By Joshua Tong – Community Engagement Project Officer
Josh breaks down the Productivity Commission’s recent report into Australia’s mental health system (November 2020) and explains how we can improve it after a year in which its limits were tested.
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Throughout 2020, the unprecedented COVID-19 pandemic has ravaged the majority of the global population and continues to do so—disrupting economies, social norms and livelihoods. It shows no sign of slowing down despite the production and delivery of vaccines.
As a necessary measure of limiting transmission and infection, isolation through the form of an austere lockdown policy was implemented in Australia. This has substantially contributed towards the deterioration of mental health—particularly for at-risk individuals— leading to increased rates of depression, anxiety, and suicide.
Hence, an inquiry report by the Productivity Commission of the Australian Government was issued in June and subsequently published in November of 2020, examining the effects and the current state of mental health in both the workplace and communities, discussing key influences, and the implications of mental health for the economy and productivity.
The report also provides recommendations and potential reforms to better support and to improve the mental health system, making specific references to marginalised groups and the significance of cultural backgrounds, predisposing factors that influence mental illness, and the importance of families and carers.
If there are any benefits to be taken from this devastating pandemic, it is that this investigation has sparked a much needed conversation surrounding the current state of the mental health system, which could create a more resilient and effective system to ameliorate the livelihoods of many.
A Surprising and Bleak Insight into Australia’s Mental Health Landscape
Undoubtedly, COVID-19, compounded by the 2019-2020 bushfires and storms, has contributed towards a decline in both Australians’ physical and mental health.
Although Australia’s health system can be regarded as one of the most progressive and prolific in the world, the mental health component of our health system is often neglected. Assessment of Australia’s international mental health performance has indicated that it is not as exceptional as it seems, often due to lack of funding and awareness when compared to other health sectors such as hospitals and primary health care.
In 2018-2019, the estimated annual cost to the economy of mental health and suicide in Australia surmounted to a staggering $70 billion, whereas the direct expenditure on mental healthcare and support services was only around $16 billion. This gap exemplifies the severe underfunding and lack of attention the Australian Government places on mental health, its impacts on the economy, and most importantly, its impact on its citizens.
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Indeed, it is projected that the “cumulative cost of lost productivity associated with mental ill-health and suicide over 5 years is estimated to be $114 billion” as stated by Jo-An Atkinson, Associate Professor of the University of Sydney’s Brain and Mind Centre.
As such, it seems that the current mental health landscape was unsatisfactory even before COVID-19, and with the onset of the pandemic, Australia’s susceptible communities were exposed. Economic downturn and stringent lockdown have heralded social isolation, financial distress and unemployment, increasing risks of suicide, and accentuated mental health disorders and illnesses associated with depression and anxiety.
The report documented the prevalence of mental ill-health in Australia, elucidating that mental illness is the “second largest contributor to years lived in ill-health and is the fourth largest contributor (after cancer, cardiovascular disease and musculoskeletal conditions) to a reduction in the total years of health life for Australians”.
Furthermore, almost half of all Australian adults have recorded that they have experienced a mental health illness, and one-in-five will eventually meet the relevant criteria in any given year.
It is also worth noting that Australia ranked second in the prevalence of mental illnesses in developed countries, behind only New Zealand. This was found in a study that explored mental illness in 20 high-income countries that included the United States, United Kingdom and Japan, although the statistics could have been confounded through better diagnosis/awareness in Australia and New Zealand compared to other high-income countries.
These findings, along with other key factors pertaining to economic participation and productivity, resulted in the Australian Government Productivity Commission’s initial inquiry towards mental health. Yet, it should not have required a global pandemic to open our eyes to this ongoing crisis, which underlines the current issues of our current mental health system and the incredible need for support, treatment and recovery.
Nevertheless, highlighted in the report was the case for major reform—including the examination of the current mental health system, effectiveness of programs and initiatives, cost/benefits of current investments in mental health, domestic and international policies, and the development of a potential framework that is more rigid, transparent and effective.
Although Australia has been neglecting the mental health of its citizens for far too long, this pandemic has pinpointed a crucial opportunity to improve our mental health system. Taking advantage of this opportunity has been possible through this late but necessary inquiry report— ensuring that the deceased and those who are currently suffering are not alone. Although there is a long and difficult road ahead, this is the right direction for Australia.
The Need For a Better, More Resilient Mental Health System, but How?
While an increase in funding can be beneficial, it has diminishing returns. We must therefore be pragmatic with where and how resources are allocated, being cautious not to fall into the pit of disillusionment following the misguided belief that simply spending a large amount will inherently solve our mental health crisis.
By utilising the findings of the report and identifying key themes, we can build upon a flexible framework that not only provides the support and treatment needed for those affected, but also targets the potential causes and onset of mental health illness. This allows for early intervention and, perhaps most essential of all, prevention.
Emphasising Prevention and Early Intervention
Prevention and early intervention should ideally be prioritised as mental illnesses often emerge in childhood and adolescence, and young people face substantial barriers in accessing treatment and support. Therefore, addressing risk, predisposing factors, and symptoms at an early stage can be imperative in improving their wellbeing. It also acts as a purposeful approach that targets life-long outcomes for people.
Although there are already educational institutions investing cogent efforts into mental health, the promotion of healthy wellbeing and the subsequent role of prevention regarding mental illnesses has not been clearly articulated by governments. As such, schools and organisations need to support their students through informed and coordinated delivery of advice, accessible services, openness and reduction of stigma, social inclusion and consistent data collection. If combined, this will provide a framework that reduces the risk of early mental ill-health development through a system that prioritises resiliency and sustainability.
Creator: Vitali Michkou | Credit: Getty Images/iStockphoto
Moreover, a re-orientation of healthcare delivery and mental health services is needed to improve the foundations established by our current mental health system. As COVID-19 has presented many challenges for in-person treatment and recovery, adaptation is vital to secure a lasting, but more importantly, efficient strategy.
Utilising Telehealth and Telemedicine as Treatment Options
With more and more services turning to online approaches, telehealth and telemedicine is emerging as a positive and essential solution for the deteriorating mental health of Australians. Thus, the focus on supported online treatments should be amplified—providing an accessible, cost-beneficial alternative which enables psychological therapy to meet people’s needs and to administer much-needed treatment and support to those most susceptible to mental illnesses.
Beyond this, accessibility has always been a barrier towards the prevention of healthcare. Up to 500,000 of those with underlying mental health illnesses are currently not accessing any mental healthcare. These are people who could benefit from greater access to low-intensity services. Often, those who are vulnerable cannot find and obtain the services that are suitable for them due to unavailability, service underprovision, lack of knowledge, high costs, and poor quality.
Furthermore, mental health is a serious issue in rural areas, with especially marginalised groups being children, the poor, and the elderly. Concerns regarding anonymity, treatment and stigma associated with mental health may be more pronounced in rural areas— leading to an under-utilisation of healthcare and services.
Therefore, resources should be aimed at developing high quality and easily accessible treatments such as telehealth, especially in rural regions and in less privileged, more vulnerable, and higher-risk communities.
Conclusion
The Productivity Commission’s damning report has highlighted the growing crisis of our mental health system— one which has been overlooked and dilapidated for far too long.
Through the rapid and unexpected onset of COVID-19, the potential to reform and revamp our current mental health system and to identify key themes, paints a promising future for the improvement of mental healthcare.
With key recommendations referencing early intervention and prevention, supporting online treatments through advancements in telehealth and telemedicine, bridging mental health gaps, and increasing accessibility in rural areas and marginalised groups, the inquiry report presents a strong foundation for a more effective and beneficial mental health framework to flourish.
As the world pushes onwards evermore, we as a society cannot rely upon a return to normality. We have to continually strive together as a community to actively seek help and to support one another in times of need. This truly paves the way to recovery and hence, to fundamentally move forward as a nation.
No matter the circumstance or situation, it is okay to not be okay. If you or other people who you may know are battling mental health issues, please realise that there is help available, and we encourage you to seek assistance and be open— talk to your friends, family or significant other, for there is always someone who is thinking of you, and it would mean the world if you kept fighting and powering through. So please do not give up!
List of services and organisations supporting mental welfare:
The Victorian Mental Illness Awareness Council (VMIAC) [(03) 9380 3900]
https://www.vmiac.org.au/
Beyond Blue [1300 22 4636]
https://www.beyondblue.org.au
Black Dog Institute [(02) 9382 4530]
https://www.blackdoginstitute.org.au/
Headspace [1800 650 890]
https://headspace.org.au
Lifeline [13 11 14]
https://www.lifeline.org.au
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