DEAR PRIME MINISTER, PREMIERS AND CHIEF MINISTERS,
The tragic events of the past week have shown just how much the neglect of mental health care is hurting Australia and Australian communities.
More than 5 million of us every year experience mental illness, and across the lifespan around half of us will be affected - with latest estimates as high as 85%. It is a public health crisis that is getting worse with a 50% rise in the level of mental ill health in teenagers and young adults to the alarming level of 39% in a given year.
This crisis is weakening our society and undermining community safety.
30 years ago Australia, along with most developed nations, embarked on a major reform of mental health care which saw the old 19th century asylums closed and the responsibility for the mentally ill handed over to the mainstream hospital system and community care. The number of beds was dramatically reduced with the promise that a high-quality, well-resourced community mental health system would take over and improve outcomes and quality of care. This promise was never fulfilled.
Instead, we have underfunded, fragmented services unable to provide accessible quality care based on the latest scientific evidence. The contrast with the rest of the health system, notably cancer care, could not be more stark.
The tragedy is that we have effective treatments and innovative models of mental health care, but they are available to only a minority of the Australians who desperately need them.
This failure leads to cyclical scandals and public inquiries most recently culminating in the historic Royal Commission into the Victorian Mental Health system.
Mental illness and related consequences, such as suicide and substance abuse, are responsible for between 15% and 20% of the health burden in Australia and for 35% of the loss of GDP or “mental wealth”. Yet we spend only 6.8% of the health budget or $12 billion per annum to address it.
This means only 50% of people with a need for care access it, typically after long delays and experience very variable quality of care. This contrasts with the $40bn devoted to the NDIS for a much smaller number of people.
But it is not just a matter of money. Mental health is poorly organised and fails to deliver evidence-based care in a timely and coordinated way. The Commonwealth funds mental health via fee for service models linked to primary care and private specialists and via Primary Health Networks which distribute funds to a bewildering array of NGOs and private providers via competitive tendering which severely fragments care and reduces its effectiveness. The States and Territories mainly provide limited packages of care around acute relapses of severe forms of illness with discharge back to general practitioners, private psychiatrists or NGOs.
These people need multidisciplinary ongoing team care, but they are simply not getting it and the consequences are tragic for themselves and society.
The Australian people are now deeply concerned. We expect governments to provide the best quality health care possible in a fair and equitable way across the nation and for all forms of illness. This is not happening.
We therefore urge you all, with the objective of a safer, more cohesive and mentally wealthy Australia, to make reform and investment in mental health care a top priority for our nation at National Cabinet.
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