Mental health reform: how far have we come?

A broken system

The Productivity Commission’s 2020 Inquiry into Mental Health found that Australia’s mental health system has not kept pace with the needs and expectations of the community it serves ¹ . This and other reports ² have emphasised the need for substantial system reform, a need which is recognised by governments, those working in mental health services, consumers, carers, and their families.

Mental ill-health and distress are widespread, with pre-COVID pandemic figures indicating that each year one in five Australian adults experience a mental illness and almost half of all Australian adults are affected by mental illness at some time in their life ³ . Each year, over 3,000 Australians die by suicide ⁴ , however, the number who attempt suicide, and the number deeply affected by suicidality, are much greater.

Demand for mental health services outstripped supply prior to the COVID-19 pandemic. While the full impact of the pandemic on mental health is not yet fully understood, the combined effect of restrictions of movement, isolation, financial stress, and remote work or schooling have led to reports of increased levels of psychological distress and demand for mental health crisis support services⁵ . And these demands are falling on an already broken system that is not fit for purpose.

Why does it matter?

So, the incidence of mental ill-health and distress is significant, and the costs are high. Clearly there are individual benefits associated with providing those experiencing mental ill-health and distress with the treatment and support they need when they need it. Families and carers also benefit enormously, as does the community more broadly. The Productivity Commission Inquiry conservatively estimated the cost of mental illness at about $200-220 billion per year⁶ . The personal and economic cost should not be ignored. ACIL Allen’s evaluation of a mobile emergency mental health response trial found the initiative resulted in more timely access to mental health assessment and treatment for people experiencing mental health crises. It also identified more appropriate uses of emergency department, ambulance, and police resources. This reinforces the importance of innovative service models to achieving good outcomes for individuals and the community.

Response

Governments around Australia are taking action to reform the mental health system. All state and territory governments have signed bilateral agreements on mental health and suicide prevention with the Commonwealth. While there is debate about the sufficiency of the funding in these agreements to achieve the reform needed, some state governments are investing substantially more in mental health than ever before. Implementing the fundamental system reforms envisaged by both the Productivity Commission and the Royal Commission into Victoria’s Mental Health System requires more than substantial funding injections – although this is a necessity.

Successful implementation will be predicated on having a sufficiently sized, highly trained, and skilled workforce. It will need to encompass a wide range of clinical and non-clinical occupations and deliver new models of care centred on the treatment and support needs of consumers, their families, and carers. When ACIL Allen provided support to the National Mental Health Workforce Strategy Taskforce (including developing a draft strategy for discussion), the need was highlighted for the mental health workforce to be broadly defined and include clinical and non-clinical occupations that are trained through vocational and tertiary education pathways.

Opportunity

There are at least three major challenges associated with providing this workforce. Firstly, it requires a rethink of the jobs and career paths offered in mental health - starting with the skills and knowledge required to deliver the treatment and support that consumers, their families and carers need and want, reflecting new models of care. This may involve rethinking of traditional occupations, training pathways that lead to them and associated occupational licensing arrangements, whose primary focus must be on keeping the community safe through provision of high-quality care and not on determining access to funding.

Secondly, to attract the numbers of people needed to perform these roles, jobs and careers need to be attractive, which means those that do them need to be respected for their work (including professional respect), employment needs to be stable and remuneration levels appropriate, to attract the best candidates. There must be time allocated for high quality supervision from supervisors who are qualified to perform the role.

And thirdly, attracting people into the mental health workforce must not be at the expense of sectors that employ staff with similar qualifications such as aged care and disability. The community will only benefit if the workforces across all these sectors grow significantly – because the jobs and careers offered are recognised as attractive.

References

^[1]Productivity Commission Inquiry Report Mental Health, No. 95, 30 June 2020, Vol 1, pp4-6 https://www.pc.gov.au/inquiries/completed/mental-health/report/mental-health-volume1.pdf

^[2]Major reports include the Royal Commission into Victoria’s Mental Health System, 2021 and the National Suicide Prevention Adviser’s Final Advice, 2020

^[3]Productivity Commission Inquiry Report Mental Health, No. 95, 30 June 2020, Vol 1, p9 https://www.pc.gov.au/inquiries/completed/mental-health/report/mental-health-volume1.pdf

^[4] ABS Causes of Death data release 2020

^[5] Australian Institute of Health and Welfare, Mental health services in Australia Productivity Commission Inquiry Report Mental Health, No. 95, 30 June 2020, Vol 1, p9 '

^[6]Productivity Commission Inquiry Report Mental Health, No. 95, 30 June 2020, Vol 1, p9 https://www.pc.gov.au/inquiries/completed/mental-health/report/mental-health-volume1.pdf