This telehealth service changed Fiona’s life, but now it’s out of money

A world-first telehealth psychiatry service is at risk of closing despite needing only $400,000 a year to survive, amid a growing push for a payroll tax levy to help fund NSW’s ballooning healthcare bill.

The NSW government, the University of Sydney and icare, the state-owned workplace insurer, spent $650,000 in March 2023 to offer telehealth psychiatry services for people with traumatic brain injuries across the state.

The money runs out in September and no funds have been allocated in the June state budget to keep it operational.

Professor Leanne Togher, a speech pathologist and brain injury specialist who helped set up the pilot program, said many of the people in the scheme lived in rural areas and had never seen a specialist for the complex mental health issues they developed after their brain injuries.

Many will be “back on their own” if the service does not receive the $400,000 a year it needs to keep going, she said.

“They won’t be able to get back to work, their marriages will break down, these things happen when people don’t get the care they need,” she said.

A fall down the stairs at home in 2015 left former occupational therapist Fiona McKay in a coma for three weeks, and an ongoing brain injury that meant she could no longer work.

McKay bounced around GPs and psychiatrists who she said “didn’t understand brain injuries”, before her doctors at the Westmead Hospital brain injury rehabilitation unit connected her with the telehealth psychiatry program led by Dr Ralf Ilchef.

“For me, it was life-changing,” she said. “There’s a lot of prolonged grief with this kind of depression, so having someone who understands brain injuries and can actually instruct people like GPs is really important.”

Mental Health Minister Rose Jackson said the telehealth service was “another example of an unfunded program from the former government” that “did not have allocated funding for future budget cycles”. It was provided through a one-off grant redirected from COVID funds not spent.

Jackson said the government was set to spend $2.7 billion on mental health this financial year and was reviewing key priority areas and gaps in the NSW mental health system.

“As the premier made clear this week – if we need to look at the amount of funding or where the funds are going, we will,” she said.

Legalise Cannabis MLC Jeremy Buckingham said it was time for NSW to “follow the lead of Queensland and Victoria” and impose a mental health levy on the payroll tax paid by the state’s biggest businesses.

In his submission to the government’s Expenditure Review Committee ahead of the budget, Buckingham said NSW had the opportunity to evolve from being a “laggard to leader in mental health” with the requisite funding.

NSW invested the least per capita in mental health services of any state or territory government in Australia, Buckingham said, and was the only jurisdiction that has reduced per capita investment over the past decade.

“Rates of psychological distress in NSW have almost doubled over the last decade. At the same time, mental health funding has flatlined,” he said.

Introduced in July 2022, the Victorian government’s mental health levy was implemented to shore up the state’s struggling mental health system. It was expected to raise an average of $843 million a year, or about $3.7 billion, by June 30, 2026.

It imposes a half a per cent surcharge on businesses with an annual wage bill exceeding $10 million.

The Queensland government followed suit in 2023, applying the levy of 0.25 or 0.75 per cent to the largest one per cent of businesses. The revenue-raising measure was projected to boost the state’s coffers by $1.6 billion over the next five years to pay for services.

The NSW government declined to say whether it would adopt any additional revenue measures to fund mental health services.

Black Dog Institute executive director and chief scientist Professor Samuel Harvey called on the Minns government to urgently establish a similar “dedicated revenue stream” as in Victoria and Queensland.

”The mental health system in NSW is in crisis, driven by decades of underinvestment. The NSW government must take urgent action to turn the system around,” he said.

Royal Australian New Zealand College of Psychiatrists (RANZCP) NSW chair, Dr Angelo Virgona, said the telehealth program was the kind of service that should be maintained and given the added stability of a dedicated revenue stream.

“We’ve seen this time and again in the mental health sector … you build up expertise, you build up services, and then they’re out of the job, and you’ve lost all that expertise,” he said. “Patients and families are sick of it. They’ve been waiting too long to get accessible and effective services.”

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