Rising treatment rates and antidepressant use have meant little without prevention. Perhaps we need a ‘wellbeing budget’.
Pervasive gaps in the quality of treatment, and a lack of action on preventing mental ill-health are the reasons why Australians haven’t seen improvement in mental health and wellbeing despite rising treatment rates.
“Getting more people into treatment in Australia hasn’t improved the mental health of the population,” said Emeritus Professor Anthony Jorm, speaking at the PHAA’s Preventive Mental Health Symposium in Melbourne.
“What the data [has shown] is that getting more people in treatment has not had the expected benefits,” said Professor Jorm, who leads the Centre for Mental Health at the University of Melbourne School of Population and Global Health.
Professor Jorm said a lack of clinically proven, quality mental health services, and insufficient attention on preventive strategies were hindering progress on mental health outcomes nationwide.
“Looking at data on psychotropic medications, particularly antidepressants, Australia is one of the biggest users of antidepressants in the developed world,” he said.
“If you go back beyond earlier than 2000, it was increasing right through the 1990s as well, and we cannot see any reduction in depressive symptoms as a result of that.
“GP mental health services [have seen] a tremendous increase over a few years, and various psychological services also showed a massive increase over that time, far outgrowing the government’s projected budget for these services.
“We try and get people out [of the system] by getting them better quickly. So, we reduced prevalence by getting them out, [but] we’re not doing anything about the flow that’s coming in.
“The prevention gap says we need to do more at the inflow, as well as the outflow.”
Professor Jarm outlined seven strategies to shift Australia’s mental health system towards an emphasis on “prevention, promotion and healing”.
These included:
- Moving towards “dimensional” rather than black-and-white thinking.
- Promoting positive indicators for mental health and wellbeing alongside indicators for mental ill-health.
- Addressing the “prevention gap” in psychological approaches driving current prevention strategies, such as school-based preventive mental health programs.
- Taking stronger action to identify and mitigate risk factors widely associated with mental health disorder prevalence, including non-health related factors such as unemployment, low income, low social connectedness and social support, and workplace characteristics.
- Taking a more “experimental” approach to social policy, with inspiration from international models such as Finland’s basic income experiment.
- Improving monitoring of national progress on mental health and wellbeing.
- Implementing a national wellbeing budget to drive the broader shift towards building an economic foundation for the prevention of mental ill-health and promotion of wellbeing.
In terms of restructuring narratives from framing mental health as a financial burden on the economy to emphasising the economy’s role in shaping mental wellbeing, Professor Jarm said federal measures such as the Measuring What Matters report were vital to moving the dial towards prevention and promotion of mental wellbeing.
“The federal treasury has introduced this framework called Measuring What Matters,” he said.
“They put out a proposal to make life satisfaction – a measure of positive wellbeing – a fundamental indicator of policy success in Australia.
“This is so important [because] a lot of gains in health cannot be measured in randomised control trials, the timeframe is too short.
“We need to look over generations, over decades to show things, and the [framework] is the sort of thing we’re going to be looking for [to measure] the big effects at a national level over many decades for mental health and wellbeing.
“The framework [also] underpins what’s called a ‘wellbeing budget’. This is a reframing of what our society and our economy is all about.
“Ultimately, we’ve got to get outside the health system. We’ve got to look at broad trends over many decades, and we need to have wellbeing and mental health as a basic indicator of how we’re going in society.”
Victorian Minister for Mental Health Ingrid Stitt announced a host of strategies aimed at shifting the state’s mental health system towards the prevention of mental ill health.
These strategies included establishing of two new mental health offices within the Victorian Department of Health, co-producing a new suicide prevention and response strategy with people with living and lived experience of suicide and implementing flagship social inclusion and wellbeing initiatives such as the Local Connections social prescribing program.
