Thread by @coopesdetat

Back on deck at #RANZCP2021, tweeting from a session on the @ozprodcom inquiry into mental health. Discussions chaired by Harvey Whiteford from @QCMHR, who was associate commissioner. @CroakeyNews will be covering the session on aged care

Intros to Whiteford. First psychiatrist ever appointed to the @WorldBank, first advisory psychiatrist to the federal government. Will be talking to us about the @ozprodcom inquiry and last week's federal budget #RANZCP2021

Inquiry spanned 18 months from Oct 2018 to June last year, with report released in Nov. Was the biggest @ozprodcom inquiry ever, 1300 submissions from a spectrum of stakeholders, says Whiteford #RANZCP2021

First the inquiry had to establish the scope of the problem, not insignificant by the numbers. Very common and across the age span. Fair to say the @ozprodcom was taken aback by scale #RANZCP2021

Mental health costs ~10% Australia's GDP #RANZCP2021

Mental and substance use disorders are the leading cause of lost life years globally and second only to musculoskeletal disorders in Australia Whiteford says #RANZCP2021

The @ozprodcom considered five key areas for reform. Much of the report focused on area 3, encompassing the many social determinants of mental health #RANZCP2021

Reform area 1: prevention and early intervention #ranzcp2021

Reform area 2: improving experiences of the mental health system. Making telehealth a permanent feature, keeping people out of ED, Biggest gap in absolute terms - people getting no help or the wrong help, the 'low intensity" and 'missing middle' #RANZCP2021

Looking at Better Access Scheme, most people only access 1, 2 or 3 treatments, well short of an 'effective dose' says Whiteford. Might benefit more from different models, which vary in cost. Need for greater efficiency #RANZCP2021

Shortfall in state/territory ambulatory community services causing lots of angst, says Whiteford. Many many many thousands more staff needed (light blue and green bars) #RANZCP2021

Also a marked shortfall in beds, public non-acute > acute. Some of the pressure on acute beds is due to insufficient ambulatory community care and other alternatives, he says #RANZCP2021

Psychiatrists are also a problem area. Striking a balance between acute care and ongoing management #RANZCP2021

Reform area 3: improving service experiences outside health (the psychosocial domain), including the NDIS, homelessness, police, legal system #ranzcp2021

Reform area 4: workplaces. Key takeaway not to wait for compensatory liability o be determined before approving treatment for a diagnosed mental illness. Waiting leads to a poorer mental health and vocational outcome - tx should be initiated ASAP #ranzcp2021

Reform area 5: funding incentives and accountability. Siloes a huge issue driving costs and poorer outcomes. Who is responsible? Pooling of funds, joint planning. Recognising models that work like ACCHOs #RANZCP2021

Whiteford showing that many of the reforms suggested by @ozprodcom saved more money than they cost to implement, even before considering other benefit metrics like QALYs #RANZCP2021

Reforms woud improve quality of life for tens of thousands of Australians and return about $1.3bn a year to the economy, costing about $2.4bn to bring in. Overall the economic arguments alone made a lot of sense #RANZCP2021

Unfortunately the report landed amid the costly #COVID19 pandemic, and urgent calls for aged care reform. Nevertheless there has been in-principle full or partial support for all 29 recs, Whiteford says #RANZCP2021. Much hinges on the yet to be brokered national agreement

Breaking down some of the budget highlights for mental health: single digital platform, universal perinatal MH screening, suicide prevention & postvention, expanded primary care capacity. Much depends on state & territory buy-in #RANZCP2021

Where to from here? Workforce is particularly important, nearly all of what we do is based on skill size and quality of our workforce, including cultural awareness. No amount of money can overcome this #RANZCP2021

States and territories are also crucial here. We need less duplication and more gap-closing. Without their buy-in this reform agenda will fall over. National cabinet must prioritise these discussions #ranzcp2021

It must also be a sustained commitment over years, not a one-off splurge. Money alone is not going to fix this, sustained implementation is required. It will take many budgets, substantial increase in quality and quantity of workforce and cultural shift #RANZCP2021

Question on lots of government money going to non-evidence based initiatives, not properly interrogated. Whiteford says evaluation is crucial. More spending is not always good spending #RANZCP2021

Despite spending a lot more money and being up to our 5th national plan the burden of mental illness doesn't seem to be changing. Treatment reduces duration and severity of episodes, more focus on outcomes rather than process and inputs #RANZCP2021

One easy thing to do would be to have a national mental health crisis phone line instead of 30. How about Head to Health? Whiteford says great if brings new people into treatment, but not if it perpetuates further silos. Emphasises need for regional planning #RANZCP2021

We need to assess where the gaps are & close them. All new initiatives should be aimed towards this. Adequately resourcing the states and territories will also be crucial given they have been left responsible for key, high-cost measures like ambulatory community care #ranzcp2021

Discussions around whether mental health and suicide prevention should be overseen by a statutory authority. Whiteford said part of the thinking around this is safeguarding independence and ability to frankly and fearlessly call out governments #RANZCP2021

Interesting discussion around RCT effect size vs real-world implementation, and loss of efficacy in translation, esp in areas like primary care. About the quality of the workforce, says Whiteford. If we improve that, we minimise loss of effect size #RANZCP2021

Whiteford says absolute numbers of workforce have to go up - more trainees, more supervisors. Nursing, including a direct MH qualification similar to midwifery. Peer workers. Payment mechanisms for psychiatrists to better reflect their workload #RANZCP2021

That is a wrap, will be back at 2pm for a symposium on mental health workforce. @RANZCP launches its Rural Psychiatry Roadmap today, aimed at improving access to services. Just 10% of psychiatrists work outside metro centres, despite 29% of the population living there #RANZCP2021