Mental health services in Australia

Prevalence

In the Mental health services in Australia online report the terms ‘mental illness’ and ‘mental disorder’ are both used to describe a wide spectrum of mental health and behavioural disorders, which can vary in both severity and duration. The most prevalent mental illnesses in Australia are Depression, Anxiety and Substance use disorders.

A program of surveys, the National Survey of Mental Health and Wellbeing (NSMHWB), began in Australia in the late 1990s. The role of these surveys is to provide evidence on the prevalence of mental illness in the Australian population, the amount of disability associated with mental disorders, and the use of health services by people with mental disorders.

These studies have 3 main components—a population-based survey of adults, a service-based survey of people with psychotic disorders, and a population-based survey of children.

Survey of Adult Population (aged 16–85)

The 2007 National Survey of Mental Health and Wellbeing of adults provides information on the 12-month and lifetime prevalence of mental disorders in the Australian population aged 16–85 years. The survey estimated that almost half (45%) of the population in this age range will experience a mental disorder at some time in their life (about 8.7 million people based on the estimated 2017 population). It also estimated that 1 in 5 (20%) of the population had experienced a common mental disorder in the previous 12 months (about 3.9 million people based on the estimated 2017 population). Of these, Anxiety disorders (such as social phobia) were the most prevalent, afflicting 1 in 7 (14.4%) of the population, followed by Affective disorders (such as depression) (6.2%), and Substance use disorders (such as alcohol dependence) (5.1%).

Readers are directed to the full NSMHWB report for further information (ABS 2008).

Survey of Children and Adolescents (aged 4–17)

A national household survey, the Australian Child and Adolescent Survey of Mental Health and Wellbeing, was conducted for the second time in 2013–14 (also referred to as the ‘Young Minds Matter’ survey).

Almost 1 in 7 (13.9%) of children and adolescents aged 4–17 years were assessed as having mental health disorders in the previous 12 months, which is equivalent to about 591,000 (based on the estimated 2017 population) children and adolescents. Attention Deficit Hyperactivity Disorder (ADHD) was the most common mental disorder (7.4% of all children and adolescents, or about 315,000 based on the estimated 2017 population), followed by Anxiety disorders (6.9% or about 293,000), major Depressive disorder (2.8% or about 119,000) and Conduct disorder (2.1% or about 89,000)— see Figure 1.

Almost one third (30.0% or 4.2% of all 4–17 year olds) with a disorder had 2 or more mental disorders at some time in the previous 12 months.

Figure 1: Prevalence of mental disorders in the past 12 months among those aged 4-17

Source: Lawrence et al. 2015.

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 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 615,000 people based on the estimated 2017 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 1.2 million people) are estimated to have a moderate disorder and a further 9–12% (about 2.6 million people) a mild disorder.

Mental and substance use disorders, such as Depression, Anxiety and Drug use, are important drivers of disability and morbidity. The Australian Burden of Disease Study 2015 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 2019). For Australia, Mental and substance use disorders were estimated to be responsible for 12% of the total burden of disease in 2015, placing it fourth as a broad disease group after Cancer (18%), Cardiovascular diseases (14%) and Musculoskeletal conditions (13%) (AIHW 2019).

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 substance use disorders were the second largest contributor (24%) of the non-fatal burden of disease in Australia, behind Musculoskeletal conditions (25%)  (AIHW 2019).

Further information can be found in the Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2015.

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 3 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 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 have been 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.

The Australian Government announced a number of mental health-related measures in the 2019 Federal budget, providing $736.6 million for mental health and suicide prevention initiatives over seven years. Significant measures include $373 million for additional services through headspace, for service improvements, additional centres and extension of the Early Psychosis Youth Services program, $114.5 million over 5 years to fund a trial of 8 adult community mental health centres, and $5.2 million over 4 years for measures in relation to Aboriginal and Torres Straint Islander suicide (Parliament of Australia, 2019).

References

ABS (Australian Bureau of Statistics) 2008. National Survey of Mental Health and Wellbeing: summary of results, Australia, 2007. ABS cat. no. 4326.0. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2019. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease Study series no. 19. Cat. no. BOD 22. Canberra: AIHW.

DoHA (Department of Health and Ageing) 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.

DSS (Department of Social Services) 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.

Parliament of Australia 2019. Health, Budget Review 2019–20. Viewed 26 June 2019.