National Mental Health Commission chairman Allan Fels has called for a radical rethink of the National Disability Insurance Scheme amid growing fears it will leave hundreds of thousands of people with a psychosocial disability behind.
Professor Fels called on federal politicians to put mental illness front and centre of their economic reform agenda, and pushed for a Productivity Commission review into the estimated $15 billion it costs the national economy each year.
The former consumer watchdog head made the comments as he launched a new statement – supported by 53 mental health organisations – on the “unacceptable” widening life expectancy gap between Australians with a mental illness and those without.
While Professor Fels believes mental health must be included in the NDIS, he expressed serious concerns about the program’s implementation – including the number of people with a mental illness or psychosocial disability who will not be eligible for support.
Australian Bureau of Statistics figures show there are about 700,000 people with severe or psychotic mental illness – but between 64,000 and 92,000 are expected to qualify for an individually funded package under the NDIS by the time it is fully implemented in 2019-20.
“More people need to get in,” Professor Fels said. “Equally worrying is the fate of large numbers of people who are deemed to qualify at best for a lower tier of support. There are grave fears as to whether they will receive any significant support at all and we deeply fear many people will fall into a big hole between the NDIS scheme and mental health schemes.”
He also raised concerns about the assessment process for determining eligibility, calling for a “radical review”.
The NDIS is principally designed for people with a physical or intellectual disability, where assessments are relatively straightforward. But assessing the eligibility of people with a mental illness is proving to be a “major problem”, he said.
Assessments have been inconsistent and unpredictable, and there is still no published eligibility criteria even though the NDIS trials started three years ago. Professor Fels wants more mental illness specialists involved in the scheme, and is calling for the government to consider whether a special gateway is needed to help the mentally ill into the scheme.
“At the moment the big risk is that mental health becomes the poor cousin of the scheme, and is squeezed between an imperfect NDIS and a contracting mental health system,” he said.
Professor Fels said there was now a “strong case” for a reference to the Productivity Commission to get mental health on the economic agenda. The total cost to the health system of people living with severe mental illness has been estimated at $15 billion a year – about 1 per cent of GDP – including the cost of health care, lost productivity and other social costs.
The “Equally Well” statement finds the mentally ill die between 14 and 23 years earlier than the general population – and suicide is only a small contributor.
Describing mental health as the “weak point” of Australia’s health system, Professor Fels said people with a mental illness were twice as likely to have cardiovascular disease, a respiratory disease, a metabolic syndrome, diabetes and osteoporosis. They are 65 per cent more likely to smoke and six times more likely to have dental problems.
Medications contribute to these problems because their side effects can lead to conditions such as obesity. Poor access to services and the high cost of screening and treatments also contribute, as does the stigma and discrimination that discourages people from seeking help.
Health professionals also ignore and dismiss the mentally ill, not investigating as frequently or treating as assertively as they would for others.
Known risk factors such as smoking, alcohol and drug use, poor nutrition, higher sedentary behaviour and lower levels of physical activity among the mentally ill also contribute to poorer physical health. The mentally ill also suffer from inadequate housing, lack of education, social exclusion, low incomes, unemployment and exposure to violence and abuse.
This piece by Adam Gartrell was first seen on ‘The Sydney Morning Herald’, July 25 2017.