By Allan Fels, Australian New Zealand School of Government
The National Mental Health Commission (NMHC) today released its first annual report card on the state of mental health and suicide prevention services in Australia. Called A Contributing Life, the report focuses on both life expectancy and quality of life.
Launching the report card in Sydney, NMHC Chair Allan Fells explains the Commission's assessment.
Australians are comfortable talking about a lot of things, but mental illness isn't one of them.
However, learning from personal stories and experiences is essential to developing a new narrative, a new view of mental health in Australia.
I thank everyone who has given their time to speak with us this year about their lived experiences of mental health difficulties or their experiences supporting others.
Sharing personal stories takes immense courage. I'd particularly like to acknowledge Chris, Julie, Maddison, Kathleen, John, Kylie, Emma Leigh and Madeline, Greg, Elaine, Men, Carol, Carmel, Pat and Keith, Jasmine and Cindy, whose stories are featured in our videos and this Report Card.
At the same time we can't do enough justice to the overwhelming good work of people in support services and elsewhere, and the very positive initiatives that are happening across Australia every day.
We commissioners all felt a strong sense of responsibility while we developed the first of our Annual Report Cards, in our first year of operation.
Today over seven million Australian adults have experienced a mental illness. One in five Australians, will experience a mental health difficulty in any given year. Virtually every family has their own story but these personal stories are too often never heard. For this reason, the Commission has placed people with a lived experience of mental health difficulties, as well as their families and supporters, at the core of all we do.
So when you read our report you'll see that it's different to the kind of report you might normally see because it goes far beyond the clinical and the medical. It looks at the whole life of those with mental health difficulties.
And the theme of our report card reflects a theme that came up again and again during our conversations with members of the community and our many stakeholders this year – A Contributing Life.
When we talk about a contributing life we mean a fulfilling life.
We mean a recognition that people living with mental health difficulties want and need the same things as everyone else, including a stable home, something meaningful to do, something to look forward to, strong connections to family, community and culture, and access to effective care, treatment and to services. To not be discriminated against. To have their rights acknowledged and acted on.
We have therefore written this report card for all Australians and we say:
We don't care about political divides, and state divides.
We aren't interested in buck passing, excuses, or even what's been deemed to be acceptable.
We care about giving all in our Australian community a fair go.
We care about services, but more importantly, we care about people.
We especially care that right now, even when excellent services are being provided, they often are not wrapped in an approach that looks at the whole life of a person with mental health difficulties. Therefore they don't necessarily offer people who experience a mental illness the best chance of recovery and a contributing life. And that includes their families.
I hope that we will all will look back on today as a special day, when all Australian governments and communities recognised that mental health and suicide prevention are and must remain a high, national priority and found the courage to address some difficult truths.
In particular, here are some of the things that worried us that we believe must, and can be fixed.
We are shocked and saddened by the long-term high rates of physical illness and early death among people with mental health difficulties.
The statistics related to the physical health of these Australians are appalling. Their health is worse than those in the general community on just about every measure.
Looking at people living with severe mental illnesses such as bi-polar disorder, schizophrenia or psychosis – their life expectancy is reduced by 25 years on average because they face an increased likelihood of heart related conditions, diabetes and obesity.
We know that there are several reasons for the poor physical health of those with severe mental illness.
First, some antipsychotic medications prescribed to manage mental illnesses such as schizophrenia also contribute to the likelihood of developing chronic physical disorders. This is a difficult issue. But it is something that people living with mental health issues, families, supporters and community members raised with us again and again during the year.
Second, smoking, poor nutrition and physical diseases have a major bearing on physical health – and their incidence is high amongst people living with severe mental illness. Mental health difficulties too often overshadow chronic physical problems.
And health carers in either hospital or the community can underemphasise physical health problems when they see a person with a mental illness.
Third, suicide contributes to the worse death rate of those with severe mental illness.
Physical health and mental wellbeing are weaved intricately together and they need to be treated as such.
It highlights that mental health practitioners and GPs must work very closely together, and as part of a team with the person, and their family.
In relation to Aboriginal and Torres Strait Islander peoples, the Commission is also concerned that dealing with mental health problems is not currently included in national policy targets even though cardiovascular disease and mental illness are the two leading drivers for the burden of disease.
Another concern relates to the rates of involuntary commitment and treatments, which have remained stubbornly around 30%, and the lack of public data around seclusion and restraint of people in care situations.
In 2005, all Australian governments agreed to reduce and where possible eliminate seclusion practices and treat people in care in the least restrictive way, but only four jurisdictions report seclusion rates publicly.
This is a very difficult and complex area and we don't have all the answers. But in the very least, the community must have the opportunity to see the data and contribute to the discussions on this issue. All governments must meet their legal obligations and existing commitment to ensure that involuntary treatments, seclusion and restraint of people in distress are minimised or eliminated.
And they must report publicly across all states and territories from 2013.
Other urgent actions include:
stopping people from being discharged from mental health services into homelessness or unstable homes
providing effective, local interventions to prevent suicide
increasing access to mental health services from 6-8 to 12 % of Australia's population, and
increasing access to home based visiting to support families and children.
The Australian community, service providers and all employers, have an important role to play too because Australia is not realising people's potential.
We foresee real potential for improving the productivity of workplaces by supporting employers and employees alike to proactively increase participation rates of people living with a mental health condition.
This is an area where, with the willing support of business, we will do much more work next year.
These are just some of the issues we have raised in our report.
However, we had to make some very tough decisions on what we could cover in our first report this year.
We know that there are issues, problems and system gaps, and that many different groups of people, such as those from culturally and linguistically diverse backgrounds, veterans, refugees, people with intellectual disability and those living with borderline personality disorders and others face very real challenges.
Throughout the years ahead we will work on additional areas requiring a special focus such as these, as separate pieces of work.
This year we have also had to rely on existing data and statistics – much of which is incomplete or not particularly helpful.
For example, in 2009-10, we know that 1.7 million Australians (8% of our population) accessed public and private specialised mental health services.
Also, Australian tax payers contributed $6.3 billion towards mental health service provision.
This is a significant investment.
Yet there is little or no accountability as to whether these services improved the health and well-being of people with a mental illness, or provided them with the services they need.
In other words, we don't know if they assisted people to move towards a contributing life.
Australia leads the world in progressive mental health policy, but it still falls down in delivery.
When the Commission was established this year attached to the Prime Minister's portfolio, it kept mental health's place at the top table, and the commitment to drive reform across all parts of government and the service system.
It also moved mental health out of the health sector and across each and every sector of a government's portfolio and in every part of the community.
We believe that Australia can improve the lives of millions of Australians if the Prime Minister and State and Territory leaders find the courage to act tenaciously in their interests. We look to them to reaffirm their commitment to improve services and supports to that people have the opportunities to live contributing lives.
This will require continuing, strong bi-partisan support, and COAG's leadership and commit to working collaboratively and swiftly to address the issues this world's-first report has raised.
reaffirming that mental health is a high national priority for all governments and the community
agreeing on the right incentives to drive good services
providing “a complete picture” of what is happening and closely monitoring and evaluating change
analysing the gaps and barriers to achieving a contributing life and putting a framework in place that sets Australia's direction
This evidence and experience needs to demonstrate what represents good value for the taxes we pay.
And the real measure of success is whether services and support are being provided in ways that make a positive difference to vulnerable people's lives.
This includes promoting inclusive approaches to supporting people with mental health difficulties – which will include their families and support people as part of the one team, offers the best recovery pathways.
The Commission takes its role in holding Australian governments accountable extremely seriously.
We will be back with our second Report Card in 12 months' time, reporting on what's happened, whether people's stories have changed and where things have improved.
I hope we'll bring good news.
This is a transcript of Allan Fels' speech at the launch of the National Mental Health Commission's report card.
Allan Fels is Chair of the National Mental Health Commission.