Productivity Commission inquiry into the benefits of improving mental health

PACFA is contributing to an ARCAP submission to the current Productivity Commission inquiry into mental health in the Australian community.

The Productivity Commission released terms of reference for an inquiry in November 2018. This is the first inquiry into mental health undertaken by the Productivity Commission and it has been labelled by various mental health organisations as a generational opportunity for real change.

The Commission released an Issues Paper in January 2019, entitled ‘The Social and Economic Benefits of Improving Mental Health’. DOWNLOAD

According to Treasurer Josh Frydenberg, “the inquiry will be able to make recommendations as to how the Government can better support Australians living with mental illness, to enable them to lead fulfilling and contributing lives.”

The inquiry will consider how mental illness can affect all aspects of a person’s quality of life including physical health, social participation, education, employment and economic productivity. By examining sectors beyond health, such as social services, housing, and justice, the Commission is taking a ‘social determinants of health’ view of mental health.

This broad lens requires a cohesive response from the counselling and psychotherapy profession and PACFA is therefore making its submission jointly with the Australian Counselling Association under the banner of ARCAP (Australian Register of Counsellors and Psychotherapists).

PACFA welcomes the approach taken by the Commission in the Issues Paper that focuses on prevention and early intervention, supporting economic and social participation, and on community-based rather than hospital-based services.

In response to the Commission’s Issues Paper, PACFA has identified some themes of relevance to counsellors and psychotherapists.

The social determinants of health
Counselling and psychotherapy can address a range of social determinants by improving education outcomes in school counselling settings, providing support with life skills and strategies to find and keep a job, improving the overall mental healthiness of workplaces, supporting healthy relationships so that vulnerable Australians are kept in housing and out of the justice system.

Supporting increased social and economic participation and contribution
Optimal utilisation of the counselling and psychotherapy workforce will benefit the Australian economy and improve productivity by supporting Australians to lead contributing lives and supporting people to explore and resolve life difficulties. PACFA will recommend that mental health professionals work to the top of their scope, based on their training, to address the changing needs of the community, meet workforce shortages, and improve efficiencies in the health system.

Stepped care
Stepped care aims to target services appropriately based on the needs of consumers, from mild through to severe mental health issues.  Counsellors and psychotherapists are suitably trained to provide services under each tier in the stepped care model, however they have a particularly important contribution to make supporting consumers with mild to moderate mental health issues and in preventative and early intervention mental health services.

Workforce required for early intervention and prevention
With the Productivity Commission focusing on consumers with mild and moderate mental illness (for example anxiety and depression) and early intervention approaches, a larger workforce needs to be ready and available to meet the demand for services. Given that there are shortages in the mental health workforce with limited availability and long waiting times between sessions in metro and low-access areas, counsellors and psychotherapists are experienced and ready to boost the workforce numbers and provide support in the stepped model of care.

Health workforce and informal carers
There is a need to support carers to ensure they continue to provide support for family members in a sustainable way that ensures they do not develop mental health issues themselves. Counsellors and psychotherapists can support the participation and productivity of carers.

Specific groups in the community
Aboriginal and Torres Strait Islander peoples, people residing in remote areas, those from low socioeconomic backgrounds, newly arrived migrants, and refugees all face particular risks to their mental health and wellbeing. Counsellors and psychotherapists present a skilled, qualified, high-value but under-utilised workforce to provide service to under-serviced groups and improve equity.

From our profession’s perspective, there are also some health system issues to be addressed in order to improve social and economic participation by those with mental health issues.

GST Exemption
GST Exemption is not currently available for counsellors and psychotherapists. An amendment to section 38 – 10 (1) of the GST Act to extend GST exemption to counsellors and psychotherapists would see reduced costs for consumers, making mental health service more accessible, and put the full-range of the mental health workforce on an equal footing.

Better Access Initiative
There are flaws and limitations to the Better Access Initiative (BAI) which is a barrier to systemic improvement in the delivery of mental health services. PACFA therefore supports the extension of Medicare provider numbers to registered counsellors and psychotherapists under the BAI and other changes to the program as detailed in our submission to the Medicare Benefits Schedule Review.

Private health insurance
The role of Private Health Insurers addressing mental health needs in the community should be strengthened.There is a need for more cost-effective programs for outpatients after hospitalisation to prevent relapse. Costly and inefficient hospital-based programs could be replaced by efficient high-value programs run by counsellors and psychotherapists within the community. Greater utilisation of the counselling and psychotherapy workforce by PHIs for ancillary services would provide gains in population mental health and related gains in productivity.

The inquiry will take 18 months and the Commission’s report will be delivered in May 2020. PACFA is optimistic the inquiry will instigate genuine and lasting improvements to the mental health sector.

PACFA encourages members to make an individual submission or brief comments to the Productivity Commission by the 5th April at the Productivity Commission website.