A way forward: equipping Australia's mental health system for the next generation

7 May 2015

By the numbers

  • 45% of all Australians will experience a mental health problem over the course of their lives; 1 in 5 will do so in any given year.
  • 75% of mental health problems first appear before the age of 25, yet more than 70% of young women and 80% of young men who need help and support don’t get it.
  • Poor mental health in young people costs Australia at least $6.29 billion per annum, including $1.3 billion in direct health costs and $1.2 billion in unemployment and disability payments.

If we continue to use only traditional service delivery approaches, a further $9 billion (in salaries alone) would be required over the next 15 years to double the number of people receiving help.

Despite intense effort and increased investment in mental health service delivery in Australia there continues to be significant unmet need for mental health services. Left untreated, mental health problems can worsen, leading to significant negative impacts on every aspect of a person’s life.

There are also substantial economic impacts, with the World Economic Forum forecasting that over the next two decades the global economic cost of mental illness will exceed that of cancer, diabetes and respiratory ailments combined.

More help must be made available to more people, more quickly

Australia’s National Mental Health Commission has recently completed a wide-ranging review of the country’s entire mental health system, examining the efficiency and effectiveness of existing programs and services.

Complicating the picture, however, is the fact that health expenditure in Australia is growing rapidly (rising by 74% in the last decade alone),2 with the recent Intergenerational Report showing that government has limited, and steadily reducing capacity to provide the level of investment required to fully meet Australia’s current and future health needs.

We need to undertake the long-term reform required to redesign and resource the mental health system while also providing more help, to more people, right now. We cannot afford to deny another generation access to mental health care and support.

The opportunity

As Australia undertakes the complex and long-term work required to reform and grow its mental health system we can take action now, with minimal investment to immediately improve the wellbeing of individuals and reduce the broader social costs associated with poor mental health.

First, we must embrace and promote scalable online interventions as the “first line of defence” in a system of mental health stepped care.

Based on our literature review and a range of online services, we know that doing so will:

  • significantly boost the overall capacity of the mental health system, so that more people get help
  • deliver this additional capacity at least five years sooner than it would take to build capacity in the health workforce, so that many more people can get help sooner
  • become less costly to deliver per person as more people take up the services, as opposed to face-to-face services which become more costly

Australia has been a world leader in the design, development, delivery and evaluation of e-mental health interventions; the task now is to fully realise their benefits.

To make the most of the potential of e-mental health, it is time to integrate online services into the broader mental health system, promote their use to health professionals and consumers and provide ongoing, sustainable funding.

Second, we must intervene early to prevent the development and progression of mental illness, especially among young people.

Evidence shows that a concerted prevention/early intervention effort in Australia can deliver significant benefits by preventing individuals from experiencing the effects of poor mental health, and avoiding financial costs to the individual, government and community.

Scenario testing outcome:

  • A school-based prevention program, delivered online, would represent a very cost-effective intervention approach by international standards.
  • An early intervention treatment program, delivered online, could help more than 78,000 young people recover from their depression and/or anxiety, avoiding more than $350 million in costs to the Australian economy.

Early intervention through low-cost, widely available e-mental health services should be a top priority for mental health service reform, and increased government investment would improve the mental health of the community while reducing costs.

A way forward

Reform of the existing mental health system is likely to be complex and to take time. But we cannot afford to risk losing another generation to the lifelong effects of poor mental health.

Smart, small investments made now could save hundreds of thousands of people from the crippling effects of a lifetime of poor mental health. These investments – along with the promotion and use of existing e-mental health services – will enable us to start providing immediate help to people who currently struggle alone.

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