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Mental Health

Draft report

This draft report was released on 31 October 2019.

You are invited to examine the draft report and to make written submissions by Thursday 23 January 2020.

Make a submission or Make a brief comment

The final report is expected to be handed to the Australian Government by May 2020.

Download the overview

Download the draft report

Video: Mental Health Draft Report

Transcript of video

Mental health affects everyone in Australia, because if you aren't one of the one in two Australians who become mentally ill at some point during your lifetime, you will certainly know someone who has been impacted by mental ill-health.

And while we spend 18 billion dollars a year on mental health, we estimate the economic effects alone of mental ill-health and suicide are up to 51 billion dollars a year.

So improving our mental health system and therefore the mental well-being of Australians will pay off in spades.

There's a lot of problems in our current mental health system but it can be improved.

For example, we now lose more people to suicide than road vehicle accidents but it wasn't always this way.

Deaths on the road have fallen dramatically due to a concerted effort across many areas and over many years.

We can do the same with mental health if we put the same effort in.

We need to make changes across not only a health system but also in our schools and workplaces.

Our draft report on Mental Health in Australia sets out an achievable path to improve mental health across Australia.

We want changes so the right services are available to people when they need them, wherever they are.

We need more mental health nurses, peer workers and psychiatrists.

We need better early identification and access to services for those under 25.

We need more low-intensity services but also alternatives to emergency services.

Better follow-up services for people who have attempted suicide and better coordination and accountability from government around providing services.

To read our overview or full draft report go to pc.gov.au

  • At a glance
  • Contents
  • Supporting data

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Key points

Australia's mental health: a generational shift is needed

  • In any year, approximately one in five Australians experiences mental ill-health. While most people manage their health themselves, many who do seek treatment are not receiving the level of care necessary. As a result, too many people suffer additional preventable physical and mental distress, relationship breakdown, stigma, and loss of life satisfaction and opportunities.
  • The treatment of mental illness has been tacked on to a health system that has been largely designed around the characteristics of physical illness. But in contrast to many physical health conditions
    • mental illness tends to first emerge in younger people (75% of those who develop mental illness, first experience mental ill-health before the age of 25 years) raising the importance of identifying risk factors and treating illness early where possible.
    • there is less awareness of what constitutes mental ill-health, the types of help available or who can assist. This creates need for not only clear gateways into mental healthcare, but effective ways to find out about and navigate the range of services available to people.
    • the importance of non-health services and organisations in both preventing mental illness from developing and in facilitating a person’s recovery are magnified, with key roles evident for — and a need for coordination between — psychosocial supports, housing services, the justice system, workplaces and social security.
    • adjustments made to facilitate people’s active participation in the community, education and workplaces have, for the most part, lagged adjustments made for physical illnesses, with a need for more definitive guidance on what adjustments are necessary and what interventions are effective.
  • The cost to the Australian economy of mental ill-health and suicide is, conservatively, in the order of $43 to $51 billion per year. Additional to this is an approximately $130 billion cost associated with diminished health and reduced life expectancy for those living with mental ill-health.

A path for maintainable long term reform

  • Changes recommended are substantial but they would set Australia on a path for maintainable long term reform of its mental health system. Priority reforms are identified and a staged reform agenda is proposed.
Reform area 1: prevention and early intervention for mental illness and suicide attempts
  • Consistent screening of social and emotional development should be included in existing early childhood physical development checks to enable early intervention.
  • Much is already expected of schools in supporting children's social and emotional wellbeing, and they should be adequately equipped for this task through: inclusion of training on child social and emotional development in professional requirements for all teachers; proactive outreach services for students disengaged with school because of mental illness; and provision in all schools of an additional senior teacher dedicated to the mental health and wellbeing of students and maintaining links to mental health support services in the local community.
  • There is no single measure that would prevent suicides but reducing known risks (for example, through follow-up of people after a suicide attempt) and becoming more systematic in prevention activity are ways forward.
Reform area 2: close critical gaps in healthcare services
  • The availability and delivery of healthcare should be reformed to allow timely access by people with mental ill-health to the right treatment for their condition. Governments should work together to ensure ongoing funded provision of:
    • services for people experiencing a mental health crisis that operate for extended hours and which, subject to the individual’s needs and circumstances, provide an alternative to hospital emergency departments
    • acute inpatient beds and specialised community mental health bed-based care sufficient to meet assessed regional needs
    • access to moderate intensity care, face-to-face and through videoconference, for a duration commensurate with effective treatment for the mental illness
    • expanded low intensity clinician-supported on-line treatment and self-help resources, ensuring this is consistently available when people need it, regardless of the time of day, their locality, or the locality choices of providers.
Reform area 3: investment in services beyond health
  • Investment is needed across Australia in long-term housing solutions for those people with severe mental illness who lack stable housing. Stable housing for this group would not only improve their mental health and inclusion within the community, but reduce their future need for higher cost mental health inpatient services.
Reform area 4: assistance for people with mental illness to get into work and enable early treatment of work-related mental illness
  • Individual placement and support programs that reconnect people with mental illness into workplaces should be progressively rolled out, subject to periodic evaluation and ongoing monitoring, to improve workforce participation and reduce future reliance on income support.
  • Mental health should be explicitly included in workplace health and safety, with codes of practice for employers developed and implemented.
  • No-liability clinical treatment should be provided for mental health related workers compensation claims until the injured worker returns to work or up to six months.
Reform area 5: fundamental reform to care coordination, governance and funding arrangements
  • Care pathways for people using the mental health system need to be clear and seamless with: single care plans for people receiving care from multiple providers; care coordination services for people with the most complex needs; and online navigation platforms for mental health referral pathways that extend beyond the health sector.
  • Reforms to the governance arrangements that underpin Australia’s mental health system are essential to inject genuine accountability, clarify responsibilities and ensure consumers and carers participate fully in the design of policies and programs that affect their lives.
    • Australian Government and State/Territory Government funding for mental health should be identified and pooled to both improve care continuity and create incentives for more efficient and effective use of taxpayer money. The preferred option is a fundamental rebuild of mental health funding arrangements with new States and Territory Regional Commissioning Authorities given responsibility for the pooled resources.
    • The National Mental Health Commission (NMHC) should be afforded statutory authority status to support it in evaluating significant mental health and suicide prevention programs. The NMHC should be tasked with annual monitoring and reporting on whole-of-government implementation of a new National Mental Health Strategy.
    • These changes should be underpinned by a new intergovernmental National Mental Health and Suicide Prevention Agreement.

Media requests

Leonora Nicol, Media Director – 0417 665 443 / 02 6240 3239 / media@pc.gov.au

Media release

Mental ill-health and suicide cost Australia nearly $500 million per day

The Productivity Commission estimates that mental ill-health and suicide are costing Australia up to $180 billion per year and treatment and services are not meeting community expectations.

"Mental ill-health has huge impacts on people, communities and our economy but mental health is treated as an add-on to the physical health system. This has to change," Productivity Commission Chair, Michael Brennan said.

The report on mental health released by the Productivity Commission emphasises the need for better support for young people.

"75% of those who develop mental illness first experience symptoms before they turn 25, and mental ill-health in critical schooling and employment years has long lasting effects for not only your job prospects but many aspects of your life. Getting help early is key to prevention and better outcomes," Chair Michael Brennan said.

Over their lifetime, one in two Australians will be affected by mental ill-health including anxiety and depression and up to a million people don't get the help they need.

"Too many people still avoid treatment because of stigma, and too many people fall through the gaps in the system because the services they need are not available or suitable," Productivity Commissioner, Stephen King said.

The report says that change is needed not only in the health system itself but in schools, workplaces, housing and the justice system.

The report includes a comprehensive set of reforms to reorient the mental health system to close service gaps, better target services to meet needs and focus on early intervention and prevention.

"While full scale change will take a long time, there are many changes that governments can start now. For example, follow-up after attempted suicide is proven to save lives and could be started immediately," Chair Michael Brennan said.

The Commission recommends better support for students and teachers including appointing wellbeing leaders in all schools.

Other recommendations include more community-based services and innovative solutions such as better use of technology as well as more health professionals in some parts of the system.

"Police and paramedics should also get more assistance from mental health professionals when dealing with crisis situations," Commissioner Stephen King said.

The Productivity Commission's draft report on mental health can be found at www.pc.gov.au and submissions for the final report are currently being taken.

Media requests

Leonora Nicol, Media Director – 0417 665 443 / 02 6240 3239 / media@pc.gov.au

Statistics from the report

Prevalence of mental illness and access to services

  • There are 3.9 million people with mental illness in Australia. 2.9 million people access mental health care services. 1
  • One in five people will experience mental ill-health (diagnosable mental illness and mental health problems) in any year. Over their life time, one in two people will experience mental ill-health. 2
  • 1 in 8 visits to GPs are related to mental health issues. 3
  • About 1.2 million people access Medicare-subsidised psychological therapy through the Better Access program. 4 However, one in three only attend one or two sessions, dropping out due to the out-of-pocket cost or difficulty finding a suitable provider. 5
  • The rate of mental health presentations at emergency departments has risen by about 70% over the past 15 years. 6
  • The prevalence of mental illness is relatively similar across Australia. However, people in capital cities are nearly twice more likely to access mental health services compared to people in remote areas. 7

Aboriginal and Torres Strait Islander people

  • Aboriginal and Torres Strait Islander people are twice as likely as non-Indigenous people to be hospitalised due to mental illness. 8
  • Aboriginal and Torres Strait Islander people are twice as likely as non-Indigenous people to die by suicide. 9
  • Aboriginal and Torres Strait Islander youth (up to 24 years old) are up to 14 times more likely to die by suicide than other Australian youth. 10

Young people and mental illness

  • One in seven children and young people (aged 4–17) have mental illness. 11
  • About 75% of adult mental health disorders emerge by the time people are 25 years. 12
  • Mental health is the leading cause of disability in people aged 10–24 years. 13
  • By year 9, students with mental illness may be up to 5 years behind students who do not have mental illness. 14

Suicide

  • In 2018, 3046 people lost their lives to suicide. We lose 8 people a day to suicide, compared to 3 a day who die on our roads.
  • Suicide is the leading cause of death for Australians aged 15–44 years.
  • Regional communities have a 54% higher rate of suicide than capital cities. 15

Workplace effects

  • In 2017-18, 55% of working age Australians with mental illness were employed, compared with 64% of all working age Australians. 16
  • The costs of lost productivity due to mental ill-health range from $10 to 18 billion. 17

Footnotes

1 Department of Health 2019, National PHN Guidance, Initial Assessment and Referral for Mental Healthcare Return to text

2 ABS 2007, National Survey of Mental Health and Wellbeing Return to text

3 University of Sydney 2016, General practice activity in Australia 2015–16 Return to text

4 Department of Health 2019, National PHN Guidance, Initial Assessment and Referral for Mental Healthcare Return to text

5 Productivity Commission estimates using unpublished MBS data Return to text

6 AIHW 2019, Mental Health Services in Australia Return to text

7 Productivity Commission estimate using 2016 ABS data Return to text

8 AIHW 2015, The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples Return to text

9 ABS 2019, Causes of Death Return to text

10 Dickson et al. 2019, A Systematic Review of the Antecedents and Prevalence of Suicide, Self-Harm and Suicide Ideation in Australian Aboriginal and Torres Strait Islander Youth Return to text

11 Department of Health 2015, Young Minds Matter, the Mental Health of Children and Adolescents Survey Return to text

12 Kessler et al 2005, Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication Return to text

13 McGorry et al 2014, Cultures for mental health care of young people: an Australian blueprint for reform Return to text

14 Goodsell et al 2017, Child and Adolescent Mental Health and Educational Outcomes Return to text

15 All suicide figures are from ABS 2019, Causes of Death. Road toll data is from the Bureau of Infrastructure, Transport and Regional Economics Return to text

16 Productivity Commission estimate using ABS 2019, National Health Survey data Return to text

17 Productivity Commission estimate using HILDA data Return to text

Fact sheet 1: Health System

Community awareness about mental illness has come a long way, but the current mental health system is not meeting people’s needs. We still see many people with mental illness not getting treatment and experiencing higher rates of unemployment, social isolation and poverty.

50%

Over their lifetime half of all Australians will experience a mental illness.

1 Million

Up to a million Australians with a diagnosed mental illness maybe missing out on treatment for their condition.

Australia on the globe

Most at risk: Aboriginal and Torres Strait Islander people, people who identify as LGBTIQ and those living in regional and remote communities.

We currently spend around $18 billion a year on mental health, but still see many people with mental illness not getting treatment and experiencing higher rates of unemployment, social isolation and poverty. Mental illness tends to first occur in younger people, raising lifetime costs.

Our draft report sets out a path for achievable, sustainable long-term reform of our mental health system.

  • The cost to Australia of mental ill-health and suicide is about $500 million per day – with direct economic costs of almost $140 million per day.
  • It doesn’t have to be that way. The evidence shows the need to intervene early to prevent and treat mental illness.
  • Over 3000 people die by suicide each year in Australia — significantly more than our current road toll. Eight people are lost to suicide each day, while three people die in motor vehicle accidents.
  • A concerted effort on many fronts and cooperation across governments has seen a dramatic drop in deaths on our roads. We can dramatically reduce the suicide rate if we put in the same effort.

Health System: Mental health inquiry information

There are some significant gaps in our current mental health system

There are not enough services for many people who have symptoms that may be too complex to be adequately treated through a GP, but whose condition does not qualify for access to specialised mental health services.

Our recommendations for improving the mental health system are across three key areas.

1 in 8 Aust.

1 in 8

1 in 8 visits to GPs are related to mental health. However, GPs themselves often find the mental health system difficult to navigate.

1. Close critical gaps in health care services

Some of our key recommendations in this area include:

  • Improving the provision of information so that people can find out what services are going to help them and what’s available in their area.
  • More low intensity services for those who need them, including access to online programs that include support from a psychologist. This will  free up more intensive services for those currently missing out.
  • More mental health nurses, peer workers and psychiatrists.
  • Provide alternatives to emergency services when people are experiencing a mental health crisis but also ensure there are beds for those who need them – either in hospitals or in the community.

2. Intervene early to prevent and treat mental illness

Some of our key recommendations in this area include:

  • Including social and emotional development in the existing physical development checks at early ages.
  • Schools to have a senior teacher dedicated to social and emotional wellbeing.
  • Better follow-up services for people who have attempted suicide.

3. Fundamental reform to coordination, governance and funding arrangements

Some of our key recommendations in this area include:

  • Having care pathways for people that are clear and seamless with single care plans for people receiving care from multiple providers and care coordination for people with severe mental illness and other complex needs.
  • Inject genuine accountability and clarify the responsibilities of governments.
  • Ensure consumers and carers have the opportunity to participate fully in the design of policies and programs that affect their lives.

Fact sheet 2: Consumers and Carers

For many people, finding the right services at the right time is almost impossible. Doctors, nurses and many other people working in the system are doing all they can to help people — but their ability to assist is severely limited by the substantial gaps in the system.

3.9 mil

In Australia, there are about 3.9 million people with mental illness and about 1 million mental health carers.

The mental health system is not listening to consumers and carers.

Consumers and carers are often excluded from decisions that affect their lives, ranging from treatment options to policy design.

Consumers and carers are looking for a mental health system where:

can access services

They can access the services they need when they need them.

gold tick

The services they receive accommodate their needs.

information flow

Information flows freely between providers, so consumers and carers do not have to tell their story over and over again.

Consumers and Carers: Mental health inquiry information

To improve people’s experience, the Productivity Commission draft report recommends:

  • Focusing on prevention and early intervention, so that people can access treatment well before they reach a crisis point.
  • Helping people access the services they need, including online therapy and after-hours services that prevent people from needing emergency departments.
  • Creating meaningful gateways and pathways, so people do not fall through the cracks in care delivery.
  • For carers, the Commission’s proposed reforms improve support services (including access to income support) and enable mental health services to talk to and support carers.
  • For families affected by mental illness, there would be greater access to family therapy, and more support for young carers in schools.
  • The Productivity Commission’s draft report recommends setting up processes whereby consumer and carer voices can be heard — and make a difference to the way mental healthcare works.

Young people

  • Young adults experience higher rates of mental illness than the rest of the adult population.
  • 26% of 16-24 year olds have an anxiety, mood or substance use disorder — and report relatively high rates of psychological distress.
  • These years are an important transition point in a person’s life regardless of their mental health.
  • Mental illness can disrupt people’s success in their education and careers, and without proper support put them on a different trajectory for their whole life.
  • That is why many of our reforms have focused on ways to support the mental health of children and young people.

Fact sheet 3: Aboriginal and Torres Strait Islander People

To improve the social and emotional wellbeing of Aboriginal and Torres Strait Islander people, mental health and suicide prevention services should provide culturally sensitive and responsive supports that take account of historic experiences and social issues faced by Aboriginal and Torres Strait Islander people.

flags

Aboriginal and Torres Strait Islander people experience far higher rates of mental ill-health compared to other Australians.

3 times more

Aboriginal and Torres Strait Islander people are three times more likely to experience high levels of psychological distress.

Hospital

Aboriginal and Torres Strait Islander people are twice as likely to be hospitalised for mental illness.

14 times

Aboriginal and Torres Strait Islander people are twice as likely as non-Indigenous people to die by suicide. Aboriginal and Torres Strait Islander youth (up to 24 years old) are up to 14 times more likely to die by suicide than other Australian youth.

There are unique risk factors experienced by Aboriginal and Torres Strait Islander people that can increase their likelihood of mental ill health, including:

  • Intergenerational trauma.
  • Racism and discrimination.
  • Disadvantage and social exclusion.

Aboriginal and Torres Strait Islander people have an holistic concept of social and emotional wellbeing which includes: connection to culture, country, spirituality and ancestors; family and kinship; and community. Aboriginal and Torres Strait Islander healthcare workers can play an important role in providing culturally capable mental healthcare for Aboriginal and Torres Strait Islander people.

Aboriginal and Torres Strait Islander people should be empowered to shape and control their futures to improve social and emotional wellbeing. Improving the mental health of Aboriginal and Torres Strait Islander people requires local leadership and local solutions.

The Productivity Commission’s Inquiry makes a number of recommendations to address these issues:

  • Expanding the role of Indigenous controlled organisations in the planning and delivery of mental health services and suicide prevention programs.
  • Ensuring Aboriginal and Torres Strait Islander people have access to mental health supports that are culturally responsive in correctional facilities and upon release.
  • Improving partnerships between traditional healers and mainstream mental health services.
  • A broader recognition of the needs of Aboriginal and Torres Strait Islander communities in the governance structures of the mental health system.

Fact sheet 4: Early Childhood, Children and Young People

Early identification of risks in children and young people enables intervention and prevention of mental illness. This can significantly improve mental health and social and economic outcomes.

Children and young people face greater mental health risks

1 in 7

Mental ill-health affects one in seven 4 to 17 year olds.

More than 1 in 4

More than one in four 16 to 24 year olds had mental illness in the past 12 months.

While life

Mental ill-health in young people can affect their whole life – with high cost for the individual, their family and the broader community.

Promoting mental health and wellbeing needs to start early in a child’s life. This includes monitoring social and emotional development in young children, in the same way their physical growth is regularly checked. It also means supporting parents, because helping parents helps their children.

For many children, preschool or school is the place where risk factors for social and emotional development are first identified. Early childhood education and care centres and schools need help to support children’s social and emotional wellbeing and to be effective gateways for students and families to seek help. Many teachers and schools find this role very challenging — teachers also need to be supported as part of their training and professional development. Schools need dedicated wellbeing leaders to assist both teachers and students.

Research shows this [pre-adolescent to early adult years] is the time that many challenges/risks and mental illnesses begin, but we do very little to prepare the family and community, as a whole’.
Connect Health and Community, sub. 94, p. 11

About 1 in 8 of 15 to 29 year olds are not engaged in school, training or work. This group is at risk of mental ill-health, and without targeted support may not re-enter education or work.

Early Childhood, Children and Young People : Mental health inquiry information

The Productivity Commission’s Inquiry makes a number of recommendations to address these issues:

  • Expansion of early childhood health checks to assess social and emotional development.
  • Expansion of parent education and support programs.
  • Skills development in social and emotional wellbeing for teachers and other educators through their initial training and professional development.
  • Ensure all schools (over a certain size) have a full-time senior teacher dedicated to student mental health and wellbeing, who also maintains links to mental health support services in the local community.
  • All tertiary institutions should have a mental health and wellbeing strategy stating how they will support student mental health.
  • The Individual Placement and Support model of employment support could be used to help place disengaged youth into education or work.

The effects of the early childhood and school education reforms would improve the wellbeing of children  and young people with poor mental health, and would have ongoing positive effects on their quality of life and employment outcomes. Over time, employment among those affected is expected to increase from 43,000 to 58,000 adding from $4.3 to $5.6 billion in income annually.

$5.6 billion

Fact sheet 5: Workplaces / Businesses

Two-way link between employment and mental health

There are strong two-way links between employment and mental health.

Being employed can improve mental health and mentally healthy workplaces are important to maintain the good mental health of those who work there.

But some workplaces can have negative impacts on mental health.

$17 billion per year

Estimates for the cost of workplace absenteeism (the inability to go to work) and presenteeism (the inability to fully function at work) due to mental ill-health range from $13 billion to $17 billion per year.

There are potential high returns to employers from investing in strategies and programs to create mentally healthy workplaces in terms of:

  • Lower absenteeism.
  • Increased productivity.
  • Reduction in compensation claims.

But employers are looking for assistance about what works and how to implement it.

Working can give people:

identity

A sense of identity.

purpose

Purpose.

satisfaction

Life satisfaction.

social interaction

Increased social interaction.

communication

Provide regular communication and shared experiences with people outside of an individual’s family.

Workplaces / Businesses: Mental health inquiry information

Mental health related workers compensation claims are more costly and require more time off work than other claims

$25k+

The typical cost of a mental health related claim was $25,650 compared with $10,600 for all other claims.

Calendar

The typical time of work was 16.2 weeks compared with 5.7 weeks for all other claims.

The Productivity Commission’s Inquiry makes a number of recommendations to address these issues:

  • Making psychological health and safety as important as physical health and safety.
  • Workplace health and safety agencies develop and implement codes of practice to assist employers, especially small employers, better manage mental health risks in the workplace.
  • Provision of medical treatment for mental health related workers compensation claims, irrespective of liability, until the injured worker returns to work or up to a period of six months following lodgement of claim.
  • Workplace health and safety agencies and employers work together to collect and disseminate information on the effectiveness of workplace mental health initiatives.

Fact sheet 6: General Practitioners (GPs)

General Practitioners (GPs) are the frontline service for most mental health care in urban and regional parts of Australia. GPs have a vital role in managing the overall health of patients with a mental illness and referring them for specialist treatment when needed.

Many GPs involved in the Productivity Commission’s Inquiry indicated they felt either overwhelmed or inadequately prepared to deal with mental health issues, and found it challenging to gather a full understanding of what services were available for patients.

GPs could be better supported in:

  • Assessing consumers with mental health problems.
  • Managing the side effects of mental health medications.
  • Connecting patients into other services (such as online mental health services).

Consumers with mental ill-health would benefit from better co-ordination between GPs and other clinicians.

The Productivity Commission’s Inquiry makes a number of recommendations to address these issues:

  • GPs should be funded (through Medicare) to create and maintain a single care plan for consumers with complex care needs.
  • All GPs should have access to psychiatric advice over the phone (funded through Medicare) to help them manage their patients.
  • Mental health referral pathways should be detailed online for all regions, for example through the HealthPathways platform.
  • Introduce a continuing professional development course that educates GPs about best practice approaches to managing medications used to treat mental illness.
  • The number of mental health nurses practicing in Australia — in GP clinics, community health services, and aged care facilities — should be significantly increased.

1 in 8 Aust.

1 in 8

1 in 8 visits to a GP are related to mental health.

4 million

About 4 million people (15% of the population) receive a mental health related prescription from their GP in a year.

Consumers with mental ill-health would benefit from better co-ordination between GPs and other clinicians.

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Volume 1

  • Preliminaries: Cover, Copyright and publication detail, Opportunity for further comment, Public hearings, Commissioners, Disclosure of interests, Contents, Acknowledgements and Abbreviations
  • Key points
  • Overview
    • Why this inquiry?
    • 1. Early help for people
    • 2. Improving peoples' experiences with mental healthcare
    • 3. Improving peoples' experience with services beyond the health system
    • 4. Increasing the participation of people with mental illness in education and work
    • 5. Reforming the funding and commissioning of services and supports
  • Draft recommendations and findings
    • PART I The case for major reform
    • PART II Reorienting health services to consumers
    • PART III Reorienting surrounding services to people
    • PART IV Early intervention and prevention
    • PART V Pulling together the reforms

PART I — The Case for Major Reform

  • Chapter 1 Inquiry background and approach
    • 1.1 Why this inquiry?
    • 1.2 What affects Australians’ mental health and wellbeing?
    • 1.3 Defining the scope of the inquiry
    • 1.4 What we heard from the community
    • 1.5 Developing a reform agenda to respond to community concerns
    • 1.6 How to get involved in the remainder of this inquiry
  • Chapter 2 Australia’s mental health
    • 2.1 The prevalence of mental ill-health in Australia
    • 2.2 What is the reduction in years of healthy life lived due to mental illness?
    • 2.3 Different groups have different needs and outcomes
  • Chapter 3 What mental ill-health and suicide are costing Australia
    • 3.1 Impacts of mental ill-health and suicide
    • 3.2 Monetary cost of mental-ill health and suicide
    • 3.3 Lifetime impacts of early setbacks
  • Chapter 4 The way forward — creating a people oriented system
    • 4.1 The goal — a people oriented system
    • 4.2 Empowering consumers to take an active part in the mental health system
    • 4.3 Systemic changes needed to create a consumer oriented system

PART II — Re-orienting health services to consumers

  • Chapter 5 Primary mental healthcare
    • 5.1 GPs are the front-line of consumer-focused care
    • 5.2 Matching consumers with the right level of care
    • 5.3 Improving psychological therapy to meet consumer needs
  • Chapter 6 Supported online treatment
    • 6.1 What is supported online mental health treatment?
    • 6.2 Why focus on supported online treatment?
    • 6.3 Benefits of supported online treatment
    • 6.4 What could limit the take-up of supported online treatment?
    • 6.5 Estimating the gains of expanding supported online treatment
  • Chapter 7 Specialist community mental health services
    • 7.1 Consumers must be matched with the right care
    • 7.2 The missing middle
    • 7.3 Addressing gaps in community services
    • 7.4 Improving access to private psychiatric care
  • Chapter 8 Emergency and acute inpatient services
    • 8.1 Crisis and emergency services
    • 8.2 Acute inpatient mental health services
  • Chapter 9 Physical and substance use comorbidities
    • 9.1 Physical comorbidities
    • 9.2 Substance use comorbidities
    • 9.3 What more should be done to address comorbidities?
  • Chapter 10 Towards integrated care: linking consumers and services
    • 10.1 Helping consumers find services
    • 10.2 Enabling coordination and continuity of care
    • 10.3 Enabling the delivery of integrated care
  • Chapter 11 Mental health workforce
    • 11.1 Why reform the health workforce?
    • 11.2 Improving the quantity, mix and allocation of skills across the health workforce
    • 11.3 Fostering more supportive work environments
    • 11.4 Addressing the mismatch between where consumers and the health workforce are located

PART III — Re-orienting surrounding services to consumers

  • Chapter 12 Psychosocial support
    • 12.1 Programs and services that support recovery
    • 12.2 The delivery of psychosocial supports and the transition to the NDIS
    • 12.3 Improving the delivery of psychosocial supports in the NDIS
    • 12.4 Improving the delivery of psychosocial supports for people not in the NDIS
  • Chapter 13 Carers and families
    • 13.1 Mental health carers provide a valuable contribution to the community
    • 13.2 Income support payments for carers
    • 13.3 Social services for carers
    • 13.4 Family-focused and carer inclusive practice
  • Chapter 14 Income and employment support
    • 14.1 The importance of income and employment support for people with mental ill-health
    • 14.2 Current income and employment support programs
    • 14.3 Improvements to the employment support system
    • 14.4 Toward an Individual Placement and Support model of employment support
    • 14.5 Income support benefits and incentives
    • 14.6 Mutual obligation requirements
  • Chapter 15 Housing and homelessness
    • 15.1 Housing and mental health are closely linked
    • 15.2 Preventing housing issues
    • 15.3 Supporting people with high needs to find and maintain housing
    • 15.4 Responding to homelessness among people with mental-ill-health
    • 15.5 Prioritising reforms
  • Chapter 16 Justice
    • 16.1 Interaction between the justice and mental health systems
    • 16.2 Criminal justice system
    • 16.3 Victims of crime
    • 16.4 Access to justice

Volume 2

Part IV — Early intervention and prevention

  • Chapter 17 Interventions in early childhood and school education
    • 17.1 Mental health and wellbeing in the first three years of life
    • 17.2 Mental health and wellbeing for preschool-aged children
    • 17.3 Supporting children and young people during their school years
    • 17.4 The wellbeing and mental health workforce within schools
    • 17.5 Are we on the right track? Assessing the effect of policy on the wellbeing of school-aged children
    • 17.6 Quantifying the benefits of recommended reforms
  • Chapter 18 Youth economic participation
    • 18.1 Youth mental health and economic participation
    • 18.2 Supporting people in tertiary education
    • 18.3 Support for youth to re-engage with education and training
  • Chapter 19 Mentally healthy workplaces
    • 19.1 Mentally healthy workplaces
    • 19.2 Workplace health and safety and workplace mental health
    • 19.3 Workers compensation arrangements and workplace mental health
    • 19.4 Employer initiatives to create mentally healthy workplaces
    • 19.5 The returns from investing in workplace initiatives
    • 19.6 Improving employer interventions
  • Chapter 20 Social participation and inclusion
    • 20.1 Barriers to social participation and inclusion
    • 20.2 Promoting social participation and inclusion
    • 20.3 Improving social participation for Aboriginal and Torres Strait Islander people
  • Chapter 21 Suicide prevention
    • 21.1 Suicide remains a significant issue in Australia
    • 21.2 The cost of suicide is high?
    • 21.3 What works in suicide prevention?
    • 21.4 Empowering Aboriginal and Torres Strait Islander people to prevent suicides
    • 21.5 Improving our approach to suicide prevention

PART V — Pulling the reforms together

  • Chapter 22 Governance
    • 22.1 Current governance arrangements
    • 22.2 Codifying federal responsibilities
    • 22.3 Strengthening the National Mental Health Strategy
    • 22.4 Enhancing consumer and carer collaboration
    • 22.5 Improving accountability
    • 22.6 Building an evaluation culture through the NMHC
  • Chapter 23 Federal roles and responsibilities
    • 23.1 Structural flaws in mental healthcare
    • 23.2 Impacts of recent reforms
    • 23.3 What system design features do we want?
    • 23.4 Changes to roles and responsibilities for psychosocial and carer supports outside of the NDIS
    • 23.5 Two options for reforming mental health system architecture
    • 23.6 The Renovate model
    • 23.7 The Rebuild model
  • Chapter 24 Funding arrangements
    • 24.1 Primary mental healthcare funding
    • 24.2 Restrictions on regional funding pools
    • 24.3 Changes to intergovernmental funding arrangements
    • 24.4 Toward more innovative payment models
    • 24.5 Private health insurance
    • 24.6 Life insurance
  • Chapter 25 A framework for monitoring, evaluation and research
    • 25.1 Data collection and use
    • 25.2 Monitoring and reporting
    • 25.3 Evaluation
    • 25.4 Research
  • Chapter 26 Benefits of reform
    • 26.1 Estimating the health and economic benefits of reforms
    • 26.2 Reforms that benefit the whole community — by responding to people’s needs
    • 26.3 Looking beyond the numbers
    • 26.4 Effective implementation is key to realising the benefits of reform

PART VI — Supporting material

  • Appendix A Inquiry conduct and participants
  • Appendix B Income and employment support
  • Appendix C Employment and mental health
  • Appendix D Bullying and mental health
  • Appendix E Calculating the cost of mental ill-health and suicide in Australia
  • Appendix F Economic benefits of improved mental health (online only)
  • References

Please note: This appendix is online only and is not in the full draft report.

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Overview

Volumes 1 and 2

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