Mental health services aren’t improving Australia’s population mental health; could we do better?
The first two decades of this century have seen considerable changes in Australia’s mental health care. The federal government has increased its involvement by providing more funding for psychologists, psychiatrists and allied health practitioners via the Better Access to Mental Health Care program. While state and territory programs have varied in how much they kept up the momentum from the 1990s national mental health strategy, overall expenditure has increased substantially – now topping 10 billion dollars annually.
However, our national monitoring of mental health in the population does not show improvement in the frequency with which Australians experience poor mental health. The latest national health survey conducted by the Australian Bureau of Statistics in 2017-2018, before the current pandemic hit us, showed a worse picture than the 2014-2015 results.
The contributors to poor mental health
There are differing opinions among advocates for mental health care as to whether any change like this should be expected. Mental health services may only make a difference where people access care, and if the care is of good evidence-based quality and delivered in ways that match what people can use. Mental health services cannot directly address many societal issues that could be contributing to poorer mental health. Greater inequity in wealth and income, intergenerational disparities in education, and access to community resources and employment opportunities are likely important influences. Socioeconomic disadvantage negatively impacts Australian communities, with at least three-fold increased rates of poor mental health found when comparing the most and least disadvantaged 20% of areas (Meadows et al., 2020). Further, the impact in various ways of social media, the internet, and generational shifts in parenting styles have been suggested as additional contributors. There are very particular influences affecting mental health in Aboriginal and Torres Strait Islander Peoples – reflecting impacts of intergenerational trauma, grief and loss - and refugees and asylum seekers, including effects of torture and trauma. (Meadows et al., 2020).
The impact of the pandemic
The substantive and evident impact on mental health from the COVID-19 pandemic has forced national and state governments to rapidly implement significant measures to boost service delivery to lessen the serious impacts on citizens, including suicidality and ability to work or study. Could this concern and visibility during the pandemic about the consequences of poor mental health awaken the public and governments to the need for better planning, resourcing and coordination of Australian mental health care? This would require a government approach complemented by a mental health workforce that understands the broad range of influences on mental health and how to engage with services cooperatively and collaboratively in order to support people who are severely impacted by social and additional adversities outside the scope of mental health care.
The challenge of delivering comprehensive care
There are many topical issues across various perspectives that contribute to this challenge. These issues include the active involvement in service development of people with lived experience, understandings of social determinants of mental health and illness, and challenges with securing equitable mental health care – including specific Aboriginal and Torres Strait Islander Peoples and other communities where approaches may need to be adapted and targeted. A particular challenge is delivering comprehensive care to all who need it irrespective of location or capacity to pay, and then delivering that care in a way that supports a personal recovery approach, individual agency and empowerment, and that is culturally adapted where necessary.
Recent reports into mental health, such as those from the Productivity Commission (Productivity Commission, 2020) and the Victorian Royal Commission (Royal Commission into Victoria’s Mental Health System, 2021), offer important pointers. However, they have not completely addressed the fragmentation of our mental health care system. In this context even the most able, sensitive and collaborative practitioners may struggle to deliver on outcomes that would be possible with a better-connected system.
How do we collaborate to do better?
Fortunately, much is known about how to enable better collaboration between services and staff, including those employed to bring their perspective of lived experience. However, this understanding of how to improve connectivity of services and practice still needs better funding and management to ensure that the money goes into what is acceptable, equitably delivered and effective. Turning around the upward trend in poor mental health that was present even before COVID-19 is something in which a well informed and engaged workforce will have a critical part to play. They in turn need to be engaged in a system where the incentives work in favour of consistently delivered, acceptable and effective care, but which may need also much wider societal and policy responses.
About the Authors
Graham Meadows, John Farhall, Ellie Fossey, Brenda Happell, Fiona McDermott and Sebastian Rosenberg are editors of Mental Health and Collaborative Community Practice, fourth edition, published by Oxford University Press. An extended team of authors, editors and associate editors provide their interdisciplinary perspectives and lived experience to help readers understand and connect with the broad facets of mental health care. www.oup.com.au/meadows4e
Meadows, G., Burke, S., Enticott, J., Isaacs, A., & Rosenberg, S. (2020). Critical environmental and social determinants of mental health problems and their care. In G. Meadows, J. Farhall, E. Fossey, B. Happell, F. McDermott, & S. Rosenberg (Eds.), Mental health and collaborative community practice: An Australian perspective (4th ed.), (pp. 30–50). Oxford University Press.
Productivity Commission. (2020). Mental Health: Productivity Commission inquiry report (Report no. 95). https://www.pc.gov.au/inquiries/completed/mental-health/report
Royal Commission into Victoria’s Mental Health System. (2021). Final report: Summary and recommendations (Parl Paper no. 202, Session 2018–21). https://finalreport.rcvmhs.vic.gov.au/