Mental health care shouldn’t begin in ED

The situation is far worse in regional Victoria – that’s the message from emergency department doctors about how they are increasingly at the frontline in mental health care.

One senior clinician told us of a recent experience in a regional hospital when a girl with a known history of depression and other mental health diagnoses was brought into the emergency department. It took three days and a four-hour trip for her to be admitted into specialist care.

Emergency departments are often the first point of access to specialist mental health care in the public health system. That's not where people with mental health issues should be presenting.

Every ambulance call-out and emergency department presentation for serious mental health issues represents a failure of the system to provide early intervention, and to stop an often preventable problem escalating into crisis. This failure is more acute in regional Victoria, where hospitals and other health services have fewer resources and far less specialisation. It is made more acute because there’s less support in critical places – for homelessness, drug and alcohol issues, family violence – all those places where mental health may emerge and converge as a critical issue and where early intervention can literally change lives.

Victorians often show national leadership in our economy, sporting prowess and education standards. But we are officially “below average” with our mental health system. A snapshot produced this week by Mental Health Victoria shows chronic underfunding and underinvestment by successive governments has left us with a system that trails the rest of Australia. We have gone from being a model for community-based preventative care, to a system that has been in decline for years. That's a problem in itself. But we are now approaching a perfect storm, with the transition to the National Disability Insurance Scheme, which will open up more gaps and see the loss of nearly 1000 specialist mental health positions by the end of June 2019.

Regional areas are already being hit hard, as the results of the NDIS trials in Barwon showed. Many rural and regional Victorians are finding they are not eligible for the NDIS, but other services that once supported them – in what's known as community mental health services – are at risk or already dropping away. Our member organisations are alarmed. They tell us mental health issues are becoming more acute before they are picked up in the system, and people have to wait until they are very unwell before they get a specialist response.

Health and social services have been sounding this alarm for years, urging better investment from state governments. This week, we are trying a new approach – showing how Victoria compares nationally, spelling out exactly what’s needed over the next four years, and providing the good news, that this is a win-win for governments.

Our report, Saving Lives, Saving Money: The Case for Better Investment in Victorian Mental Health, shows proper investment can deliver more than just better health, well-being and welfare for people with mental health issues and their carers.

It will deliver a billion-dollar return to the government, reducing ambulance call-outs and unnecessary presentations at public hospitals, increasing community safety, reducing homelessness, less absenteeism, improved economic productivity and greater workforce participation. That should be especially so in regional areas.

Angus Clelland is chief executive of Mental Health Victoria.