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‘Missing middle’ leaves too many Victorians without mental health support

Martin Foley, Victoria’s Minister for Mental Health, said recently that the state’s mental health system “wasn’t fit for purpose” − in a rare moment of political truth-telling. He said it as the COVID-19 pandemic set itself to test the fitness of the mental health system in the same way it has tested our aged care, childcare and hospital systems.

The mental health fall-out from the pandemic has a long way to run, but we are starting to see its impact. DHHS data shows that more people are presenting to emergency departments after harming themselves, and Eli Lilly, maker of the antidepressant Prozac, has reported shortages of the drug because of increased demand.

Too many Victorians are not getting the mental health support they need.

Too many Victorians are not getting the mental health support they need. Credit:Sylvia Liber

One of the reasons the mental health system is vulnerable is because shared funding between state and federal governments leaves large gaps. The state government funds public hospital units and community care for people with severe mental illnesses. Funding for this system has steadily eroded in Victoria, to the extent that the state has the lowest per capita expenditure on mental health care and the lowest number of beds. Community care is difficult to access. It is restricted mainly to people with severe psychotic illnesses, or who are considered at high risk of harming themselves or others. The people who are provided with care very definitely need it, but so do many others who cannot clear the bar to qualify for it.

Those who can’t access care via the state government mental health services can attempt to get care via Medicare-funded services. General practitioners provide much of it, and they can organise referrals to psychiatrists, psychologists and other allied health clinicians. Mental health clinicians are concentrated in wealthier suburbs, where they can charge higher fees and see patients who more often have less complicated problems. Access to them requires that a person has the wherewithal to
organise a referral, has the capacity to pay the gap between what the clinician charges and what Medicare reimburses, and has the ability to organise themselves to attend regular appointments. This is beyond many.

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