All content contained within should be restricted to those over-age. Occasionally, suicide and self-harm are mentioned and readers should take care to ensure they are in a safe place - emotionally and physically - before reading. Comments are welcome.

Friday, September 23, 2011

Dear Mr Hickie

I am what you might have thought of when you referred to "armchair critics" in your opinion piece in Fairfax Media on the 23rd September.  I am a mother of two, and a mental health consumer.  I am also a "critic" of the new mental health reforms.

First of all, you speak of "$2.2 billion to new programs".  Let's be honest shall we?  It is NOT for new programs, it is for the total mental health budget.  And it is the total mental health budget for the next five years - a point that seems lost on some.  It is not even the correct figure.

The total spend over the next five years is $1 463 300 000.  $316 200 200 was already earmarked from previous budgets, so only $1 147 100 000 is actually new money.  $1.1 billion is a far cry from $2.2 billion.  I'm not even totally sure where the $2.2 billion figure comes from, other than political spin, because I can't find it anywhere.  Even the government here, says the budget spend over the next five years is $1.5 billion.  For now, I'll assume that they mean their Ten Year Road Map for mental health or something.

Aside from all this however, is the $580 500 000 that has been cut from Better Access.  $580 million CUT from the budget.  $580 million that people such as myself will now have to find.

Your article points out that the changes "will greatly increase the number of services provided and, most importantly, access for those with the least capacity to pay privately".  I am on the Disability Support Pension, and as my carer, my husband is on the Carer's Payment.  I consider us to be about the least capable of paying as you can get.  Ideally, I need to see my psychologist every fortnight.  Every week would be great, but I don't mind keeping it real.  The current eighteen session cut off leaves me with eight fortnights to find the full fee myself.  After the changes go through, I will have to find the money for sixteen full fees.  Possibly twenty, depending on what the criteria is for the additional four sessions.

I have heard of all manner of other alternatives, and I can assure you that I have either tried them to no avail (medication, inpatient services), or been turned away (public mental health outpatient services).  ATAPS is not an option as I don't know a GP who is eligible to refer, and other GP's here have totally closed their books to new patients.

Seeing my current psychologist is the first time I have felt "better".  And that is about to be ripped away from me because I can't afford to pay the full fee privately.  Your argument on behalf of those least able to pay makes no sense at all to the people who are actually living it.

In addition to this, I will have to come up with the same fees for my son, who has Asperger's and needs psychological appointments to help him learn how to regulate his emotions.  As he was diagnosed after his sixth birthday, we are not eligible for funding from the Helping Children With Autism Package.  This is on top of his speech therapy and occupational therapy - a total out of pocket of $285 a fortnight.  We live rurally - there is no other alternative for him here and we are not in a position to move.

Let us step back for a moment, and suppose that these new services WILL cater to our needs.  Our sessions run out on November 1st of this year.  This mental health reform is a five year plan.  At what stage in that five years is our local area going to see some new services that we can utilise?  What are we to do in the meantime?

And let us not forget the issue of continuity of care shall we?  I've been seeing my psychologist for three years.  In that time, I've developed a physical disability.  Most of our sessions to date have been dealing with issues that have arisen from that, thus, even after three years, my psychologist is still acquiring my history given I've led quite the eventful life.  To change over to another service will mean all that time is lost - wasted - as I will have to start over with someone new.

The second point you raised was the issue of attacks on the evidence of the new approaches, and indeed, exactly what these new approaches consist of.  Given that I am not a health care professional, I can not in good conscious debate that point in detail here.  I will say however, that I have done enough tertiary study in statistical analysis to be highly sceptical of the studies I have read.  The outright lies (such as $2.2 billion of new money), do not help your credibility either. Nor does the fact that yourself, and many of your cohorts, fail to disclose any potential conflicts of interest.

Your third point that "academic voices have expressed concern that expanding services to include early intervention will come at the expense of desperately under-developed services for those with chronic or persistent illness" and that "no such debate characterises similar advances in cancer or heart care" can be rebutted with a simple - in other areas of medicine, early intervention is added to advanced treatment.  In the case of the last budget, funding was taken away from the only advanced treatment that some of us have available to us (Better Access).

The fourth and final argument you stated is that "a very peculiar commentary proposes that mental health academics should not engage with the broader public debate".  From what I've seen, there seems to be more of a concern that some of those academics have their own agenda's to push at the detriment of consumers; and that consumers themselves need to consulted as well (which is not happening effectively), as they know best what works for them.  And usually what works best for us is choice, because we are all individuals and we all need different things, even if our "diagnoses" are the same.

Your final statement that "those governments (including NSW) that are making genuine attempts to develop a mental health system of which we can all be proud need the public's support" is truly a laugh.  If the current developments were indeed "genuine", I imagine there wouldn't be such opposition to them.

And so Mr Hickie - your arguments may work at your dinner parties with friends - but down here in the dirt where we struggle every day living this nightmare - your arguments simply smell like bullshit.

Note: In order to keep this blog relatively small enough to read in one sitting, I have left out quite a few finer points - and there are many many finer points.  Please don't think that they have escaped me.  I simply wanted to keep this as an overview rebuttal of the article Mr Hickie wrote.

Figures from the 2011-2012 budget.
Delivering National Mental Health Reform

Total funding Old funding New funding
Leadership in mental health reform $64,100,000.00 $64,100,000.00
Coordinated care and flexible funding for people with severe and persistant mental illness $549,900,000.00 $206,100,000.00 $343,800,000.00
National Mental Health Commission $32,000,000.00 $19,800,000.00 $12,200,000.00
Mental Health Online Portal $14,400,000.00
ATAPS $205,900,000.00
Support for day to day living in the community program $19,300,000.00
Expansion youth mental health - headspace $197,300,000.00
Health and well being checks for three year olds $11,000,000.00
National partnership agreement on mental health $201,300,000.00
Research funding $26,200,000.00 $26,200,000.00
Family mental health support services $61,000,000.00
Employment services $2,400,000.00
Four mental health infrastructure projects $78,500,000.00

$1,463,300,000.00 $316,200,000.00 $1,147,100,000.00

Better Access Initiative - rationalisation of allied health treatment sessions -$174,600,000.00

Better Access Initiative - rationalisation of GP mental health services -$405,900,000.00



  1. Might I wonder what kind of car he drives? How big a house he lives in? Will the money trickle down to anybody it is supposed to help? A doctor used to be one who simple wanted to help and went from town to town helping people get well and back on their feet. Now it's about something else.

  2. Well said Linda - I'm an OT providing bulk billed BAMH services. Half my clients are in the same boat as you and it pisses me off no end that it has just been rammed by The USS Julia and is sinking fast. Here in Wollongong - the City of Innovation - no-one I've asked has ever heard of ATAPS. The Local division of General Practice refuse to speak to me. Pity my clients.

  3. Seriously, what right does he have to drive a nice car or live in a big house? He works tirelessly for his own personal agenda. What other motives could he have for raising the profile of mental health than personal gain?

    On another note, the government chooses to listen to him, even though his view is only one of many. Why isn't the government listening to people like you Linda?