Overcoming our mental health illusion
The consultation draft of what is intended to be the latest National Mental Health Plan has worryingly failed to counter the impression that mental health remains a second order concern.
At a time when demonstrated need so often overwhelms the services available, the Mental Health Plan has done little to inspire hope. Lack of consumer consultation, the absence of consideration of how new and existing workforces might be better developed and failure to mention non-government involvement all indicate a disengagement with the real world dilemmas --- and solutions --- to our mental health plight.
As community awareness grows, mental health issues are increasingly of deep concern to Australians. Mental illness, so often treatable, causes suffering to millions of people yet our so-called universal health system fails too often to ensure equity of access to therapy.
Is it that residual community prejudice about mental health makes it easier for governments to step around pleas for desperately needed services?
Putting to one side that unacceptable notion, there are two thoughts that should coax Australia to rethink attitudes about mental health. These are: economics and the illness illusion.
On economics, would it help our understanding if more of us realised the huge, yet avoidable burden mental health poses to our community?
The National Mental Health Commission estimates the cost of poor mental health to Australia at more than $60 billion a year --- an estimated $4,000 for every taxpayer.
Yet Commission Chair, Professor Allan Fels AO, says there is much we can do to improve our own mental health and that of our communities by, focusing on prevention and early intervention
“Our current focus is on treating mental illness once it hits crisis point, whereas preventative interventions can improve peoples’ lives and are cost effective.
“These interventions can involve improving health treatments as well as areas such as disability, housing and employment services.”
“Better mental health can increase national ‘mental wealth’. We’d see an increase in workforce participation, productivity and economic competitiveness as well as an increase in GDP” says Professor Fels.
Now, the illness illusion.
Throughout history, mental health and physical health have been treated as two separate entitites/concepts/conditions.
A popular view of illness has been to differentiate between mental and physical heath. Because of this we see even in 21st century Australia, many more resources focused on acute care of physical illness while those with severe mental ill health are much more likely to go without routine care.
The reality for those with mental illness is that they are much more likely to suffer and die from conditions like cardiovascular and respiratory diseases. They are likely to die between 14 and 23 years earlier than the general population. For Aboriginal and Torres Strait Islander people, mental illness widens the health gap further.
Consider the disparity of funding between psychology through Medicare which provides 10 sessions a year, versus cancer or other specialist services.
Betraying this disparity, however, is that four out of every five people living with mental illness also have a physical illness, according to official statistics.
Yet despite these disturbing figures and despite the acknowledgement and work on areas like youth and rural suicides, mental health issues often appear isolated in a silo separate from “mainstream” health deliberations.
And there’s the matter of joined-up policy and integrated services. The Plan appears narrow in its contemplation of the settings in which it is now possible to take action to better address mental health problems. The advent of the patient-centred health care home seems an obvious starting point, but the Plan is silent about the promise this model of care offers.
The Mental Health Plan lacks acknowledgement of many other relevant government reforms and initiatives, such as the reviews of the Medicare Benefits Schedule, the work of the National Mental Health Commission, and private health insurance reform.
The absence of health insurance from the Mental Health Plan is a particular paradox. The availability of quality psychiatric clinical care is now widely associated with the private sector while public hospital services struggle to provide comparable services.
The Consumers Health Forum has suggested that the plan be developed in the following ways:
- Improved integration between regional planning and services including Primary Health Networks to provide coordinated continuity of care for vulnerable people with severe mental illness.
- focusing on care after suicide attempts but also on causes and prevention
- Strengthened consumer advocacy for Aboriginal and Torres Strait Islander mental health patients.
- Inclusion of mental illness in Health Care Homes to support integrated physical and mental health care
- Further efforts to reduce stigma and discrimination toward people with mental illness, particularly severe mental illness. These plans must be long term and sustained.
All Australians --- not just those who are mentally well --- have a right to safe, high quality and accessible health care. Perpetuating the disparity between physical and mental health care costs the economy, our broader society but most importantly costs the people who – through no choice of their own – experience mental ill health. This can and must change.
Too often mental health policy has been subject to episodic attention. That fails the many Australians for whom mental illness need not become a lifetime affliction.
See CHF’s submission on the 5th National Mental Health Plan at : https://chf.org.au/sites/default/files/chf_submission_to_the_draft_5th_national_mental_health_plan_final.pdf