Key Issues in Mental Health
The Mental Health Council of Australia has identfied the following major issues in the mental health system of key concern and in need a urgent reform.
1. UNMET FOR BASIC MENTAL HEALTH SERVICES
- 62% of persons with mental disorders do not use mental health services1.
Reported reasons are:
- stigma associated with mental disorders
- fearfulness of medical treatments
- poor distribution and costs associated with specialist services, and
- the inappropriate mix of medical and psychosocial services provided by government-financed systems.
- Although 38% of persons with mental disorders do access care, that care is largely provided by general practitioners1. The decline in bulk-billing places further pressure on this very limited access for people with mental disorders to basic primary care services.
- Lack of community understanding about the treatments available for mental disorders, and poorly resourced and poorly distributed service systems, means most people with mental disorders receive no treatment or treatment that fails to meet international standards for optimal care. For example, less than 1 in 6 persons with depression or anxiety receive evidence-based treatments 2.
2. INADEQUATE FUNDING FOR BASIC MENTAL HEALTH SERVICES
- Australia spends 7% of its health budget on mental health. Whilst comparisons with other health areas are problematic, mental health accounts for at least 20% of total health costs due to death and disability.
- International comparisons are only approximate but other first-world countries spend 10-14% of their total health expenditure on mental health.
- Costs for all health areas continue to rise because of increased populations (17.6-19 million Australians) and increased demand for new treatments, new technologies and more comprehensive services.
- Despite extra expenditure in mental health over the last decade ($778 million), there is no evidence that the proportion of total health expenditure devoted to mental health has increased.
- The National Mental Health Strategy assumed that the proportion of health expenditure devoted to mental health would increase. Whilst the Commonwealth did increase its contribution significantly (by 73% per capita), growth in state and territory expenditure was only 19.8% per capita 3. NSW and Victoria recorded very low increases of only 18% and 4.4% per capita respectively.
- More than two thirds of the growth in Commonwealth expenditure was increased pharmaceutical costs (402%) rather than expansion of service systems. Increased pharmaceutical costs is a result of rapid growth in new products to treat brain-related disease and the decline in the Australian dollars' external purchasing power. There is no substantial investment to develop these products in Australia.
- The National Mental Health Strategy required all governments to broaden their mix of services and to actively promote disease prevention, early intervention and prevention of relapse. Additionally, it supported partnerships with other services (particularly primary and general health care). Such expanded roles were financed by the same overall budget and local clinicians and service providers reported actual declines in the total number of direct clinical services provided.
3. RESTRICTED ACCESS TO MENTAL HEALTH SERVICES
- Consumers of mental health care have severely limited access to primary care (exacerbated by declines in bulk-billing rates), emergency care, specialist care and rehabilitation services.
- Care systems are perceived to be chaotic, under-resourced and overly focused on brief periods of medicalised care within acute care settings.
- Private psychiatric services are grossly maldistributed and involve large out-of-pocket costs, while access to specialist psychologist and other allied health services is restricted largely by lack of government or private insurance support.
- Demands on the carers and families of people with mental illness are increasing.
4. ONGOING HUMAN RIGHTS ABUSES AND NEGLECT
- The focus of care under the National Mental Health Strategy has moved from institutional to community-based care, but no effective management system has evolved to provide high quality care or the support that is necessary to live productively within the wider community.
- Persons with mental illness report ongoing abuse within hospital care (particularly emergency departments and acute care settings of general hospitals), and ongoing abuse and neglect in the wider community.
- Persons with mental illness report ongoing discrimination in key areas of employment and insurance and restricted access to basic welfare services and support.
1. National Survey of Mental Health and Wellbeing, 1997
2. SPHERE supplement, Medical Journal of Australia; July, 2001
3. National Mental Health Report, 2002
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