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May 17, 2021 31 tweets 18 min read Twitter logo Read on Twitter
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

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More from @coopesdetat

May 18, 2021
Greatly looking forward to the next two sessions at #RANZCP2021 on Maori and Aboriginal and Torres Strait Islander mental health, feat Helen Milroy (WA Australian of the Year and Australia's first-ever Indigenous MD), Allister Bush, Mark Lawrence & Wiremu NiaNia
First up Palyku woman Helen Milroy, paying respects to elders. Will be speaking about complexities in Aboriginal MH #RANZCP2021
How do cultural perspectives cross over with illness experiences? Milroy sharing some examples #RANZCP2021
Read 62 tweets
May 18, 2021
Will be tweeting in a thread below from the joint @ranzcp-JSPN symposium on patient rights next #RANZCP2021
Our first speaker Neeraj Gill #RANZCP2021
Gill setting the scene #RANZCP2021
Read 23 tweets
May 17, 2021
Our first keynote at #RANZCP2021 today will be from Carole Warshaw, director of the US National Center on Domestic Violence, Trauma & Mental Health
Warshaw talking emergence of trauma theory and how powerful it was for survivors - DV not a psychiatric condition but has many MH and substance use related effects. Reframing #RANZCP2021
Coercive control at the heart of DV, physical violence may be a threat to enforce but not always most prominent aspect, says Warshaw. Like being in a hostage situation, aided and abetted by systems - legal, migration and medical #RANZCP2021
Read 29 tweets
May 17, 2021
Final session today is on the interplay of DV, substance use, trauma & MH. Chaired by @DrWilliams, with @ManjulaOConnor, Sathya Rao & Carole Warshaw; @croakeynews is at the veterans and first responders MH stream #RANZCP2021
First up is @ManjulaOConnor, on gender, social power & restrictive norms, leading to disparities and inequities #RANZCP2021
Gender is a system defining men and women in opposition and distributing power accordingly, privileging masculinity says O'Connor #RANZCP2021
Read 24 tweets
May 17, 2021
This afternoon I will be tweeting from #RANZCP2021 sessions on mental health workforce, and DV, trauma & substance use. John Allan getting us underway now. @croakeynews will be covering sessions on ADHD, and the MH of veterans and first responders
The psychiatry workforce is ageing, and about 50:50 public vs private says Allan. Stressors include too much work to do with not enough time to do it #ranzcp2021
Just 6 psychiatrists in Australia service very remote regions. SIX! Versus 2,671 in the cities. Significant rural maldistribution #RANZCP2021
Read 28 tweets
May 16, 2021
We'll be hearing from @kgelber next on hate speech and its consequences. A problem she says is increasing in prominence and scope #RANZCP2021
Gelber talks about the mainstreaming in modern politics of hate speech and its threat to democracy
#RANZCP2021. Political leaders including Trump engaging directly in these discourses. Australia not immune. Scale of problem is huge
Hate or the presence of hate or dislike is not the key determinant of hate speech - discrimination is, says @kgelber. Hate speech is an act of discrimination that you carry out with your words. Doesn't have to be vituperative or epithet-laden #RANZCP2021
Read 26 tweets

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