Priority 2 - First Episode Services
What is acceptable about refusing to carry out early intervention until the person is ‘acutely’ unwell, which leads to a very distressing forceful intervention, then having to administer extremely strong dosages of medication which induce obvious physical side effects which take months to subside?...What is acceptable about not keeping people with a mental illness as well as they can possibly be, thus reaching and maintaining their full potential within the illness?
Carer. Mother, Victoria, submission #178, Not For Service p. 47.
It is Time for Service for people experiencing their first episode of mental illness.
There is an urgent requirement for services to be re-organised to better meet clinical need. Currently, the services provided to people when they are first admitted are only divided by age (under 18, 18-65 and over 65 years) and are not differentiated from acute admission services provided to people with chronic or recurrent illnesses.
Clear evidence9 shows that the first episode is the best point at which to provide maximum health, family and vocational interventions to achieve full recovery.
Despite this area of the mental health system being critical, not only are existing services poorly targeted, admissions are rare and far too brief. For people experiencing their first episode, the interaction with the system needs to be thorough and profound. First episode services must offer ongoing interventions lasting up to a year if required.
First episode services can be differentiated by clinical need, including:
- adolescent onset depression and substance abuse;
- first onset psychosis;
- post natal depression;
- impulsive and conduct disorders;
- eating disorders; and
- late onset depression or cognitive impairment.
Each state and territory must commit to reorganising their services to ensure that an adequate number of clinical beds and linked community services are available to meet each of these clinical needs.
The goals of treatment are returning to good health and then returning to school, education and training and/or work. For this group in particular, the mix of clinical and vocational elements is critical. Services for eating disorders are best organised at a regional, rather than local health service area basis.
For first episode services, consideration should be given to purchasing services from the private sector as well as the public sector.
Expenditure Required: Yr 1 $500m, then $300m per annum.