Positive steps on Australia’s path to mental health reform

That’s resulted in a yawning gap for people with moderate illness who need intensive community support but not in-patient care. These Australians are often referred to as “the missing middle”.

The Productivity Commission report into mental health, handed to the government in June 2020 and released in November, found people were falling through the cracks of the country’s mental health system.

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Despite the fact one in five people experience mental illness each year, and half of all Australians will be diagnosed with a mental health condition during their life, the report found the system often fails because it is too difficult to navigate.

“Australia’s mental health system is not comprehensive and fails to provide the treatment and support that people who need it legitimately expect,” the report says.

The Productivity Commission estimates mental ill-health and suicide costs the country at least $200 billion a year, but implementing reforms would create almost $20 billion a year through improved quality of life and increased economic productivity.

The day he released the report, the Prime Minister committed to sweeping changes.

“It’s obvious that we can’t use the same template for a national mental health system as we use for a physical health system,” he said.

“We need to go beyond government. We need to go far beyond the health system and we need a whole of economy approach, whole of community approach, partnerships between all levels of government, sectors, organisations. All of us are involved in this.”

The next month, Morrison chose Coleman to oversee the reforms. A former immigration minister who stepped aside in 2019 on personal leave for almost 12 months, Coleman remains intensely private surrounding the circumstances of his leave but is energised about the task ahead.

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He says while the substantial majority of mental health investment remains in acute and severe care situations, it is clear more needs to be done earlier to assist people with depression, anxiety or pre-suicidal thoughts.

“Mental illness often first manifests itself in adolescence and early adulthood,” Coleman says. “And so focusing on everything we can do to help kids and adolescents and young adults to have the best start in life and to deal with any mental health issues as they arise is extremely important.”

Further regulation of the online space has not been ruled out by the government.

“There are very real concerns about the negative impact of digital,” Coleman says. “This is a new phenomenon, because 20 or 30 years ago kids did not have the access to the breadth of material that they have now through social media.”

He says the education system will be ground zero for helping children with mental health issues before they arise, so that should their circumstances deteriorate later they are better positioned to deal with it.

One of the country’s leading psychiatrists, Professor Patrick McGorry, says the Productivity Commission report did not give the government solid guidelines for reform but Victoria’s royal commission into mental health provides a road map.

“The [Productivity Commission] pointed out that you’re going to actually get money back in spades if you do this right … but it didn’t really help the government much in terms of knowing what to do,” he says. “The federal government was very interested in what the Victorian royal commission would come up with, and I think it’s come up with an absolutely superb blueprint.”

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Victorian Premier Daniel Andrews agrees. Committing to all 65 of the royal commission’s recommendations when the report was released on March 2, he said it would “serve as our blueprint for the biggest social reform in a generation”.

“It’s not one year, it’s not one budget, it’s not one set of forward estimates, it’s going to take continued work and a really passionate commitment,” he said.

Those recommendations include the creation of new crisis facilities and safe spaces, a new Mental Health Act and a commitment to eliminating the use of seclusion and restraints within 10 years. Victoria will be the trial site for a redesigned system.

McGorry, who chaired the royal commission’s expert advisory committee, says one of the biggest changes will be filling in the “missing middle”.

“The main thing in the Victorian royal commission is building a community mental health system with several levels which is fit for purpose,” he says, adding it will involve an increased number of adult and youth mental health hubs catering to more moderate mental health needs.

Those changes will require a high level of co-operation and funding from state and federal governments to cover the gap between federally regulated primary care and state-run acute hospital treatment.

Despite their broader political differences, McGorry believes Morrison and Andrews can make it work. “They’ve got a very positive, mutual commitment to doing this. I’ve never seen this before in my career,” he says.

“I’m very grateful to both the PM and the Premier for their leadership on it.”

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Once the Victorian prototype is working, McGorry expects NSW will be the next state to adopt sweeping reforms. The Prime Minister has made it clear to McGorry that he is committed to seeing a national agreement on both the model and funding by the end of the year.

Coleman says he is determined that the experiences of those who have been saved or failed by the system will play a critical role. “One of the things that has come out of the various reports recently has been significant numbers of people who have lived experience saying that the system didn’t work as well for them as it should have,” he says.

“So incorporating that experience and really embedding it in the system is something that needs to happen.”

Harman says reform will fail if it does not listen to those voices.

“By drawing on the deep, rich and informed insights of people who live with mental health issues – people who have tried to navigate the broken system – I think there is a clear vision with pragmatic solutions that will put the community at the heart of a remade system,” she says.

One example is John Brogden, the chairman of Lifeline Australia, a prominent voice in public discussions surrounding mental health and suicide.

The former NSW Liberal leader has shared his own struggles and suicide attempt with policy makers for more than a decade and has called for increased suicide prevention training within the community.

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He has also advocated for better support services for those at risk of suicide post-discharge and appropriate facilities and responses for people experiencing suicidal behaviour and presenting to emergency departments.

“We need a whole-of-government, sector and community plan for suicide prevention to move fast towards an Australia free of suicide,” he says.

Harman warns it will be a decade-long process that every stakeholder will need to commit to.

“We are talking about rebuilding the system,” she says. “This can’t be tinkering. And the people who it affects can’t be passengers in the process.”

If you or anyone you know needs support call Lifeline on 131 114, Kids Helpline on 1800 55 1800, or Beyond Blue’s coronavirus mental wellbeing support service on 1800 512 348.