NACCHO Aboriginal #MentalHealth #SuicidePrevention : New @ozprodcom report says Aboriginal and Torres Strait Islanders are twice as likely as non-indigenous people to be hospitalised because of mental illness, and twice as likely to die by suicide.

 ” The report says Aboriginal and Torres Strait Islanders are twice as likely as non-indigenous people to be hospitalised because of mental illness, and twice as likely to die by suicide.

For those up to 24 years of age, the suicide rate is 14 times higher for Aborigines and Torres Strait Islanders.

And services are far from uniform across the nation, with ­people in capital cities nearly twice as likely to access mental health services as those in ­remote areas.

It recommended services tailored to meet the needs of “particular groups”,  including First Nations people.

Aboriginal health practitioner play an important role in providing culturally capable care to Aboriginal and Torres Strait Islander people,”

The Productivity Commission, in a forensic examination of mental illness, finds it is costing the ­nation about $500m a day and recommends sweeping policy changes in the health system, workplaces, housing and the ­justice system. see Key findings below 

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Download NACCHO’s submission to this report

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Read over 230 Aboriginal Mental Health articles published by NACCHO over past 7 years 

Read over 150 Aboriginal Health and Suicide articles published by NACCHO over past 7 years

Today’s news coverage

From todays The Australian

One million Australians with mental health conditions ranging from anxiety and depression to psychosis and borderline personality disorders are going untreated each year, while the economic cost of mental illness has hit $180bn.

The Productivity Commission, in a forensic examination of mental illness, finds it is costing the ­nation about $500m a day and recommends sweeping policy changes in the health system, workplaces, housing and the ­justice system.

Calling for “generational changes’’ to address a problem that is getting worse despite increasing expenditure in the area, the report, to be released on Thursday, estimates there are 3.9 million people with mental illness, but only 2.9 million are ­accessing support and services.

One in eight visits to the GP is related to mental health issues, and mental health presentations at emergency departments have risen by about 70 per cent over the past 15 years.

The system is not adequately helping many people seeking treatment, the report finds, with one million having symptoms too complex to be adequately treated by a GP and limited government-funded sessions available with mental health providers.

But their condition does not reach the threshold to access state-­funded specialised services, private psychiatrists or private hospitals because of long waiting lists or high out-of-pocket costs.

The report finds many people still avoid treatment because of stigma and, with 75 per cent of people with a mental health issue first experiencing symptoms before the age of 25, calls for a greater focus on early ­intervention.

Social and emotional development checks of Australia’s 1.25 million children aged up to three years are among 25 detailed recommendations.

Productivity Commission chairman Michael Brennan said dealing with mental illness was “one of the biggest policy challenges confronting Australia”.

“Mental ill health has huge impacts on people, communities and our economy, but mental health is treated as an add-on to the physical health system — this has to change,” Mr Brennan said.

He highlighted the need for a greater emphasis on early intervention. “Seventy-five per cent of those who develop mental illness first experience symptoms before they turn 25,” he said.

“Mental ill health in critical schooling and employment years has long-lasting effects for not only your job prospects but many aspects of your life.”

Workplace, housing and education reforms to support people with mental illness are also proposed. “Mental illness is the second largest contributor to years lived in ill health,” the report finds.

“Compared to other developed countries, the prevalence of mental illness in Australia is above the OECD average.’’

The report marks the first time mental health has been examined beyond its clinical context into policy areas such as education, housing, justice and the workplace.

The report, a draft inviting public submissions, notes that one in two Australians will be affected by issues such as anxiety and ­depression during their lifetime.

“The cost to the Australian economy of mental ill health and suicide is, conservatively, in the order of $43bn-$51bn a year. ­Additional to this is an approximately $130bn a year cost associated with diminished health and reduced life expectancy for those living with mental ill health.”

The direct costs are broken down into healthcare support and services ($18bn a year), lower economic participation and lost productivity ($10bn-$18bn) and informal care provided by friends and family ($15bn).

Broader social effects such as the cost of stigma or lower social participation aren’t quantified.

The report notes that while costs have risen, “there has been no clear indication that the ­mental health of the population has improved”.

“Community awareness about mental illness has come a long way, but the mental health system has not kept pace with needs and expectations of how the wellbeing and productive capacity of people should be supported,” the commission says.

“The treatment of, and support for, people with mental illness has been tacked on to a system that has been largely ­designed around the characteristics of physical illness.

“And while service levels have increased in some areas, progress has been patchy. The right services are not available when ­needed, leading to wasted health resources and missed opportunities to improve lives.”

The report says Aborigines and Torres Strait Islanders are twice as likely as non-indigenous people to be hospitalised because of mental illness, and twice as likely to die by suicide.

For those up to 24 years of age, the suicide rate is 14 times higher for Aborigines and Torres Strait Islanders.

And services are far from uniform across the nation, with ­people in capital cities nearly twice as likely to access mental health services as those in ­remote areas.

The commission also calls out: thin services in the regions; too clinical an approach to mental health concerns; stigma and discrimination leading to a reluctance to seek support; and a lack of clarity between the tiers of government about roles, responsibilities and funding of services.

Among its recommended reforms, it calls for greater specialist mental health services to be ­delivered outside acute, expensive, hospital settings.

It also calls for greater investment in “long-term housing solutions for those with severe mental illness who lack stable housing”. “Stable housing for this group would not only improve their mental health and inclusion within the community, but reduce their future need for higher cost mental health in­patient services,” it says.

Workplace reform is also ­proposed.

The commission invites written submissions by January 23 in response to its draft report, and a final report will be provided to the government in May.

 

 

Australia’s mental health: a generational shift is needed

·     In any year, approximately one in five Australians experiences mental ill-health. While most people manage their health themselves, many who do seek treatment are not receiving the level of care necessary. As a result, too many people suffer additional preventable physical and mental distress, relationship breakdown, stigma, and loss of life satisfaction and opportunities.

·     The treatment of mental illness has been tacked on to a health system that has been largely designed around the characteristics of physical illness. But in contrast to many physical health conditions

–        mental illness tends to first emerge in younger people (75% of those who develop mental illness, first experience mental ill-health before the age of 25 years) raising the importance of identifying risk factors and treating illness early where possible.

–        there is less awareness of what constitutes mental ill-health, the types of help available or who can assist. This creates need for not only clear gateways into mental healthcare, but effective ways to find out about and navigate the range of services available to people.

–        the importance of non-health services and organisations in both preventing mental illness from developing and in facilitating a person’s recovery are magnified, with key roles evident for — and a need for coordination between — psychosocial supports, housing services, the justice system, workplaces and social security.

–        adjustments made to facilitate people’s active participation in the community, education and workplaces have, for the most part, lagged adjustments made for physical illnesses, with a need for more definitive guidance on what adjustments are necessary and what interventions are effective.

·     The cost to the Australian economy of mental ill-health and suicide is, conservatively, in the order of $43 to $51 billion per year. Additional to this is an approximately $130 billion cost associated with diminished health and reduced life expectancy for those living with mental ill-health.

A path for maintainable long term reform

·     Changes recommended are substantial but they would set Australia on a path for maintainable long term reform of its mental health system. Priority reforms are identified and a staged reform agenda is proposed.

Reform area 1: prevention and early intervention for mental illness and suicide attempts

·     Consistent screening of social and emotional development should be included in existing early childhood physical development checks to enable early intervention.

·     Much is already expected of schools in supporting children’s social and emotional wellbeing, and they should be adequately equipped for this task through: inclusion of training on child social and emotional development in professional requirements for all teachers; proactive outreach services for students disengaged with school because of mental illness; and provision in all schools of an additional senior teacher dedicated to the mental health and wellbeing of students and maintaining links to mental health support services in the local community.

·     There is no single measure that would prevent suicides but reducing known risks (for example, through follow-up of people after a suicide attempt) and becoming more systematic in prevention activity are ways forward.

Reform area 2: close critical gaps in healthcare services

·     The availability and delivery of healthcare should be reformed to allow timely access by people with mental ill-health to the right treatment for their condition. Governments should work together to ensure ongoing funded provision of:

 

–     services for people experiencing a mental health crisis that operate for extended hours and which, subject to the individual’s needs and circumstances, provide an alternative to hospital emergency departments

–     acute inpatient beds and specialised community mental health bed-based care sufficient to meet assessed regional needs

–     access to moderate intensity care, face-to-face and through videoconference, for a duration commensurate with effective treatment for the mental illness

–     expanded low intensity clinician-supported on-line treatment and self-help resources, ensuring this is consistently available when people need it, regardless of the time of day, their locality, or the locality choices of providers.

Reform area 3: investment in services beyond health

·     Investment is needed across Australia in long-term housing solutions for those people with severe mental illness who lack stable housing. Stable housing for this group would not only improve their mental health and inclusion within the community, but reduce their future need for higher cost mental health inpatient services.

Reform area 4: assistance for people with mental illness to get into work and enable early treatment of work-related mental illness

·     Individual placement and support programs that reconnect people with mental illness into workplaces should be progressively rolled out, subject to periodic evaluation and ongoing monitoring, to improve workforce participation and reduce future reliance on income support.

·     Mental health should be explicitly included in workplace health and safety, with codes of practice for employers developed and implemented.

·     No-liability clinical treatment should be provided for mental health related workers compensation claims until the injured worker returns to work or up to six months.

Reform area 5: fundamental reform to care coordination, governance and funding arrangements

·     Care pathways for people using the mental health system need to be clear and seamless with: single care plans for people receiving care from multiple providers; care coordination services for people with the most complex needs; and online navigation platforms for mental health referral pathways that extend beyond the health sector.

·     Reforms to the governance arrangements that underpin Australia’s mental health system are essential to inject genuine accountability, clarify responsibilities and ensure consumers and carers participate fully in the design of policies and programs that affect their lives.

–      Australian Government and State/Territory Government funding for mental health should be identified and pooled to both improve care continuity and create incentives for more efficient and effective use of taxpayer money. The preferred option is a fundamental rebuild of mental health funding arrangements with new States and Territory Regional Commissioning Authorities given responsibility for the pooled resources.

–      The National Mental Health Commission (NMHC) should be afforded statutory authority status to support it in evaluating significant mental health and suicide prevention programs. The NMHC should be tasked with annual monitoring and reporting on whole-of-government implementation of a new National Mental Health Strategy.

–      These changes should be underpinned by a new intergovernmental National Mental Health and Suicide Prevention Agreement.

 

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