We’re not doing enough for Australia’s seriously mentally ill
Dr Andrew Wilson is Medibank’s Group Executive Healthcare & Strategy, and a psychiatrist who has worked with Australians experiencing serious mental illness for several decades. For Mental Health Month, Dr Wilson shares his views on how Australia can improve the quality and accessibility of care for these patients.
Despite Australia’s recent elevation to the top five world health systems for healthcare access and quality, we still have significant inequity in the medical and social care available for those with serious mental illnesses (such as schizophrenia and bipolar disorder) in our cities and especially in the bush.
Serious mental illness may not be as galvanising an issue for our community as breast cancer or SIDS, but we cannot shy away from the disadvantages faced by these members of our community, regardless of where they live and especially if they are also experiencing homelessness.
We know people with mental health disorders have a substantially reduced life expectancy compared with the general population, and the Lancet Psychiatry Commission reports that although suicide contributed to a considerable proportion of these deaths, the majority of years of life lost in people with mental illness relates to poor physical health.
The poor physical health outcomes and the associated decrease in life expectancy of people with serious mental illness have not improved, and research shows the number of years of life lost due to physical health conditions in people with mental illness might actually be increasing.
For those in rural and regional Australia, the inability to access services is a serious and urgent problem, and is writ large in terms of suicide rates. One in eight Australians is currently experiencing high or very high psychological distress, and the rate of suicide is 1.7 times as high in remote areas as in major cities. Suicide is the leading cause of death for people aged between 15 and 44 in Australia, and Aboriginal and Torres Strait Islander people are twice as likely to die by suicide.
In rural Australia, lack of timely access to the right services, often minimal social and community support, as well as environmental and economic factors, all contribute to this serious situation.
In a country as wealthy and as health-educated as Australia, it’s reasonable to ask why is this so? From my perspective as a psychiatrist there are a few key factors; for many people experiencing serious mental illness, we are just not meeting their needs.
Hospital treatment and experienced medical care, while of very high quality in many locations, in other areas is limited and often only available in the most urgent of cases. There is also often a lack of social support services whilst the person is undergoing treatment or after they have been discharged. Getting responsive, multidisciplinary, community-based care models across the country remains an elusive goal, with many services desperately under-resourced or using outdated consumer engagement models.
I’ve worked extensively with patients who are experiencing serious mental illness and are homeless as a result, and more recently with the mentally ill in rural and remote Australia. There is no sugar-coating how difficult these issues are to address.
Australia has a good social welfare safety net and the benefit of an excellent dual public-private healthcare system, so what can we do?
We cannot point the finger at one party or another; every part of the system needs to work together to improve these outcomes.
In practical terms, this means all the necessary components to promote recovery: including better medical and mental health care and support, access to decent housing and social and community support, and practical assistance with day-to-day living when needed. Families are also often not part of the equation when systems of care and support are put in place, yet the carer burden for the families of the seriously mentally ill is very high and a source of poor health outcomes as well.
Particularly in rural Australia, we need better access to technology-enabled services such as video access to a broader care team, and we can improve the care system by implementing some targeted community support initiatives, such as outreach services and recovery centres as well as improving access to the NDIS.
I acknowledge the need for better clinical care that is responsive and tailored to people’s needs. With support from the right services and professionals, I’ve seen patients recover who were considered beyond hope.
A lot of the work we are doing at Medibank can help. Our skilled mental health professionals support millions of Australians each year through services like 1800RESPECT and Beyond Blue, but often these services are accessed at the beginning of the journey and acute ongoing treatment is needed. The work we have started in Adelaide with the Rapid Hospital Avoidance Program is also starting to address these service gaps.
This Mental Health Month, we need to have these difficult conversations. We need to decide, as a wealthy, health-aware nation, that we aren’t going to accept anything but the best care for a teenager experiencing the onset of a psychotic illness, or a 62 year old who has lived with schizophrenia for decades, regardless of whether they live in the inner suburbs of Adelaide, in Lightning Ridge on the outback border of New South Wales and Queensland, or on the streets of Melbourne.
It is not as simple as saying one party or another ‘needs to do more’ – we need to galvanise as a community to ensure those at highest risk of being lost are found, supported and given the opportunity to improve their health.