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Dysfunctional mental health system urgently needs much more than money: Ian Hickie

27 March:

One of Australia’s leading authorities on mental health has challenged the sector to reform what he says is a dysfunctional system instead of just seeking additional funding to “paper over the cracks and support ineffective programs”.

In an editorial in the latest edition of the Sax Institute’s journal Public Health Research & Practice, Professor Ian Hickie said: “Increased funding for expanded mental health services is crucial, but unless we overhaul the system and have the courage to defund ineffective programs, we will be throwing good money after bad”.

Professor Hickie, who is Co-Director of Health and Policy at the Brain and Mind Centre at the University of Sydney, and a Commissioner in Australia’s National Mental Health Commission, is the guest editor of the journal’s latest issue, which focuses on mental health.

“For too long we have been pumping scarce resources into a dysfunctional system riddled by silos and an absence of independent monitoring and evaluation of effectiveness,” he said. “Many parts of the system continue to put practitioners and policy makers, not patients, at the centre. It is incumbent on all of us in the sector to acknowledge and address these systemic problems, instead of hiding under the doona.”

Professor Hickie said the time was right to address these issues, as Australia had recently embarked on the most radical attempt to reshape mental health services in the past 30 years and the National Disability Insurance Scheme was set to play a major role in the mental health sector.

“We know from Australian and international experience that the best way to deliver higher-quality mental health care is through multidisciplinary teams. In many cases, however, these are resisted by professional organisations that prioritise fee-for-service, solo-practitioner or single-professional group styles of practice. We also continue to prioritise funding into institutional settings when we know that community-based psychosocial, primary and community health services can have the most impact.

“We also need a system that puts patients and their families at the heart not just of care, but of the wider decision making process. Although the era of hierarchies and the ‘doctor knows best’ mentality is over, many have not caught up to this reality.

“Finally, we need independent, national evaluation of programs. This will create a true picture of what is working and what isn’t, meaning we can direct resources accordingly. Where services can show their effectiveness, they should be supported with increased resources. But services that are not having an impact should not be supported forever.”

Professor Hickie said the latest issue of Public Health Research & Practice focussed on how to overhaul and improve the mental health sector, with papers from consumers and systems thinkers, and examples of innovative programs that are already being rolled out.

“It should be required reading for everyone in the sector,” he said.

Public Health Research & Practice is a peer-reviewed, Medline-listed quarterly online journal published by the Sax Institute. Subscribe for free at

Please acknowledge the Sax institute’s Public Health Research & Practice as the source for any stories.


Barry Dunning, Communications and Media Manager. M: 0415 510 755 E: [email protected]