The Federal Parliament House Select Committee on Mental Health and Suicide Prevention  called for submissions on the 24th of February 2021 closing on the 24th March 2021. Details on the committee can be found here

APA responded with a submission on the 16th March 2021. A copy of the submission is below.

APA Submission to the House Select Committee on Mental Health and Suicide Prevention

Good mental health is defined, according to the World Health Organisation, as:

A state of wellbeing in which an individual realises their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to their community.

The unfortunate reality is that a significant proportion of Australians will experience a mental illness at some point in their lives. The effect it has on individuals and those around them is far-reaching, from stigmatisation to isolation to poverty.

Our submission offers some practical strategies to improve the current mental health system.

There needs to be a safe place for people to go to, especially when they suffer from anxiety, depression, or suicidal thoughts. Patients and their carers know that when facing a crisis, the emergency department is always open and provides a safe haven. However, emergency departments are an inappropriate setting for most mental health interventions, consistent with feedback from the Australian College of Emergency Medicine. Extra support needs to be put in place specifically for young people, in the form of respite care centres for short-term support which are able to provide a safe and private environment. Consumer-led models like the Safe Haven Café in Melbourne, which was integrated into St Vincent’s Hospital Melbourne’s mental health services and have inspired the introduction of similar hybrid services in other states, are an important part of the service mix. APA supports the need for alternatives to emergency departments for mental health patients. Consideration should be given to developing a youth specific model based on the step-up, step-down mental health model with Prevention and Recovery Care (PARC) facilities set up specifically for young people. Feedback from consumers indicates that there is a preference to PARC facilities rather than acute settings wherever possible.

With the current COVID-19 pandemic, technology has never been a more integral part of the delivery of health care. Effective digital transformation has a vital role to play in the reform of the mental health care system, including the use of telehealth, video conferencing and supported online treatment, provided that the systems and infrastructure are sufficient to make it user friendly. Consumers indicate that they often do not have the funds to support current technology to access these on-line services. Consideration for some kind of subsidy would go a long way in assisting consumers. As such, APA supports increased access to supported online mental health treatment and increased community awareness of these programs to encourage uptake, as such digital portals allow mental health patients to have access to longer-term resources and support. Consideration should also be made around co-design of programs with young people as they know best what would work for their mental health needs.

A shift towards prevention through the primary health care setting is key to overhauling our mental health system, which is not equipped with providing acute and crisis response services. In reality, the acute sector receives the bulk of the funds whilst community health receives a much smaller proportion of the funds. There needs to be a review of fund allocation based on identified priorities and more emphasis on prevention and early intervention which in the long term is less costly and a much better outcome for consumers. It is well recognised that early intervention is a fundamental principle of health care to try to manage problems before they become more serious. We know that addressing the underlying causes of mental illness is likely to be more effective at improving health and wellbeing in the long-term. For instance, insecure and inadequate housing is a risk factor for poor physical and mental health, therefore supporting people with mental illness to find and maintain housing in the community is paramount. This means that we should focus our efforts on linking tenants to mental health services and providing access to tenancy support, as well as increasing the availability of supported accommodation places for individuals with mental illness. Increase in funding provided to state and territories for housing and homelessness services under the National Housing and Homelessness Agreement is needed to address housing issues.

Education is an important aspect of the social determinants of health that could make a huge difference for the current mental health system if the right implementations are put in place. We identified the need for more education resources and training for teachers and students regarding mental health. There needs to be an emphasis on mental health literacy and open discussion about mental health issues incorporated into school curricula, which would not only reduce the stigmatisation surrounding mental illness, but also encourage young people to seek help. Equally as crucial is promoting mental wellness through the use of mindfulness and other techniques. We also believe in upskilling family, workplaces, sports coaches, and friends regarding early symptoms of mental illness through training workshops and sessions. One such program is Tackle Your Feelings, which aims to equip AFL coaches and committee members with the tools needed to understand, recognise and manage the signs of emotional and behavioural distress. The program used a combination of online learning and face-to-face education sessions, and contribute to continuing professional development upon training completion.

Grassroots non-governmental organisations (NGO) are often the most effective way in terms of making an impactful difference in patients with mental illness, however they are not sustainably funded which has led to closures. Partners in Recovery is one such example which coordinates care from multiple sectors and services for people with severe and persistent mental illness with complex needs in a more collaborated and integrated way. We support increased funding for grassroots NGOs as an extra avenue for people with mental illness.

In keeping with the theme of prevention through the primary health setting, APA’s view is that Primary Health Networks (PHNs) are fundamental in the implementation of a stepped care model that is tailored to the needs of local communities, whereby general practice establishes a needs-based system for people with mental illness and configure teams of health care professionals to provide multidisciplinary care. As we know, there is limited access to psychiatrists, and GPs require special training in mental health. Whilst Medicare rebates are available for up to 10 allied mental health services in a calendar year, general practice should be supported by Medicare data to reduce systemic exploitation and direct efforts to those who need it most. However, more data with regard to client outcomes and assessment of practices are required to ensure consistency across PHNs. APA also supports consideration of an advanced specialist mental health pathway for GPs, which would be in line with the recent work by the National Rural Health Commissioner on a national rural generalists’ pathway for GPs wishing to specialise in areas such as obstetrics in order to better serve rural communities. Therefore, we need to recognise it as an area of special interest for GPs to allow consumers to identify those with extra training and skills in mental health.

APA also advocates for the structural weaknesses in the mental health system to be addressed. In particular, hard to reach groups including Aboriginal and Torres Strait Islander (ATSI), culturally and linguistically diverse (CALD), and refugee groups require culturally and socially appropriate places to access support for both their mental and physical health. A holistic approach, which includes families and carers in the care of people of mental illness, is often needed. For example, APA recognises that for Aboriginal and Torres Strait Islander people, the concept of health is intertwined with the wellbeing of the whole community. Traditional healers should be integrated into the model of care as they have been shown to improve social and emotional wellbeing for Aboriginal and Torres Strait Islander people. Partnership between traditional healers and mainstream mental health services should be considered to best deliver holistic and integrated care.

We recognise that some young people have Private Health Insurance (PHI), but are not utilising what they are entitled to. Moreover, many PHIs have limitations on the psychological services that can be claimed when the reality is that Australians need greater access to mental health care. In fact, PHIs encourage consumers with a Mental Health Treatment Plan to exhaust Medicare Rebates before turning to their insurance policies, amongst other stringent criteria in place. APA, in conjunction with the Australian Psychological Society, advocates for a reform of PHI packages. This includes increasing the age of dependents to encourage younger people and people with a disability to maintain PHI, as well as expansion of home and community based mental health care. The fact that access is limited to a targeted group who meet a set of specified criteria contradicts the nature of a preventative service, not to mention the cost savings of providing early intervention mental health services. We support PHIs funding preventative mental health services for members, irrespective of whether they have been admitted to hospital previously for a mental illness or not. We advocate for access to mental health services for people with a chronic physical illness, as they are at increased risk of developing a mental illness, and also for people with an existing mental illness which may impact on patients’ medical treatment (e.g. depression could affect medication compliance).