COVID pandemic’s mental ill-health legacy will plague us
Prevention and a focus on the upstream socioeconomic determinants of suicide must be strengthened, as the suicide prevention field has correctly suggested. However, these powerful forces and megatrends – including pandemics, natural disasters and economic crises – are difficult to prevent or mitigate, and it would be irresponsible to put all our eggs in the prevention basket. At the same time, we need to create much stronger safety nets for everyone in the danger zone.
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Crisis care must be strengthened. Lifeline is a national treasure, but given our dependence on it, it is unacceptable how little funding and clinical management is committed to it. We also need a single national helpline number and service, not multiple options. Lifeline also needs to be much more strongly connected to the next level of care.
The fragmentation and lack of integration between different levels of care in mental health means that people at risk are constantly in no man’s land. The market-based, outsourced primary health network model of local commissioning of mental health care through competitive tendering has seriously exacerbated the fragmentation of care at a time when we desperately need integration.
Primary care should be a universal access portal, but is in deep crisis. The recent proposal by the Minister of Health to create highly accessible multidisciplinary one-stop shops within general practice – something conceived and implemented by headspace for young people – is a potential solution. New systems of team-based multidisciplinary secondary care, including psychiatrists, are crucial to support GPs and primary care services. These platforms were started federally but have stalled and need to be redesigned and rapidly scaled up.
Vested interests, whether commercial or professional, undermined the reform process. The current debate on the number of Better Access sessions is a perfect example. The solution is to embrace value-based healthcare. British economist Mariana Mazzucato spelled out a blueprint for ensuring that value for society and its people is the goal of all public policy. It involves a mission-oriented approach to big challenges. A clearly defined objective is set and public and private sectors are expected and encouraged to combine to deliver. Profit-making and vested interest are subordinate to the higher-order value-creating mission.
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It replaces the “market failure” model that has survived despite serious flaws. The mission-oriented approach requires strong governance and a revival of, respect for and investment in the public sector.
Health care reform, and mental health reform in particular, lends itself perfectly to this approach. This strategy is partially evident within the mental health reform process initiated by the Victorian Premier and Government, but the missing pieces mean that the success of this one-off reform remains in the balance.
Mark Butler has realized that the time for knee-jerk reactions and band-aids is over. I will discuss reform paths with him when we meet today. With warning signs emerging of a worsening mental health crisis, there is no time to waste.
Professor Patrick McGorry is executive director of Orygen, the center for youth mental health at the University of Melbourne, and a former Australian of the Year.
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