Urgent fixes needed for mental health care

All Australians have the right to high-quality healthcare appropriate to their illness. To argue otherwise would be to advocate discrimination. But rights are different from realities, and in reality the Australian health system discriminates against groups and individuals every day. People with mental illness, and Aboriginal and Torres Strait Islanders, are treated differently. They’re treated worse.

That brutal truth helps explain why both groups have significantly lower life expectancy than the rest of the population. The Herald agrees with the National Mental Health Commission chairman Allan Fels: it is shocking indeed that in Australia, where we enjoy one of the best healthcare systems in the world, people with a serious mental illness die younger on average than the general population by between 14 and 23 years. They are six times more likely to die of cardiovascular disease, four times more likely to die from respiratory disease, and more likely to be diagnosed with diabetes or have a stroke under the age of 55.

Many will recall the disgusting cruelty and neglect of Miriam Merten, who died after being left in a seclusion room for five hours at Lismore Adult Mental Health Inpatient Unit. She was ignored by two nurses while she bashed her head against the concrete wall and floors and left to stumble half-naked in a corridor before collapsing. The inquiries under way may reveal whether Ms Merten’s was an isolated extreme case or symptomatic of a wider problem. The 53 organisations concerned with mental health who signed up to the Equally Well statement know, though, that the physical health symptoms of people with mental illness are often overlooked or ignored in the health system, as are the damaging side effects of their medications.

On equity, compassionate and economic grounds, urgent remedies are needed. But money talks loudest, so the economic argument is the one most likely to gain political traction. That’s why Professor Fels points to the $15 billion cost to the health system of physical illness among people living with a serious mental health issue. The Fairfax-Lateral Economics wellbeing index – which provides a broader measure of national welfare than traditional economic figures – calculated that the cost of mental illness to national wellbeing last year was $207 billion. That is equivalent to about 12 per cent of the economy’s annual output.

In the past couple of years, federal and state governments have taken welcome steps forward yet big problems remain. Without a radical rethink, the National Disability Insurance Scheme – designed primarily for people with physical or intellectual disability – looks like leaving out more than 200,000 people who need psycho-social support. It’s hard to fathom why, three years after NDIS trials started, there are still no published eligibility criteria for people with mental illness.

Professor Fels also wants the Productivity Commission to look into mental health to get it on the economic agenda. The potential economic gains from improving mental health outcomes dwarf every other economic reform on the books, including tax and industrial relations reform. It’s also more likely to attract political consensus, because who is going to argue that improving mental health care is not a good thing? It’s not theory, or ideology, it’s about ensuring people living with mental illness have the same access to a good and healthy life as everyone else: a stable home, fulfilling work, opportunities to learn, healthcare and the support of family and community.

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