WHY BIGGER ISN'T BETTER: The danger of over-spending on mental health

February 13, 2015 The Noffs Team Comments

The team here recently saw this review: The cold, hard truth about the ice bucket challenge of the success of the ALS ice bucket challenge which discusses the issues of funding cannibalism.

At first glance it is tempting to dismiss this argument as sour grapes, especially for people not intimately involved in the charity sector: we are surviving on the generosity of others, who are we to complain?

But funding cannibalism is a very serious issue not just in the personal giving sector but also in the government funding arena.

In Australia there is a dramatic gap in the level of funding for mental health and drug dependency, even though these are two sides of the same coin.

The risk as I see it is that over funding of mental health organisations will eventually mean that those organisations will wind up expanding their reach to deal with both drug dependency and mental health.

Even though we need cooperation between mental health and drug dependency organisations,  I personally feel like they are specialized area that should ultimately be operated and funded separately.

HOW DOES PUBLIC OPINION IMPACT FUNDING CHOICES?

Unfortunately for those affected by drug dependency, there is a predominant sentiment in the community generally that people who take drugs deserve what they get. It's their own fault and they should deal with the consequences, which all too often involve criminal justice.
The stigmas arising from drug use and drug dependency are many. The World Health Organisation has found through research that dependence on illegal drugs is “the most stigmatised health condition in the world”; alcohol dependency comes in fourth in that list. The attitude hardens further where those injecting drugs are concerned.1 Studies have shown, for example, that people have far more negative attitudes to those suffering drug addiction than those suffering some form of mental health condition, even though they are often linked and dependence is a form of mental health issue.2

Perhaps unsurprisingly, where moral judgements are involved and there is a widespread lack of understanding and conversation about the issue, dependence on a drug is seen as worse than straightforward consumption. Addicts are seen as blameworthy, weak, lacking moral fibre, or possessing insufficient will-power. These stigmas are not applied to people suffering from mental health issues at anywhere near the same levels.3 Ignorance around dependency hardens attitudes and inflicts real social and economic harms on those suffering drug dependency. Many people have only learned what they think they know about addiction from TV programs.4

The knock-on effects of this can be catastrophic, as the harms to which drug dependent individuals are exposed are then exacerbated by their exclusion from society and its help. This can involve exclusion from assistance programs or the jobs market, targeting by law enforcement officials, removal from social housing, and many other serious effects, none of which help the dependent individual deal with their primary problem.

This matters because the numbers of people needing treatment for drug or alcohol dependence are going up. As a proportion, the numbers around alcohol are particularly on the rise, as the table below shows.

The proportion of treatment for alcohol is rising steadily The proportion of treatment for alcohol is rising steadily 5

Around 10% of Australian men and women consume more than the Government’s recommended amount and over 6% of the population meet the criteria for being considered alcohol dependent.6 This represents a significant proportion of people who may require funded assistance for treatment.

The issue that confronts us is that the funding of mental health treatment is also enormously expensive. In 2011-12, some 32 million prescriptions were issued in Australia for treatment of a variety of mental health issues, of which over 70% were subsidised by the Government. The demand on Medicare from this funding requirement has grown too. In 2010-11, almost $7 billion was spent on treatment for mental health issues, an increase of 6% in the period from 2006-2011.7 Given the statistics on the co-existence of substance dependency and mental health issues, with at least 35% of drug dependent individuals also suffering mental health issues, much of this money will be going towards treating people with both problems.

The effectiveness of initial care for people with joint mental health and substance dependency issues differs widely, too, depending on where their first point of contact for assistance is.

In real terms, this means that inefficiencies in funding and treatment provided have provided treatment of varying qualities to people who need help to tackle drug or alcohol dependency and the mental health issues that often co-exist with or are caused by such dependence. The Government is trying to pick up the slack by pumping increasing amounts of money into the system, but poor provision of care and social stigma still mean that people are left without help or receive the wrong help.

Historically, too, the criminal justice system has been the catch all "unsafety net" there to catch people who fall through the cracks of both the mental health and drug treatment systems. This places a strain of the provision of that service too. Importantly, too, the fact that drug usage and possession (for illicit drugs at least) is still for the most part criminalized, allows the persistence of the opinion that drug dependency is a sign of criminal deviance rather than a sickness that needs to be treated.

It was not so long ago that many conditions now classed as mental illnesses were seen as criminal and the shift in public opinion away from this attitude has had a tremendous impact on the ability of mental health organisations to secure adequate funding for prevention, counseling and treatment.

In both cases there are still too many who wind up in the criminal justice system, but those suffering drug dependency are leading behind.

WHAT DOES THE FUNDING LANDSCAPE FOR MENTAL HEALTH AND DRUG ISSUES LOOK LIKE IN AUSTRALIA?

The funding gap between mental health service provision and drug and alcohol treatment is stark. In 2014/15 in Western Australia, the total funding allocation for mental health will be $707.1 million to treat and support people with mental health issues, as well as their families and carers; it will only be $84.5 million to treat the impact of drug and alcohol dependency. This is in spite of a year on year increase in the total funding which has seen almost $250 million pumped into treating both issues, as shown below.

 

The cost of treating mental health and dependency issues is rising The cost of treating mental health and dependency issues is rising 8

The Australian National Drugs Strategy recognises the significant problems with the funding picture, particularly in terms both of increasing general demand, but also, for example, because of the alcohol and prescription drug issues among a rising aged population. The NDS also recognises the need for increased partnership between Government and the charitable sector and support groups, not least to share the burden of cost more among a greater number of bodies as the costs rise ever higher.9

ULTIMATELY IT'S LAW ENFORCEMENT COSTS THAT NEED TO BE REDUCED IN ORDER TO ADEQUATELY FUND DRUG TREATMENT

The money is there to find both drug and mental health treatment and research adequately if we stop spending so much on drug law enforcement, however public attitudes to the criminalization of drugs need to change before we can have real reform.

In the meantime, we risk further marginalization of those suffering drug dependency if we over-fund mental health.

It would be tragic if the cannibalization of the budget for drug treatment resulted in mental health organisations trying to deal with both issues of mental health and drug dependency which will produce worse outcomes per dollar spent.

Instead mental health organisations could gain a lot from partnering with drug treatment services and vice versa.

When it comes to mental health systems in Australia - bigger doesn't mean better.

We should be focusing on quality services and not the quantity of them.

Matt Noffs

REFERENCES


1. Reducing Stigma and Discrimination Relating to Alcohol and other Drugs in Western Australia By Social Inclusion Action Research Group via WANADA http://www.wanada.org.au/
2. Study: Public Feels More Negative Toward People With Drug Addiction Than Those With Mental Illness By Johns Hopkins Bloomberg School of Public Health via http://www.jhsph.edu/
3. The Public Stigma of Mental Illness and Drug Addiction By Authors: Patrick W. Corrigan, Sachiko A . Kuwabara and John O'Shaughnessy
4. JHSPH studies stigma of addiction, mental illness By ALIZAY JALISI
5. Treatment By The National Centre for Education and Training on Addiction via http://nadk.flinders.edu.au/
6. Alcoholism (Alcohol Dependence) By Virtual Medical Centre via http://www.myvmc.com/
7. Preventing and treating ill health By Australian Institute of Health and Welfare (AIHW) via http://www.aihw.gov.au/
8. BUDGET BULLETIN 2014/15 By Hon Helen Morton MLC, MINISTER FOR MENTAL HEALTH
9. The National Drug Strategy 2010-2015 By National Drug Strategy, Commonwealth of Australia

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