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Labor's mental health plan [policy document]



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Labor’s Mental Health Plan Mark Latham MP Federal Labor Leader

Julia Gillard MP Shadow Minister for Health

CAMPAIGN 2004

AUSTRALIAN LABOR PARTY | CAMPAIGN 2004

Labor’s Mental Health Plan

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Labor’s Mental Health Plan

A Federal Labor Government will spend $100 million over the next four years to boost mental health services.

Labor believes that as a prosperous nation we must do more to deal with the burden of mental illness in our society and its costs to the people and families involved, the health care system and the economy.

Labor’s Mental Health Plan focuses on four major priorities:

■ Making mental health a government priority, not hiding it away.

■ Early intervention, especially for young people and new mothers with post-natal depression, to help people manage their mental health problems and be active members of their family and their community.

■ Community, school and workplace awareness and education, to take away stigma, help with access to training and work, and assist with early diagnosis.

■ Boosting the skills and resources of GPs, who are often the first health professionals consulted by people with mental health problems.

Every year some 20 per cent of the population experiences a mental health problem and 3 per cent of adults have a serious mental illness such as a psychotic disorder.

Mental disorders account for the biggest burden of disease for young people and startlingly so in the 15 to 24 year old age group. Actions to better address mental health can lead to a lifetime of difference for those who experience disease onset in their late teens or in their twenties.

Currently only 38 per cent of those with a mental health problem access care, and this care is largely provided by GPs.

In a Federal Labor Government, the Minister for Health will personally take responsibility for dealing with mental health as an area of policy and ensuring that mental health needs are on the health reform agenda.

The costs associated with inaction are substantial as mental illness touches the lives of more and more Australians. It impacts on the quality of life of individuals and holds them back from reaching their full potential. It can have devastating effects on families. And the costs to business and the economy are growing.

Mental health is not a side issue in health. It’s a core health issue.

Only Labor will make mental health a priority.

AUSTRALIAN LABOR PARTY | CAMPAIGN 2004

Labor’s Mental Health Plan

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Making mental health a government priority

A Federal Labor Government will provide $5.25 million over the next 4 years to establish a Prime Minister’s Council on Mental Health. This will ensure that mental health has the recognition it needs and deserves. The Council will advise Government on the range of issues that affect the mental health of the nation and people with mental illness and their families and carers.

There are now a variety of strategies to address major mental health and closely related areas. However, there remains a lack of coordination of philosophy, purpose and accountability. The PM’s Council on Mental Health will coordinate the National Mental Health Strategy, the National Suicide Prevention Strategy and the mental health aspects of the National Drug Strategy.

The Council will also enable cross portfolio coordination so that issues such as primary health care, housing, disability support, and employment and training can be addressed to the benefit of people with mental illness.

The PM’s Council on Mental Health will report to the Council of Australian Governments and advise the Australian Health Ministers’ Conference and Labor’s National Health Reform Commission.

With improved Commonwealth/State partnerships, all levels of Government will be required to report annually, through the Council on Mental Health, on mental health expenditures, outcomes, and progress against agreed benchmarks.

Three Reference Groups will provide advice to the PM’s Council on Mental Health:

■ A new Administrative Group, with an independent chair, to replace the current National Mental Health Working Group

This Administrative Group is responsible for coordination of national and state-based initiatives. The Chair, to be appointed following consultation with the States and Territories and the Mental Health Council of Australia, will be required to make an independent annual report on mental health.

■ Carers Reference Group

To provide a formalised and consistent means to ensure that carers are involved in service planning, policy development, and evaluation of services.

■ Client Reference Group

To provide a formalised and consistent means of ensuring that people with mental illness are involved in service planning, policy development, and evaluation of services.

The major national community-based groups and key professional organisations will be represented on these Reference Groups.

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Early intervention

A Federal Labor Government will spend $49.25 million over the next 4 years on early intervention programs to help new mothers with post-natal depression and young people at risk and their families.

Early intervention for mental illness, particularly those that lead to chronic disability or alcohol or substance abuse, is a high priority. The focus on young people and families will maximise the benefits of early intervention programs.

Screening and intervention programs for post-natal depression

Labor will provide $12 million to beyondblue for the development of programs to address post-natal depression (PND).

Programs to address PND will improve parenting and family function and the health and development of the children.

About one in seven new mothers suffer PND, and a small proportion of women suffer ante-natal depression. Some fathers also have PND.

Early pregnancy is an ideal time to identify and treat women with significant anxiety or depression. An important element of this initiative will be the development of guidelines for the early identification and treatment of women with PND.

Management of childhood anxiety and behavioural problems

Labor will provide $12.25 million to beyondblue to enable the expansion nationally of the Triple P - Positive Parenting Program - to assist young children at risk of developing a mental health problem and their parents.

Anxiety in preschool and primary school children is often followed by depression in teenage years.

In a recent Australian study, 11 to 15 per cent of Australian children aged 13 years or younger experienced significant mental health problems, behavioural problems, depression or anxiety.

The most important thing for children’s mental health is considered to be connection in and outside the family. School and family environments are critical.

The use of cognitive and coping skills along with parenting skills have been shown to help prevent the use of antidepressants, which remains controversial in children.

beyondblue currently runs a large-scale program in Queensland based on Triple P, targeting 30,000 children aged from 4 to 7 over a 3 year period. The ‘Every Family’ initiative takes the approach where parents, schoolteachers and GPs are taught to identify common forms of anxiety in children, especially during the transition to primary school.

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The Triple P program has been developed in Australia by Professor Matthew Sanders and his colleagues from the Parenting and Family Support Centre in the School of Psychology at the University of Queensland. Its development has taken over 20 years of research and assessment, and the program has been well tested in international research.

The aims of Triple P are:

■ To promote the independence and health of families by enhancing parents' knowledge, skills and confidence.

■ To promote the development of non-violent, protective and nurturing environments for children.

■ To promote the development, growth, health and social competencies of young children.

■ To reduce the incidence of child abuse, mental illness, behavioural problems, delinquency and homelessness.

■ To enhance the competence, resourcefulness and self-sufficiency of parents in raising their preadolescent children.

Young people at risk

Labor will provide $25 million in new funds that can be accessed by dedicated youth health centres to provide needed healthcare, mental health and substance abuse services to young clients aged from 12 to 20 years.

Such centres will be required to also provide for needs such as housing, jobs and training, and to have an emphasis on outreach, taking health services and preventative health messages to young Australians. To be eligible for support, the centres will be required to have matching state or private funds to supplement Commonwealth funding.

Community awareness and education

A Federal Labor Government will spend $9.7 million over the next 4 years on public awareness programs to educate people about the issues faced by people with mental health, and to help maintain a system where instances of human rights abuse and neglect can be reported.

National awareness and education programs

Labor will provide $9 million in funding that can be competitively accessed by groups wishing to run community and workplace education and awareness programs about mental health issues. Successful bids for such funds must have major business, employer or community groups as partners.

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Human rights abuse or neglect of people with mental illness

Labor will provide $700,000 to the Human Rights Commissioner for the maintenance of a reporting system for alleged examples of human rights abuse or neglect of people with mental illness and other disabilities.

People with mental illness are too commonly exposed to abuses or neglect, in relation to issues such as health care, housing, employment and access to community services. There is an urgent need to reinvigorate government commitment in this area.

Better assistance to primary care providers to deliver mental health services

Labor will invest an additional $36 million over the next 4 year to help GPs, who are on the frontline of patient care, address the mental health needs of their patients.

Currently there are several programs that provide GPs with resources to help them better address the needs of their patients’ mental health issues.

In Government, Labor will review these programs with the aim of providing a single system through which GPs can access the full range of needed mental health resources with a reduction in the current high levels of red tape and administration. This review will also consider the need for additional professionals to address mental health needs across Australia, and in particular, the costs and benefits of allowing psychologists to have direct access to Medicare.

Expansion of the Better Outcomes in Mental Health program

A Federal Labor Government will commit to the continued funding and support of the Better Outcomes in Mental Health Program and will boost current funding with an additional $27.5 million, a 14 per cent increase.

Doctors would like to see an expansion of this initiative. This program is meeting a pressing need - in the 18 months since it was initiated, one in seven GPs nationally have signed up and in small country towns participation is as high as 40 per cent.

This program provides:

■ Education and training for GPs.

■ Funding for an assessment, a mental health plan and a review for the patient.

■ Access to psychological and other allied health services by GP referral.

■ Psychiatric support and advice for the GP.

This program has been very successful, but is limited by the $10,000/GP cap on the program. An expansion of the program should look to expand the

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number of GPs that are trained, boost the services that they have access to, and raise the GP cap.

Telephone help line services

Labor will provide $8.5 million for 3 to 4 telephone help lines services to be specifically targeted at rural and remote areas where mental health services are scarce and not easy to access.

Such services (for patients and their families, friends and carers) currently operate in a number of areas in WA, NSW and ACT. This type of service is also particularly useful for young people who are less likely to visit a doctor.

The lines provide expert psychiatric advice and referral. Such a system can also provide support until referral can be made (in areas where resources are scarce), and follow-up after discharge.

The model has been evaluated in WA and NSW and found to be effective.

The services will operate as follows:

■ 24/7 access via a Freecall number to a trained mental health professional operating in a specialised environment.

■ The service will provide initial assessment, support, counselling and referral to mental health services.

■ There will be strong linkages back to other service providers such as GPs and community mental health teams.

■ There will be the potential to actively support callers who may have no ready access to services such as after hours or in rural settings.

AUSTRALIAN LABOR PARTY | CAMPAIGN 2004

Labor’s Mental Health Plan

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Labor’s Mental Health Plan is fully funded and costed.

$ million 2004-05 2005-06 2006-07 2007-8 Total

Mental health a Govt priority 0.75 1.5 1.5 1.5 5.25

PM Council reference groups

Early intervention 5.0 9.5 15.25 19.5 49.25

Post-natal depression

Childhood problems

Triple P Young people at risk

Community awareness & education 1.1 2.7 2.7 3.2 9.7

Awareness & education programs

HREOC anti-discrimination

Primary care providers 5.0 9.0 10.5 11.5 36

Boost BOMH

Tele hot line

Total 11.85 22.70 29.95 35.70 100.2

Printed and authorised by Tim Gartrell, 19 National Circuit, Barton ACT 2600

Labor’s Mental Health Plan

FACT SHEET 1:

The burden of mental health

Mental health is a major health issue. Mental health disorders are one of the leading causes of disability in the Australian community, accounting for nearly 30 per cent of the non-fatal disease burden1.

Every year some 20 per cent of the population experiences a mental health problem and 3 per cent of adults have a serious mental illness such as a psychotic disorder2.

Mental disorders account for the biggest burden of disease for young people and startlingly so in the 15 to 24 year old age group. At any point in time around 1 million young Australians (one in four), from all walks of life, are affected by mental illness3.

Actions to better address mental health can lead to a lifetime of difference for those who experience disease onset in their late teens or in their twenties.

Failure to address these problems will lead to a growing social and economic cost to the Australian community.

Currently only 38 per cent of those with a mental health problem access care, with that care largely provided by GPs. The decline in bulk billing is placing even further pressure on even this most basic form of mental and physical health care for people with mental disorders. Too often these people get a prescription but no further help. Both doctor and patient are left struggling.

The stigma, discrimination and misunderstanding associated with mental illness is still far too pervasive in our community, and too often those affected are alienated from society and unable to access needed assistance for health care, housing, employment and support.

Services for people with mental illness are provided through a range of health and welfare programs funded by the Commonwealth, State and Territory Governments, private health insurance and by individual co-payments.

Mental health is clearly an area that would benefit from better Commonwealth/State partnerships and from the better coordination of health care services.

1 Australian Institute of Health and Welfare figures, cited in Out of Hospital, Out of Mind. 2 National Survey of Mental Health and Wellbeing, ABS. 3

Youth Mental Health Coalition fact sheet.

AUSTRALIAN LABOR PARTY | CAMPAIGN 2004

Labor’s Mental Health Plan - Fact Sheets

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FACT SHEET 2:

Mental health and young Australians

Negotiating the route from childhood to adulthood is never easy, and recent data highlights the problems and pitfalls that beset children and adolescents.

■ 20 per cent of adolescents report anxiety and depression.

■ 12 per cent report antisocial or under-controlled behaviour.

■ 12 per cent of adolescents have thoughts of suicide; this rises to 42 per cent of those with severe problems.

These trends are being seen earlier, in children aged 4 to 12, and continue through to adulthood. Mental illness is a major public health problem, and in Australia depression is now the biggest cause of non-fatal disability.

There are strong links between mental health problems and abuse of alcohol, tobacco and other substances. This link starts in childhood and adolescence.

■ The most risky drinking behaviours are found in the under 25 age group.

■ The biggest increase in heroin use is seen in the 15-24 year old age group with 7 in every 1,000 Australians in this age group using heroin daily; heroin use is often preceded by binge drinking.

■ Around 30 per cent of young people in this age group smoke.

Additionally, eating disorders are prevalent; some 2.5 per cent of young women suffer from anorexia or bulimia and a much higher percentage of both male and female teenagers have attempted at least one form of potentially dangerous weight reduction (starvation, vomiting, laxatives). There is also a high rate of death and injury from motor vehicle accidents, often linked to drink driving and high-risk behaviour.

These issues are not confined to any particular socio-economic or geographical group, although those from broken homes and the unemployed are considered at greater risk. Young people in isolated and rural communities, especially those who are Aboriginal or Torres Strait Islanders are also at high risk.

With the substantial impact that these health and lifestyle problems have on education, the ability to hold a job, early pregnancy, and overall quality of life, it is therefore shocking to realise that at least a quarter of those with mental health and substance abuse problems never receive professional help. The failure of these young people to effectively engage the health services also has an impact on their physical health.

To a large extent this failure to seek help is due to the lack of accessible and appropriate resources and also the stigma attached to admitting problems with mental health and substance abuse.

Labor acknowledges the need for special efforts in this area and will work to deliver them effectively.

AUSTRALIAN LABOR PARTY | CAMPAIGN 2004

Labor’s Mental Health Plan - Fact Sheets

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FACT SHEET 3

Some examples of programs for children and youth at risk

Triple P

Anxiety in preschool and primary school children is often followed by depression in teenage years.

In a recent Australian study, 11 to 15 per cent of Australian children aged 13 years or younger experienced significant mental health problems, behavioural problems, depression or anxiety.

The most important thing for children’s mental health is seen as connection in and outside the family. School and family environments are critical.

The use of cognitive and coping skills along with parenting skills have been shown to help prevent the use of antidepressants, which remains controversial in children.

The Triple P program has been developed in Australia by Professor Matthew Sanders and his colleagues from the Parenting and Family Support Centre in the School of Psychology at the University of Queensland. Its development has taken over 20 years of research and assessment, and the program has been well tested in international research.

The aims of Triple P are:

■ To promote the independence and health of families by enhancing parents' knowledge, skills and confidence.

■ To promote the development of non-violent, protective and nurturing environments for children.

■ To promote the development, growth, health and social competencies of young children.

■ To reduce the incidence of child abuse, mental illness, behavioural problems, delinquency and homelessness.

■ To enhance the competence, resourcefulness and self-sufficiency of parents in raising their preadolescent children.

Clockwork: Time for Young People

The Clockwork program operates in Geelong in Victoria. It is an early intervention program which targets young people aged between 12 and 19 living independently or who are homeless, and with a history of child abuse or family conflict. Most have mental health concerns.

The aim of the project is to provide a comprehensive, multidisciplinary health service for young people who would not normally seek health care. This also involves improving GP knowledge on young people’s health and mental health issues, and encouraging the integration of general practice with other youth services.

AUSTRALIAN LABOR PARTY | CAMPAIGN 2004

Labor’s Mental Health Plan - Fact Sheets

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Within the Clockwork program there are a number of elements that support GPs:

■ Clockwork GP shared care project which helps GPs to work with other professionals to manage complex issues such as child abuse, homelessness, sexual health issues, depression and drug and alcohol abuse.

■ Clockwork GP practice support through resources available to GPs in their private practices.

■ Clockwork GP education which encompasses a variety of formats, including workshops, a newsletter, and practice guidelines.

■ GP special interest groups.

Clockwork also runs programs for young people that include:

■ Groups for young people at risk of leaving home or school on anger management, grief and self esteem.

■ Art therapy.

■ A group for young mothers with post natal depression.

■ Information sessions for parents in crisis.

■ Community forums for parents and teachers on adolescent depression.

Clockwork is co-located with other youth services to facilitate the provision of jobs, accommodation and drug and alcohol services to the target population.

Orygen Youth Health

Orygen Youth Health runs a youth specific health service for people in the eastern and north western metropolitan areas of Melbourne. An early intervention approach is used to minimise the impact which mental illness can have on a young person’s learning, growth and development.

A comprehensive range of services is offered including assessment, treatment for depression, eating disorders and psychosis, and education and training.

The work of the Orygen Research Centre, which conducts clinical research on the treatment and management of mental illness, is integrated into the services provided.

There are a variety of programs around Australia which look to address the mental health needs of children and youth in a holistic way. These are just a few examples.

Printed and authorised by Tim Gartrell, 19 National Circuit, Barton ACT 2600