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04 Jun 2019

Reference: “Mental health in Australia: a quick guide” Australian Parliamentary Library. 14 February 2019. Author: Lauren Cook, Social Policy Section.

https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1819/Quick_Guides/MentalHealth

The Australian Parliament routinely issues reports, guides and fact sheets. In February 2019 they issued a quick guide to Mental Health in Australia. This is a very useful snapshot of the current situation and a useful reference tool.

 

Introduction

According to the World Health Organization, mental health is ‘a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.’ When a person has a condition that affects their mental health, they may have a mental illness or mental health disorder. This includes conditions such as depression, anxiety, schizophrenia and bipolar disorder.

This quick guide provides an overview of mental health in Australia, including the prevalence of mental health conditions, the cost of mental illness, government responsibilities, and mental health services available in Australia.

 

Prevalence of mental health conditions

The Australian Bureau of Statistics (ABS) National Survey of Mental Health and Wellbeing (NSMHWB) provides the most comprehensive (albeit dated) estimates for mental disorders in Australian adults both over their lifetime and in the preceding 12 months. The survey estimated that 45% of Australians had experienced a mental disorder in their lifetime, with 20% experiencing a mental disorder in the previous year. Conducted in 2007, this was the second ABS mental health and wellbeing survey. The Department of Health has said that there are no plans to fund another survey on mental health by the ABS.

This is an indication of the prevalence and impact of mental health conditions in Australia:

  • The most recent ABS National Health Survey estimated there were 4.8 million Australians (20.%) with a mental or behavioural condition in 2017–18. This was an increase of 2.6% points from 2014–15, mainly due to an increase in the number of people reporting anxiety-related conditions, depression, or feelings of depression. While this is the most recent available data for mental health prevalence in Australia, it only provides data on people who currently identify as having mental or behavioural conditions, and does not provide data on lifetime prevalence or incidence of mental illness in the past year.
  • The Australian Child and Adolescent Survey of Mental Health and Wellbeing, conducted between June 2013 and April 2014 by the Department of Health, estimated that almost 14% of young people aged 4 to 17 years (or 560,000 people) experienced a mental disorder in the 12 months before the survey.
  • Poor mental health may also be associated with suicidality. According to the ABS, 3,128 people died in Australia from intentional self-harm in 2017, rising from 2,866 in 2016. While suicidality is not confined solely to people with poor mental health, the NSMHWB estimated that 94.2% of persons who attempted suicide in the previous 12 months had experienced a mental disorder in the same time period.
  • According to the Australian Institute of Health and Welfare’s (AIHW) Burden of Disease Study, in 2011 the Australian population lost a total of 542,554 years of healthy life as a result of mental and substance use disorders. This accounted for 12.1% of the total burden of disease, making mental and substance use abuse disorders the third highest cause of burden in Australia.

 

Cost of mental illness in Australia

Economic impact

A report commissioned by RANZCP estimated in 2014 that the cost of severe mental illness in Australia was $56.7 billion per year. This includes the direct economic costs of severe mental illness arising from the use of health and other services, as well as indirect costs due to lost productivity because people are unable to work.

Similarly, in December 2016, the National Mental Health Commission stated that the cost of mental ill-health in Australia each year was around $4,000 per person, or $60 billion in total.

The 2018 KPMG and Mental Health Australia report, Investing to Save, looked at how much mental ill-health in the workplace costs Australian employers. The report found that, mental ill-health in the workplace costs an average of $3,200 per employee with mental illness, and up to $5,600 for employees with severe mental illness. Overall, it was estimated that the cost of workplace mental ill-health in Australia was $12.8 billion in 2015–16.

 

Spending on mental health services

The Australian Institute of Health and Welfare (AIHW) estimates that spending on mental health-related services in Australia from all sources (government and non-government) was around $9.0 billion, or $373 per person, in 2015–16.

Of the $9.0 billion, $5.4 billion (59.8%) was funded by state and territory governments, $3.1 billion (35.0%) was funded by the Australian Government, and $466 million (5.2%) was funded by private health insurance funds.

In 2016–17, the Australian Government spent:

  • $1.2 billion on Medicare-subsidised mental health-specific services ($49 per person) and
  • $511 million on mental health-related subsidised prescriptions under the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS) ($21 per person).

Government responsibility for mental health services

Below is a broad outline of government responsibility for mental health services in Australia.

 

Australian Government

  • Medicare-subsidised mental health services provided by general practitioners (GPs), psychiatrists, and allied health professionals (for example, through the Better Access initiative)
  • subsidised mental health prescription medications under the PBS and Repatriation Pharmaceutical Benefits Scheme (RPBS)
  • veterans’ mental health services through the Department of Veterans’ Affairs
  • primary care quality and access through Primary Health Networks (PHNS), including funding the PHN Primary Mental Health Care Flexible Funding Pool and
  • social security payments; (Disability Support Pension).

 

State and territory governments

  • management and administration of public hospitals and
  • funding and management of community mental health services.

 

Shared responsibility

COAG has agreed to the Fifth National Mental Health and Suicide Prevention Plan, which established a national approach for collaborative government effort from 2017 to 2022.

 

Additional shared arrangements are usually detailed in national agreements, such as those agreed to by COAG, and include:

  • funding of public hospital services based on an agreed national activity-based funding (ABF) formula as outlined in the National Health Reform Agreement;
  • registration and accreditation of mental health professionals through the Australian Health Practitioner Regulation Agency (AHPRA);
  • the National Disability Insurance Scheme;
  • homelessness as outlined in the National Housing and Homelessness Agreement;
  • suicide prevention (a National Partnership Agreement is in development);
  • Mental health services; and
  • Medicare-subsidised services.

 

General practitioners

According to the Bettering the Evaluation and Care of Health (BEACH) survey of GPs, 12.4 per cent of GP encounters (or 17.7 million separate encounters) in 2015–16 involved the management of psychological problems, such as depression, anxiety and sleep disturbance. This is much higher than the 3.2 million GP mental health-specific Medicare Benefits Schedule (MBS) items (MBS Group A20) that were billed by GPs in 2015–16, indicating that GPs likely billed many of these encounters as general MBS items.

 

Psychiatrists

Under Medicare, rebates are available for consultations with psychiatrists. In 2017–18, there were 2.4 million MBS items billed by psychiatrists (MBS Group A8). According to the AIHW, psychiatrists provide the highest number of services per patient (in 2016–17, 6.2 services per patient) of all mental health-related services.

 

Allied health professionals

Under the Better Access initiative, Medicare rebates are available for up to ten individual and ten group allied health services per year to patients with a mental disorder who are referred by a GP, psychiatrist or paediatrician. The table below outlines the number of mental health-related services that were billed under Medicare by allied health professionals in 2017–18.

 

Specialised mental health care services

In addition to services subsidised under Medicare, there are a range of other specialised mental health care services in Australia. Specialised mental health care can be delivered in a range of facilities, including public and private psychiatric hospitals, psychiatric units or wards in public acute hospitals, community mental health care services, and residential mental health services. In 2015–16, there were 1,591 specialised mental health care facilities providing care:

  • Hospital emergency services: In 2016–17, there were 276,954 mental health-related presentations to hospital emergency departments.
  • Admitted hospital care: In 2016–17, there were 64,692 same day and 258,300 overnight episodes of admitted patient care.
  • Residential mental health care: mental health care can be provided in a domestic-like environment, and can include services such as rehabilitation, treatment or extended care. In 2016–17, there were 7,290 episodes of residential mental health care recorded for 5,476 residents.
  • Community mental health care services: treatment provided in the community and hospital-based outpatient care settings is known as community mental health care. In 2016–17, there were around 8.9 million community mental health care service contacts provided to approximately 420,000 patients.

Published: 04 Jun 2019