Towards a 21st century system of mental health care - an Australian approach

Our most precious natural resource, as individuals and as a nation, is our health. Sadly, in both developed and developing countries a major part of our health is sorely neglected - our mental health. Good mental health allows us to live longer, achieve more, have a better family life, more friends, and contribute to a safer and more productive society. Put simply, mental health means national wealth. We are increasingly coming to understand that mental ill-health lies behind a young woman’s concerns about her body image, behind bullying and youth violence, and behind binge drinking and drug abuse.

Mental ill-health weakens workplaces, burdens working families and drives the senseless loss of life from suicide. Our growing awareness of the widespread impact of mental ill-health on our lives has created overwhelming support for national action to break the silence around these issues, to end the neglect, and build a 21st century model of mental health care.

A 21st century approach to mental health is about solving the problems of needless disability and loss of life. Our current mental health care system, and its supports and services, are woefully inadequate. We need a new approach today, because every day here in Australia:

• Over 300 Australians with mental health issues will present in distress to emergency departments and be turned away without being referred to an appropriate service. Our current system has collapsed under the strain and keeps all but the most desperate at bay.
• Six Australians will die by suicide. Many more will attempt suicide or self-harm.
• Over 1000 years of healthy life will be lost to mental illhealth. This costs us up to $30 billion every year - three times the mineral resources rent tax.
• Australians are up to three times less likely to receive quality care for mental ill-health than for physical ill-health. This is healthcare apartheid.
• Thousands of Australians with severe mental illness are in our jails because there are no other options and they have not received the mental health care they needed, when they needed it.
• Thousands of Australians, mostly young people with mental illnesses, will sleep outside tonight because we don’t have adequate accommodation services to give them shelter.

These are not just numbers - they represent the pain and anguish of real people and real families. A 21st century approach to mental health must fix these problems and can provide real benefits to everyone.

What a 21st century approach to mental health will do

At the community level, a 21st century approach to mental health means that people understand what it means to be mentally healthy and are able to recognise, as they do with physical illnesses like heart disease and cancer, the earliest signs of mental ill-health. People need to feel comfortable about sharing their experience of mental ill-health with those close to them, and to ask for help if they need it. Currently,many people do not recognise when their mental health is failing and do not seek help. With the right information, everyone can be equipped with the knowledge and skills to respond to mental healthissues in a helpful way, just as we do now when someone sprains their ankle, has an asthma attack, faints or develops chest pain. A better understanding of mental health issues means that words like ‘nutter’, ‘schizo’ and ‘psycho’ will become as unacceptable as racist and sexist language is now. This is the antidote to the poison of stigma.

At the health care system level, a 21st century approach to mental health provides stigma-free comprehensive community-based mentalhealth care closely linked to the primary care system. This includes assertive mobile teams available 24 hours a day, just like all our other emergency services. This will stem the flow of people with mental health issues into our emergency departments and our hospitals.

Currently, Australians with serious mental illnesses have poorer access to quality physical health care and on average die 20 years earlier than expected, typically from suicide, cardiovascular disease, or cancer.

A 21st century health care system needs to deliver equity in access to mental and physical health care; these people need high quality physical health care so that their life expectancy comes to equal to that of the rest of the population.

Furthermore, this approach ensures that all people with persistent serious mental illness are able to live in a safe and secure environment, namely their own home. Stable housing is a basic human right; let’s finally correct this great failure of deinstitutionalisation.

A 21st century approach to mental health takes an active stance on preventive opportunities and tackles the key drivers of mental ill-health in childhood and youth, such as social disadvantage, child abuse, bullying, and poorly treated mental illness and addiction in the parents. Because the peak period for the onset of mental health difficulties that may well persist into adult life as serious mental illness is between 12 – 25 years193,194, a 21st century approach to mental health provides a stigma-free stream of care to young Australians that offers integrated, multidisciplinary expertise in a youth-friendly environment that creatively uses new technologies.