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MHCC ACT Sector Development Forum Australia’s mental health initiatives David Crosbie May 2010. Context and meaning. 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
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Australia’s mental health initiatives
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
Tier 13 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.
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.
42 yr old female who feels down, tearful, irritable and has withdrawn from friends over the past 4-6 months.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.
Source: Boston Consulting Group, 2006
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
18 Other Diseases(1)
Mental DisordersTHE LARGEST SINGLE CAUSE OF DISABILITY
Mental health is largest single contributor to disability burden, especially among youth and the prime working age population
(0 - 14)
(15 - 24)
(25 - 44)
(45 - 65)
Source: Boston Consulting Group, 2006
Per cent of
Source: ABS 4326.0, Mental Health and Wellbeing: Profile of Adults, Australia
Figure 4: NSMHWB: Prevalence of disorders by age by gender
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
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 diseasesOverall health system impact
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 representedInitial outcomes
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 2710Government responses to rapid uptake
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 2011Government responses to rapid uptake
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
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 services2010 Federal Budget INitiatives
“.. 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 2009guess who?
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 weeksCrisis and mental health
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 systemsthe community option
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 servicesconclusion