Stephen Carbone, Prevention United
The recent Royal Commission into Victoria’s Mental Health System uncovered a system in crisis. In its interim report, the Commission stated that, “once admired as the most progressive in our nation, the state’s mental health system has catastrophically failed to live up to expectations”. The Commission found that the system was underfunded, overstretched, and crisis driven. Stigma and discrimination were widespread, service access was inequitable, and people experienced significant difficulties getting help. Moreover, integration was lacking, holistic care was hard to find, trauma was unseen, and dignity was too often disregarded. Families and carers were also missing out.
The Commission also noted that not enough was being done to keep people mentally healthy and prevent mental health conditions from occurring in the first place wherever possible. In response, the Royal Commission proposed a total overhaul and made a total of 65 recommendations.
To its credit, the Andrews Government accepted the Commission’s findings and committed to implementing all its recommendations in full. In its 2021-2022 Budget the Andrews Government allocated $3.8 billion over four years, to kick start reform of the mental health system. Funding in that Budget was targeted to a range of issues including improved governance, more community-based and bed-based services, and suicide prevention.
This year expectations were high that mental health spending would continue to increase to make up the massive shortfall in mental health funding identified by the Royal Commission. The 2022-2023 Victorian Budget includes a further investment of $1.3 billion over four years to fix the system.
The lion’s share of this funding is directed to bed-based services with $413.1m over four years allocated to increase the number of acute mental health beds in metropolitan and regional areas, and a further $61.1m over four years to improve patient safety. The other big focus ($371.5m) is on strengthening and supporting the mental health and wellbeing workforce through a variety of initiatives such as scholarships, more training and graduate positions, and an overseas recruitment drive. This is critical, as staffing shortages will clearly limit the ability to provide more services.
There is also a strong focus on improving services for people experiencing co-occurring mental health and alcohol and other drug difficulties. Additionally, there is a variety of other smaller initiatives such as improved electronic medical records, improvements in forensic mental health services and funding to progress planning for two co-designed social and emotional wellbeing healing centres.
While all these initiatives are welcomed, critics point to the lack of funding to grow the lived and living experience (LLE) workforce and the lack of focus on carers and families in the Budget. Another major gap we’ve identified relates to the promotion of mental wellbeing and the primary prevention of mental health conditions.
The Royal Commission emphasised the importance of focusing more attention on these issues and made four key recommendations, including:
- The establishment of a Mental Health and Wellbeing Promotion Office with the Department of Health (which is occurring)
- Funding for school-based and workplace-based mental health promotion initiatives, and
- The creation of Community Collectives in each of the State’s 79 Local Government Areas to tackle social isolation and social exclusion through place-based community mobilisation approaches and social prescribing.
While the 2022-2023 Budget does provide $30.1m over four years to establish 10 new ‘social inclusion action groups’ – the new name for Community Collectives – this is well short of the 79 recommended by the Royal Commission. Moreover, while there is some further funding for school-based mental health programs, including those targeted to young people in out of home care, this funding is largely focused on supporting students who are already experiencing mental health difficulties. However, initiatives should also be designed to keep young people mentally healthy and prevent mental health issues. There is also no funding for workplace mental wellbeing initiatives or other promotion or primary prevention initiatives, nor any mention whatsoever of the mental health promotion workforce.
All in all, while it has been generally welcomed, the Budget has been described by some as a ‘pre-Royal Commission’ Budget with a strong emphasis on traditional areas like acute beds and workforce expansion, but comparatively little focus on the reforms championed by the Royal Commission. These proposed reforms were intended to put LLE at the heart of all initiatives and create a new mental healthcare system built on compassion that focuses holistically on wellbeing, not just clinical care.
In summary, the Budget also fails to include any significant funding for initiatives to promote and protect the mental health and wellbeing of the entire community, a key aim of the National Preventive Health Strategy 2021-2030, which Victoria has endorsed. It also does not prioritise the holistic needs of people with LLE and their families, carers and supporters and the contribution they can make to the workforce.
Four members of PHAA Victoria have also written a piece reviewing the Victorian State Budget in the context of public health. Read their blog here.