These days every Australian knows that sooner or later they will experience poor mental health, either personally or within their own family. What they may not know yet is that they will struggle to access the same quality healthcare that we all take for granted when we develop physical health problems.
Less than half of those with a need for mental healthcare access it, and if they do it is typically too little, too late and of variable quality. If we develop a mental illness we will die up to 20 years earlier than other Australians. We will not fulfil our true potential, and risk ending up on the scrapheap of welfare dependency and poverty. Mental health care and research suffer from serious underinvestment, yet they represent by far the best value for money for governments increasingly concerned about the sustainability of the health system.
Furthermore, Australia has innovative solutions under way or within reach, but decisive national leadership will be critical. I believe the Australian public are ready and waiting for this sea change and we will be able to get a real sense of this very soon. During Mental Health Week in October, the ABC will be presenting a whole week of themed programming across all its broadcast platforms on mental health under the banner Mental As.
This unprecedented national leadership, supported by other media partners, sponsors and ambassadors, will create an Australia-wide conversation, and will also raise much needed funds for mental health research. It could prove to be a tipping point for progress towards a happier, healthier and more productive Australia.
The World Economic Forum recently reported that non-communicable diseases will more than halve global GDP over the next 20 years, pushing millions below the poverty line. Mental health conditions will remove $US16 trillion ($17.2 trillion) from world economies and represent 35 per cent of this cost, slightly more than cardiovascular disease and much more than cancer. Why? Because mental disorders are diseases of the young.
Seventy-five per cent of cases emerge before the age of 25 years and impact heavily on the productive decades of our lives. This is not the case for the major physical NCDs, which cluster later in life. Mental health care and research represent low-hanging fruit both for improving life expectancy and much better productivity and quality of life.
Substantial savings across government are also within reach. A recent Medibank Private report revealed that while $29 billion is spent annually as a result of mental illness, this largely reflects the costs of failure to invest in quality care, with huge spending on welfare, prisons, and other downstream consequences. How can this be turned around?
We need to do two things. First, reform and invest in mental health care which must be progressively structured to reduce the impact of mental disorders on premature mortality, quality of life and economic productivity. Australia has already taken significant steps in this direction. Tomorrow is United Nations International Youth Day and the focus this year is, unsurprisingly, mental health.
Headspace, created in 2005 under Tony Abbott as health minister, focuses on access and evidence-informed care for young people on the threshold of productive life who face the major burden of mental disorders. Headspace now operates in 70 communities Australia-wide and will reach 100 sites soon. The challenge now is to extend it to the whole population and finish the job of building a stigma-free and effective youth mental health system for Australia’s young people and their families.
Since Headspace is a primary care model, it must be backed by more specialised expertise for the complex range of disorders that make up one-third of the problem. If fully implemented, economic studies estimate that up to $10 billion worth of savings are achievable annually. Mental disorders in children and older adults are also critical and also require major reform and investment.
We are at a watershed in mental health care as the National Mental Health Commission reviews the system of care, and the federal government is reconsidering the relative roles of state and federal governments. State governments have struggled with mental health care ever since deinstitutionalisation, and they have demonstrated that they simply cannot create and grow the expert specialised programs needed in community. The federal government must assume the decisive role in reform and investment – mental health has a strong claim to be treated as a special case in healthcare, since there will be a major return on investment, particularly for the federal government.
The second strategy is a much more serious research effort in mental health. A major affirmative action plan is needed. Thomas Insel, director of the National Institute of Mental Health in Washington DC, has argued passionately for this approach in the US. Mental health research in Australia has been very much the poor cousin in medical research, despite punching well above its weight internationally.
New leadership and increased investment in the emerging talent of early career researchers, translational research and new purpose built clinical research facilities are all overdue. We need to attract a much greater share of private and public donations and reach equity in NHMRC funding to balance the investments in medical research in physical disease.
The Society for Mental Research in Australia has recently been modernised and is determined to meet this challenge. Australia is poised for a sea change in mental health after years of promises and expectation. Thanks to the ABC’s leadership and a range of generous supporters, Mental Health Week this year presents the best opportunity so far for all Australians to make their voices heard.
Professor Patrick McGorry is Professor of Youth Mental Health, Orygen Youth Health Research Centre and President of the Society for Mental Health Research. Mental As features on the ABC October 5-12.
This article first appeared on ‘Sydney Morning Herald’ on 11 August 2014.