Government spending on mental health has increased, but rates of mental illness and suicide remain dramatically higher for specific communities than the general population, a productivity commission report has said.
Average government spending on mental health has increased from $242 to $309 per person in the past seven years, the report on government services’ look at the health sector said.
The states, which are responsible for “the funding, delivery and management of specialised public mental health services”, contributed 63.3% of the approximate $7bn real government recurrent expenditure on mental health services in 2011-12. All states and territories except South Australia and Tasmania saw an increase in spending in 2011-12 compared with the previous year.
The report said a high or increasing proportion of spending on community-based services, which includes ambulatory care, adult residential services and non-government organisations, was “desirable”.
“More appropriate mental health treatment options can be provided by encouraging the treatment of patients in community-based settings, rather than in standalone psychiatric hospitals and public non-psychiatric) hospitals,” it said.
Nationally, the proportion of spending on community-based services increased over successive years from 2007-08 to 2011-12. However, state-by-state breakdowns revealed decreased proportional spending in New South Wales, Tasmania, and the Northern Territory in 2011-12.
Elizabeth Priestley, the chief executive of the Mental Health Association NSW, told Guardian Australia the decrease in proportional spending in the state could be partly explained by savings from the closure of hospital beds not being retargeted to community-based services.
“The Mental Health Association has been a very strong supporter of community-based services, and we’re also supporters of closing down hospital beds and treating people in the community,” she said.
“People want to stay at home, they don’t want to go to hospital. One of these issues is of course stigma, and getting to the stage where you’re so sick you need hospital care, and being treated against your will can be very distressing.”
Without community-based support, which Priestley said comes with a high level of trust and understanding between patients and providers, people with severe mental illness can end up spending their lives in and out of hospital.
“One of the arguments for community-based services is that actually providing those services is going to be cheaper. An initial outlay of money will be required – probably more than keeping beds open. But in the long term, people will be able to stay well for much longer,” she said.
“In many ways, and at many times, they’ll be able to live a relatively normal life.”
The report also highlighted data on suicides among Australians and reiterated the large gaps between groups based on age, region and Indigenous status.
Between 2007 and 2011, 11,600 deaths by suicide were recorded. The rate was much higher for males, equivalent to 16.5 per 100,000 males, compared with 4.9 for females.
For those aged 75 to 84, and 85 years or over, the male suicide rate was about five or six times the female rate.
The Northern Territory had a dramatically higher suicide rate than other states and territories, with more than 20 deaths to suicide per 100,000 people. Rates in NSW, the ACT and Victoria were all under 10.
Nationally, the suicide rate between 2007-2011 was higher in rural areas, with 13.1 suicides per 100,000 people compared with 9.6 in capital cities. Within the state-by-state breakdown NSW, Victoria and South Australia had higher rates in urban centres.
The national rate of suicide among Indigenous Australians was 22.3 per 100,000 compared with 10.3 among non-Indigenous Australians. Rates were dramatically higher in every state and territory reported with the largest gap in Western Australia which had 35.9 suicide deaths per 100,000 Indigenous Australians compared with 12.2 non-Indigenous.
Data from Victoria, Tasmania and the ACT was not included due to insufficient levels of identification or numbers of deaths.
This article first appeared on The Guardian on 30 January, 2014.