Mental Health Policy

General
Date: September 2005

1. Introduction

Mental Health is a major health issue for our society. In the past the impact of mental illness on Australian society has been underestimated.

However in recent times its impact is being recognised. According to the National Survey of Health and Well Being, 17 per cent of Australians will experience a mental health problem at some stage of their life. Three to four per cent of Australians will experience a severe mental disorder.

According to the Australian Institute of Health and Welfare, mental health disorders are one of the leading causes of disability in the Australian community, accounting for nearly one third of non-fatal disease burden.

People with mental health problems do not go away when they are unable to get the assistance they need; they usually go elsewhere. In other areas of the health industry HSU members in ambulance services, general hospitals, aged care facilities and drug and alcohol services increasingly have to provide some form of assistance to people with mental health problems.

2. National Mental Health Strategy

Australia's delivery of mental health services is guided by the National Mental Health Strategy. While the strategy is innovative, it is also has shortcomings but, importantly, for it to be effective it must be properly resourced and supported.

In short the strategy provides for:

1. Timely and responsive service delivered to a professional standard

However, the services are characterised like this:

• Case Management occurs in some areas in name only - too few clinicians and caseloads too high;

• Pilot projects in specialised areas ceased because of lack of ongoing funding;

• Predictions of community based beds and other resources required to deliver strategy have been seriously underestimated and;

• Failure to address the suicide rate is an ongoing issue. People with mental illness are vulnerable after in-patient care. People with mental illness are 17 times more likely to complete suicide than the general population.

More than 90% of the 2,300 Australians who commit suicide every year were suffering from a mental illness.

In 2000, 2,363 people committed suicide, 5% less than 1999 and 13% lower than a record 2,723 deaths in 1997.

In supporting this aspect of the Strategy, the HSU will nationally advocate for:

(a) Early identification and appropriate treatments of mental illness in order to further decrease the rates of suicide in our community;

(b) Increased funding to a level where optimum psychiatric treatment can be delivered;

(c) Clinical service levels to be more tightly defined to enable benchmarking of caseload limits without consumers being exited from services to achieve workable caseloads;

(d) Funding for proven effective treatments, eg. Cognitive Behaviour Therapy (CBT) and family therapy;

(e) Refocusing on suicide prevention strategies to improve continuity of care post discharge.

2. Community support to complement clinical services

For this to be effective we need a properly funded disability, support and accommodation sector that provides accommodation, rehabilitation, outreach and other community supports.

However, the NGO sector only receives approximately 5% of the mental health budget nationally.

In supporting this aspect of the Strategy, the HSU will nationally advocate for:

(a) Education and training to provide high quality rehabilitation services;

(b) A systemic plan for the provision of services;

(c) Liaison systems between clinical services and the NGO sector;

3. Carers support systems

In supporting this aspect of the Strategy, the HSU will nationally advocate for:

(a) Strategic carer support systems;

(b) Family Sensitive training (FaSt) training and refreshers for all mental health professionals;

(c) National implementation of Family therapy programs.

4. Stigma reducing strategies

In supporting this aspect of the Strategy, the HSU will nationally advocate for:

(a) Media promotion;

(b) School education programs;

(c) Training of mental health professionals in relation to iatrogenic stigma (ie. stigma arising from the attitudes and behaviours of healthcare workers).

It is clear to the union that significant challenges exist to achieve a mental health workforce that has skills, knowledge and attitudes that is required for working in current services and into the future. This remains a key barrier to deliver on the National Mental Health Strategy.

These challenges are identified as:

• The current service system failing to provide a learning environment and support learning culture for better client outcomes and the impact of a lack of ongoing education has on the workforce;

• Training at the undergraduate level has failed to produce skilled and confident workforce;

• There is an absence of a state and national approach to the workforce, including attraction and retention issues;

• New initiatives being regularly funded from existing resources and the need for greater accountability of funding;

• Despite increases in funding, some states still lag behind others, but on the whole Australia compares poorly internationally;

• The impact that excessive case loads and increasing workloads has on access to services.

3. Plans of the Health Service Union

The HSU will advocate for a reinvigoration of the national mental health reform process. In particular the:

(a) Development of a national mental health strategy that does not leave large groups of the Australian community without access to adequate mental health services;

(b) Expansion of the level of funding for mental health services to be proportionate to the disease burden it imposes on the community. The HSU believes that funding needs to increase to at least 12% of total health expenditure;

(c) Coordination between the national mental health strategy and the national drug strategy; and

(d) The inclusion of mental health policy and actions in relevant ACTU health policies and activity.

4. Workforce

HSU and its state branches will advocate for a comprehensive workforce strategy that addresses both the specific needs of the mental health workforce and the needs of the broader health and community service sector workforce.

5. Education and Training

In the post deinstitutionalisation era all health and community service workers need at a minimum basic training in mental health issues, HSU and its state branches will:

(a) Advocate for a comprehensive mental health content in all undergraduate courses that prepare health and community service workers;

(b) Advocate for reform of the undergraduate nursing course to allow for increased mental health content through, streaming and direct entry options; and

(c) Express concern at the reliance of mental health services on workers from developing countries because of the impact that this has on mental health systems in those countries. The union advocates for policies that develop the local mental health workforce that lead to self sufficiency as soon as possible. The union shall continue to support overseas workers working in Australian mental health services and will encourage them to become active within the union;

(d) Promote the development of postgraduate mental health qualifications in areas of sub specialty practise, i.e. community mental health or aged persons mental health;

(e) Advocate for incentives to expand the pool of health workers from indigenous and Cultural and Linguistically Diverse (CALD) backgrounds;

(f) Advocate for increased VET sector places for the preparation of health and community service workers in the mental health sector;

(g) Advocate for the development in the VET sector of advanced mental health courses for workers such as second level nurses seeking to develop advanced mental health skills; and

(h) Removal of barriers that exist which limit the capacity of current employees in participating in undergraduate and post graduate courses.

6. Recruitment and Retention

In all areas of the mental health workforce, particularly psychology, doctors, allied health and nursing, significant issues exist in both attracting and retaining a skilled workforce.

At the heart of the recruitment problem is the lack of adequate undergraduate preparation and as a consequence a lack of confidence in new graduates in their capacity to work in a mental health setting.

HSU and its state branches will:

(a) Advocate for reasonable caseloads for community based workers that allow for proactive intervention that can assist 'recovery' rather than merely maintain people in the community;

(b) Advocate to stop the overcrowding of bed based services that have lead to patients being accommodated on mattress on the floor in acute psychiatric inpatient units;

(c) Advocate for adequate training career pathways that allow VET qualified workers opportunities to undertake advanced training articulating to tertiary qualifications; and

(d) Advocate for mechanisms to ensure educational courses at pre and post vocational levels are relevant to changing industry needs.

7. Occupational Health & Safety

Occupational Health and Safety remains a major issue for the workforce. In the mental health sector significant rates of occupational assault exist.

Traditionally employers and Government have sought to ignore the problem. However the problem has worsened and now it is a significant contributing factor in the problematic retention rates that plague the mental health sector workforce.

The HSU will:

(a) Ensure OH&S Committees have a focus on occupational assault;

(b) Advocate for Employers to:

• provide specific occupational assault training;

• resource specific workplace initiatives to pilot solutions to occupational assault.

• Develop industry wide code of practice for the management of aggressive behaviour and the post incident support of staff involved.

8. Alcohol and Other Drugs

The HSU recognises the serious health and social impact that problematic alcohol, legal and illegal drug use has on the Australian community. Tobacco use continues to cause harm to the individual and the community.

Other legal drugs such as alcohol can cause damage if not used in moderation and are a major factor in domestic\family violence and road accidents. HSU and its state branches will advocate for improved strategies to prevent and address the significant health and social problems caused by illegal drugs.

Central to HSU's Alcohol and other Drugs policy is the principle of harm minimisation for all drugs. In particular HSU and its state branches will advocate for polices that focus on the harmful effects of drugs such as tobacco, alcohol, petrol sniffing and chroming and Illicit drugs.

HSU will advocate for innovative and integrated strategies, targeting Commonwealth, State and Territory governments to develop models that coordinate the alcohol and drug interventions provided by all relevant services. In particular, models that:

(a) Improve the outcomes of alcohol and drug interventions provided by specialist alcohol and drug services;

(b) Improve the capacity of other relevant health and community services such as mental health services, youth and family services, and disability services to provide drug and alcohol strategies;

(c) Improve the coordination of care across a range of services, enhancing cross-sector complex case management between services and health professionals;

(d) Address the underlying causes of both legal and illegal drug problems in order to reduce demand; and

(e) Increase the opportunities for treatment and harm reduction for people with drug problems and ensure supply and consumption rates are monitored and reduced where needed to minimize alcohol and/or other drug harm.

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© 2003 Health Services Union (HSU)
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