Mental Health in Australia
Parallel to physical health, mental health is a major contributing component of overall health and wellbeing. It is considered by the World Health Organisation as “a state of wellbeing in which an individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” (WHO, 2014). For the estimated 45% of Australians who predicted to experience mental illness in their lifetimes however, this state can be jeopardised. Highly prevalent disorders such as depression, anxiety, or substance abuse, as well as less common conditions including psychotic disorders are non-discriminatory, widespread, and have large impacts on the lives of individuals, their communities and greater society. The most recent National Survey of Mental Health and Wellbeing was undertaken in 2007, and statistics are not always accurate due to co-morbidities, diagnostic guidelines and the implications of stigma (AIHW, 2018). It is however possible to conclude that the burden of mental illness in Australia is significant.
Mental health expenditure totalled $9 billion in 2015; a figure highlighted as a 3.5% increase since 2011. Data can also be attained through the Medicare Benefits Scheme, whereby 9.8% of Australians received Medicare subsidised mental health services in 2016-17. Through the Pharmaceuticals Benefit Scheme in the same time-period, 4% of Australians received prescriptions for mental health specific pharmaceuticals. In the twelve-month period of 2015-16 an estimated 18 million GP visits were made specifically relating to mental health; an annually increasing figure since 2006-7. In the same period 410,000 Australians accessed community mental health care services (AIHW, 2018). The 2010 National Survey of People with Psychotic Illnesses indicated that an estimated 64,000 Australians living with a psychotic illness were in contact with specialised public psychotic mental health services per year. The Australian Child and Adolescent Survey of Mental Health and Wellbeing conducted in 2013-14 estimated 560,000 4 to 17-year-olds experienced mental illness in the 12 months prior to the survey (AIHW, 2018). Further to these figures, “the number of disability-adjusted life years attributed to mental disorders increased by 37% between 1990 and 2010, with depression becoming the fourth highest cause of disability in Australia” (Harvey, et al., 2017). These statistics indicate increasing trends in Australians whereby greater proportions of the population are accessing mental healthcare, and subsequently being diagnosed with mental illness. This is in part attributed to initiatives such as World Mental Health Day.
As a global health education initiative, World Mental Health Day is founded upon advocacy principals for raising awareness and overcoming stigma. In Australia, the campaign is pioneered by not-for-profit organisation Mental Health Australia and maintains a “focus on ensuring the whole community recognises the part we all play in creating a mentally healthy society”. This is done through actively promoting mental health in a positive light and providing resources and a platform for discussion to work towards discrediting misconceptions associated with mental illness and overcoming social prejudice. The key messages of World Mental Health Day are that mental illness is a part of life, people who live with mental illness are not incompetent, weak or to be feared, and that seeking help is the best way to prevent mental illness from compromising quality of life (Mental Health Australia, 2017). The success of the campaign is largely associated with its acknowledgement of the diversity present within Australia, and a variance in causal and risk factors for mental illness, and the gaps present within the current mental health care system (Mental Health Australia, 2018).
Due to the diverse nature of the Australian landscape and its population, the risk and causal factors associated with mental illness are varied. Genetics and biological factors have long been perceived as a key risk factor for psychiatric diseases, however research continues to define specifically relevant genes within DNA. Researchers believe that the challenge in defining these genes is attributed to the considerable influence environmental and social determinants of health have over the incidence of mental illness (National Institute of Health; 2013).
Majority of the Australian terrain is considered remote or very remote, however majority of the population live in urban metropolitan cities. The stressors present in urban communities differ from those in remote regions, whereby the incidence of non-communicable disease, disability, and poor health literacy and behaviour are elevated. Despite this, the rates of mental illness are relatively stable across the nation, however presentations do differ. The prevalence of self-harm or suicide increases with rurality, indicating the severity of mental illness in such communities, and reflective of limited access to essential health resources (Rural Health, 2017). Further to this, in the present instance of drought, male farm owners and managers are on average twice as likely to die by suicide or experience poor mental health than other Australian males (The University of Sydney, 2018). Associated with this, are the stressors applied by economic determinants of health often present within remote communities, whereby incomes are 20% lower than in urban areas, and unemployment is comparably higher, and education comparably lower (National Rural Health Alliance, 2011, AIHW, 2017). There is a definite relationship between unemployment, poor education and mental illness, whereby an increase in feelings of helplessness, alienation and insecurity exacerbate the prevalence of anxiety and depression. In turn, unmanaged poor mental health can result in the presence of these health determinants (Goldsmith, et al., 2012).
It is estimated that 1 in 3 Australians over the age of 10 registered with a Specialist Homelessness Service (SHS) lives with a mental illness; a rate that has increased annually since 2011. The provision of services for these individuals were predominantly related to housing crisis, domestic or family violence, and financial troubles. Alarmingly, half of all clients reported homelessness in the 12-month period prior to presenting to their SHS agency, and majority of those seeking assistance were between 10 and 24 years of age (AIHW, 2018). Research undertaken by Mission Australia in association with The Black Dog Institute, a leading organisation in generating awareness of mental illness in Australia, found that 1 in 4 young people between 15 and 19 years of age lived with mental illness, and that mental illness maintains 45% of the global burden of disease for people aged 10 to 24 years (2017).
Within the SHS registration pool, Aboriginal and Torres Strait Islander peoples were 7 times more likely to live with mental illness, as reflected in nationwide data (AIHW, 2018). 31.6% of ATSI young people met the criteria for probable serious mental illness compared to 22.2% of non-Indigenous young people in the aforementioned Youth Mental Health Report (Mission Australia, 2017). The 2015 National Aboriginal and Torres Strait Islander Social Survey revealed 29% of respondents self-reported living with depression, anxiety, behavioural or emotional problems, however respondents from non-remote areas were twice as likely to respond than those in remote communities. The major contributing factors associated with mental illness for these population groups include less than year 10 education or equivalent, participation in the work force, cultural or familial isolation, substance abuse, incarceration, financial security, housing, intergenerational trauma, and domestic or family violence (ABS, 2016).
For these marginalised and at-risk population groups, initiatives such as World Mental Health Day provide the opportunity for open discussion surrounding mental health in the greater population. It enables awareness of risk and causal factors and provides insight into accessible resources, warning signs, and the ability to campaign for improvements to accessible public health care (Mental Health Australia, 2017).
The role of government and non-government agencies in addressing mental health in Australia
In responding to and managing the incidence and prevalence of mental illness in Australia, the Australian government are responsible for subsidising the provision of primary care. This is done through the Medicare Benefits Scheme, whereby the financial cost of visits to GP’s, or mental health practitioners under the Mental Health Plan or Better Access referral system are subsidised through either bulk billing or rebate. In conjunction with such is the Pharmaceutical Benefits Scheme/Repatriation Pharmaceutical Benefits Scheme, wherein the costs of essential medicines are subsidised. In addition, the provision of “income support, social and community support, disability services, workforce participation programs, and housing assistance” are managed by the Australian federal government (AIHW, 2018). Funding for these policies are encompassed within the annual federal health budget, and with specific regard to mental health, are guided by the National Mental Health Commission (National Mental Health Commission, 2017). Specialist acute mental health care and psychiatric hospital services are funded by state and territory governments. These services include specialised community mental health services, specialised residential mental health care services, and supported accommodation and housing environments (AIHW, 2018).
Mental health oriented non-government organisations are also key in providing mental health services in Australia. The Australian Institute of Health and Welfare categorise the private services as those that “focus on providing well-being, support and assistance to people who live with a mental illness rather than the assessment, diagnostic and treatment tasks undertaken by clinically focused services” (2018). These organisations run on private or government funding, and are usually targeted to certain demographics, or focussed on a specific mental illness. One well known example is Headspace; an organisation tailored to the provision of youth mental health services.
Headspace is predominantly funded by the Australian federal government and falls into the category of Child and Youth Mental Health; a division of public healthcare which received a $110 million investment announced at the beginning of 2018. In addition, partnerships with large organisations such as K-Mart are utilised as a source of donation. The primary focus for Headspace is to undertake “a range of activities to increase the awareness of our services and how to access them among young people, their families, friends and the broader community”, and provides an additional focus on marginalised population groups including ATSI communities (Headspace, 2018). The purpose of such non-government organisations in the Australian mental healthcare system is to identify barriers, provide outreach and initiatives that streamlined government healthcare does not extend to, and provide a platform for safe, accessible resources (Mental Health Australia, 2015).
The value of engaging the community in mental health initiatives like Mental Health Week
In acknowledging the strengths and benefits of non-government mental health organisations, it is clear that community engagement is at the forefront of initiatives such as Mental Health Week. Globally, the involvement of communities in mental health awareness and education has been used as a key strategy for generating discussion, providing support and working towards overcoming stigma. The involvement of communities is also vital in ensuring initiatives are culturally relevant and accessible to their target populations, which in turn increases service utilisation and empowers populations to take control over mental health and illness within society (Peterson, et al., 2012). This is additionally reflected in organisations ability to lobby, and the policies established as an outcome of community engaged mental health initiatives. Further, engaged communities provide supportive environments for Australians struggling with mental illness, and allow the capacity for effective assistance and resource utilisation to ensure quality of life and low burden of disease (Community Mental Health Australia, 2018).
The role and impact of the media and social media in mental health promotion
In a modern society, the engagement of communities should be accessible and include online communities, through media and social media platforms. The importance of such ensures the initiatives are generating awareness, and are effective in reaching youth, older adults, communities of low socioeconomic status, and regional communities; all population groups at risk of experiencing mental illness. The use of such provides a platform for awareness and discussion and is a key tool in providing education for mental health (Welch, et al., 2016). The use of media further enables efforts to overcome misconceptions surrounding mental illness and assists in overcoming the traditional prejudice and stigma present in communities, through highlighting accuracies, working against stereotypes, and bringing the issue to the forefront of social issues (Everymind, 2014).
Mental health is an issue at forefront of Australian communities, whereby all members of the population are at risk due to a number of causal factors. The implications of mental illness are significant, and the expenses associated through government and non-government organisations are large, however vital in working towards overcoming the stigma and prejudice associated with mental illness, creating awareness and safe platforms for discussion, and generating awareness of disease, risk factors and warning signs.
Australian Institute of Health and Welfare. (2017). Australia’s Welfare 2017: In Brief. Retrieved 17/8/18, from: https://www.aihw.gov.au/reports/australias-welfare/australias-welfare-2017-in-brief/contents/education-in-australia
Australian Institute of Health and Welfare. (2018). Mental Health Services in Australia. Retrieved 18/8/18, from: https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/specialist-homelessness-services
Australian Institute of Health and Welfare. (2018). Australia’s Health. Retrieved 16/8/18, from https://www.aihw.gov.au/getmedia/7c42913d-295f-4bc9-9c24-4e44eff4a04a/aihw-aus-221.pdf.aspx?inline=true
Community Mental Health Australia. (2018). Goals and Objectives. Retrieved 19/8/18, from: https://cmha.org.au/about-us/goals-and-objectives/
Everymind. (2014). Mental Illness in the Media. Retrieved 19/8/18, from: http://www.mindframe-media.info/for-media/reporting-mental-illness/evidence-and-research/evidence-about-mental-illness-in-the-media
Goldsmith, A., Diette, T. (2012). Exploring the link between unemployment and mental health outcomes. Retrieved 18/8/2018, from: http://www.apa.org/pi/ses/resources/indicator/2012/04/unemployment.aspx
Harvey, S., Deady, M., Wang, M., Mykletun, A., Butterworth, P., Christensen, H., & Mitchell, P. (2017). Is the prevalence of mental illness increasing in Australia? Evidence from national health surveys and administrative data, 2001-2014. The Medical Journal Of Australia, 206(11), 490-493. doi: 10.5694/mja16.00295
Headspace. (2018). Who we are. Retrieved 19/8/18, from: https://headspace.org.au/about-us/who-we-are/
Mental Health Australia. (2018). About Us. Retrieved 17/8/18, from: https://mhaustralia.org/about-us
Mental Health Australia. (2017). About. Retrieved 16/8/18, from: https://1010.org.au/about/#
Mental Health Australia. (2015). Discussion paper: Options for commissioning and funding of mental health services. Retrieved 19/8/18, from: https://mhaustralia.org/sites/default/files/docs/discussion_paper_-_options_for_commissioning_and_funding_of_mental_health_services_may_2015.pdf
Mission Australia. (2017). Youth Mental Health Report 2012-2016. Retrieved 18/8/18, from: https://blackdoginstitute.org.au/docs/default-source/research/evidence-and-policy-section/2017-youth-mental-health-report_mission-australia-and-black-dog-institute.pdf?sfvrsn=6
National Institute of Health. (2013). Common Genetic Factors Found in 5 Mental Disorders. Retrieved 16/8/18, from: https://www.nih.gov/news-events/nih-research-matters/common-genetic-factors-found-5-mental-disorders
National Mental Health Commission. (2017). 2017-18 Federal Budget: Mental Health Proves to be a Priority. Retrieved 18/8/18, from: http://www.mentalhealthcommission.gov.au/media-centre/news/2017-18-federal-budget-mental-health-proves-to-be-a-priority.aspx
National Regional Health Alliance. (2017). Mental Health in Rural and Remote Australia. Retrieved 18/8/18, from: http://ruralhealth.org.au/sites/default/files/publications/nrha-mental-health-factsheet-dec-2017.pdf
Petersen, I., Baillie, K., & Bhana, A. (2012). Understanding the benefits and challenges of community engagement in the development of community mental health services for common mental disorders: Lessons from a case study in a rural South African subdistrict site. Transcultural Psychiatry, 49(3-4), 418-437. doi: 10.1177/1363461512448375
Rural Health. (2011). The determinants of health in rural and remote Australia. Retrieved 18/8/18, from: http://ruralhealth.org.au/sites/default/files/publications/factsheet-determinants-health-rural-australia.pdf
Welch, V., Petkovic, J., Pardo Pardo, J., Rader, T., & Tugwell, P. (2016). Interactive social media interventions to promote health equity: an overview of reviews. Health Promotion And Chronic Disease Prevention In Canada, 36(4), 63-75. doi: 10.24095/hpcdp.36.4.01
University of Sydney. (2018). Mental Health and Wellbeing. Retrieved 18/8/18, from: http://sydney.edu.au/medicine/aghealth/projects/health/mentalhealth/index.php