Mental Health Planning in Mental Health Planning in Queensland.Queensland.

Dr Aaron Groves Dr Aaron Groves Director of Mental Health.Director of Mental Health.

08/04/201108/04/2011

• 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 StrategyNational 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 2008Fourth National Mental Health Plan 2009-14

• States and Territory mental health policies, plans and strategiesQueensland Plan for Mental Health 2007-17

The Policy Context2008 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 contextThe national contextFourth National Mental Health Plan 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 Recovery2. Prevention and Early Intervention3. Service Access, Coordination and

Continuity of Care4. Quality Improvement and Innovation5. Accountability – Measuring and

reporting progress

The National Drug Strategy 2004-09 The National Drug Strategy 2004-09 (in the process of being renewed) (in the process of being renewed) and associated strategiesand associated strategies

National Survey of Mental Health and Wellbeing National Survey of Mental Health and Wellbeing

20072007

• 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 challengeScope of our challenge

Mental illnessMental 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

Scope of our challengeScope of our challenge

The vast majority of mental disorders have onset early in life

0%

25%

50%

75%

100%

1 11 21 31 41 51 61 71 82

Age of Onset (years)

Cu

mu

lati

ve

pe

rce

nt

64% have onset by age 21 years

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 needOf 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 challengeScope of our challenge

Alcohol and drugsAlcohol 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 challengeScope of our challenge

Suicide 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.

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.

(1) Malignant neoplasms

(2) Cerebrovascular disease

(3) Acute myocardial infarction

(4) Other circulatory system

(5) Suicide

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 servicesSo what is happening to our beds?

0

2 , 0 0 0

4 , 0 0 0

6 , 0 0 0

8 , 0 0 0

1 0 , 0 0 0

1 2 , 0 0 0

1 9 8 6 1 9 8 8 1 9 9 0 1 9 9 2 1 9 9 4 1 9 9 6 1 9 9 8 2 0 0 0 2 0 0 2

P o s t - S t r a t e g yP r e - S t r a t e g y

Inpatient Mental Health ServicesBut… It started a long time ago!

0

5,000

10,000

15,000

20,000

25,000

30,000

Post-Strategy

Pre-Strategy

0

100

200

300

400

500

1970 1980 1990 2000 2010

AustriaBelgiumCyprusDenmarkFinlandFranceGermanyGreeceIcelandIrelandItalyLuxembourgMaltaNetherlandsNorwayPortugalSpainSwedenUnited Kingdom

Psychiatric hospital beds per 100000

Trends in availability of psychiatric beds in Western Europe

Source WHO

0

50

100

150

200

250

1970 1980 1990 2000 2010

BulgariaCroatiaCzech RepublicEstoniaHungaryLatviaLithuaniaPolandRomaniaSlovakiaSloveniaTFYR MacedoniaTurkey

Psychiatric hospital beds per 100000

Trends in availability of psychiatric beds in Central and Eastern Europe (CEE)

Source WHO

1. ExpenditurePer capita expenditure by states and territories on

general adult mental health services 2002-03 (dollars) 125.81

112.22

110.81

107.88

102.08

98.92

96.97

89.95

WA

ACT

NSW

SA

TAS

NT

VIC

QLD

Nat. Av. $104.34