Homelessness and the cost of living are big factors, but ‘shiny new hospital services’ are not the answer.
The National Mental Health Commission has released its second National Report Card looking at prevalence and drivers of mental health challenges, and the performance of the mental health system – and it’s not good news.
General practitioners continued to be one of the most accessible mental health professionals.
For the 10% of Australians who accessed Medicare-subsidised mental health-specific services, GPs were the most commonly accessed health professional, with about 78 services per 1000 people.
General psychologists, meanwhile, provided about 27 services per 1000 people while psychiatrists provided 21 per 1000 and clinical psychologists provided 20 per 1000.
While approximately one in four patients delayed mental heath care due to cost for psychologists and psychiatrists, just one in 10 patients delayed GP mental health care due to cost.
GPs also wrote about 84% of mental health related prescriptions in the 2023-24 calendar year.
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The major findings were stark:
- Prevalence of mental health disorders in 16 to 24-year-olds has increased from 25.8% in 2007 to 38.8% in 2020-2022;
- The percentage of those accessing homelessness services who had a current mental health issue has increased from 25% in 2014-15 to 32% in 2023-2024;
- More people delayed or did not see any mental health professional because of cost (12% in 2020-21 to 20.4% in 2023-24);
- Clinical outcomes and experiences of public mental healthcare are not improving;
- Just 45.1% of people with a 12-month mental disorder saw a health professional.
“When considering Australia’s broader environmental context—from ongoing cost of living pressures, heightened tensions over continuing geopolitical conflicts and rising mortgage stress and household prices—many of the trends observed in this report are not surprising,” said the report card.
“However, they do reinforce the urgent need for a broad and multi-faceted prevention approach, as well as a need to address current barriers to accessing care.
“We know that a significant proportion of Australians with mental health challenges are not accessing (or are delaying) care they need and, among those who do access care, clinical outcomes have not shown significant improvement in recent years (particularly for those living in remote and very remote areas).
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“We also continue to see significant gaps in outcomes between those with a mental health condition and those without across a range of factors, including homelessness, loneliness and experiences of discrimination.
“This is not acceptable.”
The NMHC said a whole-of-system approach was required to address the shortfalls in mental healthcare provision.
“We need to see planned service commissioning matched to people’s needs, with greater integration amongst health services and with other services, like housing and financial supports,” said the commission’s CEO, David McGrath.
The report puts together a picture of mental health in Australia by looking at mental health data, social determinants data, and system input data.
“[T]he Commission has an important monitoring and reporting role. The Report Card calls out issues for governments to pay attention to, and that’s the value of this report,” said Mr McGrath.
However, the commission said there were “significant gaps in national reporting on the performance of Australia’s mental health system”.
For mental outcomes of people with lived experience, and for social determinants affecting mental health and whole of life outcomes for people with lived experience, it had access to robust and reliable data for specific indicators.
However, in measuring the performance of system inputs and activities and their impact on mental health outcomes, there were gaps in the available data.
Dr Helen Schultz, a consultant psychiatrist and advocate for RANZCP psychiatry trainees, told TMR that what was needed was to go back to basics, prioritising long-term care for people with severe mental illness.
“It’s a huge drain on resources not to provide long term care for people that have severe and complex mental illness. They’re never thought of. They’re never considered in budgets.”
Dr Schultz said the need to focus resources on this group was apparent, but “danced around”, in the figures.
“There’s a huge over-representation of people living rough at the moment who are untreated, people with schizophrenia, and who probably now have comorbid substance abuse issues because they’re vulnerable and doing everything they can to try and dampen down the voices,” Dr Schultz told HSD.
“Some people live with severe and complex symptoms of mental illness every day of their life. They have been largely ignored throughout all of this. And they’re the ones presenting in crisis all the time.
“They’re the ones that turn up in the ED. They’re the ones with the terrible physical health outcomes. It’s a disgrace that in this day and age these people still die in their 40s and 50s from preventable diseases.
“When we look at the mental health system, and we talk about integration of services, I think the best money – and it is never spent this way – is spent on people that have severe and complex mental illness.
“The people that spend longer in hospital are those with schizophrenia or bipolar disorder or severe personality disorders like borderline personality disorder. They need long-term care and they have not been thought of with regards to service design.”
Resources should be targeted towards funding wards where people could stay and be cared for by expert staff for the duration of their episode, and centres of excellence where trainees could be supervised and work with people with complex needs, said Dr Schultz.
“At the moment, we see people who are acutely psychotic and expect them to be in and out of the hospital within 48 hours. It doesn’t work.”
Focusing on people with severe mental illness would be a return to “core business”, said Dr Schultz. And it would be reflected in a change in the metrics measured by the report, such as seclusion and restraint.
“The best way to reduce seclusion and restraint is to actually treat people when they’re sick, rather than wait for them to get to the point where they need to be restrained,” said Dr Schultz.
But there was no way to fix the mental health system without addressing workforce issues, said Dr Schultz.
“There’s no point talking about a system if we don’t have trainees coming through that are going to take up the places. If we don’t actually look after our workforce, there is no mental health system.”
The report found that in 2023 there were 16 psychiatrists per 100,000 people and, in 2022, 96 mental health nurses, 125 psychologists, 10 mental health occupational therapists and 11 accredited mental health social workers.
“Currently, there is a lack of national data on the community-managed mental health and psychosocial support workforce,” the report said.
“This includes minimal reliable data on the total number of lived experience workers in Australia due to the broad scope of lived experience workers’ engagement with the mental health sector.
“However, data is available for specialised mental health facilities: in 2022–23, there were 126 full time equivalent (FTE) paid consumer workers and 48 FTE paid carer workers employed in these facilities. The number of consumer workers and carer workers doubled from 2017–18 to 2022–23,” the report said.
“[C]ritically, these findings are not able to tell us the extent to which the mental health workforce is meeting the level of demand and the current degree of unmet need across the population. This information is crucial in supporting service planning and guiding evidence-based decision-making.”
The report said that in 2022-23, around $13.2 billion ($501 per person) was spent on mental health related services in Australia, $1 billion more than in 2021-2022 ($491). This represents 7% of total federal government health spending, remaining stable since 2013-14.
Most of it ($8.1 billion) was spent on state and territory services, including within public hospitals and specialised community mental health services.
These amounts don’t include the $5.3 billion in NDIS payments for psychosocial disability.
Psychologist services accounted for $715 million, or 47%, of spending, with Medicare-subsidised mental health specific services decreasing from $64 per person in 2018-19 to $57 in 2023-24. Prescription spending was $691 million (34% for antipsychotics and 34% for antidepressants).
