Australia has two mental health systems: one a predominately uncapped, fee-for-service, Commonwealth-funded system with high out-of-pocket payments for patients, the other a predominately capped, inpatient-oriented, state-funded system. Coordination of the two is poor, resulting in gaps and overlaps.
The disjunction between Commonwealth Medicare-funded out-of-hospital services and state inpatient-oriented systems creates a yawning gap for people who need intensive community support but not inpatient care: the missing middle.
In this submission, we propose a redesign. Primary Health Networks should have a bigger role in commissioning mental health services. The Commonwealth Government and the states should negotiate regional mental health agreements with each of the 31 PHNs. The agreements should specify:
∙ a common regional approach to determine needs and service demand
∙ consistent data and reporting systems
∙ agreed service models for different types and levels of need (particularly for people requiring complex care in the community)
∙ agreed levels of service provision based on need
∙ common access, referral, and coordination arrangements so patients can move seamlessly through the system
∙ agreed levels of funding contributions by Commonwealth and state governments to achieve the goals set out in the agreements.