Academic journal article Australian Journal of Social Issues

'Problematising' Australian Policy Representations in Responses to the Physical Health of People with Mental Health Disorders

Academic journal article Australian Journal of Social Issues

'Problematising' Australian Policy Representations in Responses to the Physical Health of People with Mental Health Disorders

Article excerpt

Introduction

This paper explores Australian policy responses to the poorer physical health of people with mental health disorders. It addresses representations of the causes of poorer physical health in mental health policy and the social implications of this representation. Discourse analysis is undertaken of 22 policy documents using Carol Bacchi's 'what's the problem represented to be?' approach (2009). Bacchi's approach explores policy solutions in relation to the representation of the policy issue, arguing that the issues that are problematised arise from and reflect existing policy directions. This approach, in turn, enables identification of issues which are not problematised and policy solutions that have not been considered. Three policy solutions are identified: collaborative care delivery involving greater use of primary care services, particularly GPs, to manage physical health; the monitoring of physical health status by mental health teams; and the promotion of lifestyle change. Policy responses are examined against the literature on the extent and causes of physical health problems among people with mental health disorders as well as consumer lobby groups' concerns with current policy approaches. These solutions are examined in light of neoliberal approaches to health policy.

Recent developments in mental health care in Australia

Australia, like many Western countries, has moved away from institutional care for people with mental health disorders towards community care over recent decades. The movement towards community care was hastened by the National Mental Health Strategy, launched by the Federal government in 1992 with the goal of mainstreaming mental health care and developing services to support people with low prevalence disorders, such as schizophrenia and bipolar affective disorder within the community (Australian Health Ministers 1992). By 1998, the release of the Second National Mental Health Plan refocussed community care towards early intervention delivered through primary care with a greater focus upon the management of high prevalence disorders such as depression and anxiety (Henderson 2005; Hickie & Groom 2002). This move was justified in part, by recognition of the incidence of untreated or poorly managed high prevalence disorders and reliance upon general practitioners to provide care for these people (Fletcher et al. 2009). A move towards primary care was supported by strategies to increase collaboration between primary care and specialist mental health services. The first of these, the Better Outcomes in Mental Health Care (BOiMHC) was launched in July 2001, with the expressed goal of improving access to primary mental health care (Fletcher et al. 2009). The first cycle of reforms allowed patients to claim through the universal health care scheme Medicare for psychological interventions and promoted referral to allied health professionals of people with high prevalence disorders through the Access to Psychological Services component of the scheme (Fletcher et al. 2009; Hickie & Groom 2002). This was supplemented in November 2006 through the Better Access program which enabled people receiving care to claim under the Medicare Benefits Scheme for services provided by psychologists, and some social workers and occupational therapists, upon referral by a GP (Fletcher et al. 2009). Medicare data for the financial year 2009-10 demonstrates that mental health related problems accounted for 11.4 per cent of GP consultations, with depression and anxiety the most commonly managed of these conditions (AIHW 2011). In addition, claims for allied mental health services have increased, accounting for 3.9 million claims in 2007-08 (AIHW 2009). More recently, support for this scheme has been reduced. Medicare Benefit Support (MBS) was withdrawn for social work and occupational therapy services from July 2010 (Medicare Australia 2010) and the 2011 Budget lowered the number of consultations available through the Better Access programs and reduced Medicare rebates for GP mental health care planning, opting instead to target resources through Medicare Locals and non-government organisations for populations viewed as having reduced access to other resources, such as those with 'severely debilitating, persistent mental illness with complex and multiagency needs' (Roxon et al. …

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