Mental health experts are urging a rethink of Australia’s broken mental health system, with new data showing a surge of Australians reached crisis point across the pandemic. Experts say the high number of people needing emergency intervention exposed huge cracks in Australia’s mental health support system.
While the federal government increased some support services during lockdowns, such as the number of psychology sessions available under Medicare, a recent study showed there were still gaping holes in the system.
“It’s an ongoing crisis,” Ian Hickie, co-director of health and policy at Sydney University’s Brain and Mind Centre, told Crikey.
“There’s a lot of talk about the pressure on emergency departments and the hospital system … but not specifically about the extent of which it is underpinned by mental health problems,” he said.
Suicide-related ambulance calls rose by more than 50% during COVID-19, according to a recent pre-print study (which is yet to be peer-reviewed). The research suggests that while Australia’s suicide rate plateaued during the height of the pandemic, mental distress didn’t — with more people reaching crisis point and seeking emergency attention.
Hickie said the data showed a worrying trend: those who attempted suicide were at increased risk of future attempts of suicide, along with an increased risk of premature death from all causes.
“It’s not only temporary, it’s been ongoing,” he said. “Earlier and effective intervention are the key to better outcomes.”
Experts say Australia’s mental health crisis has been deepening since before the pandemic, exacerbated by COVID-19, the high cost of living and climate change. The surge in demand for mental health services during the pandemic was largest among young people and women with low incomes and assets or who were subjected to domestic violence, many of whom weren’t connected with ongoing care due to long wait lists and unaffordable out-of-pocket costs.
What the new research doesn’t show is what happens to people once they arrive at hospital. Australia’s mental health system is fractured, with many lost to the “missing middle” — not eligible for disability-related services but not at a point of needing hospitalisation.
If taken to hospital, many mental health patients are often not seen for hours or are sent home without the support they need. The problem is made worse by long wait times for psychologists and psychiatrists in the public and private sector.
Lack of support programs
CEO of Community Mental Health Australia Bill Gye told Crikey the “missing middle” in mental health care has been exacerbated following the implementation of the National Disability Insurance Scheme (NDIS).
“The NDIS is a wonderful thing … but many of the states and the Commonwealth closed down a lot of all those background support programs,” he said.
“There are a couple of hundred thousand people out there who are in what we call the ‘oasis in the desert’ … where the level of [mental health] support dropped over the last seven years, right at a time when mental health issues and distress were growing.”
Gye said mental distress has been on the rise since before the pandemic. His ongoing research has shown the main stressors are finances, housing, employment, discrimination and stigma, and climate change.
Community mental health services allow for early intervention, which takes the pressure off emergency services and hospitals. Having to call an ambulance for help is not ideal for a number of reasons, Gye said. Firstly, it’s often family or friends who find someone after a self-harm attempt and have to intervene, causing trauma. An ambulance attracts attention — which can cause feelings of stigma for the person in distress. People often downplay their ideation once taken to the ER — or up-play it because it’s the only way they’ll be admitted for services. Finally, many clinical services don’t have adequate mental health services.
“Overall, it’s just not a pleasant experience whereas there are much less dramatic interventions that just as effectively could be done,” Gye said.
He pointed to Adelaide’s Urgent Mental Health Care Centre as an alternative model, which is peer-led and allows people to be seen immediately without waiting for a psychiatrist or triage.
Slipping through the cracks
The author of the pre-print study, senior lecturer in psychiatry and mental health at UNSW Daniel Lin, told Crikey the leap in calls was “quite obvious” — especially in Victoria. The rates dropped again in 2021.
More people may have called ambulances due to disruption in regular services, or due to a heightened awareness of mental health issues, the study notes.
Data on suicide rates showed no significant increase across the pandemic. While there was an increase in people arriving at the ER with self-harm or suicidal ideation, this data doesn’t capture those who arrived at the hospital but left before being triaged or admitted.
“Previous studies usually focus on fatal suicide … and we thought it might be better to capture the spectrum of suicidal severity,” Lin said.
Those who are not deemed an immediate risk by hospital staff are often referred to a GP or community-based health service — but, Lin said, the majority of people who die due to suicide have never seen professional help.
For anyone seeking help, Lifeline is on 13 11 14 and Beyond Blue is 1300 22 4636.
Further to above I always get a chuckle about the governments attitude to welfare recipients and the huge infrastructure thats been built to monitor the bank accounts etc of welfare recipients to make sure they never get a cent more than they are enitled to and they are hounded to the point of suicide if they there is a hiccup and they do get a couple of bucks more than they are entitled to.
Contrast that with the pollies themselves. Endless rorts without consequences, not even embarred to boast they all do it. Or the billionaires recieving Billions from jobkeeper they werent entitled to and refusing to give it back. And the government apparently happy to accept they cant get it back.
Words fail me.
This is a well-written piece on Mental Health in the Federal setting. I do have some suggestions on other topics that could be included in the dialogue for future articles if they are considered:
1- The Victorian Royal Commission and the learnings from the Andrews Government around the implementation of these recommendations. Challenges and successes etc.
2- Look into the rate of burnout amongst staff, how are staff treated within the system if they have their own mental health challenges? Do we have enough mental health professionals to fill roles etc…
3- We all know Community models of care are the future but what do our community models of care look like at the moment in Australia, whether it be public system or community-managed sector and how may they be improved?
Just a few random thoughts from someone who is a lived experience mental health worker in NSW. Always available to the Crikey team if you want to write more content around this topic.
Cheers,
Will Woods
Is the mental health system broken, or is society itself? Should we really be forcing everyone into contractual precarity? Perhaps if society was a bit more nurturing, and it was a bit easier for everyone to live a good life there would be less demand for mental health services?
it’s both
Society is geared to be self-interested, mercenary, ultra-competitive and contemptuous of those who either fail, can’t keep up, or are the victims of circumstances. Society – that’s the middle class, property owning, investment sector – is encouraged to do this by News Corp, by the Fin, by the IPA, and by many other voices claiming it is their right to screw those below them on the ladder. It’s why homeowners voted against a Shorten government in 2019, leading to a growing housing crisis. It’s why no one will put controls on rent or property. It’s why fossil fuel companies (among other billion dollar enterprises) seldom pay tax. It’s why Sky After Dark can put out the most ridiculous propaganda without any consequence. At a certain level of wealth, all becomes justified, and all the mechanisms of social evaluation will reflect this. Look at Scott Morrison. If you believe that those who don’t love Jesus are doomed to failure in this life, and probably the next, you don’t have to care. It’s not your fault, it’s theirs. And policy will reflect this.
Those are choices and policy settings. We’ve just learned that News is not actually influential. We, the polity, can choose differently. We have turned away from Howard’s validation of the small and mean. We can do better.
Great explanation.
I’d only add to your list of characteristics that we as a society are conditioned to be individualistic. This is another major cause of mental distress: we’re in this life on our own.
My youngest daughter went into a deep depression and had 2 instances of self harm during the first year of lockdown. Having never had any experience with this level of depression before with myself or any of my family, it was really hard to know what to do or where to turn. I rang at least 20 different psychiatrists and psychologists over a period of a day or two and luckily I found a psychiatrist who was accepting new teenage patients. I was in the fortunate position to be able to pay for my daughter to see someone and after a year she is now off her medication and is well. You do get a rebate from Medicare but there was still a $150 out of pocket cost for each session. There are so many people who can’t afford to seek help, and reform of the sector is greatly needed.
I have been through periods of depression too, including a failed suicide attempt and I can confirm that the systems is indeed busted or at least not built properly in the first place. One of the problems is that govetnments have a deep distrust of of anyone saying they need help. The first suspicion of all governments is that anyone who asks for help is either a malingering scammer or will become one immediately they get any sort of assistance. This applies, the aged pensioners, students, unemployed, the disabled, asylum seekers, prisoners, drug addicts, mental health patients and the sick ingeneral and many other groups besides.
In the case in mental health the government will reluntantly believe that there is an issue if you are in hospiital but the minute you are discharged the support is over. If you cant fork out $200+ per hour from your own resources then its too bad.
One way of easing the problem would be for Medicare to cover the cost of a few visits to a qualified and registered counsellor/psychotherapist. There are thousands of them. They are, as research has repeatedly shown, equally as helpful to people looking for reasons to stay alive as psychiatrists or clinical psychologists. The Australian Counsellors Association has been trying to convince the government of this for years but, so far, governments refuse to consider this straightforward solution to the problem.
My 25 yo son presented to GP with anxiety/depression. He was medicated, and given a list of pschologists/counsellors to call and see if they had space for him. There was a very long waiting list for all of them. So I do not think you are correct about there being ‘thousands’ available. We live on the edge of the capital city of our State.
The medication was inappropriate for my son, he missed a GP appointment and forgot to take his pill for one day – it was enough to drive him over the edge and I lost him last August. He lived with us and I tried everything to help, but I did not know enough, and the GP never followed up the missed appointment. He didn’t even know my son was dead until months later.
The system completely failed us, and we lost our only child. It was easier for me to get psych help because he died than it was for him to get help for his crisis, and I still had to wait a couple of months. I still have PTSD and nobody is monitoring me, I know I am depressed and lack the motivation to seek further help, because the thought of that battle is just exhausting, it’s too difficult to do when most of your brain in depression is telling you that you’re worthless. This is all apart from the fact that the pandemic has shredded our HCW. My GP is great, but busy, and not bulk-billed.
The system is broken, and so is society. Since Howard we have become nasty people, who anger quickly and deliberately take bad moods out on strangers, and who are suspicious of most. It didn’t used to be like that, now upsetting people is almost a badge of honour to some.
I do not require sympathy, I’m not in danger. I tell this to illustrate the system being broken.
I’m sorry for your loss. Absolutely heart breaking.
Big hugs to you
Hope you get some today