Mental Health Week this year is in the shadow of the latest shocking suicide statistics. Deaths from suicide in 2015 topped 3000 and were up 5 percent on 2014. That’s an extra 153 Australians. And for every death from suicide, more than 60 people are directly affected and usually harmed for life.
Mental health care across the nation is rationed like no other aspect of health care, and is marooned at around 7 percent of the health budget. Way too low. In the Commonwealth-funded world of primary care, if you are depressed but not recovered after 10 sessions of therapy arranged via your GP, well… that’s it for the year.
The recent scandal in NSW shows us exactly what happens if cancer is under-treated. Depression can be equally life threatening, and yet where is the outcry about the fact that only 16 percent of people with depression in Australia can access minimally adequate evidence-based care?
Access and tenure in the rest of health care is based on evidence, need and burden of disease. And there are few restrictions to expensive end-of-life care, where an enormous amount of the health budget is being spent. This magnifies the underspend in mental health care, which as the Prime Minister recognises in his use of the term “mental wealth”, is by far the most cost effective area of health care.
Even more seriously, access for complex and severe mental illnesses at State government level is extremely difficult until the situation is desperate. Everyone who has tried to get help anywhere within the system across Australia faces these barriers, and everyone working within the system knows it is increasingly overwhelmed.
This is a key driver of the increases in suicide rates and is a threat to public safety as well. Even the most affluent people struggle to access quality mental health care at a 21st century level.
The National Mental Heath Commission diagnosed these problems and proposed many of the right solutions, especially early intervention and upstream stepped care. However, without major redesign, new investment and a radical improvement in culture, work practice and expertise, things will not improve and many more people will die unnecessarily.
The move of state mental health care out of the old asylums into financially challenged acute hospitals was, in principle, a good idea. However, it is crumbling nationwide. The whole idea with a major reduction in beds was heavily dependent on a strong, proactive and expanding community mental health system. This has been eroded by inward-looking hospital-oriented management and an abject failure by States to invest to match growth in population and in community expectations, driven by awareness and reductions in stigma.
Suicides among the patients of public mental health services feel as commonplace as in remote indigenous communities; a steady stream of preventable deaths and tens of thousands of diminished lives, an absolutely demoralising experience for dedicated frontline clinicians as well as the patients’ families.
In Mental Health Week, which has been boosted in recent years by the ABC’s ‘Mental As’ initiative, we always tend to focus on awareness and tackling stigma. This was certainly a prerequisite for progress, but it now risks now becoming a distraction and a substitute for action.
Restructuring and decentralising the health bureaucracy into 31 pieces, as we have just seen Federally, unless there is new investment and strong national oversight, will be another distraction and a false dawn.
State governments must invest in and rebalance their investments so that there is an accessible, dynamic and expert community mental health system. New spaces and cultures must be developed, since emergency departments and short-stay-risk containment units are no place for distressed, disturbed and often disturbing people with acute mental illness.
The governance of mental health care can no longer be entrusted to acute hospital CEOs without more financial and operational autonomy for mental health programs. A direct and transparent relationship with State health departments for the mental health system is now essential. State community mental health services should move to embed and engage with primary care and other community services such as housing and employment. And there must be the same level of respect for clinical expertise, evidence and research capacity in mental health care as we see in general medical care, since these are the drivers of quality and humane care.
We have seen an alarming decline in capacity and quality as services have descended over the past decade into a generic risk-obsessed model, and hence to a one-size-fits-all, lowest common denominator approach.
In Victoria, there seems at last to be a recognition by the incoming Andrews Government that things have hit rock bottom in its once vaunted mental health system. That we must deal with the fundamentals not the superficial and peripheral. This will means a major shake up and new investment. Will the government be committed enough to go down this track?
Australia has an enviable track record of innovation in new models of mental health care, notably Better Access, home-based treatment, early psychosis and youth mental health. October 11 will be celebrated as ‘Headspace Day’ to mark the 10th anniversary of this nationwide successful evidence based network of services.
But these beachheads are only the start. Headspace is only the entrance foyer and front room of what needs to a whole house. There are many rooms still missing.
Specialised expertise in more complex illnesses, not only early psychosis, is the next project. It was heartening that the Turnbull government strongly recommitted to these world-leading templates of care at the election, but further investment and growth is essential.
This piece by Pat McGorry was first published on ‘The Huffington Post’ on October 10, 2016.