With Tony Abbott’s new cabinet ministry announced, Australia no longer has a Minister for Mental Health. This is far more than an aberration. A lack of accountability when it comes to mental health in this country constitutes a crisis, a crisis that has spanned decades.
The Obsessive Hope Disorder: reflections on 30 years of mental health reform and visions for the future (OHD) report was released in August, 30 years after David Richmond’s landmark inquiry, Health Services for the Psychiatrically Ill and Developmentally Disabled.
Richmond’s inquiry was intended to set the path to reform from 1983 onwards. It found that people with serious mental illnesses have poor life expectancies compared to the average population and that the mental health system lacked in infrastructure. The same is still true today.
It’s also twenty years after Brian Burdekin’s Human Rights and Equal Opportunity (HREOC) Inquiry into the Human Rights of People with a Mental Illness which found that people with mental illness suffer discrimination and stigma, and are denied rights to which they are entitled. That inquiry also found that the mental health system was inadequately funded. Once more, the same is still true today.
The current OHD report aims to document aspects of the journey of mental health reform since the two reports – Richmond’s Inquiry and the HREOC inquiry – through a comprehensive range of crowdfunded research.
It finds that while Australia has some of the best strategies and policies for dealing with mental illness, many of them have not been implemented or have been implemented badly. Despite significant government investment in mental health since 2006 (some $8 billion in funding), there is a large degree of resource waste. Further, the report points to a lack of a national systematic framework and very few guidelines for delivering mental health services. There is a hodgepodge of services available, rarely reflecting what people need or what best evidence would prescribe.
The failure of the system has huge consequences. The report argues that mental health consumers enter into ‘a bizarre lottery’ where luck seems to be the key determinate as to whether they get adequate treatment. The life expectancy of those with a mental illness has not improved since 1983 and the quality of life for those experiencing mental illness is far poorer than average.
Adjunct Professor John Mendoza, Director of ConNetica and former Chair of the National Advisory Council on Mental Health, instigated the report in 2012. He now says: ‘The outcome is worse than I expected. The really disturbing finding is the fact that we have failed for more than a generation to implement the findings of inquiries, independent reviews, and plans over and over again.’
Despite numerous government plans, reports and reviews on mental health themes, increased attention and investment, and growing evidence about what treatments and strategies work, Australia still lacks an easily accessible mental health system. Important resources and funding are being wasted and the system is wanting in uniform quality of care.
Through the dozens of plans and policies created by state and federal governments since 1992, the OHD report finds that the same issues were identified as priorities over and over. It is difficult to assess the outcomes because very little data exists – as the report points out, a lack of accountability and outcomes data was a problem a hundred years ago and one that still persists. What data and reviews are actually available shows that policy implementation had largely failed.
Moreover, while the Federal Budget has increased funding for mental health in recent years, the rate of overall increase to the annual health budget means mental health’s share is declining.
On a state level, despite commitments from every state government towards deinstitutionalisation – that is, keeping people out of hospital and in the community as much as possible – there are still hundreds of people across the country, in all jurisdictions except Victoria, living in institutional settings, places that would have previously carried the label ‘asylum’. Many of those are there involuntarily and have been there for decades. Mendoza calls this ‘a national disgrace and a violation of human rights’.
It’s also expensive. The OHD report puts the cost to taxpayers on average at $10 million each week.
Some state budgets allocate half their mental health funding to acute hospital care. But there are other more cost-effective, sub-acute interventions which could prevent the need for hospitalisation in the first place. The strategy also ignores the nature of mental health. Unlike many other conditions, as John Feneley, the Mental Health Commissioner of NSW, points out in the report, ‘effective mental health care is not about administering treatment and hoping for a response; it needs to recognise the entire context of people’s lives.’
A tangible result of government failures is inadequate access to mental health treatment – over two million people with a clinical condition did not use any service in the last year. Many people with a severe mental illness – 40 percent – had little or no contact with services.
According to Mendoza: ‘Even people living in the centres of our major urban areas cannot get access to care unless they know someone, or have the capacity to pay. If they are reliant on the public systems, then chances are slim in terms of accessing the required care.’
Mendoza argue that these systematic failures are caused by a combination of factors.
Stigma is a big factor, he says: ‘What I mean is institutional stigma and discrimination in the allocation of resources.’
There have also been many examples of ‘bureaucratic interference, delay and failure to implement the policy commitments of both Labor and Coalition governments at state and federal level’ while mental health has suffered from a lack of funding: ‘What this means is that no aspect of the ‘service system’ can operate as intended or in line with evidence. It means that every time a new program is added, it is somewhat overwhelmed by system wide deficiencies.’
Finally, there has been a lack of good public policy in planning and implementing reform, including ‘clear and defined roles of governance; transparency and accountability’. This accountability is more severely wanting in the face of a ministry which no longer names mental health as a government priority.
As a result of poor policy, the OHD report contends, the quality of life of those affected by mental illness is seriously diminished. Currently, the biggest factors that determine whether someone with a mental illness gets sufficient care for their needs and an adequate quality of life is a mix of postcode, income, origins and sheer luck.
‘Special populations’, such as those with culturally and linguistically diverse backgrounds, Indigenous people, rural and remote people, young people, people identifying as LGBTI, and those with co-morbid conditions, are especially neglected when it comes to the delivery of mental health services.
Shockingly, the OHD report claims that ‘simply put, we cannot tell if people with mental illness are better off than they were 10 or 20 years ago.’ The information is unknown because there has been very little progress in the way of determining the outcome of government policies and investments.
What is known, however, is damning.
People with mental illness experience higher death rates than the general population and higher rates of obesity, diabetes, heart disease, and some forms of cancer. Some 90 per cent of those with a mental illness also have at least one chronic health condition. People with mental illness also experience higher rates of poverty, unemployment, social exclusion, homelessness, and imprisonment. They are more likely to be victims of crime. Mental illness is the largest cause of disability in Australia.
The life expectancy of a person with a mental illness is 16–25 years under average – this has not changed in a century. Those who experience psychosis have the lowest life expectancy, which hasn’t changed in the last 30 years. Compare mental illness to breast cancer: one’s chance of survival from many common cancers is 30 per cent higher than it was twenty years ago. One’s chance of survival from mental illness today hasn’t changed over the last thirty years.
On top of this, Brian Burdekin, the head of the 1993 HREOC Inquiry, explains in the OHD report that those with mental illness are treated inhumanely in society as a result of, amongst other factors, stigma: ‘widespread ignorance in our community associated with irrational fear, discrimination, stereotypes and myths.’
Given the alarming situation, and the prevalence of mental illness, the lack of research funding is startling. The OHD report includes a review of mental health research in Australia. It found that there is ‘little evidence of any increase in the allocation of funding for mental health research’.
The lack of research is stark given that, according to ABS figures, 45 percent of Australians will experience a mental illness at some point in their lives. Additionally, the OHD report found that suicide is the leading cause of death for those aged 16-25 years: for every Year 12 class in Australia, there will be one student who has attempted suicide. In the adult population, the prevalence of mental illness exceeds that of diabetes and all cancers combined.
Yet compared to other kinds of medical research, mental health receives a small share, only 8 per cent, of the total national research funding.
It’s difficult not to look at the current situation and not raise your hands in frustration, disgust, and despair. Mendoza says, ‘The failure to implement the recommendations over and over, was disturbing – it highlights a gross failure of governance.’ It looks like Abbott’s new government, which lacks an accountable minister for mental health, is set to deepen the chasm the OHD report has uncovered.