2.5 Access to the right care at the right time

People with mental health problems and mental illness will have timely access to high quality, coordinated care appropriate to their condition and circumstances, provided by the most appropriate services.
For people with mental health problems and mental illness to have access to the right care at the right time, a range of inter-connected clinical and community service options should be available. These services should be responsive to the needs of people with mental health problems and mental illness when they arise, and they should promote positive outcomes and facilitate sustained recovery. These services will include primary care, acute care and community support services and may be provided by public and/or private sector services. There should be an adequate and appropriate workforce to provide the range of services required.

The primary care sector is a linchpin in mental health care delivery. For many people with mental health problems and mental illness, their first point of contact will be with a general practitioner. During the past decade, considerable attention has been paid as to how to equip general practitioners with better skills and knowledge to detect, diagnose and manage mental health problems. General practitioners and other primary care workers have been supported by the development of collaborative, multi-disciplinary models of care, new referral options and opportunities for secondary consultation. There will be further refinement to ensure appropriate targeting and use of evidence-based best-practice treatment approaches. Increased access to mental health nurses will complement these developments.

Beyond primary care, consideration must be given to the best way to configure the specialist mental health sector to guarantee that it is responsive to the needs of people with mental illness. Public sector expenditure on mental health services should be accounted for and reported on publicly and be structured to work in a more coordinated way, across Commonwealth, state and territory and private services and sectors. At the area/regional level, the full range of mental health services should be provided by integrated programs, ensuring a balanced and responsive mix of community and inpatient services. The important role played by private providers of inpatient and community mental health services is recognised. Community treatment should be the treatment of choice wherever appropriate, but inpatient care must be available when required. Core community services should include, but not be limited to, crisis assessment and emergency intervention, acute treatment and continuing care, as well as community-based residential support. Core inpatient services should include both acute and non-acute components. Non-acute bed-based services should be community based wherever possible and promote maximum independence and autonomy consistent with safety and physical well-being.

The integration of community and inpatient public sector mental health services has been a focus of the National Mental Health Strategy since its inception in 1992, and much progress has been made in this regard. However, integration now needs to go further and cross clinical and non-clinical, primary and tertiary sectors in order to maintain and strengthen the appropriate mix of services.

Specialist mental health services, both public and private should be part of the mainstream health system, supported by strong linkages between physical and mental health units and common accreditation expectations. Private sector services, including private hospital services, are a crucial part of the network of mental health services. Private psychiatrists, psychologists and other allied mental health providers are integral to Australia’s mental health system. Access to private providers has been enhanced through reform of the Medicare Benefits Schedule. Public and private providers should be accessible to all geographic areas. Coordination of care between state or territory and Commonwealth health systems are also important. The benefits of linking mental health services into the wider health system include:

• reducing stigma associated with mental health problems and mental illness
• improving the quality of mental health services
• increasing the potential for early detection and intervention
• enhancing equity of access to other health services for people with mental health problems and mental illness
• providing mental health services that are close to and respectful of people's family, community and cultural networks.

Mental health services in the criminal justice system, including police, the courts and the correctional system, are an essential component of the broader mental health service system. Prisoners have high rates of mental health problems and mental illness, and often their presentations are complex and characterised by multiple comorbidities. They may be particularly vulnerable early in their sentences and on release, and their symptoms may be exacerbated by stressors such as isolation, containment in a controlled environment, removal from their families and exposure to violence. Appropriate services should be available to identify and respond to the mental health needs of people who come into contact with the criminal justice system. For some, this will involve diversionary programs; for others it will involve services provided during and after their incarceration. These services may include clinical treatment to ameliorate symptoms of mental illness and support programs designed to prepare and support the individual in their return to the community.

Across all sectors further work is required to enhance access to and the quality of care. Better linkage and coordination is needed between clinical services within the health sector to ensure that the person is not ‘lost’ at critical transition points. These points include, in particular:

• discharge from hospital
• the period following presentation to hospital emergency departments
• on referral from public mental health services to general practitioners
• on referral between public and private mental health specialists.

Many people with mental health problems and mental illness have needs for care that extend beyond clinical treatment. Particularly for those with complex needs or severe mental illness, access to clinical care needs to be complemented by access to a range of supported accommodation options, stable housing, and community support services focussed on employment, income support, education and social and family support. When one or more of these is not met, the person's recovery and their capacity to live in the community are jeopardised. These services should be readily accessible and should not discriminate on the basis of mental health status. They should also be of high quality, and should be coordinated in partnership with clinical care.

Aboriginal and Torres Strait Islander peoples and culturally and linguistically diverse populations with mental health problems and mental illness require particular consideration in terms of clinical and community services. Services should be both culturally safe and respectful and in this context Aboriginal and Torres Strait Islander specific services, including community-controlled services, are of particular importance.

The role of the non-government mental health sector has expanded significantly over the past decade. The sector has become an important and integral part of the network of services for people with mental health problems and mental illness. The non-government sector provides crucial support to individuals, as well as to carers and families. Non-government sector services include psychiatric disability support services, advocacy services, peer support services, consumer-operated services, and programs addressing areas such as living skills, vocational training, accommodation support and respite care. In some instances, the non-government sector also provides clinical services.

In order to respond effectively to the varying requirements of people with mental health problems and mental illness, there is a need to develop ways of fostering partnerships and improving linkages between services provided within and across the primary care sector, the public and private specialist mental health sectors, the non-government mental health sector, and other sectors outside health. Innovative approaches to improving continuity of care should be explored. A more integrated approach across sectors, with partnerships between housing, employment, education, youth affairs, police, community and disability services, corrective services, and alcohol and drug services will be particularly important. Existing approaches have been expanded under the COAG National Action Plan on Mental Health 2006-2011, to ensure that clinical providers and community workers collaborate to meet the treatment and support needs of people with complex mental health problems. Such improved linkages are designed to encourage different elements of the system to work together so that individuals with mental health problems and mental illness can access care in a seamless fashion, irrespective of who is providing or funding that care.