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 productivity of people”

National Mental Health Plan 2003 –2008

Australian Health Ministers, July 2003

Tier 3 Tier 2 Tier 1

3 TIERS OF MENTAL ILLNESS

Prevalence < 3% (Severe Disability) 4% (Moderate Disability) 12% (Mild Disability) Key Disorders Typical Example

• • • • • •

3-400,00 cases Psychotic Disorder Bipolar Disorder Severe Depression Severe Anxiety Severe Eating Disorder 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.

• • • • •

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.

•

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Mild Anxiety Disorder 42 yr old female who feels down, tearful, irritable and has withdrawn from friends over the past 4-6 months.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.

Source: Boston Consulting Group, 2006

BURDEN OF DISEASE – TOP 10

Cancers 1 Cardiovascular disease Mental illness Nervous system Chronic respiratory Injuries 2 Diabetes Musculoskeletal Genitourinary Years of life lost (YLL) Years of lost to disability (YLD) Digestive system 0 100,000 200,000

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 300,000 400,000 500,000 Burden of disease (DALYs 3 )

THE LARGEST SINGLE CAUSE OF DISABILITY (1) Note: For example, includes diabetes, oral health, skin diseases, unintentional injuries, musculoskeletal diseases Years lived with disability is a measure of disability burden Source: AIHW, Burden of disease (2001)

18 Other Diseases (1) Cardio Vascular Chronic Respiratory Nervous System Mental Disorders Total YLDS (%) 39% 9% 9% 16% 27% 23% Mental health is largest single contributor to disability burden, especially among youth and the prime working age population Children (0 - 14) 70% Youth (15 - 24) 45% 16% Prime Working Age (25 - 44) Other Working Age (45 - 65) 2% Aged (65+)

Source: Boston Consulting Group, 2006

30 25 20 15 10 5 0

MALE AND FEMALE PREVALENCE / AGE

Per cent of disorders

Males Females

18-24 25-34 35-44 Age (years) 45-54

Source: ABS 4326.0, Mental Health and Wellbeing: Profile of Adults, Australia

Figure 4: NSMHWB: Prevalence of disorders by age by gender 55-64 65 and over

HEALTH SYSTEM - HOSPITALS

 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 - GPS

 Approx 11% of all consultations  Depression the 4 th 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

OVERALL HEALTH SYSTEM IMPACT

 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

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

SUMMARY NOV 2006 – MARCH 2009

Item No Descriptor

2710 Preparation of Mental Health Care Plan by GP 2713 GP Mental Health consultation (20 minutes +) 80010 80110 Psychological assessment and therapy for a mental disorder by a clinical psychologist lasting at least 50 minutes (up to 12 planned sessions a year) Focused psychological strategies for an assessed mental disorder by a registered psychologist lasting at least 50 minutes (up to 12 planned sessions a year)

Occasions of Service

1,835,014 2,073,177 2,449,917 4,304,483

Benefit Paid

$ 283,465,071 $ 141,888,036 $ 287,352,949 $ 349,042,852

Total

10,662,591

$

1,061,748,909

GP MENTAL HEALTH PLAN BY AGE/GENDER

MBS TAKE-UP – 4 ITEMS – QUARTERLY AVERAGE

3 YEAR UPTAKE OF NEW MBS ITEMS

180 000 160 000 140 000 120 000 100 000 80 000 60 000 40 000 20 000 0 monthly average 1 2 year 3 2710 2713 80010 80110

INITIAL OUTCOMES

 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

GOVERNMENT RESPONSES TO RAPID UPTAKE  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  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

NO. OF PSYCHIATRIC INPATIENT BEDS

NO OF MENTAL HEALTH BEDS 1993 - 2005

NO OF COMMUNITY MH BEDS PER 100,000

A NATIONAL HEALTH AND HOSPITALS NETWORK  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)

2010 FEDERAL BUDGET INITIATIVES

 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

FEDERAL GOVERNMENT COMMITMENTS

 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

GUESS WHO?

“.. 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

CRISIS AND MENTAL HEALTH

 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

THE COMMUNITY OPTION

 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

CONCLUSION

 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