The foremost recommendation from a new report focused on mental health problems in young men is: “Efforts should be made by all sectors of the community to support the engagement of young men to achieve higher levels of education.”
The second recommendation is: “Efforts should be made by all sectors of the community to support young men with mental illness to engage in more productive employment.”
And the third recommendation: “Efforts should be made by all sectors of the community to evaluate the effectiveness of current policy responses and investments in mental health.”
In the article below, mental health policy analyst Sebastian Rosenberg concludes that the mental health policy landscape looks “as piecemeal and chaotic as it has ever been”.
Counting the Cost of Mental Illness in Men
Sebastian Rosenberg writes:
This week the Inspire Foundation with Ernst and Young released a report Counting the Cost: The Impact of Young Men’s Mental Health on the Australian Economy (find it here).
The headlines are predictably grim:
- More than one in four young people report suffering depression (26.5%);
- Mental illness in young men (12-25yrs) is estimated to cost the Australian economy $3.27bn annually and account for 9 million lost work days;
- Young men with mental illness have much lower rates of educational attainment; and
- Mental illness in young men leads to lifelong disabilities and problems.
We already know thanks to the 2007 ABS Survey into Mental Health and Wellbeing that only 13% of young men received any care at all for their mental illness.
While the report focuses on young men, it brings to light the more general issue of how well Australia’s mental health system caters for all men.
Suicide now ranks as the leading cause of death for adult men up to the age of 44 years (ABS, Causes of Death, 2009). Men in Australia are four times more likely to die by suicide than women.
Perhaps the most recent high profile mental health initiative has been the introduction of the Better Access scheme, providing Medicare-subsidised mental health care plans and visits to psychologists.
The table below analyses the three most prolific of these MBS services over the first five years of the scheme by rate of access by gender.
According to the most recent Medicare data (April 2012), the Better Access scheme is now costing taxpayers more than $10m per week. The two-thirds/one-third split in favour of women over men in the scheme is further accentuated if you narrow the scope to services provided only to people aged between 15 and 34 years.
In a nutshell, in the crazed patchwork of services we call Australia’s mental health system, we have palpably failed to design services men want to come to, particularly young men.
As with so much in mental health, research into the reasons why they don’t come is not as robust as it should be. For people with a mental illness who did not use services, the 2007 ABS survey did ask some questions about what kind of assistance would be useful but the overwhelming response was that people did not want extra information, medication, counselling, social intervention or skills training.
For some men, the perception of mental health conditions such as depression and anxiety as weaknesses as opposed to illnesses can act as a barrier to seeking help. Men are also supposed to be self-reliant. There is probably still a lack of information that treatment can be effective.
The clear issue is that there remains a critical lack of understanding about what an effective male mental health service looks like. For young men in particular, research has indicated (Rickwood et al 2005) that outreach type services may be important – to make it as easy as possible for young men to access care by taking professional services to them. This is in contrast to current service settings (such as in Better Access) which rely on the person coming to the provider.
There is a lot more we need to understand so that we can design mental health services attractive to men, especially young men. The Federal Government’s commitment to replicate Professor Pat McGorry’s Orygen model nationally is noteworthy.
Whether this occurs with fidelity to the evidence-based service model deserves close scrutiny as these services start up. It would also be timely to review the Government’s support for the Headspace program to ensure it is able to provide the kind of genuine, one-stop multidisciplinary service that was originally envisaged.
Against this backdrop is the most recent health budget which showed that Commonwealth outlays on health have now reached $61bn, or a 37% increase on 2007-08 levels. Though last year’s funding for mental health was welcome, this year there is practically nothing. Meanwhile the rate of increase to the overall health budget continues largely unabated. Mental health’s share of the overall health budget is in decline.
More generally, the mental health policy landscape is quite confusing. The Coalition’s recent commitment not to proceed with Medicare Locals if elected raises new questions about the future of community mental health care.
Over $1bn was promised in 2010 for sub-acute care, with some of that directed towards mental health. How this has been spent is unclear. Half a billion dollars was directed in the 2011 Budget by the Federal Government towards Partners in Recovery – a program apparently designed to provide individualised packages of care to people with severe mental illnesses but which has not yet started.
The Better Access scheme continues, including the Greens amendment which ensures ongoing access to care for people with severe and persistent mental illnesses who were never meant to use this program in the first place.
Activity Based Funding is due to be introduced to mental health from 1 July 2013, with some danger this will reinforce the hospital-centric nature of our mental health system.
A National Disability Insurance Scheme is underway promising to cover at least some people with a mental illness though definitions are still being determined. CoAG has chosen not to continue its 2006-11 National Action Plan in mental health ($5.5bn) but has instead agreed to a much smaller partnership agreement ($200m over five years).
Across Australia’s nine jurisdictions, four have now chosen to establish mental health commissions (Federal Govt, NSW, WA and Qld) and each will have its own roadmap, strategic plan or blueprint.
The policy landscape looks as piecemeal and chaotic as it has ever been. It is not possible from this miasma to discern a model of care. What is it exactly we expect a young man with depression to do? Or a young woman with an eating disorder?
Inspire’s Counting the Cost report serves to remind us of the suffering such chaos generates.
• Sebastian Rosenberg is Senior Lecturer at the Brain and Mind Research Institute, University of Sydney
• This article was first published in the Crikey bulletin
• More reading on the report is at The Conversation