Introduction
According to the World Health
Organization, mental health is ‘a state of well-being in which every
individual realizes his or her own potential, can cope with the normal stresses
of life, can work productively and fruitfully, and is able to make a
contribution to her or his community. ’ When a person has a condition that
affects their mental health, they may have a mental illness or mental health
disorder. This includes conditions such as depression, anxiety,
schizophrenia and bipolar disorder.
In Australia, the framework for mental health services is a
highly complex mixture of public and private systems, with funding shared
between the Australian, state and territory governments, individuals and
private health insurers.
This quick guide provides an overview of mental health in
Australia, including the prevalence of mental health conditions, the cost of
mental illness, government responsibilities, and mental health services
available in Australia.
Prevalence of mental health
conditions
The Australian Bureau of Statistics (ABS) National
Survey of Mental Health and Wellbeing (NSMHWB)
provides the most comprehensive (albeit dated) estimates for mental disorders
in Australian adults both over their lifetime and in the preceding 12 months.
The survey estimated that 45 per cent of Australians had experienced
a mental disorder in their lifetime, with 20 per cent experiencing
a mental disorder in the previous year. Conducted in 2007, this was the second ABS
mental health and wellbeing survey, with the first survey conducted in 1997. The
Department of Health has said
that there are no plans to fund another survey on mental health by the ABS.
In addition to the NSMHWB, the following sources provide an
indication of the prevalence and impact of mental health conditions in Australia:
- The most recent ABS National
Health Survey estimated there were 4.8 million Australians (20.1 per cent)
with a mental or behavioural condition in 2017–18. This was an increase of
2.6 percentage points from 2014–15, mainly due to an increase in the
number of people reporting anxiety-related conditions, depression, or feelings
of depression. While this is the most recent available data for mental health
prevalence in Australia, it only provides data on people who currently identify
as having mental or behavioural conditions, and does not provide data on
lifetime prevalence or incidence of mental illness in the past year.
- The Australian
Child and Adolescent Survey of Mental Health and Wellbeing, conducted
between June 2013 and April 2014 by the Department of Health, estimated that
almost 14 per cent of young people aged 4 to 17 years (or 560,000
people) experienced a mental disorder in the 12 months before the survey.
- Poor mental health may also be associated with suicidality. According
to the ABS, 3,128 people died
in Australia from intentional self-harm in 2017, rising from 2,866 in 2016. While
suicidality is not confined solely to people with poor mental health, the NSMHWB estimated that 94.2 per cent of persons
who attempted suicide in the previous 12 months had experienced a mental
disorder in the same time period.
- According to the Australian Institute of Health and Welfare’s
(AIHW) Burden
of Disease Study, in 2011 the Australian population lost a total of 542,554
years of healthy life as a result of mental and substance use disorders. This
accounted for 12.1 per cent of the total
burden of disease, making mental and substance use abuse disorders the third
highest cause of burden in Australia.
Cost of mental illness in Australia
Economic impact
A report commissioned by the Royal
Australian & New Zealand College of Psychiatrists (RANZCP) estimated in
2014 that the cost of severe mental illness in Australia was $56.7 billion
per year. This includes the direct economic costs of severe mental illness
arising from the use of health and other services, as well as indirect costs
due to lost productivity because people are unable to work.
Similarly, in December 2016, the National Mental Health
Commission stated
that the cost of mental ill-health in Australia each year was around $4,000 per
person, or $60 billion in total.
The 2018 KPMG and Mental Health Australia report, Investing
to Save, looked at how much mental ill-health in the workplace costs
Australian employers. The report found that, mental ill-health in the workplace
costs an average of $3,200 per employee with mental illness, and up to $5,600
for employees with severe mental illness. Overall, it was estimated that the
cost of workplace mental ill-health in Australia was $12.8 billion in
2015–16.
Spending on mental health services
The Australian
Institute of Health and Welfare (AIHW) estimates that spending on mental
health-related services in Australia from all sources (government and
non-government) was around $9.0 billion, or $373 per person, in 2015–16.
Of the $9.0 billion, $5.4 billion (59.8 per cent)
was funded by state and territory governments, $3.1 billion
(35.0 per cent) was funded by the Australian Government, and
$466 million (5.2 per cent) was funded by private health
insurance funds.
In 2016–17, the Australian Government spent:
- $1.2 billion on Medicare-subsidised mental health-specific
services ($49 per person) and
- $511 million on mental health-related subsidised
prescriptions under the Pharmaceutical Benefits Scheme (PBS) and the
Repatriation Pharmaceutical Benefits Scheme (RPBS) ($21 per person).
Government responsibility for
mental health services
Responsibility for funding and regulating mental health
services in Australia is shared between the Australian and state and territory
governments. However, as noted in the Parliamentary Library publication, Health
in Australia: a Quick Guide, their respective roles are not
always clear. Below is a broad outline of government responsibility for mental
health services in Australia.
Australian Government
State and territory governments
Shared responsibility
On 4 August 2017, the Council of Australian Governments (COAG)
agreed to the Fifth
National Mental Health and Suicide Prevention Plan, which established a
national approach for collaborative government effort from 2017 to 2022.
Additional shared arrangements are usually detailed in
national agreements, such as those agreed to by COAG, and include:
Mental health services
Medicare-subsidised services
In Australia, mental health services provided by GPs,
psychiatrists, psychologists, occupational therapists and social workers may be
subsidised through Medicare.
General practitioners
According to the Bettering
the Evaluation and Care of Health (BEACH) survey of GPs, 12.4 per cent
of GP encounters (or 17.7 million separate encounters) in 2015–16
involved the management of psychological problems, such as depression, anxiety
and sleep disturbance. This is much higher than the 3.2 million GP mental
health-specific Medicare
Benefits Schedule (MBS) items (MBS Group A20) that were billed by
GPs in 2015–16, indicating that GPs likely billed many of these encounters as
general MBS items.
Psychiatrists
Under Medicare, rebates are available for consultations with
psychiatrists. In 2017–18, there were 2.4 million MBS
items billed by psychiatrists (MBS Group A8). According to the AIHW,
psychiatrists provide the highest number of services per patient (in 2016–17,
6.2 services per patient) of all mental health-related services.
Allied health professionals
Under the Better
Access initiative, Medicare rebates are available for up to ten individual
and ten group allied health services per year to patients with a mental
disorder who are referred by a GP, psychiatrist or paediatrician. The table below
outlines the number of mental health-related services that were billed under
Medicare by allied health professionals in 2017–18.
Medicare benefits claimed under the
Better Access initiative, 2017–2018.
| Professional |
MBS Items |
Services billed |
| Clinical psychologist |
80000, 80001, 80005, 80010, 80011, 80015, 80020,
80021 |
2,302,682 |
| Registered psychologist |
80100, 80101, 80105, 80110, 80111, 80115, 80120,
80121 |
2,855,039 |
| Occupational therapist |
80125, 80126, 80130, 80135, 80136, 80140, 80145,
80146 |
72,966 |
| Social worker |
80150, 80151, 80155, 80160, 80161, 80165, 80170,
80171 |
335,559 |
| Total |
All |
5,566,246 |
Source: Department of Human
Services (DHS), Medicare Group Reports, Medicare Australia Statistics, DHS, last updated 23
November 2018.
Specialised mental health care services
In addition to services subsidised under Medicare, there are
a range of other specialised mental health care services in Australia. Specialised
mental health care can be delivered in a range of facilities, including
public and private psychiatric hospitals, psychiatric units or wards in public
acute hospitals, community mental health care services, and residential mental
health services. In 2015–16, there were 1,591 specialised mental health care
facilities providing care.
- Hospital emergency services: In 2016–17, there were
276,954 mental health-related presentations to hospital
emergency departments.
- Admitted hospital care: In 2016–17, there were 64,692 same
day and 258,300 overnight
episodes of admitted patient care.
- Residential mental health care: mental health care can be
provided in a domestic-like environment, and can include services such as
rehabilitation, treatment or extended care. In 2016–17, there were 7,290
episodes of residential
mental health care recorded for 5,476 residents.
- Community mental health care services: treatment provided
in the community and hospital-based outpatient care settings is known as community
mental health care. In 2016–17, there were around 8.9 million community
mental health care service contacts provided to approximately 420,000 patients.
Other services
Disability support services
In Australia, the NDIS provides support to people with
disability, their families and carers. The NDIS was introduced
across Australia from July 2016 and is expected to be fully rolled out
across all states and territories by July 2020.
The main component of the NDIS is individualised packages of
support to eligible people with disability. The NDIS also has a broader role in
helping people with disability to:
- access mainstream services, such as health,
housing and education
-
access community services, such as sports clubs
and libraries and
- maintain informal supports, such as family and
friends.
People who experience disability as a result of a mental
health condition are referred to as having a psychosocial
disability. Once the NDIS has been fully rolled out, it is expected
that there will be 64,000 participants (13.9 per cent of all
participants) with a significant and enduring primary psychosocial disability.
Following the introduction of the NDIS, there has been concern
that the transfer of funding for existing mental health programs to the NDIS
could leave people who are ineligible for the NDIS without services or support.
In response to these concerns, the Australian Government committed $80 million
to the National
Psychosocial Support (NPS) measure, to provide psychosocial support
services to people who are not more appropriately funded through the NDIS.
Additionally, the Australian and state and territory governments have committed
to ensuring continuity
of support for people with disability already receiving services who are
ineligible for the NDIS.
Homelessness support services
Mental illness is one factor
that contributes to the level of homelessness in Australia, with
27 per cent of people who accessed specialist homelessness services
in 2016–17 having a current
mental health issue.
The main source of government-funded support for people who
are homeless or at risk of homelessness is specialist
homelessness services. These services are delivered by non-government organisations,
including agencies that specialise in delivering services to specific target
groups (such as young people or people experiencing domestic and family
violence) and agencies that provide more generic services to people in crisis.