Three things Australia could do to help fix the mental health crisis

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Eighty per cent of the 1990 voters surveyed by YouGov believed mental health should be a key priority for the next federal government and one in five said mental health was one of their top two election issues.

However, to the frustration of Orygen executive director Professor Patrick McGorry, mental health is yet to be a focus of the federal election campaign.

”I find it a puzzling paradox that the public would be supportive of governments that took more decisive action here, like they were with the NDIS, but governments have not actually seen it as a political opportunity,” McGorry said.

​One in five Australians experience a mental health condition in a given year.

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So what do experts think the incoming federal government could do to help fix the mental health crisis?

Address the missing middle

The “missing middle” describes people who fall through the cracks because their mental illness is too severe to be treated by a GP, headspace centre or 20 Medicare-subsidised sessions with a mental health professional.

However, they are not sick enough to qualify for state-funded crisis mental health services.

Alternative services, such as private psychiatrists or private hospitals, may be inaccessible because of long waiting lists or very high out-of-pocket costs.

The 2020 Productivity Commission inquiry into mental health assessed that the missing middle primarily reflects a lack of community mental health services.

McGorry said there needs to be specialist community-based services to treat more severe mental illnesses such as psychosis, eating disorders, borderline personality disorder, substance use disorders and complex mood disorders.

“Otherwise, we’re going to continue to see young people flood into emergency departments in very desperate situations in large numbers.”

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McGorry said that 10 years ago the Australian government funded services for young people with early psychosis, linked with headspace centres and local GPs, in six regions of Australia. The government announced last month this would be expanded to two new hub sites in the ACT and Tasmania.

However, McGorry said services for early psychosis and other complex disorders should be available for young people and adults across the nation.

National online waiting list

Unlike many other health conditions, there is no nationally aggregated mental health waiting list.

“We do not know who is waiting, how long they have waited, what is their level of need and whether the service they receive is the right one, with the right impact. We are blind,” says a policy paper prepared by the Brain and Mind Centre at the University of Sydney.

Professor Ian Hickie, the centre’s co-director, is calling for a nationally coordinated waiting list that would be implemented regionally.

He said the waiting list could tell you there were no interventions for eating disorders or complex drug and alcohol problems in your area, for example, or that you could see someone tomorrow but you would be $100 out of pocket.

This would require co-operation between the state and federal funded agencies and the public and private sectors: “At the moment we have different state initiatives that are not coordinated with the Commonwealth initiatives.”

Increase the mental health workforce

Australia had 3615 psychiatrists, 24,111 mental health nurses and 28,412 psychologists in 2019 according to the Australian Institute of Health and Welfare.

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In the last two years, calls to mental health support lines have skyrocketed, emergency department presentations for self-harm have risen and one in five psychologists have been forced to close their books.

Australians for Mental Health – an advocacy organisation focused on mental health reform – is calling for the capacity of this workforce to be doubled, including psychiatrists, psychologists, digital services and peer workers who are employed because of their lived experience of mental illness.

Campaign director Chris Raine said the federal government should lead the way by investing in such things as making it easier for overseas clinicians to practise in Australia and increasing commonwealth-supported places for clinical psychology at university.

Mental Health Australia chief executive Dr Leanne Beagley said barriers to care can include a lack of specialist mental health services in the regions, people having to pay extra on top of Medicare rebates, stigma and waiting lists.

“We want to see services accessible to all Australians despite their postcodes.”

What do the parties say?

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The Coalition said a re-elected Morrison government would continue to prioritise the transformation of mental health support and suicide prevention.

It points to the establishment of a national network of adult “head to health” centres and child mental health hubs and expansion of the headspace network to 164 locations.

Labor says it would restore affordable telehealth psychiatric consultations for people living in regional and rural Australia.

The Greens say it would make appointments with psychiatrists or psychologists free by ensuring mental healthcare was fully covered under Medicare.

Hickie says he has been heartened by the willingness of independent candidates to prioritise mental health and be accountable locally.

“Hopefully these issues will receive more coverage during this election campaign.”

Support is available from Beyond Blue on 1300 22 4636, headspace on 1800 650 890, Head to Health on 1800 595 212 and Lifeline on 13 11 14.