Public sector psychiatric health care

Public sector psychiatric health care

11 Oct 2010

A study of expenditure trends in the public psychiatric sector raises questions about the highly controversial period of deinstitutionalisation and accompanying rise of managerialism of the 1990s.

mental health It has found that the share of expenses per patient on management and administration has increased – while the share spent per patient for nursing has decreased.

La Trobe health economist, Ruth Williams, says the research compared data from 1992-93 when the process began, with 2005-06 when deinstitutionalisation was well in place.

She says that, ironically, the new era of managerialism had argued for programs to cut back administrative and managerial expenses.  

‘Our study finds the opposite happened,’ says Dr Williams who carried out the research with Dr Darrel Doessel from Griffith University.

‘It reveals statistically significant trends which suggest there are “too many chiefs and not enough Indians”. It also strongly indicates the need for greater managerial accountability in this sector, and finds evidence of unmet demand.’

The work by the two researchers is concerned with a wide range of mental health issues.  

Strange as it may seem, they argue government policy on suicide – and in Australia’s mental health sector in general – is not based firmly enough on economics research.

‘Some pockets of underdevelopment and misery in our society are overlooked by the economics profession,’ says Dr Williams.

‘For the scandals and crises in mental health to end, we need contributions not just from clinicians, accountants, and psychological researchers.’
She says it is difficult for economists to be heard above all those other voices. 

There is also a message to the economics profession that mental health is trivial: ‘that they should focus on conventional topics like recessions, trade, banking, finance and tourism’.

But economic ‘diagnoses’ of the various problems in the sector need to be provided.  The researchers argue this is now possible: sufficient collections of data exist.

For example, one of their studies deals with the conventional ‘headcount’ measure for suicide using a 100 years of Australian mortality data.

‘We apply a measure of suicide that takes account of its societal importance as a cause of death – and the time span data enables us to comment on some “big societal trends”’.

This, she says, reveals the upward trend in suicide rates has occurred during a period when the death rate from ‘all causes’ declined – major causes like heart disease, and smaller ones, like motor vehicle accidents. Even the cancer mortality rate has begun to turn down, she says.

‘When years of life lost to suicide are weighted, suicide is an even “bigger” cause of death.’  

Improvement a ‘pimple on a pumpkin’

‘So while there has been a decline in the suicide rate in recent years, which is in the right direction, there is no room for complacency. The magnitude is “a pimple on a pumpkin” relative to the overall upward trend.  

‘We find this same trend for all mentally-related causes of death, not just suicide’.

Other research highlights what Dr Williams and Dr Doessel describe as the problem of “the worried well”. They use mental health services while the needs of severely mental ill people remain under-resourced, she says.

‘Some Australians attract mental health resources that could be used for people in much greater need. Shifting resources to address severe issues, like child and adolescent service delivery, is one great need’.

Every million dollars of the mental health budget has several alternative uses, Dr Williams argues.

'They can fund about 6,375 mental health plans written by GPs. Alternatively, we can have 12,000 hours of private psychiatry services funded by Medicare; we could partially fund the construction of a dedicated facility; or 20 mental illness support groups could be funded at $50,000 each; and so on ….’

Dr Ruth Williams
Regional School of Business
Phone: 03 5444 7275

Ernest Raetz
Media and Communications
Phone: 03 9479 2315




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