The looming closure of Toowong Private Hospital in Brisbane is the latest to spark outrage. It therefore presents an existential threat to the future of mental health care in Australia. Dr Rachel David, CEO of Private Healthcare Australia, the peak body for the big for-profit health insurers Bupa, Medibank Private and NIB. She said the extent of the problem could be only the “tip of the iceberg.” The hospital, which has been in continuous operation in the community for nearly 50 years, serves more than 3,000 patients annually. This Wednesday it will be closing its doors for the last time.
Dr. David underscored the need for a reset in how we think about funding mental health treatment. She also strongly refuted the allegations that health insurers are failing to sufficiently reimburse private hospitals. As she noted, eight members of her association are facing these same daunting hurdles. Seven of these facilities are mental health hospitals, which points to a very concerning trend within the sector.
The Personal Impact on Patients
Toowoong Private’s closure means a painful loss for patients like Brisbane’s 37-year-old Rebecca Kuenstner. Kuenstner has spent the past nine years as a patient at the facility. She attributes much of her health to this amazing care she has received during that period.
“This has probably been the best thing that’s ever happened to me,” – Rebecca Kuenstner
Kuenstner recalled how the hospital created a sense of home and family for her while she received treatment. She said she was scared for her future without the care network the hospital had provided.
“Moving forward, I haven’t found where I’m going to be going to or where my support’s going to be in the future … if I need help,” – Rebecca Kuenstner
She underscored the importance of community support, especially in mental health care. It was the connections she made at Toowong that proved most critical to her recovery journey.
“That connection is probably the most important one after you’re discharged so you’re not left on your own. That was a very important part of my journey,” – Rebecca Kuenstner
Industry Concerns and Criticism
Brett Heffernan, who represents over 600 private hospitals across Australia, criticized the insurance industry’s role in the closure of Toowong Private Hospital. He pointed out that one large health fund held up renegotiating an annual contract for 13 months. In the meantime, one of the other funds that was paying for patients outright wouldn’t contract with the hospital at all.
“It makes a mockery of the government’s claim that mental health is a national priority,” – Brett Heffernan
Heffernan’s comments echo deepening frustrations across the industry as facilities are continuing to go under/unable to make it in today’s underfunded climate. The administrators of Toowong Private Hospital, likewise, are currently chasing down its financial ruinations. Further, they have disclosed for the first time that their hospital has lost money each of the last 5 years.
Rethinking Mental Health Care Funding
For far too long, Dr. David contends, funding models have been stuck in the past and failed to keep pace with the evolution of mental health treatment. She highlighted that the majority of care is being delivered in communities today. Hospitals were the main sites of care just a few decades ago.
“We need a funding model that takes account of the fact that because of improvements in medication and techniques and medical understanding, a lot more mental health treatment is taking place in the community now than it did in the 1980s and 1990s,” – Dr. Rachel David
Additionally, Dr. David thinks that flexibility in funding is incredibly important, particularly with the current mental health crisis Australia is facing. She created alarm over the industry’s habit of establishing thresholds for hospitalization that screen out all but the most ill of the ill.
“There is a strong preference … only to treat the most severely unwell patients in hospital,” – Dr. Rachel David
Moreover, she pushed for health insurers to pay for outpatient specialty clinic visits, which would have removed some of the burden from inpatient institutions.
“Even if we were to double what we paid hospitals it still wouldn’t stop the closure of more stand-alone mental health facilities,” – Dr. Rachel David
