The National Mental Health Commission on Monday released its National Report 2019 on Australia’s mental health and suicide prevention system.
The 97 page report comes, as Croakey readers will know, amid ongoing investigations by the Royal Commission into Victoria’s Mental Health System, and the Productivity Commission’s inquiry into the social and economic benefits of improving mental health.
According to its media release, the Commission continues to recommend a whole-of-government approach to mental health and suicide prevention. It says:
This broad approach ensures factors which impact individuals’ mental health and wellbeing such as housing, employment, education and social justice are addressed alongside the delivery of mental health care.”
‘Fixing Australia’s mental health system’ was the topic of a recent panel discussion at the National Press Club involving former chair of the National Advisory Council on Mental Health, Adj. Professor John Mendoza, beyondblue CEO Georgie Harman and the head of ANU’s Mental Health Research Centre Professor Luis Salvador-Carulla.
Mendoza said the topic “remains among our most pressing and greatest policy challenges” and he urged a comprehensive focus on equity of access to services and a comprehensive focus on the social determinants, ranging from housing to climate change.
Below is an edited version of his NPC address.
Mendoza will be participating in Croakey’s #CoveringClimateNow #TwitterFest on Tuesday, on the topic: The Big Driver of Despair: global warming & mental illness.
John Mendoza writes
Over the past 15 years, I have been privy to thousands of firsthand accounts of the experiences of mental illness and mental health care. So, I will use two stories to illustrate how we might begin to FIX Australia’s mental health crisis.
Ella grew up in a loving family on Sydney’s northern beaches but she became unhappy with body image in Year 12. She started on an exercise and diet regime that took over. Compulsions, a distorted reality and stress over her HSC (Higher School Certificate) led to her collapsing.
Ella had developed anorexia and binge eating and had been seeing her GP and other doctors. Her family remained 100 per cent supportive and attentive.
The next few years were miserable. Trapped, out of control, hating herself and her body. While unsure as to what to do, her mum facilitated Ella’s help seeking: multiple psychologists, psychiatrists, medication, acupuncture, meditation, yoga, hypnotherapy, but nothing was working and Ella developed anxiety and depression and began to self-harm.
With her mum’s support, Ella checked into an Eating Disorders Clinic for 6 weeks, for private inpatient therapy that turned her life around.
University played its role through disability services which enabled Ella to take longer to complete her degree. Ella, now in her mid-20s, has a fulltime job, a long-term relationship and is managing her mental health.
What Ella’s story demonstrates is:
- The need to provide access to collaborative, team based primary and specialist care. Primary care is the engine room of the Australian healthcare system. But it is not funded or organised for collaborative team-based care for people with complex or chronic conditions. As complexity increases, access to team based, collaborative care should be the norm.
- Every student in every school must receive social and emotional learning programs – learning resilience is as important as the other 3 Rs. About 1 in 10 students will need rapid access to specialist support. Parents also need to be better equipped to support young people when they develop mental health problems.
- Publicly subsided Medicare services have to be equally available to all Australians. Ella was fortunate to have a family where unconditional love abounded and the financial resources to get the care were available. If she lived in Blacktown, there are no private psychiatrists, very few psychologists, too few GPs and an almost total reliance on the ED and public acute care services. This has to change.
Ben, 29, grew up in Ashfield in a family with considerable conflict. From a young age Ben had learning difficulties, was anxious and a loner, changed schools, was suspended and eventually dropped out in Year 11. He began drinking at age 14. Ben continued to live with his father after his parents split and had a number of low skilled, low paid cash-in-hand jobs.
At 19, Ben had his first psychotic episode in a public place. It was a traumatic experience; he was taken by police to the Royal X, admitted for 9 days, prescribed medication, given a case manager and provided with an Outpatient appointment. Ben did not engage with outpatient services and his case manager was unable to maintain ongoing contact with him. The case manager has a caseload of 45 “Bens”.
Ben was sacked from his job for repeated absences. He attended Centrelink and after a 8-week wait received Newstart. He applied for Disability Support Pension but was not approved given a lack of supporting documentation. Later it was a similar story with NDIS.
Ben experienced several psychotic episodes, was heavily fined for driving without a licence, was arrested several times, spent time in prison, and was periodically homeless.
He was well known to ED, the psychiatric inpatient and outpatient services, police, ambulance, homeless services. He was found naked at 7.30am, in the city, proclaiming to be Jesus. He was taken to ED under an ITO, held in a secure bed in ED for 50 hours and then discharged with a script and an appointment with community mental health. Ben was found dead the next day.
What Ben’s story demonstrates is:
- That Police and other Emergency services across Australia, have become the de facto frontline mental health services. The lack of assertive community-based care means people like Ben cycle through ED, acute care, unstable housing and prison. We must recommit to proven assertive community care and crisis resolution services.
- The need for a Housing First policy in all jurisdictions is acute. Finland has, through bipartisan efforts over two decades, eliminated homelessness. Providing safe, stable housing is cost effective and we need to stop mucking around and just do it.
- A traumatic childhood is strongly associated with mental illness and suicide in early adulthood. The more adverse experiences, the more likely that result. Programs such as First 1000 days and other proven pre-natal and early childhood programs must be universally available. Every child needs the best possible start in a nurturing and safe home.
Six steps to end the mental health crisis
To reiterate there are six actions to start to end the seemingly perpetual crisis in mental health in Australia:
- Access to team based, collaborative care as complexity increases.
- Social and emotional learning programs in every school for every student.
- Equality of access to publicly subsided Medicare services.
- Recommit to proven crisis resolution services and alternatives to ED.
- Housing First policy in all jurisdictions.
- Pre-natal and early childhood development programs in all regions.
There is a sense that this is THE opportune moment for real mental health reform; to ‘FIX mental health’. But we must face the fact that we have had, since the First National Mental Health Plan in 1992, more than 130 reviews or inquiries conducted predominately by Parliamentary Committees and statutory authorities – one every 85 days.
Fixing mental health services for all will not be easy but should be achievable with substantial health care reform. Access to good mental health care must not be largely dependent on your postcode, pay packet and persistence.
Fixing the shortage of social housing, fixing the NDIS, fixing disability employment services – these are all doable and all necessary if we are to FIX the mental health crisis.
It will be much harder to FIX the crisis if we do not address growing poverty. We know that disadvantage starts before birth and accumulates to the point where the most disadvantaged 40 per cent of the population are 2.5 times more likely to die by suicide than if they were in the top 20 per cent. Can we fix that?
We know that anxiety and depression among young women have almost doubled in the 8 years to 2017: the first era of social media and the gig economy with more precarious employment. Can we fix that?
Global warming and its impact on human health has been highlighted by a recent Lancet report. We know communities will be hit harder and more often in the decades to come. Are we preparing them for that? Can we take action to fix that?
There is little doubt, that fixing Australia’s mental health crisis remains among our most pressing and greatest policy challenges.
Adj. Professor John Mendoza is a Director of ConNetica, a former chair of the National Advisory Council on Mental Health, and former chief executive of the Mental Health Council of Australia.