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A better way to invest in mental health

The recently released, Charter 2020: Time To Fix Mental Health, sets out nine guiding principles crucial to improving Australia’s mental health system. This document was coordinated by Mental Health Australia (MHA) and has been signed by over 100 organisations.

An overarching theme of Charter 2020 is the need to see mental health in a broad perspective, including taking a person-centred, social determinants of health approach and prioritising investments into prevention and well-being, including a focus on the social and emotional well-being of Aboriginal and Torres Strait Islander Australians.

MHA hopes that the Charter will be the lens through which governments view the findings of the Productivity Commission’s current inquiry into mental health. The release of the Charter is timely given that the Commission’s draft report is due to be released this Thursday.

Below, Carmel Tebbutt, chief executive officer at NSW Mental Health Co-ordinating Council, outlines the reasons why the approach set out in the Charter is so important in order to improve Australia’s mental health outcomes and provides evidence of the economic benefits of investing in community and social support for people with mental illnesses.


Carmel Tebbutt writes:

The Productivity Commission calls mental health, “a key driver of economic participation and productivity in Australia [with] the potential to impact incomes and living standards and social engagement and connectedness”.

Those words, introducing the Commission’s current inquiry into mental health, are an important reminder that services are not only about treating symptoms; the purpose of our mental health system is – or should be – to support people to achieve the elements of a good life: positive relationships, a home, meaningful work or other activity.

Too often, mental health conditions dislocate people from these things. Australia does relatively poorly in providing employment opportunities for people who experience mental health conditions, and that has severe consequences.

The OECD has reported that Australians with a severe mental health disorder are three times as likely as those with good mental health to live below the poverty line, a bigger gap than any of the other eight developed economies it considered.

People who have poor mental health are also more likely to be homeless or incarcerated, to experience family breakdown or have their children removed, and to miss out on physical health care.

Psychological therapies, medication, and – in times of crisis – hospital care delivered by expert clinical teams can all be extremely important in helping people manage their mental health.

But they are less effective in restoring what people who live with mental health issues usually value most: the ability to live a regular life and follow their personal aspirations like everyone else.

An unprecedented consensus

Among experts there is unprecedented consensus about the best ways forward. More than 100 signatories from across Australia – including community mental health organisations, psychiatrists, consumer leaders, public servants and academics – have endorsed Charter 2020: Time to Fix Mental Health.

The Charter sets out nine guiding principles for policy, system and practice change in the context of the Productivity Commission review. Running through these is a deeper theme: the connection between mental health and the circumstances of people’s lives.

The Charter calls for a system that honours people’s experiences of their own mental health and invests in better integration of services and a community-based workforce to help people before they reach crisis point, keeping them out of hospital whenever possible.

People who experience mental health challenges – especially if they are severe and ongoing – may need support with housing, transport, employment or education to better maintain their physical health and sustain and develop personal relationships.

Practical assistance, specially tailored for people’s mental health needs, can make a huge difference. The NSW Housing and Accommodation Support Initiative (HASI) helps more than 1000 people a year to live independently, assisting with shopping and budgeting, joining social activities, or whatever supports them to rebuild the sense of confidence and purpose that are often shattered by mental health challenges.

This intensive support – typically delivered by community organisations under contract to government – costs money, but participants are then much less likely to experience a mental health crisis for which they need emergency care or a hospital admission. That means, according to a University of NSW analysis, that HASI pays for itself in health system savings, even before the personal benefits of improved mental health are factored in.

Shifting the balance of funding towards community services

And yet, despite such successes, Australia remains under-invested in community supports. Statistics released this month by the Australian Institute of Health and Welfare show that of the $5.7 billion the states and territories spent on mental health in 2016-17, the majority – $2.8 billion – went to hospital treatment.

A continuing over-reliance on hospitals, where it costs more than $1000 per day to care for someone, means less funding is available to develop a complete range of community services – including programs provided by state governments and others delivered by the non-government community mental health sector.

This sector makes a unique contribution to supporting people in all domains of their lives. It is extremely diverse, comprising large well-known national charities, small grassroots service organisations, and supports for vulnerable demographics such as new parents and people who identify as LGBTQI. These characteristics promote flexibility and responsiveness to individual clients.

The professionals who work on the front-line of community mental health are committed, highly skilled and educated, including through the well-regarded Certificate IV in Mental Health as well as higher education qualifications. Their particular expertise in holding hope for and supporting people through dark times should be recognised alongside that of nurses, GPs, psychologists and psychiatrists.

More community mental health programs also need to be systematically measured and evaluated as HASI was, to demonstrate how support that clearly transforms people’s lives can also deliver a strong return in financial terms.

The Productivity Commission’s Interim Report

The Productivity Commission’s interim report, expected this week, will explore the value of good mental health as a public asset as well as a private benefit. It is a critical opportunity for lasting reform and, as the Charter 2020 shows, there is real agreement on the way forward. A new national agreement for mental health is essential.

It must prioritise integrated and coordinated mental health services and recognise that community support is just as essential as clinical services in helping people who living with mental health conditions to recover and reach their potential.

• Carmel Tebbutt is the chief executive officer at NSW Mental Health Co-ordinating Council. She was NSW Deputy Premier from 2008 to 2011 and NSW Minister for Health from 2009 to 2011.

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2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013