Philip, it seems obvious that, as you suggest, a system based on patient needs is required. While you are in general referring to patients with much more severe problems than mine, I suffered long-term depression on top of viral illnesses - for 10-11 months I was at the extreme stage normally associated with suicidal tendencies/suicide.

In such cases, optimal treatment seems to involve a combination of medication, self-help (e.g. with cognitive behaviour therapy) and contact with an appropriate therapist. For the latter, I had to pay per visit about half of the weekly Disability Support Pension, so didn't continue for long. The Commonwealth Medical Officer who assessed me for DSP urged me to pursue CBT (of which I'd been sceptical), and recommended David D Burns' "Feeling good - the new mood therapy." Burns is a leader in the field, and his book is an excellent self-help guide; but while Burns helped, I didn't pursue all his advice and techniques rigorously, I think I'd have benefitted from, and would have improved more quickly with, occasional therapist back-up. (I'm not fully recovered after 4 years, but am off medication.)

You conclude that "While a major investment of public resources is required to deal with the mental health crisis, the money will not be well spent unless issues of accountability and service direction are addressed." This is very timely, given that the Beattie Government has just announced massive increases in health funding while appearing neither to understand nor to address the real issues. Pumping more money into a bad system is just flushing it down the drain.

Yes Phillip. But can we cut to the nitty gritty. Crisis management replaced case management. Crisis management seeks to treat only those acute symptoms a patient displays (usually with a big dose of neuroleptic or anti depressant medication) before dropping the 'case'. Case magement implies accountablity for the total person. On going support, follow-up and attention the whole person - living skills, accomodation, networks and physical health - accountability in other words. The establishment of a working relationship with a seriously mentally ill person can take years. The provision of care takes money. You made no mention of political accountability, something mental health workers have been screaming about for decades now. Case workers have been decimated by crisis team mentality. It takes years to build up experienced case teams. They have been dismantled and case workers burnt out with stress from cuts to services. It is going to take a long time to re-build services. Whipping mental health workers with accountabilty requirements is not necessarily going to change anything without a return to excellence in practice, something we don't hear about anymore. Great damage has been caused by the forced medication regimens crisis mentality places on staff and patients, where Treatment Orders have replaced counselling and patient involvement in medication decisions. Thanks for writing on so hard a topic and all the best with the struggle.
Barfenzie

I believe that there needs to be service direction within mental health but also not to just talk but to do more for these beautiful people. I am aware of major issues with Pshiatric cases were they are thrown out into the street because there is not enough staff to help and you have to be able to prove that you are insane enough for people to help you. What happens to the ones that get rejected? Suicide is mainly caused by people that can see no alternative to their problems except to opt out of life. Most of the time, these people are lonely and have no support. I see a lot of patients in my practice that have been given so many anti-depressants because it is a "quick fix" to being depressed. Fairly quickly, I can get them off their anti-depressants and see the world in a different light. People nowadays are not taught that they are worthy. Isn't this where depression comes from? Why not (with only a small amount of money needed) get pshycologists into the schools and say "You are all worthy people. Find your passion in life and pursue it. Don't feel that you are nothing when you can be everything!"