Critical support for an increasing number of Australians with mental health conditions like anxiety and depression has stalled, as the states and federal government argue about the details of a multi-billion-dollar funding plan promised more than a year ago.
The five-year national agreement was meant to be finalised last November but discussions have hit a roadblock, with some states accusing the Commonwealth of shirking its responsibilities by failing to properly fund the deal.
The spat means hundreds of millions of dollars in funding is not flowing, with federal officials revealing in parliament last year $770 million had been tied up in protracted negotiations between governments.
Australian Psychological Society president Tamara Cavenett said that had direct implications for Australians with mental illness.
"When we're talking about dollars, we're talking about people's lives — it's not just the single individual, it's the cascade effect of that," she said.
Suicide Prevention Australia boss Nieves Murray said the tug-of-war was, "holding up the delivery of more supports for our community at a very crucial and important time in our history".
The $2.3 billion plan was first flagged in December 2020, on the back of a damning Productivity Commission review which found longstanding problems in the system including dysfunctional approaches to the funding of services and a lack of clarity between governments about their roles.
It was formally announced in the last budget with much fanfare, designed to fix gaps in the system that leave those with complex mental health needs without proper care.
The government said it would also provide additional funding for prevention and early intervention, with more money for services like free adult drop-in centres.
There was also funding to bolster the workforce with hundreds of additional training spots, clinical placements and scholarships to increase the number of nurses, psychologists and psychiatrists.
While the nation's leaders have assented to the agreement "in-principle", some Labor states like Western Australia and Victoria have publicly expressed disappointment in the negotiations.
One sticking point is funding, with Victorian Premier Daniel Andrews accusing the federal government of underfunding the plan.
"We've got an amount of money being put forward by the Commonwealth government that is but a fraction of what the state of Victoria is investing and it's being dressed up as a national plan," he said.
"We don't think that's commensurate with our population, the need, and acknowledging the enormous challenges in delivering mental health services into what is the biggest health care jurisdiction in the world — we have significant challenges with remote communities and regional communities."
Another point of debate is who picks up responsibility for the so-called "missing middle" — those who are often too sick to be treated by GPs or psychologists but not acute enough to be cared for by state-based services.
WA Health Minister Amber-Jade Sanderson believes that should be a Commonwealth responsibility.
"The states are responsible for acute care and prevention and so we are making significant investment, we've increased our investment in the last year alone by half a billion dollars, into acute care for mental health and specialised community support services," she said.
"We feel that the federal government is somewhat behind the eight ball in terms of funding the primary care aspect."
New South Wales and the federal governments have separately agreed to a five-year $383 million deal, saying it forms "part" of the national agreement.
That includes money for additional care to support people who have tried to take their own lives and funds to establish new adult mental health treatment centres.
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Pressure on services greater than ever
Prominent mental health expert and former mental health commissioner Ian Hickie called for the plan to be urgently finalised, given the pandemic had exacerbated mental health conditions in Australia.
"At a time when we really need new services on the ground, new arrangements about how they're delivered, and really to make sure that those who are missing out, get them, we have no clear directions from our major governments," Professor Hickie said.
"Anxiety and depression have gotten worse, use of alcohol and associated problems have got worse, eating disorders have got worse, so things have become more severe.
Global studies have shown that mental health conditions like anxiety and depression rose 25 per cent during the pandemic, with mental health lines in Australia receiving record numbers of calls.
One of the people who has struggled to get help is 34-year-old Canberra public servant Lauren Beckman.
She was diagnosed with anxiety and depression following the birth of her daughter about six years ago but has consistently encountered barriers to treatment and therapy.
"To even be able to readily access it, you need to go to a GP and get your mental health plan to get the Medicare subsidised sessions," Ms Beckman said.
"But then once you do that, and you've paid for a GP appointment and gone through all of that, then you also have to find a psychologist that has books open and that is really hard.
"We need to be able to invest in the prevention and the maintenance of people's mental health before it gets to that crisis point where we're seeing, you know, especially young people be pushed further and further outside the system because they can't get the help that they need until it's too late.
A recent survey of psychologists found one in three has closed their books after a significant rise in demand for their services.
Mrs Cavenett urged governments to work together to provide crucial support to struggling Australians.
"Demand has exceeded the supply of workforce and demand has exceeded the supply of services and on top of that, we're watching crisis after crisis occur so we do absolutely need to get this right and we need that funding to be released and to be spent."
In a statement, a Health Department spokesperson said negotiations between Commonwealth, state and territory governments were "nearing completion."
"All states and territories have been active participants and partners in negotiations," the statement said.
"Final endorsement of the National Agreement is expected in early 2022, with the agreement to be publicly available thereafter."
