Australian state and federal governments are attacked on mental health
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《英国医生杂志》
More than a decade of mental health reform in Australia has failed to translate into better services, a new report says.
The report is the most extensive investigation into Australia抯 mental health services since national reform of mental health care began in 1992.
Its 1008 pages detail many personal tragedies, including accounts of patients harming themselves or others after being unable to get appropriate care. It also describes systemic problems, such as underfunding and workforce shortages.
"In short, the available evidence suggests that persons with mental illness still struggle on a daily basis to access appropriate health care or be treated with respect or dignity when they do enter our health care systems," the report says.
"Any person seeking mental health care runs the serious risk that his or her basic needs will be ignored, trivialised or neglected."
It says the consequences of the "broken and failing" system include inappropriate use of seclusion, over-reliance on sedating drugs, homelessness, unemployment, incarceration, poverty, and suicide.
The report was released on 19 October by the Mental Health Council of Australia, the Brain and Mind Research Institute at the University of Sydney, and the Human Rights and Equal Opportunity Commission.
It urges action from Australian federal and state governments to improve leadership, accountability, and investment in mental health care. It also calls for an annual national mental health report card to be established, which would be presented to the prime minister and heads of governments.
Australia抯 human rights commissioner, Sev Ozdowski, said the report described a "crumbling" mental health system and should serve as a wake-up call.
Ian Hickie, executive director of the Brain and Mind Research Institute and a co-author of the report, said Australia had been an international leader in developing mental health policies based on deinstitutionalisation and care in the community but that "the experiences of care today remain as tragic as in 1993."
"The fact that at the end of the day the rhetoric of policy is not matched by service delivery is a cautionary word for everyone," he said. "Policies without implementation aren抰 worth the paper they抮e written on.
"The real danger is backlash. We have further increased stigma around mental illness by exposing the community to untreated people."
The report describes many instances of patients getting care only when they were actively suicidal or potentially dangerous. "We are running so completely contrary to the rest of health care, where early identification and treatment are seen as the most cost effective and most humane approaches," Professor Hickie said.
The report is based on several sources, including extensive public consultations, meetings with community, professional, and non-government groups, written submissions, and two surveys. National standards for mental health services were used to analyse responses, with particular attention on human rights issues.
Some health ministers and departments have found fault with the report抯 analysis methods, and Jeff Kennett, chairman of the national depression initiative, Beyondblue, and a former premier of Victoria, criticised its negativity.
Its release prompted arguments between federal and state governments over their split responsibilities for mental health. The federal parliamentary secretary for health, Christopher Pyne, issued a statement attacking state governments.
The federal health minister Tony Abbott said that care might be more efficient if it was dealt with by one level of government, although the prime minister, John Howard, has previously ruled out the federal government taking over full responsibility for health.
Professor Hickie said he was confident that Mr Howard recognised that improving mental health care was an important issue for the community.
Not for Service: Experiences of Injustice and Despair in Mental Health Care in Australia is available at www.mhca.org.au.(Sydney Melissa Sweet)
The report is the most extensive investigation into Australia抯 mental health services since national reform of mental health care began in 1992.
Its 1008 pages detail many personal tragedies, including accounts of patients harming themselves or others after being unable to get appropriate care. It also describes systemic problems, such as underfunding and workforce shortages.
"In short, the available evidence suggests that persons with mental illness still struggle on a daily basis to access appropriate health care or be treated with respect or dignity when they do enter our health care systems," the report says.
"Any person seeking mental health care runs the serious risk that his or her basic needs will be ignored, trivialised or neglected."
It says the consequences of the "broken and failing" system include inappropriate use of seclusion, over-reliance on sedating drugs, homelessness, unemployment, incarceration, poverty, and suicide.
The report was released on 19 October by the Mental Health Council of Australia, the Brain and Mind Research Institute at the University of Sydney, and the Human Rights and Equal Opportunity Commission.
It urges action from Australian federal and state governments to improve leadership, accountability, and investment in mental health care. It also calls for an annual national mental health report card to be established, which would be presented to the prime minister and heads of governments.
Australia抯 human rights commissioner, Sev Ozdowski, said the report described a "crumbling" mental health system and should serve as a wake-up call.
Ian Hickie, executive director of the Brain and Mind Research Institute and a co-author of the report, said Australia had been an international leader in developing mental health policies based on deinstitutionalisation and care in the community but that "the experiences of care today remain as tragic as in 1993."
"The fact that at the end of the day the rhetoric of policy is not matched by service delivery is a cautionary word for everyone," he said. "Policies without implementation aren抰 worth the paper they抮e written on.
"The real danger is backlash. We have further increased stigma around mental illness by exposing the community to untreated people."
The report describes many instances of patients getting care only when they were actively suicidal or potentially dangerous. "We are running so completely contrary to the rest of health care, where early identification and treatment are seen as the most cost effective and most humane approaches," Professor Hickie said.
The report is based on several sources, including extensive public consultations, meetings with community, professional, and non-government groups, written submissions, and two surveys. National standards for mental health services were used to analyse responses, with particular attention on human rights issues.
Some health ministers and departments have found fault with the report抯 analysis methods, and Jeff Kennett, chairman of the national depression initiative, Beyondblue, and a former premier of Victoria, criticised its negativity.
Its release prompted arguments between federal and state governments over their split responsibilities for mental health. The federal parliamentary secretary for health, Christopher Pyne, issued a statement attacking state governments.
The federal health minister Tony Abbott said that care might be more efficient if it was dealt with by one level of government, although the prime minister, John Howard, has previously ruled out the federal government taking over full responsibility for health.
Professor Hickie said he was confident that Mr Howard recognised that improving mental health care was an important issue for the community.
Not for Service: Experiences of Injustice and Despair in Mental Health Care in Australia is available at www.mhca.org.au.(Sydney Melissa Sweet)