The mental health system isn't working as it should. Here's how we could fix it
1st November 2019
Mental health concerns cost Australia up to $180 billion a year - or $500 million every day - in lost productivity and participation, according to economic research group, the Productivity Commission.
The commission's massive draft report on mental health found that the mental health care system we currently have simply isn't meeting demand.
"Mental ill-health has huge impacts on people, communities and our economy but mental health is treated as an add-on to the physical health system. This has to change," head of the Productivity Commission Michael Brennan said.
The report found that half of all Australians will experience a mental health episode over the course of their lives, and one in every eight visits to the GP relates to mental health.
And while governments have been increasing expenditure on mental health support through the Medicare system, outcomes for patients haven't improved.
So what do we do about it?
The Productivity Commission (PC) looked at all facets of Australian society and how they impact on rates of mental ill health and suicide. Everything from the school system, jails, hospitals, communities and the internet were under the spotlight.
There's no overall cost listed in the report, and that's because many of the reforms are long term, or focus on prevention, which makes estimates hard.
However, the report lists some of the economic benefits of the changes, which should be taken into consideration when assessing the costs.
"Those reforms that were able to be quantified at this stage were estimated, conservatively, to be likely to provide a boost to Australia's economy of around $100 million for some small-scale reforms up to $5.6 billion for larger reforms, in each year in the long term, through the increased economic participation of people with mental ill-health," the report said.
The final report isn't due out till next year. The analysis was commissioned by the Federal Government, but despite that there's no guarantee that all of the report's recommendations will be adopted. In the end, it's up to the government to decide.
It made dozens of recommendations on how each sector can improve. We've summarised the findings for you.
What does it recommend for young people?
Young people are right at the coalface of Australia's mental health crisis. Three out of four people who have a mental health concern develop their first symptoms before the age of 25, the report found.
So there were a lot of recommendations on how things could improve for adolescents and young adults.
One of the biggest ones was overhauling the funding that Headspace centres receive.
You might remember that Headspace got the lion's share of mental health funding in this year's federal budget - $373 million, to be exact. The PC report recommended that Headspace get conditional funding based on the type of care it offers. In other words, the more complex the clients in an individual centre, the more cash that centre should get. Headspace should also only get funding if it meets its targets, the report said.
The report recommended that governments should put more money towards online support for people with mild and moderate conditions. Those treatment options should particularly target children and young adults.
"Funding should be expanded for services to accommodate up to 150, 000 clients per year in supported online treatment," it said.
The report said every school should have a "wellness leader" who could "oversee school wellbeing policies" and help both students and teachers get the help they need - sort of like a counsellor whose job is prevention rather than crisis support.
Should a young person present to the emergency department with a mental health crisis, the report recommended they should have designated adolescent mental health beds so they don't have to reside with adults.
What does this mean for my out-of-pocket costs?
One of the biggest concerns for patients is around the cost of mental health support. Many argue that ten Medicare-subsidised sessions with a clinician simply doesn't go far enough, and they can't afford to pay the full price themselves.
The PC report agreed. It recommended that the number of publicly-supported places double to 20 for patients with complex conditions.
"The clinical evidence suggests that of those people with mental illness who are best treated through individual face-to-face psychological therapy, most need more than 10 sessions... for their condition to significantly improve."
Under the recommendation, GPs would assess a patient after 10 sessions to see if they need to be re-referred for 10 more. Individual and group therapy would also be subsidised by Medicare.
Moreover, the report recommended an expansion of the current telehealth system, where people in remote or rural parts of the country can access Medicare-subised video conferencing sessions with a clinician. The report said people living in metropolitan areas should get the same services.
What does it recommend for people in crisis?
It's not a surprise to a lot of you, but the report found that forcing people who are experiencing a mental health crisis into the hospital system was not always the best course of treatment.
"Public and private hospitals should take steps to improve the emergency department experience they provide for people with a mental illness. This could include providing separate spaces for people with mental illness, or otherwise creating an environment more suitable to their needs," the report said.
The report found that people who survived a suicide attempt often didn't get the right care they needed.
"Australian, State and Territory Governments should offer effective aftercare to anyone who presents to a hospital, GP or other government service following a suicide attempt," it said.
"Aftercare should be directly provided or referred, and include support prior to discharge or leaving the service, as well as proactive follow-up support within the first day, week and three months of discharge, when the individual is most vulnerable."
People living with mental illness in jails weren't properly catered to, either.
"Governments should ensure that people with mental illness who exit institutional care (particularly hospitals or prisons) receive a comprehensive mental health discharge plan, and services have the capacity to meet their needs."
The PC report recommended that all people who are entering jail or other institutions be screened for mental health concerns, and given appropriate treatment if one is identified.
What does it recommend for the community?
The report recommended that a national destigmatisation strategy be implemented that would ease isolation and normalise mental health conditions.
It also highlighted the link between untreated mental illness and homelessness, saying governments should create more supported housing spots for people with complex or severe conditions.
The report recognised a shortage of mental health professionals, and recommended an increase in the number of trained psychiatrists, and the creation of a specialised training stream for mental health nurses.
But it also noted that not all mental illness requires medical care, and that sometimes group therapy and peer work can have a positive impact on people living with mental health concerns.
Governments should "commission a national review to develop a comprehensive system of qualifications and professional development for peer workers. This should consider how peer worker qualifications would be recognised as prior learning for health professional qualifications."
Indigenous communities should take the lead on Indigenous suicide prevention, the report said, and community-led support services should be given priority if an Aboriginal or Torres Strait Islander needs aftercare following a suicide attempt.
Governments should not look solely to medical care for Indigenous people, it said.
"The Australian Government should evaluate best practices for partnerships between traditional healers and mainstream mental health services for Aboriginal and Torres Strait Islander people."
The report recommended that mental health professionals be embedded with police, to help de-escalate situations in which officers respond to people who might be experiencing a mental health episode.
It recommended "mental health professionals are embedded in police communication centres to provide real-time information on the individual to whom police are responding, to advise on responses and referral pathways, and to prioritise deployment of co-responder resources."
In other words, it said mental health professionals should be able to accompany police or ambulance services if they think a crisis situation is unfolding.
If you or anyone you know needs help:
- 1800 RESPECT on 1800 737 732
- Lifeline on 13 11 14
- Kids Helpline on 1800 551 800
- Suicide Call Back Service on 1300 659 467
- BeyondBlue on 1300 22 46 36
- Headspace on 1800 650 890
This article was originally published by triple j Hack on abc.net.au