The commission estimated the direct economic costs at between A$43 billion and A$70 billion, with an additional A$151 billion due to the cost of disability and premature death.
While there have been many reports on mental health reform in the past, this one is different. The Productivity Commission looks at issues through an economic rather than a health lens. Its remit in producing the report was to examine “the effect of mental health on people’s ability to participate in and prosper in the community and workplace, and the effects it has more generally on our economy and productivity”.
This meant the report covered the impact of mental ill-health on the whole of Australian society and the role of all levels and sectors of government in helping to alleviate it.
While this economic lens inevitably involved an analysis of costs, the report’s real significance is in the more than 100 “actions” the commission recommended the federal, state and territory governments take.
Besides the health sector, these recommended actions involve families, schools, tertiary education, workplaces, income and employment support, insurance, criminal justice, police, housing and Indigenous communities. This breadth of coverage reflects the huge impact of mental ill-health right across Australian society, and acknowledges a whole-of-government, and indeed whole-of-society, response is needed.
This extraordinary breadth makes it hard to summarise the recommendations briefly, but there are some key themes that stand out:
the commission has recognised mental ill-health often has its origins early in life, and action for prevention and early intervention is needed in families, preschools and schools
telehealth and online services are likely to become increasingly important. This is an area where Australia is already a world leader, but the report recommends a major integration and expansion of these approaches
tertiary educational institutions are recommended to see mental health as central to their mission. This includes the need for better services for international students.
mentally healthy workplaces are vital, with recommendations covering psychological health and safety, employers’ duty of care, workers’ compensation claims, and standards for employee assistance providers
the report recognises the higher risk of mental ill-health and suicide among Indigenous Australians, with recommendations on empowering Indigenous communities and including a role for traditional healers
there is recognition of the poor physical health and substantially reduced life expectancy of people with severe mental illnesses, with recommendations for improved physical health care
the importance of social factors in mental illness is reflected in recommendations on reforms in housing, justice and income support.
An overarching theme behind all the recommendations is the need for better data and evaluation. In the past, large sums of public money have been spent on programs that have never been properly evaluated or, when they were evaluated, found not to deliver the expected benefits. The commission urges all innovations be rigorously evaluated before being rolled out.
Where to from here?
If the commission’s recommendations were fully implemented, Australia would be the undisputed world leader in mental health reform. The cost of implementation is inevitably a barrier, but the commission has done the hard-nosed economic analysis and concluded the benefits outweigh the costs.
The report estimates the recommended reforms would deliver up to A$18 billion in benefits per year, mainly from improvements to people’s quality of life, plus a further A$1.3 billion a year from increased economic participation and productivity. These benefits would require up to A$4.2 billion of expenditure per year.
Many of the recommended actions, such as giving Australians the right to choose their preferred mental health specialist and the recognition of mental health advance directives by state and territory governments, cost little or nothing, as they merely represent better ways of doing things we already do.
The danger is governments will see the recommended actions as a menu from which they choose a few items at budget time. Over the past 20 years, Australia has been through a piecemeal process of lobbyist-led reform, in which ministers fund particular programs that make good “announceables” when an election or budget rolls around.
This approach has failed to improve Australians’ mental health. What we need is unified support from the mental health sector, and the community more generally, for the commission’s recommendations as a total reform package.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.