Mental Health Planning in
Queensland.
Dr Aaron Groves
Director of Mental Health.
08/04/2011
• I would like to pay my respect and
acknowledge the Wurundjeri,
Boonerwrung, Taungurong, Djajawurrung
and the Wathaurung people who make up
the Kulin Nation the area we call
Melbourne.
• In addition I acknowledge the Turrbal
people part and present on whose land I
walk, I work and I live.
National Mental Health Strategy
•
•
•
•
•
Mental Health Statement of Rights and Responsibilities
1991
National Mental Health Policy 1992
National Mental Health Plan, 1992–98
 Medicare Agreements 1993-98
Second National Mental Health Plan,1998–03
 Australian Health Care Agreements 1998-03
National Mental Health Plan 2003–08
 Australian Health Care Agreements 2003-08
•
COAG National Action Plan for Mental Health 2006-11
•
National Mental Health Policy 2008
Fourth National Mental Health Plan 2009-14
•
States and Territory mental health policies, plans and
strategies
Queensland Plan for Mental Health 2007-17
The Policy Context
2008 National Mental Health Policy: principles
underpinning future mental health reform
• To promote the mental health and wellbeing of the
Australian community and, where possible, prevent the
development of mental health problems and mental illness;
• To reduce the impact of mental health problems and mental
illness, including the effects of stigma on individuals,
families and the community;
• To promote recovery from mental health problems and
mental illness; and
• To assure the rights of people with mental health problems
and mental illness, and to enable them to participate
meaningfully in society.
The national context
Fourth National Mental Health Plan
• Launched by Australian Health
Ministers in November 2009
• Operationalises the revised National
Mental Health Policy 2008
• 34 actions under 5 priority areas:
1. Social Inclusion and Recovery
2. Prevention and Early Intervention
3. Service Access, Coordination and
Continuity of Care
4. Quality Improvement and Innovation
5. Accountability – Measuring and
reporting progress
The National Drug Strategy 2004-09
(in the process of being renewed)
and associated strategies
National Survey of Mental Health and Wellbeing
2007
• One in five Australians had experienced
a mental illness in the last 12 months
– 14.4% Anxiety disorders (panic
disorders, agoraphobia, social
phobias, GAD, OCD, PTSD)
– 6.2% Affective disorders
(depression, dysthymia, bipolar
affective disorder)
– 5.1% Substance use disorders
(alcohol and other drugs) .
• 45 % of Australians experience mental
disorder at some point in their lifetime.
• Under-estimate for a number of
reasons
– Household survey
– Common mental disorders
– Relatively low response rate.
Scope of our challenge
Mental illness
• One quarter of the total disability burden due to mental
illness
• Third leading cause of overall disease burden after
cardiovascular diseases and cancer
• Almost half the population will experience a mental disorder
in their lifetime, 1 in 5 in any 12 month period
The ‘burden’ of mental health disorders on
Australian society
Cardiovascular
Cancer
Mental
Nervous system
Injury
Chronic respiratory
Musculoskeletal
Years of life
lost due to
death
Digestive
Diabetes
Genitourinary
Years lost due
to disability
Infectious
Congenital
Respiratory infections
Neonatal
Other
0
100
200
300
400
Years of healthy life lost (thousands)
500
600
Scope of our challenge
The vast majority of mental
disorders have onset early in life
Any Lifetime ICD-10 Mental Disorder:
Cumulative Proportion of Cases by Age of On
Cumulative percent
100%
75%
50%
64% have onset
by age 21 years
25%
0%
1
11
21
31
41
51
61
71
82
Age of Onset (years)
Cum%: Any Anxiety or Affective Di
Treated prevalence
• Only around one-third (35% or 3.2 million people) who
were assessed as having a 12-month mental disorder
accessed services for mental health problems
– 41% women with disorders compared with 28% of men
– Highest treatment rates were for affective disorders with
45%
– Half of those who received services (51.7%) had two or
more disorders.
– Two-thirds with mental disorder and a suicidal behaviour
• Of those with 12-month disorders who received services,
their needs were only partially or not met
–
–
–
–
–
information (28.6%)
medication (9%)
counselling (25.7%)
social intervention (23.6%)
skills training (17.9%)
Why people aren’t receiving
services?
• Most report no need
Of those with 12-month disorders who didn’t
receive services:
– 94.4% reported no need for information;
– 97.9% reported no need for medication;
– 89.7% reported no need counselling;
– 94.3% reported no need for social intervention;
and
– 96.4% reported no need for skills training.
Key messages
• Proportion of the population receiving services has
not changed much since 1997
• Appears we are providing services differently
– greatly increased servicing by psychologists
– perhaps more people seeing GP+
• Messages seem to have got through for depression,
particularly to middle aged
– Not doing so well for other disorders, young and men
• Many people who could benefit from effective
treatments report that they don’t need services
– need to look at stigma and mental health literacy
– as well as disseminating treatment information (effectiveness,
availability, cost, access)
Scope of our challenge
Alcohol and drugs
• One fifth of total injury burden in Queensland is due to
excessive alcohol consumption
• 1 in 10 adults drink at levels placing them at risk of long term
harm
• This rises to 1 in 5 in the 18-24 age group
• Alcohol related expenditure $15.3 billion nationwide in
2004/05, 13% in healthcare system
• 1 in 7 Queenslanders used illicit drugs in the past year
• Again, this rises to 1 in 3 in the 20-29 year age group
Scope of our challenge
Suicide
• More than 1 in 8 Australian adults contemplate suicide in
their lifetime
• 500 completed suicides in Queensland each year
• 2nd leading cause potential years of life lost for males, 4th for
females
• Estimated economic cost of up to $17.5 billion per annum
nationwide
Physical illness and mental illness the facts:
Largest data linkage study of its type
in Australia:
•231,311 people, who were on the
mental health register had their
records between 1980-1998
examined
•There records were compared with
the rest of the population
•There life expectancy was 12 years
shorter than the rest of the
population, that is it was the same as
Aboriginal people in WA
THEY FOUND THAT SUICIDE WAS NOT THE MAIN CAUSE
OF CLIENT MORTALITY, BUT THE FIFTH-HIGHEST CAUSE.
(1) Malignant neoplasms
(3) Acute myocardial infarction
(2) Cerebrovascular disease
(4) Other circulatory system
(5) Suicide
Source:
Lawrence D, Coghlan R. H health inequalities and the health needs of people
with mental illness. NSW Public Health Bulletin 2002; 13(7): 155– 158.
Physical illness and mental illness the facts:
•Very high rates of smoking and
therefore much higher rates of
respiratory disease
•Higher rates of deficiency anaemias
•Higher rates of injury particularly being
inflicted by others
•Ischaemic Heart Disease caused twice
the number of excess deaths than
suicide
•Yet lower rates of revascularization
•Lower rates of hospitalization
•Higher rates of surgical complications
Inpatient Mental Health services
So what is happening to our beds?
12,000
Pre-Strategy
Post-Strategy
10,000
8,000
6,000
4,000
2,000
0
1986 1988 1990 1992 1994 1996 1998 2000 2002
Inpatient Mental Health Services
But… It started a long time ago!
Note - this is ALL beds, not just stand alones
30,000
25,000
PreStrategy
PostStrategy
20,000
15,000
10,000
5,000
19
65
19
67
19
69
19
71
19
73
19
75
19
77
19
79
19
81
19
83
19
85
19
87
19
89
19
91
19
93
19
95
19
97
19
99
20
01
20
03
0
Trends in availability of psychiatric beds in Western
Europe
Psychiatric hospital beds per 100000
500
400
Austria
Belgium
Cyprus
Denmark
Finland
France
Germany
Greece
Iceland
Ireland
Italy
Luxembourg
Malta
Netherlands
Norway
Portugal
Spain
Sweden
United Kingdom
300
200
100
Source WHO
0
1970
1980
1990
2000
2010
Trends in availability of psychiatric beds in Central and Eastern
Europe (CEE)
Psychiatric hospital beds per 100000
250
200
Bulgaria
Croatia
Czech Republic
Estonia
Hungary
Latvia
Lithuania
Poland
Romania
Slovakia
Slovenia
TFYR Macedonia
Turkey
150
100
50
Source WHO
0
1970
1980
1990
2000
2010
1. Expenditure
Per capita expenditure by states and territories on
general adult mental health services 2002-03 (dollars)
125.81
WA
112.22
ACT
110.81
NSW
107.88
SA
102.08
TAS
NT
VIC
QLD
98.92
96.97
89.95
Nat. Av.
$104.34