Mental health care reform - just won't work without carers!
Recent years have witnessed a heightened community and government appreciation of the need for mental health reform. At the Commonwealth level, the 2011-12 Budget contained a major reform package of mental health services. In January 2012 the National Mental Health Commission opened for business and the Government released its draft Ten Year Roadmap for National Mental Health Reform.
In commenting on these developments the President of Carers Australia, Mr Tim Moore said that ‘they auger well for the improvement of mental health services in Australia. But real success in reforming the mental health sector cannot be successfully achieved without the inclusion of carers. Mr Moore said that ‘it is essential that the concerns of carers are listened to by those who make and deliver mental health care policy and services – only by doing this will real solutions be provided for those with a mental health issue and their carers. Mental health carers are central to reform because family members and friends are the major source of care and support for Australians with a mental illness. They are a critical part of the care team and they have a deep and unique understanding of the needs and concerns of people with a mental illness.’
Mr Moore said ‘that as a result of de-institutionalisation, carers have had to take on an even higher share of the care of people with a mental illness in the community, and this care often takes place in isolation.’
A carer perspective on mental health care was captured by the Mental Health Council’s (MHCA) Carer Engagement Project, conducted as part of the 2009 report Adversity to Advocacy: The Lives and Hopes of Mental Health Carers.
Carers surveyed in the project identified as key issues for mental health policy priorities that would improve the support of the people they care for as well as things that would better support carers. Included in the former were increased investment in holistic recovery-based care, more and better trained staff and more housing options. Amongst the issues more directly related to carers were a desire to be listened to and respected, including by mental health professionals, more flexible respite options, recognition of the effect that caring can have on physical and mental health, greater support in meeting the costs of care and greater support to participate in the workforce.
The current reform agenda offers a rare opportunity to change the mental health system in a way which addresses the issues raised in the Carer Engagement Project. Some suggestions for change are outlined below:
Federal Government’s Ten Year Roadmap for National Mental Health Reform
The Roadmap must address the needs not only of people with a mental illness but also their carers. Performance indicators are needed to measure carer services and outcomes for carers, including indicators of carer health and wellbeing and economic and social participation.
The newly established National Mental Health Commission
Carers of people with a mental illness should be a priority focus of the Commission. Carer participation and consultation structures need to be built into the operation and design of the Commission.
Reform needed outside the mental health sector
The needs of people with a mental illness and their carers will not be met by the mental health sector alone. Increased investment and improvements to other key services, including disability, health and housing services will be critical.
The availability of affordable and appropriate supported housing for people with a mental illness must be significantly improved. A lack of secure and stable housing is a considerable barrier to recovery and places additional pressures on carers and the care relationship.
National Disability Insurance Scheme
The National Disability Insurance Scheme must provide adequate coverage and levels of support to people with significant and enduring psychiatric disabilities, and their carers.
Income support system
Changes need to be made to tools used by Centrelink in assessing claims made by carers applying for Carer Payment and Carer Allowance. The current tools are biased towards the recognition of physical assistance provided by carers rather than emotional and social support, organising, encouraging and dealing with emergencies. As a result, mental health carers have a lower rate of access to these payments.
Carers’ financial circumstances can also be detrimentally affected by inadequate financial support for people with a mental illness.
National Carer Strategy
The National Carer Strategy presents the opportunity to create change for carers of people with a mental illness. The Strategy’s priority areas closely align with the issues identified in the Carer Engagement Project.
Carers Australia recently outlined priorities in regard to the current mental health reform agenda via a policy position statement. To read Carers Australia’s mental health reform policy position statement in full, click here.