Prof. Patrick McGorry thinks the enormous economic and personal strain of mental illness in Australia calls for a radical re-imagining of how we treat it.
Australia is in the grip of a national crisis in mental health care.
Every year in Australia around 3,000 people die from suicide. Most have sought help from our health system, but it has failed them and their bereaved families and friends. Suicide clusters hidden from public view are claiming the lives of large numbers of young people in regional and metropolitan Australia. If these deaths were due to a viral epidemic or road trauma there would be decisive action.
However, suicide is the just tip of a massive iceberg. Four million Australians experience mental illness every year and it impacts nearly all families. With 690,000 experiencing severe mental illness, it is the largest cause of disability, yet less than 10 per cent can access the NDIS. Mental illness causes nearly 15 per cent of the health burden, similar to heart disease and cancer, yet it is allocated just over 5 per cent of the health budget.
The World Economic Forum estimates that the direct and indirect costs of mental illness amount to 4 per cent of GDP, more than that of cancer, diabetes and chronic respiratory disease combined. Investing in mental health care with major return on investment is the best buy in health care by a country mile.
Severe mental illness is the largest cause of disability, yet less than 10 per cent can access the NDIS.
The paradox is that we’ve never had greater awareness of mental illness. Yet this awareness hasn’t led to better mental health care. Many argue that the awareness industry has become a barrier, because it has created the impression that governments have responded to the problem. The scale of the challenge has led to a defeatist attitude in some parts of the mental health sector, which holds out false hope that well-meaning ‘workarounds’, and unproven preventive approaches are the only realistic way forward.
Dying for Help: Tasmania's critically overcrowded psychiatric wards
Across Australian in the 1990s, the 19th century asylums were swept away by deinstitutionalisation and governments pocketed vast amounts of revenue from land sales and saved vast amounts on bed reductions. They promised that we could drastically reduce bed numbers and relocate them within general hospitals, provided we built strong community mental health services. This promise has been broken in the most irresponsible manner with fatal consequences for tens of thousands of Australians.
As the Australian population surged to 25 million, state governments disinvested in community mental health care. Successive federal governments have flattered to deceive, but simply haven’t understood the scale of the problem. The result? Implosion. A rising tide of desperate people with life-threatening mental illnesses and crises surging into emergency departments, and flooding streets and prisons.
Emergency departments are highly unsuitable environments for distressed people. People with mental illness, already agitated, suicidal or psychotic go to the back of the queue. When they eventually become agitated by long delays, they are typically forcibly restrained and sedated. They seek help but are harmed or sent away without any real care. Hundreds of thousands of Australians – the “missing middle” – are too ill for primary care, but not desperately ill enough to qualify for emergency care. Early intervention and continuity of care, routine in cancer and cardiovascular medicine, are denied to people with mental illness. Expert and sustained specialist care for mental illness is largely a mirage.
This solution is readily affordable.
There are solutions. The National Mental Health Commission has proposed a “stepped-care” model with investment upstream to build the missing steps in care and turn off the flow into emergency departments. What would this look like? Every Australian community would have its own stigma-free, mental health collaborative care hub, with an expert multidisciplinary team of GPs, psychiatrists, allied health professionals, addiction specialists, and 24-hour mobile home intensive care unit. Developmentally appropriate versions, vertically integrated with primary care for children, young people, older adults and the elderly would be crucial. Every Federal Electorate would over time be home to at least one of these hubs. Headspace, with its one-stop-shop design, is a small-scale prototype and an example of the first step in such a reform. This solution is readily affordable, with each of these hubs costing around $15m and even less in rural and regional Australia. The annual cost of the fully scaled-up reform would be less than $2bn, or one-tenth of the cost of the NDIS which covers only 400,000 Australians. Remember, four million Australians experience mental illness each year.
What is needed to make this happen? The answer is political will. How can this be created? The missing ingredient is large-scale engagement of the public in their own self-interest. The campaign “Every Australian Counts” led to the NDIS being funded. Mental illness affects 10 times more people, yet Australians have been relatively silent in demanding a fair go for the mentally ill. Australians for Mental Health is a new charity aimed at creating a social movement to affect reform and achieve equity in health care for Australians with mental illness. Led by people with lived experience, it could be a game changer as we enter a new election season.
Prof. Pat McGorry AO is Executive Director of Orygen, the National Centre of Excellence in Youth Mental Health.
If you would like to talk to someone about your mental health, here are some people ready for your call:
• SANE Australia Helpline 1800 18 SANE (7263) www.sane.org
• beyondblue support service line 1300 22 46 36
• Lifeline 13 11 14 www.lifeline.org.au
• MensLine Australia 1300 78 99 78 www.mensline.org.au