Monash university finds rural Australians under serviced for mental health issues

Monash university finds rural Australians under serviced for mental health issues

Minto Felix
The Age
March 9, 2015

Last week’s Monash University findings from the largest ever study into Australian mental health services paint a bleak picture for individuals living in rural and remote areas. This examination of 25 million mental health items, taken between 2007 and 2011 from Medicare data, highlights that those living in metropolitan areas have about three times better access to psychological services than those living in rural and remote locations. Unfortunate as this is, these findings should not at all be surprising given the high levels of mental illness in rural and remote areas. However, what is alarming is the significant number of young people experiencing mental illness within this demographic. Given that 75 per cent of mental illness occurs before a person turns the age 26, it places an already vulnerable population group at an increased risk.

But unequal access isn’t the only challenge in youth mental health. The McClure report on welfare also shone a light on the proportion of people who receive disability support pensions, a significant 30 per cent of whom are diagnosed with psychiatric or psychological conditions, and again, who develop these illnesses young in life. Despite the overwhelming majority of young people wanting to complete education and work, life chances are often damaged due to a lack of early intervention and a mismatch in care delivery for them and their families. This pattern of young people as most at-risk extends to drug and alcohol abuse, suicides, and so many other mental ill-health scenarios. Costing the world about $16 trillion to address, mental illness profoundly impacts families and communities, but no doubt, bears a particular burden on the one in four young people who live with serious mental ill-health.

“Youth participation is not only essential for an individual’s own healing process, but it can be an instrument of enormous change.”

Despite the massive reforms in youth mental health over the past decade, enormous obstacles still stand. And in order to conquer these new and emerging challenges, the most important actors need to be front and centre of forming the solutions – young people.

Termed by mental health professionals as youth participation, this concept is nothing other than young people having ownership over their mental health, and being empowered to shape mental healthcare in all respects. Youth participation is not only essential for an individual’s own healing process, but it can be an instrument of enormous change. We are beginning to see examples of this engagement in action – the Youth Reference Groups affiliated with headspace Centres around the country, and ReachOut, the online youth-led mental health network. But deeper investment in this area is urgently needed.

For young people to make a meaningful difference on the mental health landscape, they need to work alongside researchers in shaping future priorities. Together with policy makers, they need to design the systems of care that will best match their needs. To the fullest extent possible, young people should be involved in every aspect of health services.

Among both young people experiencing mental ill-health as well as mental health professionals, there can at times be a patronising tone in the way we are addressed. But  the lived experiences of young people need to be part of the diagnosis, prevention, and cure of mental illness. Such an approach can also work to reduce the stigma experienced by so many young people that live with mental illness, and builds trust in health care services.

Taking stock of the bigger picture – within local communities and across the nation, we are indeed in need of a revolution that is driven by young people to tackle these complex health challenges. Young people who are prepared to demand appropriate health services, equipped to influence others, excited to innovate with technology and other tools in therapy and committed to driving positive reform on mental health.

Minto Felix is a mental healthcare advocate.

This page reproduces an article on the website of The Age newspaper. Comments can be made on the page linked.

Melbourne psychiatrist wants end to ‘fingers crossed’ approach to antenatal mental health

Melbourne psychiatrist wants end to ‘fingers crossed’ approach to antenatal mental health

Rachel Kleinman
The Age
March 14, 2015

As Samantha* cradled her newborn in the first days of his life, she began to sense her mental health deteriorating.

Within two days, she was experiencing familiar manic symptoms such as racing and confused thoughts. Samantha, a public servant from Melbourne’s north, was transferred to a mother and baby unit where she remained for more than three weeks until she stabilised enough to take her baby son home. It took a couple of months to fully recover from the postnatal episode.

In consultation with her mental health clinicians, Samantha had stopped taking her anti-psychotic medication quetiapine prior to her son’s birth because of concerns about its safety in breast milk. “If I had my time again, I don’t think I would come off the medication. Knowing what I went through after the birth, I would just stay on it,” Samantha, 31, said.

A Melbourne psychiatrist and researcher said clinical research into safe use of anti-psychotic medication during pregnancy is extremely sparse. “What we actually want is clinical practice guidelines based on evidence … At the moment, everyone is just crossing their fingers and hoping for the best,” said Jayashri Kulkarni, from the Monash Alfred Psychiatric Research Centre.

In 2005, Professor Kulkarni and her colleagues established a world-first database, known as the National Register of Antipsychotic Medication in Pregnancy. The project tracks the impacts of taking anti-psychotic medication on pregnant women, their foetus and the newborn baby up to 12 months of age.

The gap between prescribing and clinical evidence is enormous. According to Pharmaceutical Benefits Scheme figures, use of quetiapine (the most common anti-psychotic) has increased from 1500 annual filled prescriptions in 2000 to more than 1 million in 2014.

“And nobody in the world has any data about outcomes for babies whose mothers took anti-psychotics during pregnancy,” Professor Kulkarni said.

“Anti-psychotics are prescribed for serious mental disorders such as schizophrenia, bipolar disorder and major depression,” she said. “But they are also now used [at lower doses] to treat anxiety, eating disorders and insomnia.”

Mental illness, to varying degrees, can affect up to 10 per cent of pregnant women. And women with a pre-existing psychiatric condition are more likely to experience a relapse of symptoms during pregnancy. But Professor Kulkarni said antenatal mental health is heavily neglected.

So far the study has tracked 240 women and their babies. Findings included higher rates of gestational diabetes and pregnancy weight gain beyond 15 kilograms in mums. Weight gain is a common side effect of anti-psychotics and the impact of gestational diabetes on maternal and neo-natal health is widespread. Study participants had higher rates of babies admitted to intensive or special care, often for respiratory distress. And there was a pattern of withdrawal symptoms among some newborns, who were jittery, had goose flesh and were colder than usual. “On the plus side, most of our babies were healthy, [with] no limb or organ malformation or serious abnormalities,” Professor Kulkarni said.

The centre needs more pregnant women on anti-psychotic medication to join the study. Contact Heather Gilbert on 03 9076 6591 for more information.


This page reproduces an article on The Age website.

Victoria’s mental health sector struggling with demand

Victoria’s mental health sector struggling with demand

Richard Willingham
The Age
March 22, 2015

Mental health services, including those for prisoners and the state’s most acutely unwell, are stretched to the limit, the sector and unions say.

The industry says community treatment teams have been hurt by a lack of investment in the sector while the Thomas Embling Hospital at Fairfield is facing rising demand on the back of an “unique” explosion in the prison population. Thomas Embling Hospital is described as ‘bursting at the seams’.

Last year the Health and Human Services Department prepared a master plan mapping out the next 10 years of forensic mental health services in Victoria. It is yet to be released.

The high-security Thomas Embling psychiatric hospital serves patients from the justice system as well as highly acute patients from the public. It has been described by the Health and Community Services Union as “bursting at the seams”.

Chairman of the Victorian Institute of Forensic Mental Health Bill Healy said last year that the hospital was only designed to service a prison population that was 40 per cent of what it is now. Writing in Forensicare’s annual report Mr Healy said there had been as “extraordinary increase” in the prison population in the past three-four years, many of whom needed specialist mental health services

“The human impact on prisoners with a mental illness, correctional staff and clinical staff where mentally ill prisoners are waiting more than 30 days for involuntary treatment is concerning to myself and the board,” Mr Healy said.

The former government was briefed on some of the options in the master plan just before last November’s election, including expanding services at Fairfield or building a new acute forensic service at another site.

Labor promised to create a 10-year mental health plan including services for those in the justice system and that plan is currently being developed.

Extra mental health capacity in prisons will be created by the Ravenhall prison, which was signed off by the Napthine government – it includes 75 mental health beds as well as services for another 100 patients.

The health union’s state secretary, Lloyd Williams, said there were continuing concerns about the lack of investment in mental health in the state.

He blamed the previous Napthine government, saying Victoria had dropped to the state with the lowest investment in mental health than any other state.

“You end up with a crisis driven, squeaky wheel situation, where people in the most difficulties get the most focus,” Mr Williams said.

“The demand on staff is so high because they are so stretched. People are burned out and new graduates aren’t joining the system as it is overworked.”

With a more reactive system it was easier for people to fall through the cracks, he said.

The former government said it had increased funding to community mental health services by 30 per cent.

Other issues dogging the sector include an ageing workforce and the ability to attract and retain staff.

The peak body representing community managed mental health services Vicserv’s chief executive, Kim Koop, said the expectation on mental health services were high but “resources don’t allow these expectations to be met”.

Minister for Mental Health Martin Foley said the government was working on its promised 10-year plan, which would include planning for forensic mental health services and services for patients from the criminal justice system.

“The former Liberal government’s preoccupation with funding prison beds instead of forensic treatment beds and facilities has created the situation where a significant number of prisoners with mental health conditions and illnesses have not been getting the treatment they need,” Mr Foley said.

This page reproduces an article published on The Age website.

Facebook steps up suicide prevention

Facebook steps up suicide prevention

Kristian Silver
The Age,
March 27, 2015

A Facebook suicide prevention initiative has been welcomed by mental health groups.

Facebook will roll out suicide prevention and support tools for vulnerable Australian users in the next few months, according to the social network’s local head of policy.

The initiative was welcomed by mental health groups when it was unveiled in the United States earlier this year.

It allows users to report concerning online posts, which are then reviewed by Facebook who can then send the original poster a message of support or advice on where to seek professional help.

Mia Garlick, Facebook’s Australia and New Zealand policy head, said the company was working with the Young and Well Cooperative Research Centre on a localised version of the suicide prevention initiative.

“All the feedback has been strong and powerful from a lot of the clinical experts and we’re looking forward to rolling that out in Australia in the coming months,” she told Fairfax Media.

Facebook has also ramped up its campaign to tackle bullying, taking its approach off screen for the first time in Queensland during a workshop with students and teachers last week.

Ms Garlick said initial reports of abuse or bullying online were handled by teams working round-the-clock in the United States, Ireland and India. There were also Australian staff who could work with police if required.

However Ms Garlick said the social network does not keep statistics on the bullying complaints it receives, or data on who the culprits and victims are.

“We don’t have those statistics and sometimes I’m not sure that statistics help us tell the story. For every person who does get bullied, it’s such a strong and bad situation that almost looking at the numbers doesn’t help,” she said.

“What we want to do is solve [problems] every single time it happens and make sure those people feel supported.”

Ms Garlick welcomed the announcement of Australia’s first children’s e-safety commissioner, who has the power to fine Facebook $17,000 a day if it does not comply with takedown orders for offensive material.

It still remains unclear what would happen if the social media site did not agree with an order made by the commissioner.

“We’ll have to cross that bridge when we come to it. We’ve been engaged with the Australian government for many years when it comes to what constitutes harassing bullying and content,” Ms Garlick said.

“For bullying and harassing content, we try and action it within a 24-hour timeframe. Sometimes there’s a lot of context in a bullying situation, and that’s where people on the ground can let us know what that is so we can see it in a proper light … So sometimes it can take longer than 24 hours.”

This page reproduces an article on The Age website where comments may be made.


Mental Health funding confirmed

Mental Health funding confirmed

The Hon Sussan Ley MP
Media Release
April 2, 2015

Mental health services will have their funding renewed in a move to give them certainty, Minister for Health Sussan Ley has announced.

PDF printable version of Mental Health funding confirmed

Mental health services will have their funding renewed in a move to give them certainty, Minister for Health Sussan Ley announced today.

Ms Ley said the 12 month extension – worth almost $300 million – would allow frontline services to continue to be delivered while work progressed on the current Mental Health Review.

Ms Ley thanked the sector for their patience and said negotiations would commence immediately, with priority placed on frontline services.

“The Abbott Government is committed to working with the mental health sector to deliver effective, efficient and high-quality services,” Ms Ley said.

“We are also committed to building a world-class mental health system, which is why we commissioned the Mental Health Review.

“This review will allow Government to form long term plans to ensure our high-quality mental health services continue to provide the right care, at the right time in the right setting.

“However, most people also recognise that to achieve this, improvements need to be made in the way mental health is organised and funded in Australia and it’s important this opportunity for positive reform isn’t rushed.

“Therefore extending funding for another 12 months will provide frontline mental health services with clarity and certainty while we work through the complex issues raised in the review.”

Ms Ley said the Abbott Government had tasked the Mental Health Commission to complete a review into the mental health sector following an election commitment.

Ms Ley said the Government was currently working through the findings of the review and it would be released soon.

This page reproduces the announcement on the Department Of Health’s website.

‘Horror stories’: Think twice before telling your boss

‘Horror stories’: Think twice before telling your boss you have mental health issues

Larissa Nicholson
Sydney Morning Herald
April 15, 2015

Mental illness still carries significant stigma in many workplaces, BeyondBlue has warned.

Workers who tell bosses about their mental health issues are risking their careers, the head of national charity BeyondBlue has warned.

BeyondBlue chief executive Georgie Harman said that openness about mental health issues could potentially help managers create the best environment to aid recovery.

But workers should speak openly only where they were confident they would be supported, she said at an event in Melbourne to promote improved mental health outcomes in businesses.

The tragic actions of Germanwings pilot Andreas Lubitz brought workplace mental health issues into sharp focus.

BeyondBlue still heard “horror stories” about people finding themselves stigmatised and victims of outdated attitudes to mental illness at work.

Debate over the disclosure of mental health issues has intensified in the wake of the Germanwings plane crash, after co-pilot Andreas Lubitz was later revealed to have suffered from depression.

But Ms Harman said workers considering revealing mental illness should think about what support networks employers had in place, the culture of their workplace and how their immediate manager was likely to react to the discussion.

For employees considering whether to reveal their condition in workplaces where there was little awareness of mental health issues, Ms Harman had simple advice:

“Don’t, because you might not get that promotion, you might get the sack, there might be repercussions.”

Ms Harman said she would like to see every workplace have an open disclosure policy and the end of discrimination.

“But where we want to be is a workplace culture where everyone feels they are confident and safe to disclose. That’s nirvana,” she said.

Ms Harman said the construction and banking industries had been particularly proactive in building healthy workplaces, but businesses in other sectors needed to change to treat mentally ill employees more fairly.

But there was still a long way to go, she said.

“We’re not encouraging full and open disclosure in every circumstance.”

“But where we want to be is a workplace culture where everyone feels they are confident and safe to disclose. That’s nirvana,” she said.

Ms Harman said the construction and banking industries had been particularly proactive in building healthy workplaces, but businesses in other sectors needed to change to treat mentally ill employees more fairly.

Starts at the top

It was a good idea to start at the top of a business – with the chief executive announcing that creating a safe environment for employees to disclose their mental illness was a priority, Ms Harman said.

Monitoring workloads and stamping out bullying providing would help, she said, as would providing flexible work arrangements and return-to-work plans for people experiencing a mental illness.

The Mentally Healthy Workplace Alliance had created an online tool to help workers weight up the pros and cons of telling their manager about their mental ill health, as part of their “Heads Up” initiative.

BeyondBlue co-hosted a workshop with Diversity Council Australia and the Business Council of Australia in Melbourne on Tuesday morning to teach employers how to build mentally healthy environments for workers.

Business Council chief executive Jennifer Westacott said creating a mentally healthy workplace was important on both ethical and economic grounds. She said PwC had found mental health issues cost the Australian economy $10.9 billion dollars a year.

But for every $1 businesses spent on mental health initiatives, they got $2.30 in return, due to lower absenteeism and higher productivity among other factors.

“Work should be a dignifying experience, it’s not just about the money you take home,” she said.

ANZ Bank, Wesfarmers and Bupa are providing adult colouring books to employees to help them handle workplace stress, a Fairfax Media report revealed last week.

Ms Harman said she was aware of only a little evidence behind the approach, but encouraged businesses to do whatever worked.

“Create a fun environment, create an environment where people know it’s OK to say I need a mental health day, if that means colouring books … if it works, great.”

Technological revolution in mental health care

Technological revolution in mental health care means care can be provided for $9.70 per patient

Sue Dunlevy
May 6, 2015

AN extra $9 billion will need to be spent on mental health and 9,000 new psychologists trained as the population grows and more people seek help in the next 15 years a new report shows.

However, the care could be delivered at a fraction of the cost, just $9.70 per person annually, if early mental health intervention was delivered through online services the Ernst and Young report says.

It costs $845 to treat each person per year face to face with a psychologist but just $9.70 through an online mental health service says the report titled A Way Forward: Equipping Australia’s Mental Health System for the Next Generation.

The report also finds people prefer seeking help online because it is anonymous, there is no stigma attached and research shows online care is just as effective as face to face care in early stages of mental illness.

And online services can fill the gaps in rural and regional areas where access to psychologists and doctors can be extremely difficult for those with a mental health problem.

“In the time that it takes to train additional health professionals, existing online services could be helping literally thousands of people every year who are currently struggling and alone,” the authors say.

Online mental health services can involve cognitive behaviour courses that help people identify unhelpful thoughts and behaviours and learn healthier skills and habits. They provide fact sheets on common mental health problems, online forums where people with mental problems can speak to others with difficulties, and videos showing how other people with common mental health problems coped with their situation.

The report was prepared for online mental health service which provides mental health help for around 140,000 young Australians a month.

The report says e-mental health could provide an excellent “first line of defence” in a system of mental health stepped care.

Online services can deal with people suffering from early stages of anxiety and depression while those with more severe mental illness should be treated by GPs and the most severe cases by psychologists and psychiatrists.

“No it (online services) can’t treat all people, but it can be a first line of defence that helps people find a solution that is better for them,” says ReachOut chief Jono Nicholas.

One in two Australians will experience a mental health problem during their lifetime but up to 70 per cent of young women and 80 per cent of young men will receive no help at all.

“We’re not realising the potential of these online services,” says Mr Nicholas.

Australian research has found it takes an average 6.9 years for those experiencing depression and anxiety to recognise they have a disorder and a further 1.3 years to seek help.

In this time their mental illness will likely have progressed to become more severe and may have led to family breakdown, employment problems, crime, suicide and other problems, the report says.

Under the existing government funded Better Access initiative it costs $507 per person to provide 6 face to face sessions of care and $845 per person for ten sessions of care.

By contrast, the report finds it costs $97,000 to build a high end online mental health service but the cost of the service is just $9.70 per patient once 10,000 patients use it.

It costs $290,000 to train 4.7 new psychologists who could treat a maximum of 1,416 people but you could build a high end online service that could treat 100,000 people for the same money.

The report concedes that it is impossible to treat all new cases of anxiety or depression as many people never present for help.

Research shows only half the burden of all mental health disorders can be averted with treatment.

However it estimates screening adolescents for early signs of depression and providing brief cognitive behaviour therapy could reduce incidence depression by 35 per cent.

An online program targeting 13-25 year olds mild depression and anxiety could help 78,500 people recover and avoid $346.4 million in costs per annum, the report says.

Reachout says if all the 371,915 young people with a mental illness who currently are not seeking help accessed an online service it would cost just 26 cents a head to provide them with early help.

If you need help you can call Lifeline on 131114 or contact ReachOut.

The material on this page has been transcribed from an article on the website

Major Project for Men’s Mental Health

Major Project for Men’s Mental Health

Pro Bono Australia
June 18, 2015

Two major Not for Profits have joined forces in a bid to reduce the stigma around men’s mental health issues.

Not for Profit, beyondblue has launched a what is describes as world-first research project involving thousands of men, including former Australian Rules Football players as well as refugees, to end the embarrassment that stops them from getting help for conditions such as depression and anxiety.

The STRIDE (Stigma Reduction Interventions: Digital Environments) project includes six smaller projects that use technology, such as apps and websites, along with evidence-based techniques to show men that taking action on mental illness is nothing to be ashamed of.

It is funded by beyondblue with donations from The Movember Foundation and has been unveiled to coincide with Men’s Health Week this week.

beyondblue CEO Georgie Harman said STRIDE was a response to the “shocking” number of men who die by suicide in Australia each year, which is almost double the number who die on the roads.

“Nearly 2000 men die by suicide each year, with men three times more likely to die this way than women,” Harman said.

“This is a national tragedy and is fuelled by the fact that men don’t seek help for mental health problems as much as women because they don’t want to be seen as weak or as a burden on others.

“In recent years there have been increases in awareness about depression and anxiety but we now need to focus on using digital tools to reduce the stigma that prevents men from seeking support and keeps the suicide rate high.

“We must focus on stigma reduction within the digital environment because this is where men spend an increasing amount of time, and STRIDE aims to do this by challenging the attitudes of participating men, showing them the benefits they can reap if they tackle these conditions and analysing which elements of each of the six smaller projects has worked best.

“I have no doubt this project will save men’s lives, while teaching us the best ways to reduce the stigma of mental health conditions among men.”

The Movember Foundation’s Executive Director of Programs, Paul Villanti, said STRIDE’s scope meant it would include a wide range of at-risk men.

“Each of these six projects will drive men within the target communities to confront any negative or stigmatising attitudes they hold about mental health conditions,” Villanti said.

“Stigmatising beliefs can be the biggest barriers to men getting help but STRIDE will aim to remove these barriers and save lives.

“In the Tell Your Story project, 600 refugees with post-traumatic stress disorder (PTSD) will hear stories in their first language, from fellow refugees with PTSD who have sought support.”

Villanti said participating men will learn why their fellow refugees sought help and how it made them feel better.

Former Australian Rules Football players will also be part of the project.

“Another project, Real Courage, will have up to 1,000 former Australian football players, coaches and construction workers involved,” Villanti said.

“These men come from male-dominated environments, where traits such as self-reliance and stoicism are celebrated and where men can suddenly find themselves sidelined due to injury or other factors, which can lead to loss of self-esteem and shifts in the way they see themselves. To encourage conversations, ambassadors from these communities will share their stories.

The projects commence on July 1 and will run for two years before being evaluated.

Information on the six projects can be found here.

This page reproduces an article on the Pro Bono Australia website.

Mental Illness & Insurance

Mental Illness & Insurance

This topic has been the subject of four reports on the ABC. The links provided here go in each case to a page containing a video and transcript.

The first is Meet the young woman taking on an insurance giant for the rights of people with mental illness :

A 21-year-old girl is taking on an insurance giant to fight for what she believes is the rights for people with mental illness to be treated like anyone else when it comes to getting insurance.

The second article is Big insurers face more claims following QBE’s court challenge over mental illness policy and follows on from the first :

Insurance exclusions based on mental illness may be an issue in life insurance as well as travel insurance, according to those who contacted us after the story of Ella Ingram who sued QBE for rejecting her claim when she cancelled a trip due due to severe depression.

The third article is Bali doctor hero refused income protection due to PTSD :

A doctor who suffered post traumatic stress disorder caused by being one of the first responders at the Bali bombings has been refused income protection because of his mental health.

The fourth article is Landmark insurance case to change rules for people with mental illness :

A young Melbourne woman has won a landmark case against QBE, which refused to give her travel insurance because she had suffered depression.

Commissioning And Contracting For Better Mental Health Outcomes Report

Commissioning And Contracting For Better Mental Health Outcomes Report

Mr Peter O’Rourke
Mental Health Australia Limited
November 18, 2015

Mental Health Australia engaged Rooftop Social to examine a range of ways in which commissioning and contracting arrangements might be improved to achieve a more effective and efficient Australian mental health system. The study involved a review of published and unpublished literature in Australia and elsewhere, guided by consultation with relevant practitioners and specialists.

The report’s findings have relevance for several areas of national reform, including the White Paper on the Reform of the Federation, the finalisation of arrangements for full rollout of the National Disability Insurance Scheme and the establishment of Primary Health Networks.

Some of the report’s more significant and pressing recommendations include:

  • developing clear policies acknowledging that NFPs represent an essential supply chain for the delivery of human services and that governments have a responsibility to help maintain that supply chain in a healthy and productive state
  • taking action on the 2010 Productivity Commission recommendations relating to changes in NFP commissioning and contracting arrangements, including the recommendation that the Department of Finance develops a suitable set of guidelines for the contracting of human services
  • based on experiences with Western Australia’s Delivering Community Services in Partnership policy, adopting mechanisms to improve government/NFP relationships such as longer‐term contracts, indexation of payments, equitable contract provisions and mutually respectful, collaborative approaches
  • exploring options for promoting cross‐portfolio approaches to mental health services, for example through the use of pooled funding and other innovative approaches to financing
  • examining the feasibility and implications of moving away from activity or input requirements towards outcome‐based contracting, while exercising appropriate caution in considering any introduction of payments related to the achievement of outcomes.

The information on this page was copied from a page on the website of Mental Health Australia Limited which also contains the following links to relevant documents :

Commissioning and Contracting for Better Mental Health Outcomes
Discussion Paper: Options for commissioning and funding of mental health services