Mental health budget 2019 lowdown: Prevention targets missing in action

Summary

Mental health received less additional funding this year compared to last year, mostly tied to government election commitments for:

Recovery College which has received $3.6 million over four years;
Step-Up, Step-Down services in regional towns with $22.4 million being allocated to the construction and commencing of operation of four regional Step Up Step Down services across the next two years; and
$15.6 million for 20 new secure hospital beds at Fremantle.

What we welcome:

WAAMH is pleased the Budget reiterates the commitment to reform the Criminal Law (Mentally Impaired Accused) Act. The new Bill, expected to be introduced in winter 2019 will increase options available to the courts to include community based options, introduce limitation periods for custody orders and empower the Mentally Impaired Accused Review Board to make decisions about leave and release.

WAAMH is relieved that this year the Budget narrative does mention the significant strategic policy work the Commission is undertaking, including the Plan and the 2 Year Plan Update as being significant issues impacting the landscape, alongside other major mental health policy including Accommodation Support Strategy (draft) and the draft Workforce Strategy which are expected to be completed during 2019.

However, WAAMH remains concerned at the delay in finalising these key strategic documents, and at the lack of key performance indicators the draft documents contain. The significant gap between policy and robust investment in mental health reform remains significant.

The major focus this year for mental health and alcohol and other drugs (AOD) is the Methamphetamine Action Plan which has received a comprehensive announcement across a balanced suite of programs.

WAAMH welcomes extension of the Suicide Prevention Strategy with funding of $8.1 million over 18 months, which will see community managed suicide prevention initiatives continue while government plans a new Suicide Prevention Strategy in tandem with Commonwealth suicide prevention planning processes through COAG.

What could be improved:

WAAMH and its Aboriginal colleagues are disappointed that there are no new initiatives to respond to the Aboriginal suicide crisis across our state in the interim. While the guidance of an overarching Strategy for longer term suicide prevention investment is important, many had hoped for some particular acknowledgement in this Budget of the sense of urgency that is clear across the State, including a perceived lack of attention to suspected suicides here in the South West.

Government has a major missed opportunity to invest in prevention of mental health issues, with this budget continuing to cut mental health prevention spending – the opposite of its own Sustainable Health Review and MHAOD 10 Year Plan recommendations to increase prevention to 5% of health and mental health total spending.

This budget shows a total cut of 38% to prevention over the past two years. This cut equates to 17% acros one year. While some contracts are still being negotiated which is expected to reduce the gap, the reality is that the government continues to fall further behind in its prevention targets. This lack of progress in prevention investment is particularly disappointing given that that the Commission’s Prevention and Promotion Plan has been finalised which provides a blueprint for implementation.

Community support funding remains neutral this year with the only new initiative the Recovery College. This is not unexpected – the Two Year Draft Plan Update now indicates community support increases are planned for the second phase of the Plan from 2020. However the lack of investment in community support - the support type where the gap between demand and people’s needs being met is highest – remains a significant disappointment and shows that government has been unable to deliver its intent to develop a balanced mental health system.

Detailed planning for the divestment of Graylands has been funded in this year’s budget, with $3 million over two years being allocated to plan for the divestment of infrastructure and decommissioning of services, to then recommission new services in Health Service Provider regions, with the intent that people needing secure hospitalisation remain closer to home.

The NDIS has been acknowledged in the Budget narrative as an important issue, but few details are publicly available about the modelling or other work that state government might be undertaking.

Now that the past three Budgets have funded Labor’s election commitments, WAAMH will continue to work with Government to see new investment in next 12-24 months to back the Plan and shift the focus to prevention & community support, as part of building a sustainable health system that meets the needs of consumers and family members.

Suicide prevention

WAAMH is delighted that one of our pre-budget submission asks was delivered by government, with the Suicide Prevention 2020 Strategy extended for 18 months with $8.1 million funding while program evaluations are finalised and a new strategy is developed.
We understand that the majority of the programs funded under this Strategy will continue, including those delivered by WAAMH members.
The Mental Health Commission has indicated that planning for a new strategy will occur in tandem with current COAG planning processes for the Commonwealth’s suicide prevention work to improve integration of state and Commonwealth initiatives.
WAAMH strongly welcomes advice from the Commission that new engagement mechanisms will be developed to inform WA’s planning work, including strong engagement with Aboriginal stakeholders to develop culturally secure suicide prevention approaches.
WAAMH, AHCWA and Moorditj Koort have issued a statement expressing deep concern at the lack of any new initiatives to respond to suicides of Aboriginal people in the interim, and calling for investment in Aboriginal led approaches.
However, WAAMH does strongly support the planned evaluation of suicide prevention services and development of a new strategy that will be based on best practice, strong evaluation and seek to integrate with Commonwealth suicide prevention initiatives.

Prevention

The prevention spend for mental health and AOD combined will be $13 million this coming year compared to $20 million in 2017-18. Of this:

Mental health receives 5.88 million
AOD receives $7.2 million

This alarming cut of 38% over two years to the overall prevention spend flies in the face of Government’s own policy with the recent Sustainable Health Review recommending we increase health prevention spending to 5% of the total health budget.
With most funds allocated to the suicide prevention strategy, there is only approximately $526,000 allocated to general mental health prevention funding.
Without a significant state injection of funds, the prevention funding targets set out in the 10 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 targets of 4% by 2020 and 5% by 2025.

Community Support

There is no new funding for community support services in this Budget, other than for the Recovery College. The total spending on community support remains largely stable.
The Recovery College has received funding of $3.6 million over 4 years. Tender documents will be released in June.
The Recovery College will operate using a hub and satellite design, which will be progressively implemented state-wide over a two-year period.
There remains a concerning lack of any indication of future planning or budget processes to increase community support, other than reference to the need to identify accommodation and community services support needs to relieve beds and Emergency Departments pressures.
However, significant mental health strategic policy, including the 2 Year Plan Update and the Accommodation Support Strategy (draft), reiterate the need for significant growth in community support as part of a balanced system. These documents are expected to be completed in 2019.
A new clouding of the language used by government regarding ‘a move towards community based services’ is concerning. While the government’s initiatives to decommission Graylands and build Step Up Step Downs will reduce hospitalisation and institutionalisation, these kinds of services do not replace the need for a five-fold increase in recovery focused community supports – as set out in the 10 Year Plan.
Indexation for the community supports has again been reduced this year, with advice from the Commission that this is tied to indexation policy, and compliant with the Delivering Community Services in Partnership Policy.
WAAMH will step up its advocacy over the next two years so that consumers and families can receive better support for their recovery in the community.

Community bed-based Step-Up, Step-Down services

As expected, the government continued its focus on funding its community bed-based Step Up Step Down services – the major feature of Labor’s election platform.
Significant increases to community bed based services – up from $48.5 m in 2017-18, to $$56.26m in 2018-19 to a budgeted $67.17m in 2019-20 - reflect the government’s continuing commitment to its election commitment to build step up step down services across regional Western Australia.
Step up/step down services are currently planned, funded and being progressed in Broome, Bunbury, Geraldton, Kalgoorlie and Karratha.
Funding has been allocated to the Kalgoorlie Step Up Step Down from 2021-22.
Step Up Step Down funding includes significant funding for a capital build which is work completed by the Department for Communities, and projected operational funding in future years.
WAAMH understands that this completes the funding for the government’s planned Step Up Step Down services across the state.

Sustainable Health Review (SHR)

Despite SHR recommendations to increase prevention investment, this has not been realised in this Budget.
The SHR has been allocated funds of $26 million to start implementing its recommendations, which the Treasurer stated will be an ongoing process.
This includes $18.9 million for innovative pilots – a share of which will be allocated to a mental health Safe Haven Café.
While few details are available, WAAMH welcomes the recognition that we need to offer an alternative environment to emergency departments.
According to the SHR Final Report, safe haven cafés work alongside EDs to provide a safe environment for respite and peer support for people seeking assistance after-hours but who do not need acute care. Mental health safe haven cafés also help people learn more about their own needs and find options available for them locally to get further support. See page 65 of the SHR Final Report.

Specialised Services

The lack of new funding for forensic services is very disappointing, and while the Budget includes some narrative about the need in this area – particularly for children and youth – the lack of investment is concerning. We appear to be no closer to new or expanded forensic services than this time last year.

Hospitals

Hospital funding remains mostly stable. There are fewer major increases in hospital bed funding as we have seen in previous years.
The Health Budget contains $10 million for 20 new secure beds at Fremantle Hospital. WAAMH has been advised that these local secure beds are required to support the divestment of Graylands, so that people who need a secure bed can be admitted closer to home.
Some funds have also been allocated to a Midland Mental Health Emergency Centre.

Youth

There is no new funding for youth mental health in this budget.
WAAMH remains concerned that there appears to be little focus on youth mental health in the Budget narrative, with no indication that youth mental health is a priority for this government.

Rural and remote

AOD services in the regions see some new investment this year with expansion of specialist drug services. $40.5 m has been allocated to the North Wrest Drug and Alcohol Support Program within the Kimberley, Pilbara and Mid West regions, comprehensive youth alcohol and drug services, and low-medical withdrawal beds.
The extension of the Suicide Prevention Strategy for 18 months will see the Aboriginal Family Wellbeing Pilot Project continued, which provides training to Aboriginal worked and community members including in remote areas.
Funding has been allocated for the Kalgoorlie and Geraldton Step Up Step Down services, and capital works funding has been provided to Department for Communities to build facilities for the Bunbury, Kalgoorlie and Karratha services. The service in Albany opened this year.
There are no other new initiatives in the Budget to improve access to mental health services for people in rural and remote areas.

Background Papers available: Budget Papers

The State Budget was handed down on Thursday 9 May 2019. Mental Health details are in Budget Paper No. 2, Volume 1, Part 5. The Commission’s briefing is at the MHC website.

This briefing will be updated as more information comes to light in the coming weeks.

Contact:

For more information please contact Chelsea McKinney, Systemic Advocacy Manager:

Tel: 6246 3000

Email: cmckinney@waamh.org.au