WARNING: The following quick guide includes information
on suicide and mental illness. For help or information contact Beyond Blue on
1300 224 636, or Lifeline on 13 11 14.
Introduction
Mental illnesses are health
conditions that involve significant changes to thinking, behaviour or
emotions. Although mental illness can occur at any age, three quarters of all
mental illnesses begin by age 24. Some mental illnesses are mild and may only
have a limited impact on daily life, while others may require hospitalisation.
Mental illnesses include:
- Anxiety
- Depression
- Personality
disorders
- Schizophrenia
- Bipolar
disorder
- Post-traumatic
stress disorder (PTSD)
- Eating
disorders
In Australia, the framework for mental health services is a
highly complex mixture of public and private systems, with funding shared
between the Australian Government, state and territory governments, individuals
and private health insurers.
This quick guide provides an overview of mental health in
Australia, including spending on mental health services, government
responsibilities, recent policy developments and key issues.
Prevalence
Estimates of the prevalence of mental illnesses among the Australian
population vary, due to ongoing stigma attached to seeking a diagnosis and
treatment, as well as the impact of external events on people’s mental
wellbeing and resulting fluctuations in the incidence of mental health concerns.
Natural disasters, for example, can cause
poor mental and physical health, although most people recover well
following these events, while the prevalence of common forms of mental illness,
such as depression and anxiety, may more
than double during a humanitarian crisis.
In 2017–18, the Australian Bureau of Statistics’ (ABS) National
Health Survey found there were 4.8 million Australians (20%) with a mental
or behavioural condition, compared with 4 million Australians (18%) in 2014–15.
The 2007 National
Survey of Mental Health and Wellbeing estimated that 45% of Australians
aged 16–85 years experienced a mental disorder at some point in their life. It
should be noted that the surveys used different methodologies.
The Australian Institute of Health and Welfare (AIHW) in its
report on Australia’s
Health 2020 found that in 2015, mental and substance use disorders formed 12%
of Australia’s total burden of disease, which is ‘defined as the combined loss
of years of healthy life due to premature death (known as fatal burden) and
living with ill health (known as non-fatal burden)’. This made mental and
substance use disorders the fourth highest contributing disease group to total
burden of disease and second highest non-fatal disease group contributing to
total burden.
Suicide
is often, but not always, associated with mental illness. According
to the ABS, in 2020, 3,139 people died from suicide, down from 3,318 people
in 2019. This represented 12.1 deaths per 100,000 people in 2020, down from
12.9 per 100,000 in 2019. More than 90% of people who died by suicide in 2020
had risk factors identified that included depression, substance use and abuse,
and issues in spousal relationships.
Spending on mental health
The AIHW
has estimated that spending on mental health-related services in Australia
from all sources (government and non-government) was around $11 billion, or
$431 per person, in 2019–20.
Of the $11 billion, $6.6 billion (60%) was funded by state
and territory governments, with the Australian Government contributing $3.8
billion (35%), and private health and third-party insurance spending $584
million (5%).
AIHW estimated that in 2019–20, the Australian Government spent
$1.4 billion, or $53 per person on Medicare-subsidised mental health-specific
services, and $566 million, or $22 per person on subsidised mental
health-related prescriptions under the Pharmaceutical Benefits Scheme and the
Repatriation Pharmaceutical Benefits Scheme.
The Productivity Commission, in its 2020
inquiry into mental health, estimated that individual out-of-pocket
expenses on healthcare and related expenses for mental illness and suicide
amounted to $700 million in 2018–19 (Volume 1, p. 11). Given indirect
and hidden costs (such as reduced capacity to work), this figure is likely
higher.
Access to mental health services
General
practitioners (GPs) provide an initial point of contact for many people seeking
assistance with mental illness and are able to refer patients to specialised services
through Mental
Health Treatment Plans. Mental Health Treatment Plans currently entitle a
person to Medicare rebates for up to 20 individual psychological appointments
per calendar year. This is double the number of sessions covered prior to the
COVID-19 pandemic, with the additional 10 sessions available until 30 June
2022.
Since 2019, additional support has been made available for
those living with an eating disorder through Eating
Disorder Management Plans (EDPs). These
allow an individual to access up to 40 sessions of evidence-based psychological
treatment in a 12-month period, as well as up to 20 dietetic services per
12-month period.
There are reported challenges related to access, including a mental
health workforce that is concentrated in metropolitan Australia,
out-of-pocket costs for treatment that may be prohibitive, and lengthy wait
times to see psychiatrists and psychologists. Additionally, the ‘missing
middle’ is increasingly acknowledged as an at-risk group, referring
to those with complex mental illnesses whose needs are greater than what can be
addressed by primary care, but who are considered ‘not sick enough’ to access
specialist mental health services.
Government responsibility for
mental health services
Responsibility for public funding of and regulating mental
health services is shared between the Australian and state and territory
governments, with their respective roles not always clear. The following table
provides a broad outline of government responsibility for mental health
services in Australia. Note that this table gives only a general overview of a
complex system.
Table 1: Overview of division of responsibilities for
mental health services
| Australian
Government
|
State
and territory governments
|
- Leads national policy development, including through the National Mental Health and Suicide Prevention Plan
- Funds Primary Health Networks, which coordinate regional primary healthcare
- Leads and coordinates federal policy development, program
design and service delivery for Aboriginal and Torres Strait Islanders
- Funds Veterans’ mental health services
- Co-funds public hospitals with state and territory
governments
- Funds Medicare subsidies
for consultation with GPs, specialists, psychologists and other allied health
professionals
- Funds subsidised prescriptions through the Pharmaceutical Benefits Scheme and the Repatriation Pharmaceutical Benefits Scheme
- Co-funds helplines and mental health crisis and support
services
- With the states and territories, co-funds the National
Disability Insurance Scheme (NDIS), which provides funding for individualised
support for eligible people with psychosocial disability
- Provides some clinical and non-clinical community-based
mental healthcare (for example, Adult Mental Health Centres) and funds some
initiatives delivered by non-government organisations (for example, Headspace)
|
- Through state and territory mental health commissions,
focus on strategy and community engagement, set performance standards and
coordinate government action across portfolios (varies by jurisdiction)*
- Set legislative, regulatory and policy frameworks for
mental health service delivery within their respective jurisdictions
- Co-fund public hospitals (with the federal government)
- Administer and deliver hospital and emergency services
- Fund, deliver and manage specialised community mental
health care services (including community-based ambulatory care, outpatient
services and day clinics) and community-based residential care
- Co-fund national hotlines and mental health crisis and
support services, and fund and provide state-based mental health hotlines
- With the Australian Government, co-fund the NDIS
|
Sources: Productivity
Commission, Mental
Health – Volume 3, no. 95, (Canberra, June 2020), 1080–1082;
Productivity Commission, Report
on Government Services 2021: 13 Services for Mental Health: Roles and
Responsibilities, (Canberra, January 2021); AIHW, Mental
Health Services in Australia, (Canberra, 14 October 2021); AIHW, Community
Mental Health Care Services 2019-20 Section, (Canberra, October 2021),
1; National Mental Health Commission, Fifth
National Mental Health and Suicide Prevention Plan, (Sydney, 2017), 9.
*Not all states and territories have mental health commissions
Mental health workforce
Aside from GPs, other professionals working in the mental
health sector include psychiatrists, mental health nurses and allied health professionals,
such as psychologists, social workers and occupational therapists.
According
to the AIHW, in 2019 there were 3,615 psychiatrists, 24,111 mental health
nurses, and 28,412 psychologists employed in Australia, the vast majority of
whom work in major cities. A 2018 Senate inquiry into the Accessibility
and quality of mental health services in rural and remote Australia noted significant
challenges in the provision of qualified mental health professionals in rural
and remote areas. These challenges
included the availability of housing, uncertainty caused by short-term
funding cycles, low remuneration packages, and fewer opportunities for
professional development.
As of early 2022, the Australian Government was in the
process of developing a 10-year National
Mental Health Workforce Strategy. It is expected that this
Strategy will consider the sustainability, retention, training and
equitable distribution of the mental health workforce. A final strategy was yet
to be released as of May 2022.
Recent and anticipated policy developments
Governments at all levels have shown interest in increasing funding
and improving mental health services over recent years. The following section
outlines some of the key recent and anticipated policy developments at the
national level.
National Mental Health and Suicide
Prevention Plan
In response to the Productivity
Commission’s 2020 inquiry into mental health and final
advice provided by the National
Suicide Prevention Adviser, the Australian Government released a National
Mental Health and Suicide Prevention Plan in
2021. As well as outlining that an agreement would be reached with the state
and territory governments (outlined below), the announcement committed an additional $2.3 billion of funding over 4 years from 2021–22, to be spread across 5 pillars:
- $248.6
million for prevention and early intervention
- $298.2
million for suicide prevention
- $1.4
billion for treatment
- $107.0
million for supporting the vulnerable
- $202.0
million for workforce and governance.
National Agreement on Mental Health
and Suicide Prevention
The National
Agreement on Mental Health and Suicide Prevention came into effect in March
2022. The Agreement is designed to: clarify federal and jurisdictional roles
and responsibilities; progress improvements in mental health services;
establish collaborative approaches to monitoring and evaluation; reduce system
gaps; expand and enhance the workforce; and work to improve mental health and
suicide prevention. It is supplemented by individual
bilateral agreements with the states and territories.
National Children’s Mental Health
and Wellbeing Strategy
The National
Children’s Mental Health and Wellbeing Strategy was launched in October
2021. Relevant to children from birth to 12 years of age, the Strategy is based
on 4
focus areas: family and community; service system; education settings; and
evidence and evaluation.
Underpinning the Strategy are 8 guiding principles:
child-centred; strengths-based; prevention-focused; equity and access;
universal system; evidence-informed best practice and continuous quality
evaluation; early intervention; and needs-based, not diagnoses driven.
National Disaster Mental Health and
Wellbeing Framework
As at early 2022, a National
Disaster Mental Health and Wellbeing Framework was being developed by the
National Mental Health Commission. The Framework will focus on providing mental
health services during, and following, disasters. Work on this Framework forms
part of the Australian Government’s $76 million Bushfire
Mental Health Response Package, promised following the 2019–20 bushfires. The
Framework was delivered
to the Australian Government in October 2021. As of May 2022, the Framework
had not been publicly released.
Interface with other systems
Mental health services are not limited to those available
through the health system. Many people with mental illness also engage with
other systems, such as education, the NDIS, aged care, the Department of Veterans’
Affairs, homelessness services, child protection systems and prisons. For
example:
- eligible
people who have a psychosocial disability are able to access individualised
funding through
the NDIS for therapies and particular forms of support to address the
functional impacts of their psychosocial disability on their everyday lives. However, some
questions have been raised about the difficulties of accessing the NDIS for
people with severe mental illness
- the Royal Commission into Aged
Care Quality and Safety heard evidence that people receiving aged care services
do not have access to the mental health services they need. One hearing heard
concerns that the high prevalence of depression among those living in permanent
residential aged care is compounded by inadequate treatment and an ill-equipped
aged care workforce. In addition, people living in residential care may be
ineligible for, or have difficulty accessing, Medicare-subsidised specialist
mental health services
- current
and former members of the Australian Defence Force are eligible for free
mental healthcare using a Veteran
White Card or a Veteran
Gold Card, whether or not their mental health condition is related to their
service. Family members of veterans are also able to access some additional
services. A report by the interim National
Commissioner for Defence and Veteran Suicide Prevention in September 2021 reported
significantly higher rates of suicide among ex-serving Australians, an issue
now being investigated by the Royal Commission
into Defence and Veteran Suicide
- children
involved with child protection services are significantly more
likely to be diagnosed with mental health conditions than children unknown
to the child protection system, with those placed in out-of-home care 5 times
more likely to be diagnosed with a mental illness than those not known to child
protection services. The Department of Social Services funds Family
Mental Health Support Services, which offer assistance to children at risk
of, or experiencing, a mental illness, and prioritise vulnerable children,
including those in contact with child protection services
- mental
illness is a key
risk factor for homelessness, but homelessness can also increase the risk
of mental illness. The AIHW reported that 32% of people who accessed specialist
homelessness services in 2020–21 had a current
mental health condition. Additional
data from AIHW suggests this figure may be higher, at 37%. The rate of mental
health conditions among clients accessing specialist homelessness services is 7
times higher for Aboriginal and Torres Strait Islander peoples than
non-Indigenous Australians.
- people
in prisons experience higher
rates of mental illness than the general population, with 40% of prison
entrants surveyed in 2018 reporting that they had been told they had a mental
health condition at some point during their lives.
The impact of the COVID-19 pandemic
on mental health
Mental health considerations have come to the fore during
the COVID-19
pandemic, as people have experienced lockdowns and physical isolation, as
well as disruptions to employment and schooling. The full impact of the
pandemic on people’s mental health is still emerging.
Crisis helplines have reported substantial increases in the
volume of calls in 2020 and 2021, compared to 2019. The
AIHW reported that in the 4 weeks to 9 January 2022, Lifeline answered
77,156 calls, which represented a 21.7% increase from the same period 2 years earlier.
The Australian
Psychological Society in November 2021 reported ‘unprecedented demand’ for
mental health services, finding that 1 in 5 members had to close their books to
new clients—a twentyfold increase on pre-pandemic
figures.
Some of the mental health-specific responses introduced by
the Australian Government and states and territories include:
- the National
Mental Health and Wellbeing Pandemic Response Plan was released in May
2020, with $48.1 million in funding. The Plan has 3 aims: monitor and predict
the impact of the pandemic; reach people in the community; and provide clear
pathways of care through improved service linkage and coordination
- a
further 10 individual sessions of subsidised psychological therapy, through the Better
Access initiative until 30 June 2022, for those with a mental health plan
who are experiencing distress due to the pandemic. This doubles the number
previously available
- Head
to Health Pop up services in NSW, Victoria and the ACT, providing an
emergency response to the pandemic, plus additional HeadtoHelp
clinics in Victoria.
The importance of telehealth services during the pandemic has
been highlighted
by the AIHW, who reported that between 16 March 2020 and 19 September 2021,
about 29% of the 21 million Medicare Benefits Scheme mental health-related
services processed nationally were delivered via telehealth. This amounted to
$714.3 million in benefits paid for MBS mental health-related telehealth
services. Modified telehealth arrangements are now a permanent
feature of the Australian healthcare system, with the Australian
Government providing $106 million over 4 years to support their
continuation. Telehealth options may offer greater flexibility for those
seeking access to healthcare, including mental
health support.