What can Australia’s approach to mental health teach the English? Professor Paul Burstow sets out some of his reflections from a recent two-week fact finding visit.
Australia offers an interesting analogue for England in thinking about how mental health treatment and illness prevention might develop. Inevitably there are limitations on what can be learnt and what can be transferred, but there are lessons. In the post below, Professor Paul Burstow looks at what Australia's approach to mental health can teach the English.
In January 2017, the UK Prime Minister, Theresa May, gave a speech setting out her Government’s commitments on mental health. She gave special emphasis to the mental health of children and young people and in the workplace. Plans for a Green Paper were announced along with a review of workplace mental health. Both of these initiatives could gain insights from Australia.
The smaller population and continental scale of Australia create their own unique challenges and have driven innovation, particularly in e-health. The Federal/State split in accountabilities for health funding and delivery, the fee for service payment system that supports independent healthcare contractors make for a complex system. In the area of youth mental health this has led to the open access, youth primary care model Headspace to be developed.
Over the past 15 years youth mental health (12-24 years old) has become a clear public policy priority for successive Australian Governments. Prime Ministers of both governing parties have given political sponsorship for this focus and provided the investment.
Social entrepreneurship harnessing the best available evidence is the hallmark of the creation and expansion of Headspace to 110 sites across rural and urban Australia. However, creating a standalone service has its pitfalls. New boundaries are created, existing service providers can feel threatened and the whole system remains untransformed.
Headspace has achieved some significant gains, access has been widened and a ‘no wrong door’ policy helps to ensure that young people don’t fall through the net, more young people are getting a service and evaluation has demonstrated important gains in terms of labour market participation and social function. Young people have been involved in designing Headspace so that it has a look and feel quite different to traditional GP or community healthcare services.
The political sponsorship also led to the creation of a national Mental Health Commission tasked with the job of reviewing the mental health system and recommending a plan of action. The Commission included in its recommendations a shift of resources from treatment to primary care and prevention and offered economic modelling evidence of the upstream cost savings such a shift could deliver. Although the idea was shot-down at the time it has seeded an important debate about the value of adopting a prevention and early intervention paradigm.
Out of necessity Australia has been an early adopter of technology to extend the reach of healthcare professionals and widen access to help. The worlds first online mental health platform was launched in Australia in 1992, called ReachOut, the platform has evolved as digital technology opened up new possibilities. With need outstripping the ability of conventional face to face services to respond there has been an explosion in the number of apps and online tools available to people. Self-assessment, monitoring, self-management, peer networking tools and online consultations are all features of a thriving open market place where innovation is happening real-time.
Evidence and evaluation have played a critical role in driving investment decisions both at a Federal and State level. In Victoria the Health Promotion Agency VicHealth has amassed a rich array of research evidence across both the life course and life settings. In New South Wales (NSWs) the Health and Education Services have collaborated to trial both for proof of concept and scaleabilty of a number of school based and community based interventions. Along with a three yearly national child development survey of new school starters universal and targeted screening programmes have been adopted to inform investment and identify the most promising localities to target help on. New programmes introduced in NSW have been subject to evaluation to inform investment decisions.
Schools are not the only setting where early intervention and prevention approaches are being adopted. The workplace is recognised as offering the opportunity to promote good mental health and create psychologically safe environments. A mental health friendly alliance of NGOs, Superannuation Funds and the Mental Health Commission has raised the profile of the workplace. The funding arrangements for pensions and insurance have created a climate in which workplace mental health and wellbeing are being actively pursued but at arms length from State and Federal Government. This business to business approach is still in its infancy but is already raising the bar.
On the evidence seen during the visit and the materials reviewed since investment decisions supporting early intervention and prevention has benefited from the adoption of a ‘good enough’ approach to evidence backed with mixed method evaluation. Those crafting the Mrs May’s Green Paper on mental health and schools and undertaking the review of workplace mental health would do well to look at what Australia is doing.