Budgets 2020/21: Mental health in the spotlight, but imbalance remains

STATE BUDGET 2020/ 2021

This information will be updated as more information becomes available from the Mental Health Commission (MHC) and budget estimates process.

Summary
Mental health and alcohol and other drugs (AOD) received more funding in this year’s budget than last year, with most of this tied to hospital and bed-based services, including:

$25.1 million for a 16 bed youth mental health, AOD and homelessness service (already announced)
$24.1 million for a 20 bed community care unit (already announced)
An extra $62.8 million to meet demand for mental health hospital services in the public health system
$24.4 million for Fremantle Hospital (already announced)
$8.57 million for mental health prevention - equating to 0.9% of the mental health specific budget allocated to prevention
$46.6 million for mental health community support - equating to 5.1% of the mental health specific budget allocated to community support

While investment in prevention has increased marginally in this year’s budget, the increase in funding for this area pales in comparison to the increase in investment in bed-based and treatment services, perpetuating the imbalance of service types required in WA. There has also been no significant investment in community support this year, meaning that we are no closer to reaching the levels of investment required for this area, which are 5 times what we currently have now.

What we welcome:
WAAMH is pleased to see a commitment to suicide prevention, with new funding of $46.9m allocated over 4 years, with $7.5 million of this is allocated to 2020/21.

$32.3 million of this will be used to fund continuing operation of existing suicide prevention services and support the implementation of the keenly awaited WA Suicide Prevention Framework 2021-2025 over four years. This represents an increase compared to the funding allocated to the existing WA suicide prevention strategy, Suicide Prevention 2020: together we can save lives, which was funded in 2015/16 to the tune of $25.9 million four years.

$9.8 million of the $46.9 million has already been announced to support the development and implementation of regional Aboriginal suicide prevention plans.

The remaining $4.8 million will be used to enhance suicide prevention over two years, including additional aftercare support; a support service for communities affected by suicide; and increasing capacity in services that provide long-term support to children bereaved by suicide.

WAAMH is also glad to note the $39.4 million allocated over four years for the Fair Work Acquisition Equal Remuneration Order on non-government organisations for the mental health and AOD sectors, to deliver pay equity following the 2012 Fair Work Australia Equal Renumeration Order.

$7.3 million has also been allocated over three years as part of the State Government’s response to the Kimberley Coronial inquiry and Learnings from the Message Stick inquiry. This will help to deliver additional clinical mental health services in the Kimberley; FASD education campaigns and programs; and $1.6 million engagement and empowerment programs for Aboriginal girls in public schools from 2021. This $1.6 million will go towards a variety of engagement programs that will encourage health and wellbeing, post-school pathways to employment, developing leadership skills and celebrating connection to traditions and cultures.

WAAMH notes that the Budget narrative demonstrates a commitment to the recovery of WA post COVID-19, with a focus on suicide prevention, accommodation and support services, mobile clinical outreach, and AOD facility upgrades.

The narrative also demonstrates a commitment to the WA State Priorities 2020-2024 for mental health and AOD, released by the Minister for Mental Health in March 2020, and the need to support the direction towards a consumer-focused, holistic, integrated and sustainable approach to mental health and AOD. However, the minimal increases in investment in prevention and community support this year do not mirror this commitment and are yet again overshadowed by the increases in investment in hospital-based services, perpetuating imbalance in the WA mental health system.

What could be improved:
This year’s budget has been touted as a win for mental health, with the political narrative focusing on the record of over $1 billion dollars in mental health investment. While WAAMH recognises the significance of this investment, the government has again missed a significant opportunity to invest adequately in prevention of mental health issues, with this budget falling well short of the required investment in mental health and AOD prevention and community support – investments that are detailed in their own government policy.

While modelling shows that 6% of the mental health budget is needed for prevention by 2025, this budget allocates only 0.9% - a far cry from the recommendations of the Western Australian Mental Health, Alcohol and Other Drug Services Plan 2015–2025 (The Ten Year Plan) and the Sustainable Health Review, which both identify the need to balance investment in the mental health system across service types. This lack of progress in prevention investment is particularly disappointing given that that the Western Australian Mental Health Promotion, Mental Illness, Alcohol and Other Drug Prevention Plan 2018-2025 (which is not mentioned in this year’s budget), provides a blueprint for implementation of initiatives in this area.

Community support funding remains essentially neutral this year, with only a minor increase in investment of $2.5 million. The lack of significantly increased investment in community support – where we currently need 5 times as many hours of support than we have, and where the gap between demand and people’s needs being met is higher than for any other type of service – remains a significant disappointment and shows that government has been unable to deliver its intent to develop a balanced mental health system.

Despite narrative around the importance of the mental health of young people and the development of the Young People Priority Framework which was announced in August 2020 and due to be finalised by December 2020, WAAMH is disappointed to see that there is no funding allocated to the implementation of this framework in the current budget.

There is also no MHC funding to address demand for forensic mental health capacity, instead only a reference to ‘recommencing the planning work required to support expansion of the State’s forensic mental health capacity’ and ‘updating projected demand for forensic mental health services including estimating the potential impact of changes to the Criminal Law (Mentally Impaired Accused) Act 1996’. This is particularly disappointing in light of long term and ongoing advocacy from WAAMH to modernise the CLIMIA Act to improve access to justice and the realisation of people’s human rights.

DETAILED BUDGET BREAKDOWN

Prevention
Prevention spending for mental health and AOD combined has increased in this year’s budget by just $1.8 million to $17.27 million. This equates to just 1.7% of the total Mental Health Commission budget for the coming year, far below the 4% in 2020 outlined in the Western Australian Mental Health, Alcohol and Other Drug Services Plan 2015–2025 (The Ten Year Plan).

Of the $17.27 million:

Mental health receives $8.57 million
AOD receives $8.7 million

Concerningly, this allocation means that for mental health specifically, the proportion of expenditure on prevention is only 0.9% this year, when the 2025 target indicates 6% is required. By comparison, prevention makes up 8.8% of the AOD budget this year.

With most funds allocated to the suicide prevention strategy, there is only approximately $1 million allocated to general mental health prevention funding. Without a significant state injection of funds, the prevention funding targets set out in The Ten Year Plan will remain unmet into the foreseeable future.

WAAMH will continue its advocacy to get prevention funding on track and meet the Plan’s target of 5% of the total MHC budget for mental health prevention by 2025.

Suicide prevention
Suicide prevention is a major focus of the 2020/21 State budget for mental health prevention, with $46.9m allocated over 4 years.

$32.3 million of this will be used to fund continuing operation of existing suicide prevention services and support the implementation of the keenly awaited WA Suicide Prevention Framework 2021-2025 over four years. The remaining $4.8 million will be used to enhance suicide prevention over two years, including additional aftercare support; a support service for communities affected by suicide; and increasing capacity in services that provide long-term support to children bereaved by suicide.

This is in addition to the already announced $9.8 million over 4 years for the development and implementation of regional specific Aboriginal suicide prevention plans.

Community Support
Community supports are non-clinical supports that advance people’s personal recovery, rights and opportunities. Community supports work with people to secure a job, form relationships, build fulfilling lives, develop skills and interests, prevent hospital admissions and issues escalating to crisis point, while promoting healing and keeping people living well in their own homes. WAAMH consistently hears from consumers, families and carers that we need more community supports in WA and the Plan Update from 2018 showed that we need 5 times as many community support hours provided in WA as we currently have.

Despite this, the total spending on community support remains largely stable in this year’s budget.

Total community support spending for mental health and AOD has been increased by just $2.5 million in this budget, to a total of $54.15 million.

Of this $54.15 million:

Mental health receives $46.61 million
AOD receives $7.5 million

For mental health, this translates to 5.1% of the mental health budget, a far cry from the 22% expected by 2025 and a slight reduction from the 2019/20 budget when the proportion was 5.2%. By comparison, the proportion of AOD funding allocated to community support is 7.6%.

There is a concerning lack of further indication of future planning or budget processes to increase community support. While some additional money ($3.368 million) has been allocated to the community bed based Step Up Step Down services over three years, which will help to reduce hospitalisation and institutionalisation, these kinds of transitional services do not replace the need for a five-fold increase in recovery focused community supports – as set out in The Ten Year Plan.

WAAMH continues to advocate for increases in investment in community supports via our ongoing advocacy and the Prevent Heal Support campaign, so that consumers and families can receive better support for their recovery in the community.

Community Treatment
Community treatment funding remains mostly stable, with $426.9 million allocated in this budget, equating to approximately 42% of the MHC budget – the target for 2025 is 34% of the MHC budget.

This equates to an increase of $14.2 million for community treatment services in 2020/21 from last year and represents a slight reduction in proportion of MHC budget compared to last year.

The budget narrative for mental health treatment explains that two Safe Haven Cafés will be established, one in the metropolitan area and the other in the Kimberley region, which are expected to open in late 2020 (delayed due to the impact of COVID-19). $520,000 over two years has been allocated for this initiative. A Safe Haven Café is a peer-based non-clinical service for people with mental health issues who may otherwise attend emergency departments after hours.

For further detail on community treatment investment, see the Mental Health Commission Budget Bulletin here.

Community Bed-based Services
Community Bed-based Services have seen a significant increase in funding of $30.9 million, to $87.8 million.

This is primarily related to:

New funding for the A Safe Place initiative, including a Community Care Unit which is expected to have 20 beds, and a 16 bed youth mental health, AOD and homelessness service (both already announced).
Commencement of a new step up/step down service in Bunbury from March 2020.
Commencement of the Midland Intervention Centre and the Methamphetamine Action Plan - Kimberley AOD Services with four low medical withdrawal beds.

These initiatives are welcome and will support people to transition from hospital to community. However they still fall far short of a balanced investment approach, which would see a range of supported accommodation options across a pathway including lower level supports needs as well as these more intensive services.

For further detail on community bed-based services, see the Mental Health Commission Budget Bulletin here.

Hospital bed-based services
Hospital funding remains mostly stable, with $426.5 million allocated in this budget.

Of this, mental health receives $422.9 million, and AOD receives $3.6 million. For mental health, this equates to approximately 46% of the mental health budget – far higher than the target for 2025, which is 29%.

This includes $62.8 million over 4 years to meet demand for mental health hospital services in the public health system, and $24.4m for Fremantle Hospital (already announced).

New inpatient beds are being progressed in Fremantle, Joondalup and Geraldton, to be operational over the next few years.

This year’s figures again demonstrate the trend in WA that as a proportion of spending, hospital-based services are consistently over-represented in the mental health budget. In order to balance the system we need to move towards increasing the proportion of investment in prevention and community support, while maintaining a flexible and responsive hospital based system. This does not necessarily mean reducing funding for hospitals – rather, it means increasing investment in other service streams to achieve balance in the proportion of funding across the system.

For further detail on hospital investment, see the Mental Health Commission Budget Bulletin here.

Additional positives:

Justice and mental health
The Department of Justice has commenced preparation for a further 344 bed expansion at Casuarina Prison with a focus on providing infrastructure to manage prisoners with complex needs and the refurbishment of a unit at Bandyup Women’s Prison as a mental health facility. $2.4 million has been provided to improve mental health services at Bandyup Women’s Prison as part of the WA Recovery Plan. Planning has also commenced for the future replacement of Broome Regional Prison, including consultation with the Traditional Owners to identify a preferred site.

Aboriginal Mental Health and Suicide Prevention
This budget includes $19.8 million to be spent on mental health initiatives to improve the wellbeing of Aboriginal people, including $9.8 million for Aboriginal Suicide Prevention Plans and $10 million under the Commitment to Aboriginal Youth Wellbeing package. This is welcomed, as previous budgets have not delivered appropriately in this area.

FEDERAL BUDGET 2020/ 2021
The State budget announcements come in the context of the recently revealed Federal budget. WAAMH was pleased to see a strong focus on mental health in the Federal budget, although its focus is limited to a few key areas, and many system reform issues remain unaddressed. While we await the release of the much anticipated Productivity Commission report into mental health, along with potential further consultation tied to that, we have provided some brief details about some of the key Federal announcements below.

Mental Health and Suicide Prevention
The Federal budget this year includes a record $5.7 billion for mental health hand suicide prevention.

WAAMH are very happy to see a funding boost of $43 million over three years for the Individual Placement Support (IPS) Trial, to support an additional 2,500 young people who require mental health support to get into employment or further education. This includes an expansion of the current 24 trial sites at headspace to 50 from June 2021 next year for a further 3 years. This is amazing news for WAAMH, which been a leader in the IPS field nationally for many years. It is fabulous to see a solid commitment towards supporting young people into employment and education, following an evidence-based model that we know works. Find out more about IPS here.

The federal budget also included a doubling of Medicare-subsidised mental health sessions through the Better Access program, from 10 to 20 per annum, was the only new mental health announcement, with $100.8 million allocated to this.

There is significant concern that this initiative does no ensure equity of access to mental health care, as sessions may only be accessible for those who can afford co-payments and live in areas where psychologists are available. In addition, concern has been raised about the ongoing lack of evaluation of the Better Access program, bringing into question the evidence base for this program, as well as its ability to adequately support people with complex mental health needs who require ongoing and more frequent support.

Over the next four years from 2020–21, the Australian Government is investing $630.4 million in the national headspace network. This includes $534.4 million for the establishment of new services and ongoing service delivery at existing services and $96 million to address demand and reduce wait times to access headspace services.

While headspace benefits many young people, concerns have also been raised about the limitations of the headspace model, which provides a narrow spectrum of care and tends to favour young people with less complex needs, resources and access, who speak English and live in urban areas.

For an excellent and detailed breakdown of the Federal Mental Health budget 2020-21, see the Mental Health Australia Budget Analysis available here.

Background Papers available: Budget Papers

The State Budget was handed down on Thursday October 8, 2020. Mental Health details are in Budget Paper No. 2, Volume 1, Part 5.

The Mental Health Commission’s briefing is at the MHC website.

Federal budget papers are available here.