mental health planning in queensland. dr aaron groves director of mental health. 08/04/2011
TRANSCRIPT
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)
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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?
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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