According to key experts and stakeholders, Australia’s mental health system is in crisis. Too many Australians are unable to access mental health care when they need it.
What will I advocate for?
- Reduce waste and prioritise access to affordable, high quality mental health care
- Improve access to mental health care for people requiring support
- Expand the mental health care workforce
- Create effective waiting lists by region in Australia
- Reform mental health emergency services
- Implement preventative programmes that tackle the root causes of mental illness
- Improve, as a matter of urgency, access to mental health services for young people
- Support and expand community-based and geographically focused mental services
- Support community-based recovery for people suffering mental illness
The expert and stakeholder mental health advocacy group, Australians for Mental Health, has identified what it calls, ‘the missing middle’ – people who are ill enough to require care, but not ill enough to be hospitalised. People in need of care are often faced with long wait times when they seek to make an appointment with a mental health care professional. Those who are fortunate enough to be able to find an appointment are then often faced with staggering costs that are out of reach for many.
We have now had numerous inquiries and reports, presenting recommendations for better coordination between the states and the Federal Government. The Federal Government is already well aware of what is required to improve our mental health services in this country; however, the political will to implement these necessary reforms seems unfortunately absent.
Instead, the Morrison Government wastes enormous amounts of taxpayer money as a consequence of this inaction. For example, in this year’s budget, Lifeline was given a $52 million funding boost; however, without any other reforms to the provision of care, Lifeline’s crucial work will be hampered. Lifeline cannot deliver the necessary ongoing psychiatric and/or psychological support the ‘missing middle’ so desperately needs.
Stakeholders have criticised theLiberal-National Government for ‘cherrypicking’ recommendations – essentially finding band aid solutions – rather than doing the work of systematic reform.
The impact of these failures has been brought into stark focus by Covid, with mental health needs far outstripping available support.
Apart from the enormous suffering that people without adequate access to mental health care experience, this systems failure also has serious economic ramifications. A systematic review conducted in 2017 describes the ‘significant burden mental illness places on all facets of society, including individuals, families, workplaces and the wider economy. Mental illness results in a greater chance of leaving school early, a lower probability of gaining full-time employment and a reduced quality of life.’
Citing Canadian data, the authors conclude that ‘total economic costs associated with mental illness will increase six-fold over the next 30 years with costs likely to exceed A$2.8 trillion (based on 2015 Australian dollars).’
In Australia, the Productivity Commission Inquiry Report into Mental Health values the gains from fundamental mental health care reform at $18 billion, with an added boost of $1.3 billion to the economy from increased workforce participation alone.
In Australia, finding adequate mental health care that is also affordable has been described as, ‘like hunting for unicorns.’ This should not be the case. As the community-backed representative for Goldstein, I have spoken with numerous stakeholders and have sought advice from prominent experts in this field.
If elected, I will be guided by these stakeholder experiences and expert advice, and will advocate for the following:
Reduce waste and prioritise access to affordable, high quality mental health care
- Through the establishment of a Federal coordinating body that will work with the states to achieve the above
- Such coordination between Federal, State and local authorities will allow for the creation of a regionally managed system that enables targeted, specialist support (detailed in the 2019 Productivity Commission report into mental health services)
- This body would be responsible for working with State and Territory Governments to undertake a national strategic needs assessments that ensures an adequate number of inpatient mental health beds
- This body would also be responsible for coordinating with State and Territory Governments to assess the additional funding and resources required for ‘the missing middle’ – ie. non-hospital services (such as psychiatrists and psychologists), step-up/step-down services, short stay units, and hospital in the home
- Provision of mental health care services should be seamless, ‘regardless of the level of government providing the funding or service,’ as recommended by the Productivity Commission.
- Also, as recommended by the Productivity Commission, ‘The ‘back office’ to our mental healthcare system needs redesigning with local planning to meet local needs. Providers and governments should be held to account through the transparent monitoring, reporting and evaluation of what works, with meaningful input from those with lived experience of mental illness, and their carers.’
Improve access to mental health care for people requiring support
- In 2020-21, over 13% of people requiring mental health care delayed seeing a mental health care provider (or did not see one at all). For 18.2% of people needing to see a psychatrist, the primary reason was cost.
- GP, Dr Adrian Plaskitt, states, ‘The overall effect is an abundance of psychology services for well-heeled patients in wealthy areas… However, patients with severe and ongoing problems like psychotic illneses, victims of childhood sexual abuse… for these people five sessions at $60 or $80 a pop are just not going to help. And these people do not in general have the personal resources to access the private service.’
- As a result, we currently have a ‘funding paradox’ in which services are increased in those places where people are able to pay the high costs (and are less likely to need acute care), while services for those who cannot afford care continue to be cut.
- According to Dr Plaskitt and other health care professionals, this skews funding away from those more likely to suffer from severe mental health problems.
Expand the mental health care workforce
- Improved access to mental health care can only occur if there are sufficient numbers of mental health care workers.
- There are currently unacceptable roadblocks to this expansion, both in terms of funding for training places, as well as professional roadblocks. Indeed, the Royal Australian and New Zealand College of Psychiatrists has stated that workforce expansion must be a top priority for Government.
- Failure to do this puts unacceptable pressures on our primary healthcare system.
Create effective waiting lists by region in Australia
- These waiting lists will be for specialist assessment and the provision of specialised psychological and medical interventions
- This should be undertaken with transparency and ease of use as a priority.
- Digital technologies will allow for the coordination of rapid and equitable distribution of care and affordable and equitable access to specialist care (including psychologists, psychiatrists, specialist eating disorder clinicians, trauma services and the like).
- People in need of care should be able to track times and locations where affordable mental health assessments and/or care are available on their phones for both Specialist assessment; and, provision of specialised psychological and medical interventions.
- The use of digital waiting lists will also add transparency, so that demand-supply issues are clear and those needing support know where they stand.
Reform mental health emergency services
- Base these reforms as per the recommendations of The Australasian College of Emergency Medicine
- Police are often frontline responders to mental health emergencies. This leads to poor outcomes for the people involved, and ultimately costs the taxpayer far more than effective, efficient, and targeted help.
- Staff in emergency departments must have adequate training and resourcing to manage emergency mental health care presentations
- The Federal Government must mandate that the states implement a programme of finite stays for emergency mental health presentations in hospital emergency departments, while ensuring there is provision for adequate, targeted mental health support for such patients.
- Incident reviews, reported to the relevant state Health Minister, should occur for all mental health emergency department stays of 24 hours or more
- Restrictive practices in emergency departments must occur within clear clinical governance frameworks, with attendant, standardised reporting to ensure that such practices are proportionate and never used unnecessarily.
- There must be regular audits of these practices that include follow-up assessments of patient progress and wellbeing, ensuring the patient is offered adequate, ongoing support
- Service silos must be eliminated to enable proper coordination of services and adequacy of provision
- Similarly, multi-disciplinary and specialised care should be well coordinated and not subject to service silos
Implement preventive programmes that tackle the root causes of mental illness
- There are numerous social determinants at the root cause of mental illness. As many advocates and professionals point out, addressing these social factors will result in, not only vastly reduced death and suffering, but also significant savings for the taxpayer.
Improve, as a matter of urgency, access to mental health services for young people
- In my discussions with young people, one of their key concerns is mental health. Issues such as housing and spiralling costs of living, as well as climate change, are being identified by experts, such as Children’s Commissioner, Anne Hollonds and Professor Patrick McGorry, as key contributors to young people’s poor mental health.
- Due to underfunding and poor coordination, young people are finding it increasingly difficult to navigate and access the mental health system.
- This is particularly alarming considering more than 75% of mental health issues emerge before the age of 25.
- Professor Ian Hickie, psychiatrist and co-director of health and policy at the University of Sydney’s Brain and Mind Centre, contends that the current parlous state of our underfunded and patchwork approach to mental health services prevents people from getting well and instead condemns them to a cycle of needing acute care.
- Professor Hickie says, ‘“In mental health we are dominated by activity-based funding and data, such as funding psychological sessions or hospital beds, which often has a poor relationship with outcomes,” he says.’
- While the Government is well aware of this problem, stating that, ‘In 2017-18, an estimated 339,000 young people aged 18–24 (15%) experienced high or very high levels of psychological distress,’ it nevertheless continues to fail young people when it comes to service provision.
- Specific pandemic-related mental health support for young people is necessary as well. This must go beyond simply subsidising mental health services, and instead create dedicated youth mental health care infrastructure, such as a youth support helpline and easily accessible information about available support on government websites.
- Dr Karen Price, the president of the Royal Australasian College of General Practitioners, is another leading health professional who believes that mental health cannot be divorced from societal health more broadly. If we are serious about young people’s mental health, we must therefore be serious about the wider context in which mental ill health emerges.
Support and expand community-based and geographically focused mental services
- To be able to offer more accessible and personalised mental health support
Support community-based recovery for people suffering mental illness
- Ensure that this is in line with the Productivity Commission’s recommendations, that effective services support community-based recovery for people suffering mental illness