Mental illnesses are the third leading cause of disability burden in Australia and globally after cancer and cardiovascular disease.Despite vast improvements to treatment access and uptake, the incidence of mental health issues in Australia has not improved suggesting that a different approach may be required.
How does mental illness affect Australians?
Approximately 45% of Australians aged 16-85 years will experience a mental disorder during their lifetime, with about 1 in 5 (20%) Australians having experienced one of the most common mental disorders within the last 12 months. Anxiety disorders were the most common, affecting ~14% of Australians in a 12-month period, followed by depression (~6%) and substance abuse (~5%).
Psychotic illnesses such as schizophrenia or bipolar disorder are less common and affect approximately 3% of Australians. In addition, approximately 2% of Australians will experience eating disorders such as anorexia or bulimia in their lifetimes.
Prevalence of mental illness is greatest amongst those between 16-24 years old and decreases with age. There are also differences between genders, with the disability burden for depression and anxiety being nearly twice as high for females as it is for males. Likewise, women are 9 times more likely to develop an eating disorder than men. On the other hand, the burden for substance abuse is more than three times higher in males than females.
The 'treatment gap'
The first Australian National Survey of Mental Health and Well-being (1997) identified a problematic 'treatment gap' – a high number of people had mental disorders but were not getting treatment. Following this Australia has made a big effort in investing into improvements to mental health services over the last two decades. For example, from 1992-2004 the total spending on mental heath by the Commonwealth increased by 149%, with the states and territories increasing their spending by 67%. There has also been an increase in the number of psychological services funded by Medicare . Other initiatives include the government-funded 60 'headspace' youth mental health services, and other state-specific schemes such as WA's Statewide Specialist Aboriginal Mental Health Services.
Following this effort, the estimated treatment rate increased from ~35-37% in 2007 to ~46% in 2010. In addition, between 1997-2007 the number of people with mental disorders reporting that their needs were not met decreased. However, despite this various studies have shown no expected gains in decreasing the burden of mental health disorders have even demonstrated trends of worsening mental health within some subgroups.
What next?
Thus far the primary effort for tackling mental health has gone into improving treatment access. Although this is excellent progress the lack of gains in decreasing the disability burden for mental health suggests that a greater emphasis needs to be put on prevention to reduce the number of developing disorders before they require treatment. Prevention strategies are often more community-based rather than clinical. One success story is the National suicide prevention strategy, using the Living is for everyone (LIFE) framework, which has seen a steady decline in the suicide rate.
A 'two-pronged' approach of continuing with better treatment access combined with an increase in effort aimed at the prevention of mental health issues would be the best way for effective change in reducing the disease burden for these disorders.
Other resources
National Survey Mental Health and Wellbeing (NSMHW) 2007
http://www.aihw.gov.au/publication-detail/?id=6442467990
Global burden of disease attributable to mental and substance use disorders
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61611-6/abstract
How does mental illness affect Australians?
Approximately 45% of Australians aged 16-85 years will experience a mental disorder during their lifetime, with about 1 in 5 (20%) Australians having experienced one of the most common mental disorders within the last 12 months. Anxiety disorders were the most common, affecting ~14% of Australians in a 12-month period, followed by depression (~6%) and substance abuse (~5%).
Psychotic illnesses such as schizophrenia or bipolar disorder are less common and affect approximately 3% of Australians. In addition, approximately 2% of Australians will experience eating disorders such as anorexia or bulimia in their lifetimes.
Prevalence of mental illness is greatest amongst those between 16-24 years old and decreases with age. There are also differences between genders, with the disability burden for depression and anxiety being nearly twice as high for females as it is for males. Likewise, women are 9 times more likely to develop an eating disorder than men. On the other hand, the burden for substance abuse is more than three times higher in males than females.
The 'treatment gap'
The first Australian National Survey of Mental Health and Well-being (1997) identified a problematic 'treatment gap' – a high number of people had mental disorders but were not getting treatment. Following this Australia has made a big effort in investing into improvements to mental health services over the last two decades. For example, from 1992-2004 the total spending on mental heath by the Commonwealth increased by 149%, with the states and territories increasing their spending by 67%. There has also been an increase in the number of psychological services funded by Medicare . Other initiatives include the government-funded 60 'headspace' youth mental health services, and other state-specific schemes such as WA's Statewide Specialist Aboriginal Mental Health Services.
Following this effort, the estimated treatment rate increased from ~35-37% in 2007 to ~46% in 2010. In addition, between 1997-2007 the number of people with mental disorders reporting that their needs were not met decreased. However, despite this various studies have shown no expected gains in decreasing the burden of mental health disorders have even demonstrated trends of worsening mental health within some subgroups.
What next?
Thus far the primary effort for tackling mental health has gone into improving treatment access. Although this is excellent progress the lack of gains in decreasing the disability burden for mental health suggests that a greater emphasis needs to be put on prevention to reduce the number of developing disorders before they require treatment. Prevention strategies are often more community-based rather than clinical. One success story is the National suicide prevention strategy, using the Living is for everyone (LIFE) framework, which has seen a steady decline in the suicide rate.
A 'two-pronged' approach of continuing with better treatment access combined with an increase in effort aimed at the prevention of mental health issues would be the best way for effective change in reducing the disease burden for these disorders.
Other resources
National Survey Mental Health and Wellbeing (NSMHW) 2007
http://www.aihw.gov.au/publication-detail/?id=6442467990
Global burden of disease attributable to mental and substance use disorders
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61611-6/abstract
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