02/08/2021
With nearly half of all Australians expected to experience a mental health problem in their lifetime, the need for an effective mental health system has never been greater. To better understand what system reform looks like, Nous and CEDA recently convened a livestream discussion on the topic.
I was fortunate to facilitate a panel with speakers who brought vast experience: Lucinda Brogden AM, the Chair of the National Mental Health Commission, Professor Allan Fels AO, a Professorial Fellow at the University of Melbourne and Patron of Mental Health Victoria, and Jason Trethowan, Chief Executive Officer of Headspace.
From our discussion, five key themes emerged for the reform agenda.
1. The system needs to achieve better integration
The mental health system includes many dis-integrated services, and a continuum of services has not been achieved. The lack of integration means the pathway can be difficult to navigate. “The fact that you have to navigate it suggests it is not as joined up as one would like,” Jason said.
The system has a “missing middle” in the treatment and support continuum – while the Federal Government supports primary health and GPs in treating those with mild to moderate conditions and symptoms, and the states and territories provide tertiary services mainly to those with severe and persistent conditions and symptoms, there is a lack of support for people with moderate but complex conditions and symptoms. These people are too unwell for primary care settings but are not sufficiently unwell to meet the intake thresholds for tertiary treatment.
2. We need to combat stigma
We have made good progress in changing community attitudes towards people with mental health issues, and now we need formal systems to follow. Jason noted survey findings that 74 per cent of young Australians say there is still stigma surrounding mental illness. Insurance, banking and justice systems all need to improve the way they respond.
We also need to create mentally healthy workplaces so people can get the support they need at work and then stay connected through their recovery. The workplace is the second-highest place where people experience stigma, Lucy said, adding that the upcoming National Stigma Reduction Strategy offers great potential to achieve lasting change.
3. All parts of government need to work together
Governments need to lead from the top, which means first ministers need to tackle this issue and drive action. Mental health issues are entwined – both causally and consequentially – with social issues such as housing, education and employment, so we need responses across a range of government agencies to address the social determinants. Only first ministers can make this happen.
Treasury departments need to recognise the unavoidable treatment and support costs of not addressing these issues, as well as the opportunity cost. The Productivity Commission has put the cost of mental ill-health and suicide at $200 billion a year. As Allan told us: “The economic benefits alone from mental health reform dwarf the economic benefits you would get from most other microeconomic reforms being talked about.”
4. Victoria’s Royal Commission offers a blueprint
The Royal Commission report handed down earlier this year offers guidance not just for Victoria but for all states. The two-year report, which brought together people with lived experience as well as practitioners and experts, offered guidance on the governance structures required for change. “It brings together agreed views across the board on what should be done in detail at state level,” Allan said. The policies that result need to involve co-design so that people involved can shape them, drawing on their experience.
5. We need a trained workforce to realise these plans
Previous reports have indicated a 15-year lag in developing a mental health workforce, so we need to act now. We need to give health professionals the skills they need and support them to develop fulfilling careers. “If we want people to do a good job we need to give them a good job to do,” Lucy said.
Jason noted the need to put in place good systems, data, IT and buildings, while Allan noted the big maldistribution of the workforce, with metro areas well serviced while regional areas miss out. The UK has created a good work culture in mental health systems and services, offering an example we could seek to emulate. It is vital for professional colleges to think creatively about their curriculum and training, while work peer groups also warrant greater recognition.
It is pleasing that governments are taking a serious interest in mental health. Our livestream offered lot of practical guidance on how to turn that interest into action.