Background:
The provision of mental health services is subject to persistent criticism, often with the implication that allocated resources are inadequate. However, the mental health sector is also subject to another dilemma, which we define as a ‘structural imbalance’ problem.
Methods:
The study shows the dimensions of structural imbalance in Australia's mental health sector by recourse to two data sets: the Mental Health and Well-being: Profile of Adults, Australia 1997, published by the ABS; and the National Minimum Data Set – Institutional Mental Health Services published by the AIHW. This study also examines the concept by reference to the Australian Government's COAG mental health initiatives announced in April and state government responses in July 2006.
Results:
The two dimensions of the structural imbalance are 1) that some people, with no clinical manifestations of mental illness, consume mental health services and 2) another group of people have clinical manifestations of mental illness but (for various reasons) do not consume mental health services. We show how the situation coexists with various patterns of resource distribution in the public and private health sectors, acute vs. chronic conditions, institutional vs. noninstitutional service provision and private vs. public medical practice.
Conclusions:
‘Throwing more money’ at the preexisting structures will do nothing to address the structural imbalance problem. Remedies are discussed by reference to the content and processes of reform undertaken in the British National Health Service in recent years.
