Writing in the ABC Online magazine The Drum, John Mendoza has described the Abbott/Turnbull Government’s recently announced mental health reform package as ”the most transformative reform package in a generation”.

painting courtesy of Painting by seeds with mental health recovery wishes
The reform package was announced in late November 2015 by Prime Minister Turnbull, Health Minister, Sussan Ley, the chair of the National Mental Health Commission, Professor Allan Fels and Commissioner Ian Hickie as a response to the Review of Mental Health Programmes and Services by the National Mental Health Commission.
The key to the new model is that federal funding for reform will be directed to 31 primary health networks around Australia. The networks will use a contestability model to contract out mental health services locally. Contracting the required local mental health services will cost $365 million from July 2016-17 and rise to $370 million in 2017-18 and $385 million in 2018-19.
Some key features of the reform package include:
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Locally planned mental health services will be commissioned through Primary Health Networks (PHNs). Under the reform, new integrated care packages would be commissioned through 31 Primary Health Networks (the rebadged Divisions of General Practice/ Medicare Locals) across Australia.
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The newly-established PHNs will have a flexible funding pool to commission local services, including access to mental health nurses, psychological treatments, vocational services, drug and alcohol services and peer support.
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People with severe and complex mental health needs will be offered coordinated care packages, similar to packages offered by the National Disability Insurance Scheme (NDIS).
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A new digital mental health gateway will be established to coordinate e-health services, including a new telephone hotline to help people find the most appropriate services for their needs.
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PHNs will coordinate a new approach to suicide prevention by focusing on activities to address local needs.
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the existing Headspace youth mental health facilities will remain, as will the Headspace head office, but new services for young people will be allocated through the PHNs.
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Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing services will be integrated.
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a commitment to national leadership in mental health reform.


Painting from the blog How to juggle glass: surviving mental illness at University
Mendoza applauds this proposed new architecture because it provides individualised and seamless support, to enable the right care at the right time from the right mix of providers to enable people to live fulfilling lives; is locally planned and integrated, and not ‘one size fits all’; is focussed on the needs of people, not providers; uses available and emerging digital technologies; emphasises clinical excellence and improved outcomes; foreshadows bundled packages of health and social care for those who have complex needs and entrenched disadvantage and has a planned, phased rollout of the reforms.

Painting from the blog How to juggle glass: surviving mental illness at University
Despite this, there is no new money in the reform package just a reallocation of $350 million of existing funds to primary health networks (or PHNs) to commission — but not deliver — mental health services.
PHNs are newly established agencies. There are questions over their capacity to manage these responsibilities and deliver genuine client centred care. The Primary Health Networks have no history and limited experience and capability to deliver or contract mental health services.
Some health commentators see the PHNs as ideological creations of the Abbott/ Turnbull Government and question the way they were created and their ability to deliver outcomes. Economist John Thompson writes about the creation of PHNs:
Many in the health system are of the view that the whole exercise is a very expensive ideological move that, despite very substantial financial resources and lengthy disruption and dislocation, may not achieve the results that the fledgling Medicare Locals were beginning to realise.

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the 2014 tendering process was poorly planned, hurriedly implemented, and resulted in a loss of services.
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the process was not equitable and transparent, with an apparent inherent bias toward larger providers at the expense of local knowledge and expertise that smaller providers have developed in response to clients’ needs.
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throughout the process the Department kept providers and peak bodies at a distance and the NFP sector felt the department undervalued their expertise, experience and role.
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the process damaged relationships between providers by pitting them against each other and engendered greater mistrust.
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the outcomes of the contestable process were poor.
This agenda to introduce more for-profit corporate and business providers into health, social and community services delivery is a major priority of the Abbott/Turnbull Government’s social policy agenda, particularly in areas where there are currently few for- profit corporate providers such as disability (through the NDIS), mental health and welfare services.
In announcing the Government’s response to the Harper Competition Review, Treasurer Scott Morrison laid out the Federal Government’s agenda when he committed the Commonwealth Government to a radical process of marketization and privatisation of health, education and human services to introduce more for- profit corporate and business providers.
6) The Government has confirmed that there will be a loss of some services as a result of them losing funding under the new model.
The loss of mental health services, particularly community based services, peer-led services, agencies with specialist expertise or those located in regional areas where there are fewer services, will have major consequences.
7) Indigenous mental health groups welcomed the announcement and the commitment of $85 million to Indigenous mental health, but called for greater detail about the reforms and urged the government to consult and collaborate with the Aboriginal community.
10) Concerns have also been raised that the reform package neglects the role of people with lived experience and peer approaches, and an increased role for peer workers, issues now widely accepted and promoted in the mental health sector as providing a progressive social movement of informed consumers capable of driving reform.
11) Finally, and perhaps even more importantly, other social policy reforms of the Abbott/Turnbull Government are likely to undermine the intent of the reforms.
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As part of its crackdown on the Disability Pension (DSP) the Abbott/Turnbull Government outsourced the assessment of eligibility for the DSP, resulting in 8000 young people being kicked off the DSP, forcing sick people deeper into poverty. This includes many people with mental health issues. In addition, the number of applicants for the DSP being rejected is the first place has risen dramatically from a third in 2008 to almost two thirds in 2016. 70,000 new applications have been rejected.
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The Budget measures of the Abbott/Turnbull Government are significantly increasing the financial stress experienced by many people with mental illness and creating additional cost barriers to them accessing care.
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Tax reform proposals, particularly the proposed increase in the GST, will hit vulnerable people the hardest, including people with mental illness and mental health issues.
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The new Family Payments Bill and cuts in payments to single parents and families will impact on families affected by mental illness or mental health problems.
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Problems with Centrelink.

painting by Liz Kelder
There is much still unknown about the proposed reforms, however given the severity of the crisis in mental health systems throughout Australia, the reforms are overdue and welcome, as John Mendoza notes, and it is hoped they make a significant difference to the lives of people affected by mental illness and mental health problems.
However, in light of the underlying concerns raised in this paper and questions about some assumptions underlying the reforms, the fear is that the reforms will go the way of many previous reforms. Well meaning and likely to deliver benefit to a proportion of people in need, but ultimately unable to address the systemic problems and extent and severity of need. We will see.
If you are going to quote Sebastian Rosenberg in your article, you could at least get his name right.
Thank you Simon for pointing out that error. We apologise for the error and will make the change. Thanks for bringing it to my attention.
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