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Australia

WA's mental health care system 'ineffective and inefficient': report

Western Australia’s state-funded mental health care system provides inefficient and ineffective services, with funding misdirected to provide more hospital beds rather than prevention programs, according to a recent Auditor General’s report.

The Access to State-Managed Adult Mental Health Services audit, released on Wednesday, found that mental health outcomes in WA had declined rather than improved due to the state government failing to fund and implement a plan made almost five years ago.

File photo. The Auditor General found WA's mental health system to be inefficient and ineffective.

File photo. The Auditor General found WA's mental health system to be inefficient and ineffective. Credit:Nicolas Walker

The audit looked at how the Mental Health Commission, Department of Health and health service providers were structured and how people accessed care in hospitals, emergency departments and community mental health teams between 2013 and 2017.

The audit also analysed the government's progress in enacting the Better Choices. Better Lives: Western Australian Mental Health, Alcohol and Other Drug Services Plan 2015-2025, developed to guide investment decisions for the optimal mix and level of services required to meet the needs of WA within the decade.

The audit found there had been limited progress in implementing the plan to rebalance the mix of services available, meaning that the system continued to deliver services "inefficiently and ineffectively".

Auditor-General Caroline Spencer said the plan had identified an urgent need to expand community mental health services and rely less on costly hospital beds, but that had not been the state’s focus.

"We found a system under significant pressure, which often struggles to meet the demand for mental health care," she said. "One of the reasons for this is the mix of services currently available does not match what the state needs."

During the five-year period, from 2013-17, more than 212,600 people accessed mental health services, of which just 10 per cent or 21,000 used 90 per cent of hospital care and almost half of emergency and community treatment services.

"This is one of the key groups of people who the MHC and WA Health should focus on understanding so they can provide pathways that enable these people to spend as much time as possible in the community and then move through more intensive services as they need to," the report read.

"This approach would reduce the amount of time these people spend in very expensive hospital beds and EDs."

The plan focused on reducing funding for hospital beds from 42 per cent to 29 per cent by 2025. However, by the end of 2017-18 state funding had instead risen to 47 per cent for mental health.

The percentage of people accessing mental health services in WA between 2013 and 2017.

The percentage of people accessing mental health services in WA between 2013 and 2017. Credit:Office of the Auditor General Western Australia.

Across WA, 18 hospitals provide about 740 dedicated mental health beds, excluding the state forensic centre, and a third of those are ‘secure’ and intended for people at risk of physical harm to themselves or others.

"EDs are being used as a gateway, and hospital care has become harder to access with people spending more time in ED in order to access a secure mental health bed," the report read.

"From 2013 to 2017, almost half the people seeking care first accessed state-funded mental health services through an ED. Over the same period, we found 2278 people had three or more ED visits in the seven days before they were admitted to hospital for mental health care.

"This suggests community pathways to hospitals are not working for a significant number of patients."

Through the MHC, the state invests about $800 million each year in a range of community and hospital-based mental health services that are delivered by health service providers and non-government organisations.

The audit found the proportion of funding towards community treatment services remained the same at 43 per cent, while funding for both prevention and community support decreased from 3 per cent to 1 per cent and 8 per cent to 5 per cent respectively.

According to the report, the MHC had not developed a system-wide implementation strategy to support the plan, and the lack of agreed funding meant enacting the plan had relied on "ad-hoc" investment.

"The MHC’s 2019 progress report notes that it had only finalised 24 per cent of projects it expected to complete by 2017, with a further 67 per cent in progress,” the report read.

Comparison of MHC funding mix proposed in the plan to reach optimal spend on mental health care services.

Comparison of MHC funding mix proposed in the plan to reach optimal spend on mental health care services. Credit:Office of the Auditor General Western Australia.

"For some people this means there are gaps in services, so they continue to rely on acute, higher cost and often less suitable care settings. People accessing community treatment services in 2017 were receiving less care on average than in 2013."

Greens mental health spokeswoman Alison Xamon said the report painted a damning picture of a disjointed state-funded mental health care system that was out of touch with how people used services, resulting in an inefficient system that heavily relied on crisis-style care.

"We are not making any headway and in some instances we are going backwards," she said. "The auditor general’s finding that people accessing community treatment services in 2017 were receiving less care on average than in 2013 is incredibly disheartening to say the least.

"Unless government takes heed of the auditor general’s findings the acute end of the care spectrum, such as our struggling emergency departments, will continue to be under enormous strain."

Health Minister Roger Cook said the government accepted the report’s findings and said the MHC and Department of Health were working to address the issues raised.

"The mental health system is complex, with thousands of people accessing treatment each year and the treatments available have improved significantly since those in practice decades ago," he said.

"Since coming to office the McGowan Government have increased spending on mental health by over $100 million, this has resulted in a record annual spend of $942.1 million.

"This increase has facilitated the introduction of several initiatives that have seen a shift away from institutionalised care to more community-based care, centred around the individual, with recovery at its core."

The audit found the Better Choices. Better Lives: Western Australian Mental Health, Alcohol and Other Drug Services Plan 2015-2025 had not been funded, and investment would be ‘dependent on government’s fiscal capacity’ and ‘subject to government approval through normal budgetary processes’.

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