This week saw the release of the report Counting the Cost: The Impact of Young Men’s Mental Health on the Australian Economy by the Inspire Foundation with Ernst and Young. The headlines were predictably grim:
- More than one in four young people report suffering depression (26.5%).
- Mental illness in young men (12-25 years) is estimated to cost the Australian economy $3.27 billion annually and account for nine million lost work days.
- Young men with mental illness have much lower rates of educational attainment.
- Mental illness in young men leads to lifelong disabilities and problems.
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. 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.
Suicide now ranks as the leading cause of death for adult men up to the age of 44 years. 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 $10 million 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 15-34 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 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.
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 $61 billion, 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 $1 billion was promised in 2010 for sub-acute care, with some of that directed towards mental health. How this has been spent is unclear.
Around $0.5 billion 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 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.
The National Disability Insurance Scheme promises to cover at least some people with a mental illness, though definitions are still being determined. The Council of Australian Governments (CoAG) has chosen not to continue its 2006-11 National Action Plan in mental health ($5.5 billion) but has instead agreed to a much smaller partnership agreement ($200 million over five years). Across Australia’s nine jurisdictions, four have now chosen to establish mental health commissions (federal, NSW, WA and Queensland) 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.