RECENTLY, millions of Australians participated, for a whole week, in an unprecedented national conversation about mental health catalysed by the ABC and other media partners, including this newspaper.
It was unique and inspiring, but will it finally translate into parity in healthcare for the four million Australians who experience mental ill health every year?
Despite the welcome openness in Mental Health Week, people with mental illness are still dying up to 20 years earlier than the rest of us because of a serious failure to make expertise accessible at the right time and in the right settings, and to invest in research for cures, and safer treatment.
Mental illness represents 13 per cent of the burden of illness but attracts only 7 per cent of health and research expenditure, yet it is the most damaging illness in its impact on the economy.
Successive federal governments across two decades, including the Abbott government, have undertaken reforms and investment, notably support for allied health professionals in primary care and world-leading innovations in youth mental healthcare.
State governments, however, have been disinvesting in community care, resulting in reinstitutionalisation and a retreat into the acute hospital. This is a recipe for late intervention, preventable deaths, widespread misery, unfulfilled potential and huge waste on unnecessary welfare payments.
Fortunately there are solutions, but continuing leadership, innovation and investment from the federal government is critical.
In mental health we need to apply the lessons learned from cancer and cardiac disease. Improved outcomes for cancer have come partly from early detection, timely intervention and sustained specialised care in the community and hospital settings.
This is not available anywhere in Australia for mental illness, but our research shows this would save thousands of lives and greatly reduce costs to the economy.
This is because mental illnesses kill and disable people in the prime working years, as the World Economic Forum’s 2011 report on non-communicable diseases makes clear. Prevention also has a role to play but has been placed in the too hard basket.
We also need to invest equitably in mental health research. As with cancer, no one should be satisfied with existing treatments. In mental health we urgently need novel therapies, such as neuroprotective agents and new psychological and social therapies, which can cure or limit the impact of these illnesses with fewer side effects, reduce health costs and maximise productivity.
The “Mental As” campaign raised $1.5 million for mental health research. This was a good start; yet we are seriously underinvesting in medical research, one of Australia’s great strengths, spending only 64 per cent of the OECD average, as a percentage of gross domestic product, in health and medical research.
Existing structures are also not working and priorities are highly debatable. Last Friday, the annual round of research grants from the National Health and Medical Research Council were announced. The success rate has been in free fall, plummeting to an all-time low of 15 per cent this year from a high of 26.7 per cent six years ago, with more than four out of five projects not funded. Researchers spend many months and all their summer holidays working on grant applications knowing 85 per cent will not be funded.
This is a demoralising, unsustainable waste of our top scientific talent. It has to change.
Some processes and structures of the NHMRC also seem outmoded compared, for example, with Canada and Britain. Despite recent rhetoric and largely cosmetic changes, clinical and translational research, which is much likelier to yield short to medium-term breakthroughs, remains relatively neglected, as are early career researchers.
The NHMRC must modernise in the light of recent changes in key overseas research funding bodies. As in other nations, budget allocations should be based on burden of disease, research translation and national priorities.
Mental health, which should be a top priority, remains mired on a miserly 7 per cent of the research spend and much of this is not well targeted. Corporate and philanthropic donations also go preferentially to traditional areas of medical research. A level playing field is essential.
For these reasons, we must support the Abbott government’s proposals for a $20 billion Medical Research Future Fund.
We need much greater investment in medical research. We have the talent, experience and unique platforms to capitalise on such investment for the benefit of all mankind. Medical research is a great Australian tradition and we could be on the threshold of a new era. Our mental health researchers punch way above their weight on the world stage.
We need affirmative action to translate their public health importance, and unprecedented public support, into longer, more fulfilling productive lives.
Patrick McGorry is president, Society of Mental Health Research.
This article first appeared on ‘The Australian’ on 21 October 2014.