription costs, and address domestic and family violence (DFV) are welcome, but much more is needed to prevent the conditions which can lead to trauma and mental ill-health in the first place.
As Sir Michael Marmot said, why treat people but then send them back to the conditions that make them sick?
And this leads us to a most significant gap in this suite of budget initiatives – investment in the community supports for the many people with more severe mental health challenges and psychosocial disability who do not have access to NDIS. The government has assured us that the national analysis report on ‘Unmet Needs’ is coming and that the Foundational Supports mentioned by the NDIS Review that state and federal governments will have responsibility for providing together, are coming.
So, while there continues to be investment ironically in more short-term ‘therapies’ and more doors and buildings to receive people in distress and crisis, we are yet to see the investment in tangible ongoing community supports that can walk alongside the many people who need them, and the families, carers and kin who support them.
Health related funding announcements summarised
The Department of Health and Aged Care have released a downloadable 'Health Stakeholder Pack'. We offer a brief summary of the key points contained in it below.
$588.5 million over eight years from 2024–25 (and $113.4 million per year ongoing) to establish a national low intensity digital mental health service based off the UK “talking therapies” model. This service will provide access to staff trained in evidence-based therapies, as well as tools and resources. The Government estimates around 150,000 Australians will use this ‘early intervention’ service each year. A new national early intervention service will provide access to someone trained in evidence-based therapies, who can provide safe and high-quality care to get people through whatever is troubling them. Others will benefit from a bit of coaching or advice, and to be given the tools and resources they need to work through things, at their own pace and in their own time.
$71.7 million over four years from 2024–25 (and $24.4 million per year ongoing) for Primary Health Networks (PHNs), in partnership with GPs, to commission wrap around care for people with severe and/or complex needs in primary care settings.
$29.9 million over four years from 2024–25 to uplift Head to Health services to expand access to free community based mental health services for adults with moderate to severe mental health needs. Medicare Mental Health Centres will be built on the established Head to Health network, which will have their clinical capability upgraded to ensure that every centre can provide free access to a psychologist and psychiatrist, as part of a multidisciplinary team. The Government has committed that the network of 61 Medicare Mental Health Centres will be opened by the middle of 2026. They will have their clinical capability upgraded to ensure every centre has psychiatrists, psychologists and GPs on call.
At least 30 of the 61 Medicare Mental Health Centres will be in rural and regional Australia. These will offer free, walk-in access to healthcare professionals for adults with complex and high mental health needs.
$29.7 million over three years from 2024–25 to improve child and youth mental health services through uplifting workforce capability and co-designing new models of care.
$7.1 million over four years from 2024–25 to build and support the lived experience peer mental health workforce, through the establishment of a national professional association for peer workers, delivery of a workforce census and exploration of further training pathways.
$12.8 million over four years from 2024–25 to extend the Indigenous Youth Connection to Culture program which supports First Nations youth in 12 communities through place-based activities to reduce suicide rates and improve mental health outcomes. $10.0 million in 2024–25 to maintain funding to deliver targeted and culturally appropriate mental health supports for First Nations Australians, delivered by the National Aboriginal Community Controlled Health Organisation (NACCHO).
$3 billion to strengthen the pharmacy sector and keep medicines cheaper by implementing a one-year freeze on the maximum cost of a Pharmaceutical Benefits Scheme (PBS) prescription for everyone with a Medicare card and up to a 5-year freeze for pensioners and other Commonwealth concession cardholders ($318m). For concessional cardholders there will be a 5-year freeze ensuring PBS medicines remain at $7.70. For general patients there will only be a 1-year freeze of the current maximum price of $31.60. Medicines for mental health are consistently in the top 10 dispensed PBS medicines in Australia. Whilst the freeze on price hikes is welcome, the fact that for general patients it will only be frozen for 1 year, rather than 5, will further spread the divide. In addition, from the 1st July the $1 discount available for PBS medicines will be phased out each year, until the discount is zero, causing the cost of some PBS medicines to increase.
$35.9 million over four years from 2024–25 to extend terminating mental health measures (e.g. such as those provided in disaster affected communities), to enhance the delivery of mental health and suicide prevention services and to provide greater funding certainty for service providers.
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