Australia's mental health system is in crisis. As the issue continues to gain attention it will no doubt become politicised in this election year. Ongoing advocacy and lobbying from esteemed psychiatrist and Australian of the Year, Professor Patrick McGorry, and the high profile resignation of Professor John Mendoza from the National Advisory Council on Mental Health have galvanised public opinion — for proof just glance at the op-ed pages of any recent Australian newspaper.
Sensitive to this, the Federal Opposition recently announced its election commitment of $1.5 billion in new funding for mental health services. This has raised the stakes. That mental health is on the political agenda is good news for Australia's most marginalised and vulnerable. Moral leadership, incorporating commitment to extra funding, innovative policy and evidence based practice must follow the rhetoric.
When Australians experience serious physical injury, in almost all cases our emergency services and hospitals provide the acute care necessary to sustain and nurture life. Sadly, thousands are unable to access a similar standard of care when it comes to mental ill health. This has a raft of implications for our communities given the overlap of mental ill health with homelessness, offending behaviour, gambling addiction, relationship breakdown, substance abuse, domestic violence and impulsive risk taking.
The Opposition proposal of large scale investment in the youth mental health model, including early intervention services for first episode psychosis in addition to increased acute inpatient services is a significant milestone in the move towards mental health reform. With 75 per cent of mental ill health occurring prior to 24 years of age, getting in early is a sound approach for preventing future episodes.
Youth specific services are essential given the unique needs and challenges inherent in working with this population. In my experience, when young people are supported by services that meet their needs they often respond quickly and positively. As crisis remits they move from risky to resilient. Early intervention makes good economic sense as it prevents the progression of an episode from mild to severe, from first episode to chronic, from negative thinking to suicidal ideation.
Both sides of politics agree that more has to be done to improve mental health services. There are votes in mental health, and if Gillard wants to lead on this issue, she can look to furthering on the Coalition's commitment. This will require innovative policy. However investment needn't occur solely within the realm of hospitals. Greater emphasis on innovative prevention programs and public awareness campaigns should occur.
The building blocks of early intervention can be woven into school curricula through basic mental health first aid training. Suitably trained primary and secondary teachers could provide evaluation based programs to their students for effectively managing stress and worry, and actively promoting resilience and self-awareness. Similar large scale programs could be developed for the workplace.
These programs could be expected to have both short term efficacy in managing distress and longer term benefits in reducing mental health stigma and increasing coping behaviours.
There are two other key aspects for the Government to address: men's mental health and Indigenous mental health. In comparison to women, Australian men are far less likely to seek help for mental ill health, but are four times more likely to commit suicide. Hence we must look to making mental health services a more feasible option for men. Central to this will be programs encouraging greater numbers of men to enter the caring professions as psychologists, occupational therapists, social workers, youth workers and counsellors.
We also need to reappraise help-seeking among men as courageous. It is encouraging that greater numbers of men are breaking with societal norms and are talking more openly about their experiences of mental ill health. This should be affirmed and encouraged.
There is a need for greater research and funding into culturally appropriate mental health services for Indigenous Australians, where major gaps in service delivery remain. Positive steps are being made in Indigenous communities to improve mental health literacy. Additional resources must be invested in training members of Aboriginal communities to provide mental health services, including culturally appropriate mental health assessment.
Mental health reform is long overdue. Australia has the capacity, ingenuity, financial resources and on-the-ground know-how to lead the world on this issue. Opportunity awaits our new PM to move towards greater parity between physical and mental health. To show moral leadership on mental health reform is the right thing to do. It has the capacity to transform the lives of Australia's most marginalised and vulnerable.
Simon Rice is a Provisional Psychologist and Research Assistant in the Australian Catholic University's School of Psychology.
Comments should be short, respectful and on topic. Email is requested for identification purposes only.
12 July 2010
More empty words from trendy people jumping on the latest band wagon! Minor reactive depressions may be prevented by schools programs; serious chronic illnesses associated with permanent structural or chemical changes in the brain will not be. When are we going to hear about the adoption of treatment, housing and employment options that have proven to be successful overseas? Patrick McGorry and John Mendoza have done a great job getting mental illness on the public agenda, but it is interesting to note how much of the attention has gone to Patrick McGorry's own program. If one checks the statistics carefully, it appears that early interventions help a considerable number of young people and their parents through a temporary difficult time. They do not prevent the development of, for example, schizophrenia or bipolar disorder.Thus we need better treatment, better housing options and better employment opportunities (not more hospital beds) for people with mental illnesses of all ages. People with serious, incurable mental illnesses in other countries have such options why are they not available in Australia?
Harold A. Maio
12 July 2010
Australia's mental health system is in crisis.
Do you mean health system, or are there two? Is that there are two the real problem?
12 July 2010
I agree in principle with 90% of what Simon has suggested in his article however we need to be careful when suggesting building psycho-education into other systems such as education. Psychological first aide is a program that most are able to do without any training however we should not over burden those who are already over burdened by introducing quasi counselling as part o their job description. It takes several years to train a counsellor and longer to train a psychologist.There are also significant boundary and conflict of interest issues when other professionals start to counsel or diagnose. If mental health is to appropriately utilise the current mental health workforce more efficiently the public should have access to Medicare re-bateable counselling (to registered counsellors) in the first instance as opposed to expecting others to take on a para professional role or to restrict Medicare only to treatment services. Early intervention is only successful when appropriate services are readily available before a condition develops into a clinical, acute or psychotic event not after and we have a whole workforce of counsellors who able to work in this area to alleviate the current burden on GP's and psychologists.
12 July 2010
Harold puts his finger on it. A fundamental issue in Australia is that we have two highly unequal systems of health care; one for the comfortably off privately insured and one for the rest. In psychiatry, my experience would suggest that the breakdown of specialist doctors is about 3 to 1 in private to public practice. In Hobart , which I know well and is probably typical, there are about 30 trained psychiatrist in total of whom about 7 spend at least some time in public and the other 23 are solely in private and shut their books when they have about 3-400 patients: they can earn a half million dollars a year on that practice. Private rooms are comfortable and the patients well dressed and well behaved in general. The public docs have to care for almost all the societal mess that represents public psychiatry, and most of the acute work, frequently in pretty dismal surrounds and are also responsible for the training of students and new psychiatry doctors. Bizarrely, for all this commitment to the `nasty` end, a full time public consultant will be earning well less than 50% of his average private colleague, although this is a good wage! Until Australia is prepared to change its health care culture to put resources where it is most needed, and have a single health care system which we are all prepared to share , and fund it, then we will not thrive as a society. It is notable that although as a community we spend now about 9.7% of GDP on healthcare, the public share of that is amongst the lowest in the OECD. These funding/sharing/prioritising issues are fundamental to our problems, and yet Rudd specifically excluded them from the Health and Hospital Reform Commission`s brief!
12 July 2010
Point taken re not overburdening schools Philip and about serious mental illness Sheelah but there is great scope for mental health education in general health education.So much of what happens in your average high school is not conducive to mental health.Pity we have not put as much real commitment into tackling bullying as into removing asbestos from ceilings!!in both cases the long term effects are horrendous...
26 July 2010
There is a place for mental health issues in the school curriculum. Kids, like everyone have their share amongst them. Some people develop into serious and concerning conditions. And people, of whatever socio-economic background who seek psychotherapeutic treatment are often in considerable pain. The myth of the worried well hailing from the leafy green suburbs belies those shattered interiors which cripple emotional and thus economic potential.
Rather than funding and rebating according to the degree the clinician happens to have done, policymakers might consider restructuring Medicare according to service provided - or a combination of the two.