Introduction
This is a critical moment for mental health in Australia.
The Commonwealth Government has already committed $1.8bn over five years towards mental health reform. The Prime Minister’s involvement, and that of the Council of Australian Governments (COAG) more generally, represent an unprecedented opportunity for the advancement of mental health in Australia – the issue is centre stage. This opportunity must not be missed but new investments must be properly targeted.
Time for Service is the first of a series of MHCA papers presenting solutions to Australia’s mental health crisis. It presents practical solutions that governments should fund and implement now through the Council of Australian Governments (CoAG). The solutions proposed aim to deliver new pathways to new services, offer flexibility and choice, and make a real difference to people with a mental illness and their carers.
The state of mental health services in Australia has been well documented, including in the Mental Health Council of Australia’s own Not for Service Report and most recently by the report of a Senate Committee of Inquiry entitled From Crisis to Community. It is commonly agreed that a lack of investment and accountability following deinstitutionalisation has led to a crisis in public confidence because people cannot access the mental health services they need when they need them.
There is a massive under-investment in mental health services – mental health is responsible for 13% of the burden of disease but attracts only 7% of the health budget1.
Indicators of the crisis are that:
- 20% of the Australian population will experience mental illness2. This has a profound affect on the whole community;
- two-thirds of people with a mental illness do not receive any treatment in any twelve month period3;
- there is unprecedented pressure on all parts of the mental health system, particularly access to acute care beds and access block in hospital emergency departments;
- there is increasing homelessness among people with a mental illness with reports indicating that up to 85% of homeless people have a mental illness;
- rates of suicide for men aged <75 years tripled in the thirty years from 1960-19904;
- seclusion and restraint still feature in our mental health system;
- people with mental illness are grossly over-represented in our prisons;
- depression alone accounts for six million full work days lost per year5;
- less than 30% of people with a disability due to mental illness participate in the workforce6. This is less than half the rate of comparable OECD countries.
It is not time for another report. Australia needs a clear and immediate response to this mental health crisis. It is Time for Service .
Mental illness is a key factor in social exclusion, leading to unemployment, poor housing, poor health and family breakdown. New investment in specific strategies designed to prevent this social exclusion is urgently required to re-integrate people with a mental illness who may otherwise fall through the net.
The priorities for the future mental health system are clear. Australia needs a system which focuses on recovery by providing:
- services designed to prevent mental illness and provide for early intervention once mental illness appears. Current investment is too focused on services for people once they are already acutely unwell;
- services designed to help people live independently in their homes – if this means living with family then there must be support for families and carers as well as support for consumers;
- services to help people with a mental illness so they can complete their education, take up or go back to work and participate in the social life of their community; and
- proper funding for the community services needed to make deinstitutionalisation really work for people with mental illness. This involves a full spectrum of health care services, accommodation options from short to longer term, and rehabilitation, vocational training and education services.
The vast bulk of mental health investment is currently aimed at clinical care, medical improvement and remission of symptoms. While important, this is only part of the picture of an improved mental health system.
The traditional and completely inadequate response of governments to the mental health crisis has been further investment in hospital beds. However, according to a number of unpublished data up to 40% of patients in acute mental health inpatient facilities could be discharged from these facilities if suitable services and supports were available.
A response which focuses on mental health beds, particularly acute care beds, will do nothing to alleviate the crisis. Time for Service instead calls for a fundamental rebalancing of our mental health system towards services historically and critically underfunded.
Currently, it is common for people to be discharged from hospital having not received adequate clinical care. They are then discharged into the community with little or no support. Time for Service calls for a massive investment in a range of community-based recovery support services, both clinical and non-clinical, designed to maintain hope in, and a focus on, the person’s recovery. The types of services required include sub-acute clinical care, counselling, living skills training, employment assistance, supported accommodation and community inclusion. Investment in these services is a cornerstone of mental health system reform which will promote recovery, and reduce people’s dependence on expensive treatment services.
Early intervention is vital, particularly among the young 75% of mental health problems start before the age of 25. It is critical that services are provided early to prevent the problems developing.
If a woman has a breast lump, the person is encouraged to get advice as soon as possible from a doctor to find out if it is cancer. If it’s serious, treatment is provided early to get the best result.
In mental health, people are sent away and told to come back only when the lump has spread and when the problem is worse if not overwhelming. Then some services might be provided. This is a dysfunctional system, known to fail in cancer and in heart disease. The whole mindset in mental health must change to early intervention, particularly for young people and those with alcohol and drug problems.