Models of Service Delivery and Funding of Mental Health Services

Abstract

Mental health funding is neither neutral nor impartial. Decisions about funding shape the nature of care, its availability, duration, and the relationships between service providers. It is estimated that Australia spends $28.6bn on mental health annually, including funding for services, employment, disability support, and other payments. Almost $10bn is provided by Australia’s nine governments for mental health services specifically, with the states and territories providing $6bn, the Australian Government $3.4bn. Mental health funding is often tied to a model of care, a population or geographic group, or to provide general support for an organization. But in the Australian mental health “system” relationships are complex and fragmented. Repeated inquiries have revealed major gaps in the spectrum of care. Consumers, carers, and even providers are too often left lost, confused, and frustrated. This fragmentation is mirrored in the way mental health is funded. In fact, Australian mental health funding is not really any kind of joined-up system at all. Rather, multiple funders engage with a confounding and sometimes competing array of service providers, obscuring role clarity and diminishing accountability. Services operate in silos to overlapping or even conflicting goals. This situation applies to rural and remote areas as much as urban contexts. This chapter describes this chaotic situation and considers the implications arising for the organization and delivery of mental health services in rural and remote communities. Our findings suggest a situation so flawed fundamental changes in governance and accountability are necessary. These changes that would see capital city-based funders working collaboratively with local experts and rural leaders, with strong accountability to the rural communities they are supposed to serve. This would drive more integration in funding, reflecting local context, better supporting, and improving rural mental health.