MHCC ACT Sector Development Forum Australia’s mental health initiatives David Crosbie May 2010

1. MHCC ACT Sector Development Forum Australia’s mental health initiatives David Crosbie May 2010

2. Context and meaning

3. Mental health problems Mental health problems and mental illness refer to the range of cognitive, emotional and behavioural disorders that interfere with the lives and productivity of people” National Mental Health Plan 2003–2008 Australian Health Ministers, July 2003

4. Key Disorders Typical Example Prevalence Tier 3 Tier 2 Tier 1 3 TIERS OF MENTAL ILLNESS 37 yr old male who episodically hears voices. He also has severe depression and has attempted suicide several times. He is unemployed, lives in public housing and is alienated from friends and family. • 3-400,00 cases • Psychotic Disorder • Bipolar Disorder • Severe Depression • Severe Anxiety • Severe Eating Disorder < 3% (Severe Disability) • 4-700,000 cases • Moderate Depression • Moderate Anxiety Disorder • Personality Disorders • Substance-Related Disorder • Eating Disorders • Adjustment Disorder 27 yr old male with chaotic behaviour and complex problems. He is suicidal, uses drugs heavily, and experiences panic attacks. Gets into fights and was arrested for assault 4 weeks ago. He can not hold onto a job and is currently unemployed. 4% (Moderate Disability) • Approx 2m cases/year • Mild Depressive Disorder • Mild Anxiety Disorder 42 yr old female who feels down, tearful, irritable and has withdrawn from friends over the past 4-6 months. She takes many sick days because she feels down. 12% (Mild Disability) Source: Boston Consulting Group, 2006

5. Burden of disease – top 10 Years of life lost (YLL) Years of lost to disability (YLD) Source: Source: AIHW, The Burden of Disease and Injury in Australia 2003 Figure 7: Burden of disease for top 10 disease groups in Australia: 2003

6. 39% 18 Other Diseases(1) 9% Cardio- Vascular 9% Chronic Respiratory 16% Nervous System 27% Mental Disorders THE LARGEST SINGLE CAUSE OF DISABILITY • For example, includes diabetes, oral health, skin diseases, unintentional injuries, musculoskeletal diseases • Note: Years lived with disability is a measure of disability burden • Source: AIHW, Burden of disease (2001) Total YLDS(%) Mental health is largest single contributor to disability burden, especially among youth and the prime working age population (0 - 14) (15 - 24) (65+) (25 - 44) (45 - 65) Source: Boston Consulting Group, 2006

7. Male and Female Prevalence / age Per cent of disorders Source: ABS 4326.0, Mental Health and Wellbeing: Profile of Adults, Australia Figure 4: NSMHWB: Prevalence of disorders by age by gender

8. Approx 4% of hospital presentations Approx 12% of hospital bed days Approx 3 million hospital bed days for people with mental illness as primary presentation Approximately 3 million hospital bed days for people with co-existing mental health problems (approx 4 times longer stays for cancer, diabetes, stroke, coronary heart disease) Health system - hospitals

9. Approx 11% of all consultations Depression the 4th most common GP problem with 80% patient repeat rate Approx 20% of all prescriptions (20 million per year) - antidepressants, antipsychotics, anti-anxiety Over 1,5 million GP mental health plans in last 3 years Health system - GPs

10. Mental health accounts for 36% of all health costs for people aged 15 – 44 Indirect costs are almost certainly equal or higher than direct costs - e.g. co-morbidity 93% of mental health burden is disability (not premature mortality) Mental health accounts for 24% of the total burden of disability for all diseases Overall health system impact

11. operating in blind service systems • Output based funding • Little attempt to review need and service use • Funding not tied to even the most basic of outcome indicators • No real support for agency based research or follow-up • Limited support for broader need and outcome indicators

14. Summary Nov 2006 – MArch 2009

15. GP Mental health plan by age/gender

16. MBS Take-up – 4 items – quarterly average

17. 3 year Uptake of new MBS items

18. The Better Access program is being evaluated and this will reveal more information Increase in access has been less than anticipated in the early stages – 1997 compared to 2007 access figures suggest little or no change Consumers and professionals using these items indicate they support the new services Access has largely matched professional group distribution Groups outside traditional primary care not well represented Initial outcomes

19. The Rudd Government increased the budget initially allocated for the Program from $538m for the period 2006-11 to $753m in the 2008-09 Federal Budget. The actual figure will be closer to $2 billion In the 2009-10 budget the government sought to slow down the program by introducing a new requirement for GPs to have met training requirements to be eligible to receive the full rebate for item 2710 Government responses to rapid uptake

20. The 2010 Budget - Social Workers and Occupational Therapists removed from the Better Access Program - argued collaborative care being better than fee for service – the savings (roughly $60 million) redirected into increased funding for Access to Allied Psychological Services program This measure has now been put on hold until at least April 2011 Government responses to rapid uptake

21. No. of psychiatric inpatient beds

22. No of mental health beds 1993 - 2005

23. No of community MH beds per 100,000

24. The failure to provide adequate care in the community puts pressure on our hospital services. Australia’s hospitalisation rate is higher than many comparable countries. (pg.14) ... many patients – particularly those with chronic and complex conditions and those who are most disadvantaged – end up in hospital when they could have received better care in the community. (pg. 13) A national health and hospitals network

25. Increased funding for Headspace ($20 million per annum) Increased funding for early psychosis intervention ($7 million per annum) Increased support for ATAPS ($15 million) Increased funding for mental health nurses ($7 million next 2 years Subacute and primary care initiatives that have some potential to increase mental health services 2010 Federal Budget INitiatives

26. PBS $750 million per annum MBS Better Access $500 PHAMS $60m Respite $50mm Training places / workforce dev. $50m Keeping people in work / education $20 Suicide prevention $15m Phone /web counselling $15m Federal government commitments

27. “.. We also face a serious problem of rising mental illness in our community. Some 65% of people who need mental health care go untreated. .. A lack of early identification and intervention, forces people suffering from acute mental illness to turn to hospitals ... as their first and only option for help.” ...“Why is it that mental health problems are so often picked up by our Police and AOD workers, not our health services? .... This is the problem today, but it will become a greater problem in the future ...” December 2009 guess who?

28. There were over half a million psychiatric presentations at public and private hospital emergency departments in 2006/07 that were turned away without admission Hospitals simply do not have community placements to discharge people to. Over 40% of people in acute hospital mental health beds would not be there if a community bed was available. The average hospital stay is 9 days, but many patients will be re-admitted within 4 weeks Crisis and mental health

29. Despite the obvious need for community residential mental health treatment options, in the last 15 years state and territory governments have halved the number of community beds available The lack of community-based options has ensured mental health treatment becomes a series of intensive crisis-driven episodes in acute settings followed by periods of limited or no care, relying on consumers and carers to make their own way through disconnected service systems the community option

30. Although people engaged in their GP primary care services are receiving better services, mental health remains largely crisis driven Hospital emergency departments and other systems are failing to respond adequately to mental health issues We need a new model of community mental health care that incorporates what consumers and carers need with direct linkages to clinical health services conclusion