Introduction by Croakey: A Lancet Psychiatry Commission on youth mental health published today highlights an alarming global trend in declining mental health of young adults, with global “megatrends” driving the decline.
Lead author Professor Patrick McGorry told the ABC it is “clear governments were failing young people”.
The latest data on mental health by the Australian Institute of Health and Welfare shows that while the prevalence of mental illness remained broadly similar between 2007 and 2020-22 for people aged 25–85 years, there was increased prevalence among young adults aged 16-24 years.
In 2007, 26 percent of those aged 16–24 years had a mental illness, which increased to 39 percent in 2020–2022.
Ahead of a meeting of Health and Mental Health Ministers this Friday, 80 mental health organisations are calling for Federal, State and Territory governments to work together for “serious action” on mental health reform.
As a priority, the organisations are asking for governments to immediately release the analysis of unmet need for psychosocial support outside the National Disability Insurance Scheme (NDIS), commit to ongoing twice-yearly mental health minister meetings to discuss sector and reform priorities, and commit to a national accord to co-fund a system of supports bridging primary and acute care.
They recommend that the national accord be human-rights based, person-centred, co-produced with people with lived experience, culturally safe, funded through the next National Health Reform Agreement (NHRA), integrated and complementary to the NDIS, and supported by appropriate data.
Below, Carolyn Nikoloski, CEO of Mental Health Australia, the national peak advocacy body for the mental health sector and one of the co-signatories of the Statement of Priorities, discusses the four key priorities, emphasising the “crucial opportunity” this week’s meeting is for people needing mental health support.
Carolyn Nikoloski writes:
Mental Health Australia has been joined by 80 mental health organisations nationwide calling for Health and Mental Health Ministers to take decisive, collective action at their meeting this Friday, 16 August.
This is the first national Health and Mental Health Ministers meeting in years and is a crucial opportunity ahead of the upcoming state and federal elections to agree on bold reform that will make real change for people needing mental health support in Australia.
In a joint Statement of Priorities released on Monday, the mental health sector has outlined immediate actions for governments to implement that will improve access to mental health supports.
Urgent national health issue
New analysis shows that mental health conditions and substance use disorders are now the leading cause of poor health in Australia (26 percent of non-fatal burden of disease in 2023), and the rate of young people experiencing mental health conditions has increased by an alarming 50 percent over recent years.
There is a huge gap in mental health supports in the community, including at least 154,000 people missing out on the psychosocial supports they need.
This gap puts pressure on primary and acute care, where mental health issues are now the most common health issue managed by GPs. People presenting to Emergency Departments with mental health needs routinely wait longer and experience longer treatment periods than people with other urgent health challenges.
This is a national issue that requires national solutions. While the Australian Government is focused on primary healthcare, and state and territory governments on delivering acute mental healthcare, both have a stake in the piece missing in the middle – and collective action is needed to address it.
Collective action
There is an ongoing gap between primary care and acute and emergency services, and fragmentation between services, jurisdictions and portfolios that makes mental health support very difficult to access and navigate.
In the National Mental Health and Suicide Prevention Agreement, the Australian, state and territory governments affirmed their “shared responsibility to address existing gaps over time in the funding and delivery of new and additional community-based mental health services to support equitable access to treatment, care and support”.
Collectively, we are calling on governments to commit to a new national accord to co-fund a system of supports bridging primary and acute care. This system should be co-produced with people who know what is needed – people with lived experience of mental ill-health and their family, carers and supporters, along with the broader mental health sector.
It is time for a new collaborative approach to mental health that provides better outcomes for people with mental ill-health and more efficient use of resources.
Key priorities
Complementary to a new national accord, our Statement of Priorities outlines actions across other priority areas that require intergovernmental collaboration.
Psychosocial services are an essential component of the mental health system between primary and acute care, providing recovery supports for people in the community. Both the Australian and state and territory governments fund some psychosocial services; however, a 2020 inquiry found that at least 154,000 people are missing out on the psychosocial supports they need.
Governments have collectively undertaken a further analysis of this level of unmet need for psychosocial supports outside the National Disability Insurance Scheme (NDIS).
Mental Health Australia understands this analysis is now complete and under consideration by governments. We’re calling for an immediate public release of this crucial part of the puzzle, and commitment from governments to co-fund services to fully address the unmet need for psychosocial supports outside the NDIS.
There are also significant gaps in prevention and support for infants, children and young people experiencing mental ill-health. Governments have already developed a National Children’s Mental Health and Wellbeing Strategy.
We’re calling on governments together to fund the full implementation of this Strategy and to commit to further sustainable funding for youth mental health services.
Delivering these priorities relies on growing the mental health workforce. There is already a 32 percent shortfall across the mental health workforce, anticipated to grow to 42 percent by 2030 without action.
Again, governments have already developed a strategy: the National Mental Health Workforce Strategy outlines actions needed by the Australian and state and territory governments together with training providers, professional bodies and service providers to attract, train and retain the mental health workforce.
Governments must now fund the full implementation of this Strategy. We recommend starting with year-by-year targets for increasing access to training through increased subsidies, placements and traineeships.
This must also include the community-managed mental health and lived experience peer workforces, which are not adequately featured in the Strategy due to lack of data.
The road ahead
While this sounds like a significant further investment, governments currently spend only seven percent of total health expenditure on mental health (down from eight percent in 2019-20). This is a very low baseline compared against the impact of mental ill-health.
For too long successive governments have not invested enough in preventing mental health conditions from developing in the first place, and ensuring that we have a high-quality, effective, accessible mental health system.
It means that we haven’t been able to fundamentally change the trajectory of mental health in Australia or achieve the benefits of this investment – including increased economic participation and improved quality of life.
The challenge governments are facing in responding to mental health need is huge, but the passion and expertise in the mental health sector is equal to the challenge.
The mental health sector stands ready and willing to work with governments, if governments are only willing to work with each other first.
More on The Lancet Commission
See Croakey’s archive of articles on mental health
