Saturday, July 23, 2011

Market based approaches are a threat to vulnerable people

images by Simon Bosch, courtesy of the Sydney Morning Herald

State and Federal Governments of all persuasion continue their love affair with "market based approaches" to the provision of health services and human and community services. 

These market based approaches take many forms, including privatization and contracting out of government services, competitive tendering of services to not-for- profit and for profit agencies, increasing use of for-profit providers and the private sector  to provide services, use of user pay and cost recovery principles, the application of business metrics and the imposition of corporate management models and approaches that have their origins in the for- profit business context.

But they all are predicated on the assumption that applying market principles to the delivery of health and human and community services will drive innovation, deliver greater efficiency and better quality services and save Governments money.

However, the worsening crises we face in so many areas of social and public policy are largely the result of an over reliance on market based approaches in service delivery and/or the increasing reliance on the private/corporate sector as a provider of services.

The crises in affordable housing, the collapse of corporate provider ABC Learning in childcare, the crises enveloping aged care, the problems resulting from the privatization of employment services, the costs and inaccessibility of many health, medical and dental services, the accelerating cost of public services such as water, gas and electricity, the rationing of services for children and families, are all examples of social policy problems that have been created or compounded by market based approaches.

Adele Horin's piece in the Sydney Morning Herald Sad Truth behind Closed Doors is further evidence of the dangers of relying on market based and for- profit approaches in the delivery of health and human services. Horin shows that a reliance on market based approaches is a threat to the health and well being of vulnerable people. 

Horin argues that the reliance on for- profit providers of boarding houses  to accommodate and support people with mental illness has failed to protect and improve the lives of  vulnerable people. Horin draws on the work of Sydney academic Gabriel Drake who calls the rise of licensed boarding houses in Sydney, as "the privatisation of the back wards". 

In a study of inner Sydney licensed boarding houses, Drake describes a situation where large numbers of people with only their disability in common,  live together with little to do, receive poor mental and physical health care, and have few chances to learn skills. Their pension is handed over. They can't afford a bus fare. They become highly dependent on the boarding house owner.

Horin describes how the failure by Governments to provide the funds  and support to people with mental illness who were "de-institutionalized" and moved out of large psychiatric institutions meant that they were thrown to the vagaries of the "market"
And so hundreds moved into the boarding houses which were run for profit with minimal or no accountability or monitoring. People with sometimes serious conditions, such as schizophrenia, went from the state being in charge of their welfare to a boarding house owner.

The state passed a law to license boarding houses that accommodated people with psychological or intellectual disabilities. But three Ombudsman's reports in nine years - two of them secret and the latest delivered to the Minister for Disability Services last month - testify to the failure of the responsible government department, Ageing, Disability and Home Care, to do its job of inspecting and monitoring the boarding houses properly.

A weak law, and some aggressive licensees, did not help the hapless bureaucrats in their role of protecting and improving the lives of the vulnerable residents.

It is time the state government took a serious look at boarding houses, both the licensed kind, and the unlicensed, which cater to a slightly different clientele of poor, single tenants often with alcohol and gambling addictions.


  1. It's worth noting there's another problem with our mental health care systems, one which is right at the core of so many different issues: namely, that they're all built around responding to crises in mental illness, rather than supporting and sustaining mental health.

    This means, for example, that as someone with serious depression, I can get access to a strictly limited number of free or low-cost counselling sessions to help me get through crises and into the workforce (never mind about whether or not I want to go into the workforce, or whether there's actually somewhere in the workforce for me to be) through my JSA or DSE provider. However, what I can't get is the ongoing support I need in order to be able to sustain even an ongoing performance of mental "normality". So instead of receiving support to maintain a healthy mental state, I'll receive crisis intervention to set me back on my feet, and then nothing else until I fall right back over again.

    I doubt anyone who isn't mentally ill knows just how very depressing and demoralising it is to be treated in this manner. I've often found the only way I can receive reasonable recognition for my very real mental illness is to discontinue any medically recommended treatment for it. If I'm not physically and dramatically manifesting the symptoms of my mental illness in front of people who represent various government agencies, they refuse to take me seriously - so I have to be in a condition where I can readily break down in tears in front of them in order to "prove" that I'm not mentally stable. I get more support from our mental health system through taking steps which mean I'm going to stay mentally ill than I would for taking steps which would make me mentally healthy in the long term - so the system encourages me to refuse treatment, to discontinue my medication, to isolate myself from others, to comply as much as possible with the stereotype of "mentally ill person", because if I don't, I won't be able to access the services I'm offered (and never mind that the services I'm offered don't ever match up with what I actually need).

    The system as it currently stands encourages mentally ill people to remain mentally ill; it discourages them from moving toward mental health; it strongly encourages the development of more intense forms of mental illness.

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