Mental Health
# 264,000 or almost 1 in 5 South Australians aged over 18 years will have a mental disorder in any 12 month period.
# 58,000 or 3-4 per cent of South Australians will experience a serious mental disorder such as schizophrenia, bipolar mood disorder, some forms of depression, anxiety disorders and dementia.
# 160 South Australians die as a result of suicide each year. For every suicide, there are at least 30 attempted suicides. 23 per cent of all deaths for young people aged between 15-24 years will be due to suicide.
# Mental health represents 20 per cent of total health costs due to death and disability but receives only 8 per cent of the health budget.
# Five of the ten leading causes of disability worldwide are mental disorders-major depression, alcohol use, bipolar disorder, schizophrenia and obsessive compulsive disorder.
# 38 per cent of people with a mental illness will access some form of care. This care will primarily be delivered by general practitioners. 62 per cent will have a mental illness but not access any services. These people will be supported by their families, friends or receive no support.
# 75 per cent of homeless people in emergency accommodation will have at least one mental disorder
# The death rate of people with a mental illness is 2.5 times higher than for the general population. The greater number of deaths is due to physical conditions eg. heart disease and not suicide
Overall Mental Health Expenditure
Figures presented below unless otherwise stated have been taken from the National Mental Health Report 2002. The latest data available is from the year 2000.
# SA government spending on mental health has grown from $104.7 million (1993) to $148.3 million (2002).
# In 2000, SA ranked second to WA in per capita spending on mental health, 5 per cent above the national average.
Investment in Service Mix
Inpatient Services
# SA is 39 per cent above the national average on psychiatric inpatient beds despite a reduction from 779 (1993) to 655 (2000).
# In SA per capita spending on inpatient services is above the national average of $41.59 (2000) having grown from $49.54 (1993) to $54.81 (2000).
# Despite decreasing spending on stand alone psychiatric hospitals from 59.1 per cent (1993) to 45.4 per cent (2000), total service expenditure in SA was still almost double the national average 23.2 per cent in 2000. Victoria sets the benchmark at 6.8 per cent.
# Given increases in the cost of inpatient services, few savings have been made through reductions in stand alone psychiatric hospitals in order to grow community services in SA.
# Community Services
# Percentage total service expenditure on community services is well below the national average of 49.2 per cent (2000) despite growth in SA from 30.4 per cent (1993) to 37.3 per cent (2000).
# The growth of community services in SA between 1993 to 2000 was largely as a result of the expansion of community based clinical mental health services (ambulatory care).
# A relatively low share of spending was directed to the non-government sector for the provision of nonclinical services with minimal spending on community based residential services which could provide alternatives to hospital care.
# Total mental health expenditure for non-government organizations in SA grew from 1.6 per cent (1993) to 2.6 per cent (2000) but remains less than half of the national average of 5.4 per cent (2000). On a per capita basis this amounts to only $2.30. Victoria is the benchmark at 9.8 per cent and still increasing.
# Total mental health expenditure for 24 hour community residential services in SA was 0.9 per cent (1993) and decreased to 0.3 per cent in 2000. These services receive only one twentieth of the national average of 6.7 per cent. This equates on a per capita basis to 29 cents.
Non-government sector and psychiatric disability
# Mental illness is one of the leading causes of disability.
# Non-government services which usually deliver non-clinical disability support services and community residential services receive only 2.9 per cent (S 4.3 million) of total mental health expenditure in SA. Victoria’s psychiatric disability support services and community residential options receive 25.3 per cent of total mental health expenditure.
# The National Health Strategy Issues Paper (Feb 1993) acknowledged the role of the nongovernment sector in the provision of psychiatric disability support services (such as in home support, employment and social /recreational opportunities, respite and carer support) and highlighted the need for funding transfers in order to provide a balanced mix of services. These funding transfers have not occurred in SA.
# SA has no clearly articulated plan for the development of statewide psychiatric disability support or community residential services.
# Although the Commonwealth allocates funding for psychiatric disability through the Commonwealth State/Territory Disability Agreement, SA has not allocated disability funds to people with mental illness.
# SA is the only mainland state that has a nongovernment mental health peak body that is not endorsed to represent the state on the Mental Health Council of Australia.
Progress in SA Mental Health Reform
# A mid term review undertaken by international experts in 2001 of progress made under the Second National Mental Health Plan indicates the following in relation to progress made SA.
- Services are not mainstreamed
- Services are still focused on an illness model
- Community services are inadequate to meet the increasing level of need
- Accommodation and support services are lacking
- Implementation of partnership models is slow
- Strong resistance to change among service providers is causing a political stalemate
- Stigma is inherent in service delivery and funding
# National Mental Health Report (2002) also indicates that SA has been slow in implementing the Second National Mental Health Plan (19982003) and has as yet not fully implemented the goals of the First National Mental Health Plan (1993-1998) in particular shifting the focus of care from institutions to the community, and providing a balanced and comprehensive range of inpatient, clinical and non-clinical services in the community.
Transparency and Accountability
# It is difficult to monitor progress and measure outcomes in relation to mental health reform in SA.
# SA does not have a strategic plan for mental health reform which outlines what is to be done, by when, the desired outcomes for people affected by mental illness and is costed.
# Information is difficult to obtain. The most accessible information is the National Mental Health Report which is compiled annually by the Commonwealth to evaluate state/territory mental health reform however the information in these reports is always two years out of date and limited in scope.
# SA does not have transparent processes and pathways for mental health that allow key stakeholders to be involved in policy and planning of mental health reform eg - SA has no ministerial mental health advisory structure.
- SA has a Mental Health Reform Steering Committee which is dominated by departmental staff and industrial bodies. Consumers and carers are not adequately represented. SA’s non-government mental health peak body is not represented at all.
- SA government has not endorsed its non-government mental health peak body to sit on the Mental Health Council of Australia, the national mental health peak body. This forum provides significant opportunity for the state to influence the national mental health reform agenda.
Sources:
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- Australian Bureau of Statistics, National Survey of Mental Health and Wellbeing, 1997.
- Mental Health Coalition of SA, Submission to the Generation Health Review, August 2002.
- SANE Australia, see www.sane.org. au
- SA Generational Health Review Discussion Paper, October 2002.
- Trotter Betts, V , Thomicroft, G, International Review on the Second National Mental Health Plan for Australia, September 2001.
- WA Centre for Health Services Research, Duty to Care: Preventable Physical Illness in People with Mental Illness, 2001
- Whiteford et al, Responding to the Burden of Disease, WHO, July 2001.
- Youth Affairs Council of SA, Beyond the Revolving Door: A Model for Improving Support and Accommodation for Young People with Mental Health Issues, 2001.
*Source: Mental Health Resource Centre
South Australia Council of Social Service Inc
