Child and adolescent males (16.3%) were more likely than females (11.5%) to have experienced mental disorders in the previous 12 months. The prevalence of mental disorders was slightly higher for older females (12.8% for 12–17 year olds) than for younger females (10.6% for 4–11 year olds). However, the prevalence for males did not differ markedly between the younger and older age groups (16.5% and 15.9% respectively).
There were a number of significant methodological differences between the Young Minds Matter survey and the first child and adolescent survey conducted in 1998. However, it is possible to compare the prevalence data for 3 mental health disorders (Major depressive disorder, ADHD and Conduct disorder). Prevalence of Depressive disorder increased from 2.1 % to 3.2%, ADHD decreased from 9.8% to 7.8%, and Conduct disorder decreased from 2.7% to 2.1%.
Readers are directed to the full report for further information (Lawrence et al. 2015).
Survey of People Living with Psychotic Illness (aged 16–84)
Mental illness includes conditions with low prevalence and severe consequences, including psychotic illnesses and a range of other conditions such as eating disorders, and severe personality disorder (DoHA 2010). Psychotic illnesses are characterised by fundamental distortions of thinking, perception and emotional response and include Schizophrenia, Schizoaffective disorder, Bipolar disorder and Delusional disorder (Morgan et al. 2011).
Estimates from the 2010 National Psychosis Survey were that 64,000 people in Australia aged 18–64 had a psychotic illness and were in contact with public specialised mental health services each year. This equates to 5 cases per 1,000 population or 0.5% of the population (Morgan et al. 2011). The survey found the most frequently recorded of these disorders was Schizophrenia which accounted for almost half of all diagnoses (47.0%).
Readers are directed to the full report for further information.
Impact and burden
Mental disorders can vary in severity and be episodic or persistent in nature. A recent review estimated that 2–3% of Australians (about 730,000 people based on the estimated 2016 population) have a severe mental disorder, as judged by diagnosis, intensity and duration of symptoms, and degree of disability caused (DoHA 2013). This group is not confined to those with psychotic disorders and it also includes people with severe and disabling forms of depression and anxiety. Another 4–6% of the population (about 1.5 million people) are estimated to have a moderate disorder and a further 9–12% (about 2.9 million people) a mild disorder.
Mental and behavioural disorders, such as Depression, Anxiety and Drug use, are important drivers of disability and morbidity. The Australian Burden of Disease Study 2011 examined the health loss due to disease and injury that is not improved by current treatment, rehabilitative and preventative efforts of the health system and society (AIHW 2016 ). For Australia, Mental and substance use disorders were estimated to be responsible for 12.1% of the total burden of disease in 2011, placing it third as a broad disease group after Cancer (18.5%) and Cardiovascular diseases (14.6%) (AIHW 2016.)
In terms of the non-fatal burden of disease, which is a measure of the number of years of ’healthy’ life lost due to living with a disability, Mental and behavioural disorders were the largest contributor (23.6%) of the non-fatal burden of disease in Australia followed by Musculoskeletal disorders (22.7%) and Respiratory disorders (11.9%) (AIHW 2016.)
For further information see Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011.
In addition, in 2013, almost a third (31%) of people in receipt of the Disability Support Pension had a primary medical condition of ‘psychological/psychiatric’ (DSS 2014).
There is an association between diagnosis of mental health disorders and a physical disorder, often referred to as a ‘comorbid’ disorder. From the 2007 NSMHWB of adults, 1 in 8 (12.0%) of people with a 12-month mental disorder also reported a physical condition, with 1 in 20 (5.0%) reporting 2 or more physical conditions.
According to the 2010 National Psychosis Survey, people with psychotic illness also frequently experience poor physical health outcomes and comorbidities (Morgan et al. 2011. ) For example, over one-quarter (27%) of survey participants had heart or circulatory conditions and over one-fifth (21%) had diabetes (compared with 16% and 6% respectively in the general population). The prevalence of Diabetes found in the National Survey of People Living with Psychotic Illness is more than 3 times the rate seen in the general population. Other comorbidities included Epilepsy (7% compared with 0.8% in the general population) and Severe headaches/migraines (25% compared with 9% in the general population).
National mental health policies and strategies
The Australian Government and all state and territory governments share responsibility for mental health policy and the provision of support services for Australians living with a mental disorder. State and territory governments are responsible for the funding and provision of state and territory public specialised mental health services and associated psychosocial support services. The Australian Government leads in national mental health reform initiatives and also funds a range of services for people living with mental health difficulties.
These provisions are coordinated and monitored through a range of initiatives, including nationally agreed strategies and plans.
Overview
The importance of good mental health, and its impact on Australians, have long been recognised by the Australian Government and all state and territory governments. Over the last three decades these governments have worked together, via the National Mental Health Strategy, to develop mental health programs and services to better address the mental health needs of Australians. The National Mental Health Strategy has included five 5-year National Mental Health Plans which cover the period 1993 to 2022, with the Council of Australian Governments (COAG) National Action Plan on Mental Health overlapping between 2006 and 2011.
Recent national developments
In 2014, the Australian Government requested the National Mental Health Commission (the Commission) to undertake a wide ranging review of existing mental health programs and services across the government, non-government and private sectors. The review’s report was released in June 2015 and was considered by a Mental Health Expert Reference Group established by the Australian government’s Department of Health to provide advice to inform the Australian government's response to the review.
Subsequently, a further series of mental health reform activities have been initiated, including the transfer of responsibility for a range of Australian Government mental health and suicide prevention activities to the newly created Australian government’s Primary Health Networks (PHNs) from 1 July 2016. The role of PHNs is to lead mental health planning and integration with states and territory, non-government organisation, NDIS providers, private sector, Indigenous, drug and alcohol and other related services and organisations. In addition, 12 PHNs will be established as suicide prevention trial sites which will operate for 3 years.
The Fifth National Mental Health and Suicide Prevention Plan was agreed by Health Ministers in August 2017. The Commission has responsibility for reporting on the implementation progress of the fifth plan.
The Independent Hospital Pricing Authority, an independent government agency established by the Australian Government as part of the National Health Reform Act 2011, has developed the Australian Mental Health Care Classification (AMHCC) Version 1.0. The development of the AMHCC is intended to improve the clinical meaningfulness of the way that mental health care services can be classified, leading to improvements in the cost-predictiveness of care and support the implementation of new models of care.
A staged implementation of the National Disability Insurance Scheme (NDIS) began in July 2013. People with a psychosocial disability who have significant and permanent functional impairment will be eligible to access funding through the NDIS. In addition, for people with a disability other than a psychosocial disability, funding may also be provided for mental health-related services and support if required.
References
Australian Bureau of Statistics (ABS) 2008. National Survey of Mental Health and Wellbeing: summary of results, Australia, 2007. ABS cat. no. 4326.0. Canberra: ABS.
Australian Institute of Health and Welfare (AIHW) 2016. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. BOD 4. Canberra: AIHW.
Department of Health and Ageing (DoHA) 2010. National mental health report 2010: summary of 15 years of reform in Australia’s mental health services under the National Mental Health Strategy 1993-2008. Canberra: Commonwealth of Australia.
DoHA 2013. National Mental Health Report 2013: tracking progress of mental health reform in Australia 1993 – 2011. Canberra: Commonwealth of Australia.
Department of Social Services (DSS) 2014. Characteristics of Disability Support Pension Recipients, June 2013. Canberra: DSS.
Lawrence D, Johnson S, Hafekost J, Boterhoven De Haan K, Sawyer M, Ainley J, Zubrick SR 2015. The Mental Health of Children and Adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra: Department of Health.
Morgan VA, Waterreus A, Jablensky A, Mackinnon A, McGrath JJ, Carr V, et al. 2011. People living with psychotic illness 2010. Canberra: Australian Government Department of Health and Ageing.