Crossing the border

Here at ARAFMI, we hear stories from time to time about people being denied mental health care on the basis of being from out of state.

Have a think about that.  You're on holiday in Queensland and slip on some steps and break an arm.  You go to the hospital.  They don't refuse to treat you because you're from NSW.  They set your arm and send you on your way.

Why should treating a person in need of mental health assistance be any different?  It seems a less than tacit way of acknowledging that mental health services are currently inadequately resourced to deal with the needs of the area that they are funded to service.  Someone from "out of state" (cue the voice of doom from the Simpsons) is a problem for two reasons, and they are both economic ones.

Firstly, that person from out of state is not a part of the mental health service's catchment area.  As such, they are (from the perspective of the service) an additional, and unaffordable, expense.  

Secondly, in more serious cases that person from out of state might require treatment for an extended period of time - perhaps months.  As noted above, this is an additional expense to the service, but more importantly it makes problems like "bed lock" - where there are patients in need of beds but available beds are already filled - worse.  This has the flow-on effect of people who are still unwell being discharged from hospital not because they are ready, but because someone whose condition is worse has been brought in.

The Richmond Report, back in 1983, started the movement away from hospital-based care to treatment in the community.  The problem is that subsequent investments in community-based services (which would have the likely benefit of reducing the need for acute inpatient beds) have been inadequate.  The most recent NSW budget invests heavily in hospital infrastructure - beds - but funding for community services has remained largely unchanged.

With recent developments in the funding of Australian health services, cross-border issues seemed to receive less than token attention, with a suggestion that services in border areas develop ad hoc arrangements with their sister services.  In 2012, this is, I would suggest, inadequate.  The ultimate problem is that these kind of issues - where people are refused service on the basis of their place of residence - kill.  They deserve more attention than they have currently been given.