Mental Health and Suicide Prevention – Stage 2

Budget Review 2022–23 Index

Rebecca Storen and Emma Vines

Background

In the 2021–22 Federal Budget, the Australian Government released its response to the Productivity Commission’s inquiry into Mental Health and the National Suicide Prevention Adviser’s Final Advice through its National Mental Health and Suicide Prevention Plan (national plan), alongside $2.3 billion in funding. At the time, stakeholders broadly welcomed the announcement, noting it as an ‘important first step’ but the involvement of the state and territories was unclear and at least one stakeholder noted that the measures did not ‘sufficiently address the immediate workforce shortages …’.

Stage 2 of the national plan

The 2022–23 Budget expands on the initial measures announced by funding stage 2 activities. The Government has committed to provide $547.0 million over 5 years from 2021–22 through the Prioritising mental health measure, which is split across the 5 pillars of the national plan (Budget measures: budget paper no. 2: 2022–23, pp. 108–10):

$76.4 million over 5 years for prevention and early intervention
$46.7 million over 2 years from 2022–23 for suicide prevention
$285.5 million over 5 years for treatment
$44.9 million over 4 years from 2021–22 for supporting people who may be vulnerable
$93.2 million over 5 years for workforce and governance.

Budget paper no. 2 notes part of the funding for this measure is provided in this Budget and the remaining cost will be partially met within existing resources of several agencies and partially offset by the Department of Defence (p. 111). Total payments for this measure will be approximately $303.2 million over the 5 years (p. 108).

This article primarily uses the grouping of activities identified in Budget paper no. 2 rather than the groupings used in the Department of Health factsheets and the joint press release from the Ministers responsible for health and mental health. These latter sources state that the Budget provides $648.6 million for stage 2 of the national plan and other suicide prevention and mental health commitments (Health portfolio 2022–23 budget stakeholder pack, p. 93).

Prevention and early intervention

Building on the $248.6 million commitment in the 2021–22 Budget (Budget measures: budget paper no. 2: 2021–22 (pp. 117–118),the Government has announced $76.4 million in additional funding for prevention and early intervention activities (Budget paper no. 2, p. 108; Health portfolio budget stakeholder pack, pp. 93–94), including:

$52.3 million over 4 years from July 2022 for Lifeline
$9.7 million over 3 years from 2022–23 for nationally consistent mechanisms to help schools and teachers to better manage mental health and welfare concerns, including through:

a national measure of student wellbeing
accreditation guidelines for mental health and wellbeing programs
trauma informed professional development for teachers

$3.3 million of additional funding for the Raise Foundation to continue its mentoring program with year 8 students at public schools most at risk of disengagement or poor wellbeing
$3.9 million for research activities and services to the Thompson Institute, University of the Sunshine Coast (USC).

The Black Dog Institute has welcomed the measures announced in the Budget, especially the regional focus for suicide prevention and workforce shortages (discussed below), however it does note that the Budget ‘falls short’ on support for children under 12 years of age and is a missed opportunity for early intervention ‘despite the release of a National Children’s Mental Health and Wellbeing Strategy’.

Suicide prevention

Of the $46.7 million provided in the Budget for suicide prevention, $42.7 million will be for activities through the Primary Health Networks (PHNs), including approximately $1.6 million for data development, reporting and an evaluation. Additionally, $4.0 million over 2 years will extend the Suicide Prevention Research Fund, which is managed by Suicide Prevention Australia on behalf of the Australian Government (Health portfolio budget stakeholder pack, pp. 95–96).

Treatment

The majority of the $285.5 million committed to treatment activities will be provided to headspace to continue and expand its Early Psychosis Youth Services program with $206.5 million over 3 years from 2022–23, as announced in the Ministers’ joint budget media release (p. 10). In an evaluation of the program in 2020, the evaluators noted that the program delivered good outcomes for young people but ‘the current design … was not shown to be as efficient or cost effective as it could be, nor was it sustainable for a broader expansion in its current format’ (p. 16). In addition, the evaluated program was not available in Tasmania, the Australian Capital Territory (ACT) or rural and regional locations (p. 12). The additional funding, welcomed by headspace, will see the program expanded into Tasmania and the ACT.

In addition, $14.8 million over 5 years will be provided to headspace to continue several other programs, including flying headspace and the Schools Suicide Prevention Activities Program (Budget paper no. 2, p. 109).

The Budget also provides $24.3 million for new and existing services for people with an eating disorder (Ministers’ media release, p. 10), including:

$20.0 million for competitive grants to implement specialised treatment services in the community
$1.6 million for the National Eating Disorders Collaboration for, among other things, the implementation of a National Eating Disorders Strategy (which does not appear to have been publicly released).

There is also $15.1 million for new Medicare Benefits Schedule (MBS) items for multidisciplinary case conferencing for people with a mental health or eating disorder, with referred patients eligible for 4 case conferences each calendar year (Health portfolio budget stakeholders pack, p. 98).

The Butterfly Foundation has welcomed these announcements, noting that several of the measures will address some of the gaps the organisation has been advocating for with government.

Supporting people who may be vulnerable

The Budget provides $44.9 million over 4 years from 2021–22, including:

$17.8 million over 2 years from 2022–23 (Health portfolio budget stakeholders pack, p. 102) for targeted support for culturally and linguistically diverse communities, with:

$10.0 million for one year’s top-up funding for the Program of Assistance for Survivors of Torture and Trauma to assist service providers to meet the anticipated increase in demand from humanitarian entrants to Australia and survivors of torture and trauma
$7.8 million to provide translating and interpreting services for people accessing mental health programs commissioned by the PHNs

as discussed elsewhere in the Budget Review, $8.6 million over 3 years from 2022–23 to establish a National Closing the Gap Policy Partnership on Social and Emotional Wellbeing that will seek to reduce the impact of mental ill-health and suicide on Indigenous Australians through co-led and co-designed initiatives
$8.5 million over 3 years from 2022–23 to expand the Red Dust program across remote Northern Territory communities (Health portfolio budget stakeholders pack, pp. 101–102).

The Budget also provides $8.3 million this financial year to the Thompson Institute to establish a national post-traumatic stress disorder (PTSD) centre, which will be the national hub for treatment for trauma-related mental health conditions. According to the press release from USC, the team plans to expand its facility and services, including for a PTSD brain bank, to assist in allowing rapid research translation into clinical practice (see also Budget paper no. 2, p. 110).

Workforce and governance

Budget paper no. 2 (pp. 110–111) provides $93.2 million over 5 years from 2021–22 for workforce and governance, with the majority of that funding ($64.7 million) committed to implementing the first stages of the 10-year Mental Health Workforce Strategy (noting that the Health portfolio budget stakeholders pack identifies $89.2 million for workforce and governance measures and $60.7 million for the Strategy (p. 11) although it does not indicate the number of years this covers).

This funding was welcomed by the National Mental Health Commission. However, while funding has been committed and the Strategy was expected to be presented to states and territories by the end of 2021, it does not appear to have been publicly released. During consultation on the draft strategy between August and September 2021, the Commission criticised the draft for falling ‘short of adequately addressing its intended purpose’ (p. 3). Without the release of the final endorsed Strategy, it is unknown how substantial revisions were, and stakeholders do not appear to have commented yet on the specifics of the final Strategy itself.

Of the budgeted funding for the Strategy, the primary allocation is $28.6 million over 3 years from 2023–24 to increase the size of the psychiatry workforce through ‘training posts, funding for supervisors, specific rural and remote initiatives and recruitment’ (Budget paper no. 2, p. 110). The Royal Australian and New Zealand College of Psychiatrists has welcomed this announcement as an attempt to address workforce maldistribution and shortages, but noted that additional key reforms are still required.

Additional allocations to support implementation of the Strategy (Budget paper no. 2, pp. 110–111) include:

$18.3 million over 3 years from 2022–23 for a national mental health ‘pathways to practice’ program for nursing, allied health and psychology students
$6.2 million over 3 years from 2021–22 to support the mental health of health workers
$4.7 million over 3 years to provide general practitioners with access to psychiatrist support for treating their patients
$1.3 million over 2 years from 2023–24 to build the capacity of mental health workers to respond to people with both substance use and mental health conditions
$0.4 million over 2 years from 2022–23 for a stigma reduction program to encourage secondary and tertiary students to pursue a mental health career.

An additional $4.2 million over 5 years from 2021–22 has been committed to support general practitioners’ employment in rural and regional headspace centres, while the Australian Public Service (APS) Commission will receive $3.5 million over 4 years from 2022–23 to continue the APS Mental Health and Suicide Prevention Unit (Budget paper no. 2, p. 111).

National Agreement on Mental Health and Suicide Prevention

In March 2022, the National Agreement on Mental Health and Suicide Prevention was announced, despite not being signed by Victoria, Western Australia, or the ACT (the ACT has since signed a bilateral agreement with the Australian Government under the National Agreement).

Underpinning the National Agreement are bilateral agreements between the Australian and state and territory governments. Federal financial relations: budget paper no. 3 (p. 26) outlines Government support for these agreements as at 18 March, with $50.1 million committed for agreements with South Australia, New South Wales (NSW) and the Northern Territory. However, it is noted that this does not reflect the total funding for states under the bilateral schedules, with part of the Commonwealth’s contribution to be made through payments to the Department of Health and PHNs.

Flood package (cross portfolio measure)

The Flood package measure (Budget paper no. 2, pp. 61–62; Health portfolio budget stakeholders pack, pp. 86–87) which is described as supporting recovery from the 2022 floods in NSW and Queensland, includes:

$31.2 million over 2 years from 2021–22 to meet the anticipated increase in demand for mental health support of people affected by the floods, including:

$16.6 million for local mental health services to meet the immediate need of their communities
$9 million for activities to support the mental health of children and young people through headspace and Royal Far West, as well as funding to rebuild or relocate headspace Lismore
$3.0 million towards Wellbeing and Resilience Grants

$10.0 million over 4 years from 2022–23 for the Resilient Kids program to support school-aged children in the Northern Rivers region
$4.7 million over 2 years from 2021–22 in primary health care funding for communities impacted by the floods, including:

$2.4 million for 8 PHNs to establish primary health care emergency response teams for urgent access to health services
$0.7 million over 6 months for temporary surge workforce for primary care in the Lismore region
$1.5 million to establish temporary primary health care services.

Additionally, the Black Dog Institute will receive $4.0 million to establish a national mental health service for emergency service workers and volunteers (Health portfolio budget stakeholders pack, p. 98).

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