When will Australia finally deal with mental health?

And 2020 has shown just how fragile our mental health is. Lifeline has gone from an average of 2500 calls a day before the pandemic, to well over 3000 calls a day at times.

“It’s been off the charts for Lifeline,” Mr Brogden says.

The increase in demand is expected to last. In the 10 months since the height of the summer’s catastrophic bushfires, Lifeline still consistently receives between 200 and 300 calls per day about it. Mr Brogden expects calls due to the pandemic will continue well into next year.

“There will be no vaccine for mental health in 2021,” he says.

2020 has thrown a spotlight on the mental health of our nation, but even before COVID-19 and bushfires it’s long been a key focus of the government.

Mr Morrison tells The Sydney Morning Herald and The Age it is vital to focus on mental health and suicide because they affect the lives of “almost every Australian”.

The government has committed an estimated $5.7 billion to mental health this year, which includes telehealth access, and $500 million alone to respond directly to the mental health effects of the pandemic.

“But we need to continually improve these services, particularly in these challenging times, as anxiety levels and stresses are elevated,” Mr Morrison says.

Health Minister Greg Hunt says reforming mental health care at a structural level is a task the government is taking seriously, and his drive for change has been backed by the Prime Minister and Treasurer Josh Frydenberg.

“It’s an ongoing national task, it will be with us for the foreseeable future. They’re permanent responsibilities,” he says.

None of the experts interviewed for this article doubted the government’s sincere commitment to improving the mental health of the country, but some were concerned any reform would not go far enough.

The big question … is are they up to the task?

Professor Ian Hickie

‘Report after report’

Mr Brogden said while perceptions of mental illness have changed since his suicide attempt in 2005, there was much work to be done.

The greatest indicator of somebody suiciding is a previous attempt, Mr Brogden says, which is why follow up care after someone has been discharged from hospital is a critical missing part of the health system.

“It’s like taking a drowning person, pulling them out of the water, and then throwing them back in again,” he says.

His experience is echoed in the findings of the Productivity Commission report on mental health.

The report revealed mental ill health, suicide, and disability related to mental illness costs the country roughly $200 billion a year. It found one in five people experience mental illness every year, and half of all Australians will be diagnosed with a mental health condition over their lifetime.

Despite how widespread the problem is, the report found many people were being treated too late or not at all, as they struggled to navigate the country’s overly complex mental health system.

In a 45-minute speech delivered following the release of the report on Monday, Mr Morrison said it was tough reading, and any reforms to prevention, early intervention and treatment would require an enormous response.

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“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,” he said.

But Professor Pat McGorry, co-founder of Headspace and former Australian of the Year, says the country has spent plenty of time examining problems with the mental health system.

“If you’re looking at history, it’s not a great track record, it’s report after report,” he says.

Psychiatrist and former National Mental Health Commissioner Ian Hickie agrees.

“What’s emerged here is a very extensive dissection of the system, but it repeats previous reports, and notes others underway – the Royal Commission in Victoria, the Commonwealth is preparing its own 2030 vision report, and Suicide prevention report due in December,” he says.

‘Oceans of work’ for meaningful reform

So is the Productivity Commission’s foray into the space of mental healthcare any different from previous reports?

Christine Morgan, chief executive of the National Mental Health Commission and the Prime Minister’s adviser on suicide prevention, certainly thinks so.

“The penny is really starting to drop with all of us that there is an ocean of work to be done,” she says.

The Prime Minister also released the National Mental Health Commission’s interim report on suicide prevention. Like the Productivity Commission’s report, it says major structural changes are needed so mental health can be addressed across different areas including housing, education, and employment.

Despite the enormity of attempting such large changes, Mr Morgan believes the pandemic has shown large changes can be made quickly.

“I see [the pandemic] as being a classic tutorial in the benefits of prevention and early intervention, we are focusing in on that classic phrase of ‘getting ahead of the curve’. Let’s apply that to mental health as well,” she says.

She believes federal government and state and territory leaders understand the economic imperatives of meeting people’s needs where they are – whether that is at school, work or in their regional communities.

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“I think that commitment is there,” Ms Morgan says, but warns action needs to happen while mental health is at the forefront of people’s minds.

“That momentum for reform is not something that we want to lose.”

Professor Hickie points out it’s not the first time an Australian government has sought to reform mental health care in such a way. John Howard formed the first national mental health initiative with NSW Premier Morris Iemma that lasted five years, Julia Gillard brought mental health into cabinet, and Malcolm Turnbull also focused on it as an issue, he says.

“I have no doubt about [Prime Minister Scott Morrison’s] sincerity, he spoke with considerable commitment,” Professor Hickie says.

“The trouble is I’ve heard the same commitment and tone from John Howard, Julia Gillard, and Malcolm Turnbull. The task is hard.”

His worry is that the government will pick a few small things to fund, rather than work on a wholesale reform.

“The big question … is are they up to the task?”

No more reviews, its time for decisions: sector

Opposition health spokesman Chris Bowen says the government has been slow to act, given they received the Productivity Commission report in June and have indicated they will respond to it by the May 2021 budget.

“The PC report highlights the over $200-billion impact of mental ill-health and the needless suffering endured in Australian’s fractured system. We need to act now, we can’t afford to wait,” he says.

But Mr Hunt says the government has been acting and is willing to make big changes, pointing to the expansion of the Better Access Scheme to 20 mental health sessions on a trial basis for two year

The next two major areas of focus in aftercare for those leaving hospital after a suicide attempt, and adult mental health hubs. The phase after that will involve “significant” work, he says.

“Then as you go forward, think of the structural changes, think of what we’re doing in terms of missing areas of acute care, prevention, then access and treatment,” Mr Hunt says, adding this work will be done in partnership with the states.

Scott Morrison says through National Cabinet he is working closely with state and territory leaders on improving the mental health needs of the country.

“We have learned that to improve the mental health of our population, our mental health system must look beyond symptoms and work out what help a person needs to be resilient and be well, recover from mental ill health and remain well. Because multiple factors, biological, environmental and social, all affect mental health and wellbeing,” he says.

“All levels of government need to work more closely together to ensure people get the support they need and I look forward to mental health being front and centre at our first National Federation Reform Council next month.”

Professor McGorry worries the Productivity Commission report will be used as a blueprint, rather than a guide.

“It has some good guidance, and some missed opportunities,” he says, particularly concerned about the sense he gets from the report they want to “shift everything down a notch”.

He thinks the Prime Minister and health minister are waiting until the final suicide prevention report is completed in December, and the findings of Victoria’s Royal Commission into mental health are released in February before making any big decisions.

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“Whether the government understands the scale of what we have to do, I’m unsure, but I’ve never seen the level of commitment from Prime Ministers and premiers that we do at the moment.”

Mr Brogden says he’s an optimist, and major change just requires somebody who’s going to make it the focus of their political career.

The Prime Minister takes the gold medal for putting it all on the table, he says, but now the whole sector will be looking to next year’s budget to see what structural change and funding boost the government is willing to stand behind.

“We’re now at the point where a little bit here or there is not going to cut it; we don’t need any more reports, we don’t need any more reviews, we’ve got all the information we need to start making decisions,” he says “Everybody’s got to put their shoulder to the wheel.”