The newly released 2012 Report Card on Mental Health and Suicide Prevention has a single clear message – despite numerous reports, strategies and policies on mental health and considerable spending, Australia still has a failing grade.
This new report card is considered in tone, but reading between the lines, the frustration with the status quo is palpable. It makes the case that mental health is literally a life-and-death issue that is everyone’s responsibility. Too many Australians with mental health needs do not get treatment and only about 50 per cent of those who do, get the services they need. Mental health is at the root of the majority of suicides and suicide attempts, and people with serious mental illness die up to 32 years earlier than those who are not mentally ill.
The huge burden mental illness imposes on patients, their families and carers, healthcare and social welfare systems, and society as a whole makes it shameful that we have not done more sooner and imperative that we do more now.
Despite a growing volume of evidence about mental health needs in Australia and how to address them effectively, there is still a lot we don’t know and much of what we do know is not being utilised.
For people with mental illness, the spectrum, capacity and quality of services available depends on where they live and their income.
We must move beyond counting hospital beds, Medicare services and prescriptions to improving health outcomes by ensuring that mental healthcare is well-targeted, effective, accessible and affordable, that it includes the full range of services for patients and their carers such as case management, housing, employment and disability assistance, and that it is delivered in a co-ordinated fashion.
Certainly no one should be discharged from care into homelessness, and families and carers should not be left alone to cope with situations that vary from dangerous to soul destroying.
The report card makes plain what most stakeholders think about the fourth National Mental Health Plan by stating: ”Australia has no nationally agreed picture of what a good mental health framework should look like and how it should be properly resourced.” It challenges government to be brave enough to set goals and targets and be publicly assessed against these.
The report also issues a veiled threat that if governments don’t deliver an honest picture of how Australia is performing and if the current Ten Year Roadmap for National Mental Health Reform doesn’t deliver, then ”we [the National Mental Health Commission] will work with others”.
But the reality is that there is no one else to work with. Mental health reform in Australia is totally reliant on leadership and sustained investment from the highest levels of the Commonwealth, state and territory governments.
There are many in the mental health sector who find fault with this report. To some extent they are justified: it says much the same thing that the Richmond report said back in 1983; there is too little focus on prevention and early intervention, especially for children and youth, and the huge burden of depression and anxiety in the chronically ill and elderly; and the strong links between mental health problems and substance abuse are not being effectively addressed.
The real question is, what happens now? What is the agenda for the next 10 or 20 years and, given the ephemeral nature of governments, how do we get long-term commitments and sustained funding so that each annual report card from the commission will show the needed progress on the agreed-upon priorities and directions? Can all this start to happen now without resorting to yet another round of consultations and strategy development?
From the beginning of the 20th century, Australia has averaged a report or inquiry into mental health every 2½ years. Despite these reports and inquiries and dozens of plans and policies, Australia is not succeeding at matching mental health services to need.
Since 2006 Australian governments have committed to spend $8 billion of new money on mental health, but spending between jurisdictions continues to be unco-ordinated and lacking accountability.
For the National Mental Health Commission’s Report Card to become the game changer that everyone so desperately hopes for, what is needed is a culture change that sees mental health and wellbeing as a key indicator of the nation’s commitment its citizens.
There should be no conversation or policy about healthcare reform, closing the gap on indigenous disadvantage, tackling homelessness, addressing social inclusion, improving education, and productivity without ensuring that mental health is also on the table.
Dr Lesley Russell is a senior research fellow at the Australian Primary Health Care Research Institute at the Australian National University.
As first appeared in The Canberra Times, 30 November 2012.