Under the 2017 NSW budget, funding for mental health services has increased by 87 million (from 1.8 to 1.9 billion). This increase in mental health funding demonstrates that the government recognises the overwhelming impact of mental health issues on our community.
However, the distribution of funding shows the government is not yet prepared to make the major changes our community urgently needs. Being is disappointed to see most new funding will flow to business as usual rather than mental health reform and early intervention.
The largest component of the new funding is over $45 million to improve hospital services. This includes $23 million, to be used to deliver increased hospital services for patients, and $22.5 million, to be used in hospital infrastructure upgrades in Port Macquarie and Campbelltown.
We are concerned that the government would devote such a large portion of new funding to the hospital system, when it is well established that people with mental health issues have better experiences when provided with care in the community. The Living Well plan, developed by the NSW Mental Health Commission and endorsed by the government, advises that hospital-based care should be a back-up only, noting “NSW remains overly reliant on hospitals in the delivery of mental health care.” However, until we start to heavily invest in community care, people will continue to need hospital services.
The budget sets aside $6.4 million to help 115 people move out of long-term hospital units back to the community. NSW has an appalling history in relation to people residing for periods longer than one year and in some instances over 20 years in institutional environments due to a lack of housing and support being available in the community. We wholeheartedly support the continuation of the investment in the Pathways to Community Living Initiative that will seek to complete the process of de-institutionalisation in NSW. This will bring full recognition of the recommendations of the 2012 NSW Ombudsman report, Denial of rights: the need to improve accommodation and support for people with psychiatric disability. We applaud this, and hope that this funding will be used not only to help with the initial transition from hospital to community, but for ongoing support to help people stay well in their communities.
Mental health reform
The 2017 budget increased funding to support mental health reform by $20 million. This brings the total spending on mental health reform to $95 million a year. While we welcome this commitment to reform, we know that the demand for good community mental health services still far outstrips the supply. Recent accounts by Mental Health Australia suggest the burden of disease for mental health and drug and alcohol misuse in Australia accounts for about 12% of the total disease burden. Mental health funding is still less than 10% of the overall budget, and not sufficient to bring the substantial changes we need to see in NSW.
For people experiencing domestic and family violence, $10 million dollars has been allocated for a new Integrated Violence Abuse and Neglect Service. This is urgently needed, and includes a commitment to psychosocial follow-up with people who use the services. This follow-up, along with education about domestic violence, is a vital part of helping people build a life free from violence.
Education and early intervention
The most noticeable gap in the funding is a commitment to education and to early intervention, despite the evidence that mental health issues should be treated before they hit crisis point. Early interventions improve the lives of people with mental health issues and their loved ones, as well as being most cost effective.
Being is particularly concerned about the impact that a continuing lack of mental health awareness and education has for some culturally and linguistically diverse (CALD) communities. CALD community members in NSW have frequently drawn our attention to the barriers they face due to lack of mental health literacy and stigma towards mental illness. Education is the first step to ensuring equity of access to services.
This absence will also impact young people, who face growing rates of mental illness. Sam Refshauge, CEO of Youth mental health organisation batyr, commented about this absence in the budget, stating: “Investment in preventative forms of education, particularly aimed at school and university aged young people, as well as the training of young people with a lived experience to tell their story of support and recovery, both have been seen to have a very positive impact on the prevalence of mental ill-health among young people aged 15 – 24”.
Being is also concerned about the continued lack of investment into TAFE, and the undervaluing of the role TAFE has. We have heard from consumers the importance of having these education pathways available as an alternative to higher education, for their affordability, wide course range and flexibility. TAFE has also been traditionally an institution who has strong support systems in place for people with disability. With this continued lack of investment from government, this will undermine the role TAFE can play as they are forced to make staff cuts and increase student fees.
Peer workers and other health professionals
It is fantastic to see the government recognising the pivotal role of peer workers in mental health recovery. In the current budget, $3.6 million will be used to fund peer workers and Aboriginal Clinical Leaders. We urge the government to continue investing in peer workers, both in hospital and community settings. In particular, we would like to see a substantial increase to the public mental health peer workforce which is severely stretched. The Local Health Districts agreement with the Ministry of Health includes a Key Performance Indicator in relation to increasing the peer workforce. Although there have been small changes to the numbers of people employed in these vital roles, the numbers are still wildly disproportionate to the numbers of clinical roles. Evidence supports that the inclusion of peer workers as part of multidisciplinary teams brings positive outcomes to consumers. The budget provides a much-welcomed commitment to growing the peer workforce and Being will continue to advocate for further investment in coming years.
We were also encouraged to see 1.1 million allocated to employ ten mental health clinical nurse educators. However, it is concerning that they will be focussed on educating new graduate and undergraduate nurses. Many practising mental health nurses receive little support or specialist mental health training, and we suggest this education should be extended to all mental health nurses.
People often talk to us about how important having a safe and secure home is to their mental health. It is well established that NSW is having a housing affordability crisis, and it is disappointing to see the budget has not done more to address this.
The budget devotes most new resources to helping first-home buyers, but provides no relief for renters. The financial strain of paying huge rent continues to cause distress to many people with mental health issues.
We frequently hear from people concerned about the NDIS and the impact on their services. Modelling suggests that up to 100,000 people in Australia may lose support services because they are not found eligible for the NDIS. This would have a devastating impact on people with mental health issues in NSW and across the country.
The federal government recognised this by allocating $80 million federally for psychosocial support for people who were not eligible for the NDIS. According to NSW Health, NSW would be eligible for $20-30 million of this funding. The current NSW budget also allocates an additional $4.8 million to enhancing psychosocial supports. Being is glad to see both federal and state governments recognise this gap, and we will continue to advocate for increased funding so no person is left without the services they need.
Being congratulates the NSW Government for a much-needed boost in mental health funding. However to people living with a mental illness in NSW this is only a drop in the ocean in regards to the need for further financial investment in services but also the investment in the cultural change required to really make our mental health support services recovery orientated and trauma informed. We will continue to work with the government towards this vision.