Remarks - University of Melbourne 2018 Dean’s Lecture: The future of mental health policy
Wednesday, 16 May 2018
Topics: The Turnbull Government’s mental health policies; the extension of the National Suicide Prevention Trial with a further $13 million investment; record mental health funding in the Budget.
Thank you Professor Kapur for your kind words. Good afternoon everyone. Early yesterday morning as I was thinking through today’s lecture, I heard the kookaburras in our back yard calling. In Aboriginal symbolism, the sound of the kookaburra’s laughter is a sign for the sky people to light the great fire, the sun, that illuminates and warms the earth at dawn. It made me think that for so many people who live in darkness and fear that dawn has yet not come. So in acknowledging our Indigenous Australians, and the Elders past and present, today I would also like to pay tribute to the many Australians, including indigenous Australians, who face mental and chronic health challenges.
In all of us there is a battle between light and dark. Our task as a Government, as a society, is to ensure that everyone has the support to keep the fire of hope burning in the dark. The tools to fight the battle, and the opportunity to welcome in the dawn of a happy, meaningful and contributing life.
And so it is a great privilege to be here today along with so many eminent individuals whose work in mental health has such an important impact in the lives of so many Australians – Professor Pat McGorry; Professor David Copolov; Professor David Forbes; Emma Kealy, the Victorian Shadow Minister for Health; Dr Lynne Coulson Barr, Victoria's Mental Health Complaints Commissioner and many others.
As many of you know, mental health is a deep personal concern of mine, and therefore it is a particular honour to be invited to deliver a Dean’s Lecture on the subject. It is also great to be back here at the University of Melbourne - the alma mater of Nobel Laureates Sir Mcfarlane Burnett and Elizabeth Blackburn; the home of Nobel Laureate Peter Charles Doherty; and hopefully home to future Nobel Laureates Pat McGorry and Jane Gunn. I know I’ll be accused of being biased, but I really think this is Australia’s leading university. I was lucky enough to graduate from this esteemed institution in 1990 and I say to everyone here, this really is a university in the finest of traditions. It is a wonderful place to learn and the research is world class. It provides enormous opportunities and sets people on a path to achieve whatever they aspire to.
I note the work you are currently undertaking to evaluate the approaches taken and clinical care coordination provided by the Primary Health Network’s mental health lead sites. The results of this work will form an important addition to the evidence base and help to inform future national policies in mental health. The University of Melbourne is a very nurturing and supportive environment something that ties in nicely with the theme of my lecture: Australia’s mental health policies, the challenges we face, the importance of research and the Government’s priorities and investments in this vital space.
The prevalence of mental health illness
Mental illness does not discriminate. It affects men and women across all demographics and is far more prevalent than most people realise. I have absolutely no doubt there are people sitting in this room today who are experiencing mental health conditions. And some will be suffering in silence. It’s a sad truth and a situation that is unfortunately all too common. No one should be shocked by my observation that some people here will be dealing with a mental health issue because around four million Australians experience a mental illness in any one year.
Nearly half of all Australians will experience mental illness in their lifetime. Up to two million Australians experience anxiety and approximately a million adult Australians suffer from depression. There is a multitude of other mental health conditions Australians face from bipolar and manic depression, perinatal depression to psychoses, eating disorders and suicidality.
Normalisation of mental illness
Mental health carries an enormous cost, both a personal cost to those directly affected, but also to the wider community and economy. Over the past two decades, we have come a long way to destigmatising mental illness but we still have a way to go on this journey. The work to destigmatise mental illness won’t end until we, as a country, make it completely normal talk openly about it like we do any other illness. And until Australians experiencing mental illness are as comfortable talking about it as those with other ailments.
But it is also not enough to simply normalise conversations about mental health. It is imperative people with mental health issues receive the type of help they need where and when they need it.
Central to achieving this are the Primary Healthcare Networks (PHNs), which commission local services to match local needs. They provide a complete spectrum of services from prevention and early interventions, to services for those with mild, moderate or severe mental health concerns.
Their task is to ensure the greatest possible access to mental health services that are tailored to the individual’s needs. But our response is not simply about access. It is about ensuring the highest possible levels of safety, quality and efficacy.
With this in mind, the Australian Government understands the link between research and positive patient outcomes and that is why we are investing so heavily in health, medical research and innovation. It’s about giving Australians in need hope and creating the opportunity to have a better and longer life. The key is to get the research breakthroughs out of the laboratories and into the health system so patients can benefit. We are supporting research into all aspects of mental health. In order for us to take effective preventive and early intervention measures, we need to better understand why so many Australians are suffering from anxiety, depression and other mental health conditions.
Support through the Medical Research Future Fund
As part of last week’s Budget, I announced the Government was investing further through our game-changing Medical Research Future Fund, bringing the total investment to $2 billion. I am so passionate about the Medical Research Future Fund because it is supporting Australia’s greatest minds to come up with the next big medical breakthrough.
Think penicillin, the pacemaker, Gardasil, and the bionic ear - this particular breakthrough made by Australian researchers, Professor Clark and his team from University of Melbourne in the 1970s, that have improved the health and wellbeing of billions of people worldwide. The Medical Research Future Fund is further unlocking Australia’s research potential and delivering more advanced healthcare and medical technology that will improve the health of Australians and grow our exports.
We are absolutely committed to health and medical research, and will provide a record $6 billion over the next four years through the NHMRC, Biomedical Translation Fund and the Medical Research Future Fund for our best and brightest researchers. The announcement of the $1.3 billion National Health and Medical Industry Growth Plan in the 2018–19 Budget acknowledges that health and medical research is key when it comes to developing new treatments and cures.
It’s also vital in generating new highly skilled jobs and business to simulate Australian economic growth. This new Industry Growth Plan includes a suite of programs to be funded through the MRFF that will bring research out of the lab and into real life. It also includes a landmark genomics mission a first for the Australian healthcare landscape. This will help ensure that Australia remains a global leader in transformation applied health and medical research.
$6.1m for the Melbourne Academic Centre for Health
And, so I am delighted today to announce that through the Medical Research Future Fund, the Government will be providing the Melbourne Academic Centre for Health with an additional $6.1 million to continue its vital medical research. Again I would like to acknowledge Professor Kapur as the Chair of the Melbourne Academic Centre for Health’s Executive Board and Professor Jones, the organisation’s executive director.
The Melbourne Academic Centre for Health is a wonderful collaboration between some of Melbourne’s leading health and medical research organisations - the University of Melbourne, Austin Health, the Murdoch Children’s Research Institute, the Peter MacCallum Cancer Centre and St Vincent’s Hospital, to name a few. The funding I have just announced comes on top of the $2.2 million the Government provided to the Melbourne Academic Centre for Health provided in 2016-17 through the Medical Research Future Fund.
It will enable the Melbourne Academic Centre for Health to build on the research work it has already undertaken in relation to asthma, retinal photography and artificial intelligence, the degeneration of muscles and precision medicine for epilepsy sufferers. This is cutting-edge research being conducted right here in Melbourne, research that will directly benefit patents here in Melbourne, across Australia and beyond.
Mental Health – a key Government priority
The Australian Government has elevated mental health as a priority issue, and we are transforming the way such care is delivered in Australia. To support this, we have invested a record $4.3 billion in mental health initiatives in 2017-18. We continue to make mental health a priority and have invested an additional $338 million in mental health in this year’s budget. But as I have said before, it’s not about the money. It’s about how our investments and reforms are improving the lives of real people. And so I am absolutely determined that the spending we make in mental health gets to the people who need it - delivering the care, relief and treatment they need.
Fifth National Mental Health and Suicide Prevention Plan
The National Mental Health Commission reviewed Australia’s system for delivering mental health programs and services and found there was a critical need for long-term reform to produce an efficient, integrated and sustainable mental health system and to better target our efforts. In response, we are implementing reforms that are transforming Commonwealth mental health funding and program delivery to achieve a more efficient, integrated and sustainable mental health system. The Government’s ambitious mental health reform agenda for the next five years is outlined in our Fifth National Mental Health and Suicide Prevention Plan.
This plan is creating an integrated mental health system across all states and territories but with services and programs adapted to local needs. This represents a fundamental change in thinking.
Rather than dictating change from the top down as has occurred through the four previous national plans, the fifth plan recognises that services are delivered at the regional and local level and that a one-size-fits-all approach is less effective than tailoring services to meet local need. The Fifth National Mental Health and Suicide Prevention Plan focuses on eight targeted priority areas that include achieving integrated regional planning and service delivery, effective suicide prevention, improving the physical health of people living with mental health and reducing stigma and discrimination.
A key aspect to the fifth national plan is its focus on improving mental health outcomes for Aboriginal and Torres Strait Islander people who remain far too overrepresented in Australia’s suicide figures. Our new national plan will ensure suicide-prevention initiatives are evidence-based and implemented throughout communities. There will also be more effective follow-up support for people who have attempted to take their lives.
Improving service delivery
These reforms are enabling patients to access mental health services earlier. This work has also included the creation of a working group to examine ways we can improve the delivery of mental health and rehabilitation care. One of the biggest challenges we face is to develop and expand our mental health services, inside and outside of hospitals, clinical and non-clinical. It is vital we keep a close eye on emerging service delivery gaps and when we identify them, move quickly to plug the holes. Such a gap has emerged with the transition of certain community mental health services also known as psychosocial services into the National Disability Insurance Scheme.
I think this is a worrying trend and it’s one I am committed to reversing. But in the meantime, the Government is investing $80 million in services to assist Australians with psychosocial conditions who are more appropriately supported through the National Disability Insurance Scheme. I am pleased to say that we have reached agreement with six out of eight of the states and territories for matching funding for the psychosocial support measure, and I am confident that the remaining two states will agree to match the Commonwealth’s investment in the very near future.
To continue to expand our services, and close any gaps to access, we are also actively pursuing new ways to deliver mental health services for instance through telehealth and online services. By embracing this new technology, we are making services accessible to people when they need them and delivering them more cost effectively. The Government’s digital mental health gateway Head to Health will receive $4.7 million to continue to help people to access evidence-based information and advice on mental health services through an improved telephone service and enhanced portal.
Evidence shows that for many people, digital interventions can be as effective as face-to-face services. Importantly, we’re also putting more mental health care nurses on the ground in rural and remote areas through increased funding to the Royal Flying Doctor Service. Another important development in the way that services are provided is the recognition that improving the mental health system and outcomes for people with mental illness can only be done in partnership with consumers, carers, mental health stakeholders and state and territory governments.
The Australian Government is absolutely committed to continued and meaningful consultation and engagement as we move to implement these critical reforms. People, especially people with mental health conditions, are counting on us, and we will not let them down.
The momentum the Australian Government started last year by making mental health a key priority, a foundational pillar in our long-term national health plan has been backed in by this year’s Budget. We are not just changing the conversation around mental health. We are backing our words with action through considered and comprehensive policy that will make a real difference to the lives of millions of Australians. Through the record funding allocated in the 2018—19 Budget, we are addressing a number of gaps in service delivery.
With suicide prevention a major issue, we’re funding a $73 million suicide prevention package to support Lifeline Australia, beyondblue and SANE Australia. SANE Australia will deliver a targeted suicide-awareness campaign Better Off With You. It will challenge the perceptions of people who are contemplating suicide that they are a burden on their family, friends and other people. Beyondblue’s Way Back Support Service, aftercare following a suicide attempt, is being extended, providing outreach, follow-up care and practical support to people discharged from hospital after a suicide attempt. No group is at greater risk of dying by suicide than people who have previously attempted suicide and the highest period of risk is the three months following a suicide attempt. Lifeline’s unique telephone crisis service, the biggest in Australia, is set to get even better - meeting increasing demand, providing more responsive and consistent services, and improving connectivity to other services in order to better support people in need.
Extension of the National Suicide Prevention Trial
Today I am also really pleased to announce that the Government will be extending the National Suicide Prevention Trial for an additional year to June 2020. This will provide up to $13 million, in addition to the $36 million already committed, to ensure that the 12 trials sites can continue to reach out deep into communities across Australia to gather evidence on how to prevent suicide in these areas, improve the statistics, and save lives.
The 12 sites - in Darwin, the Kimberley, Western NSW, Mid-West Western Australia, Brisbane North, North Coast NSW, North Western Melbourne, Perth South, Northern Queensland, Tasmania and Country South Australia— will each receive additional funding of $1million. They will be supported in their efforts through additional funding to the Black Dog Institute. The evaluation of the trial, being undertaken by the University of Melbourne, will also be extended to strengthen its findings and build the evidence for what works in suicide prevention.
Every life lost to suicide is an enormous tragedy and this is why the Australian Government is committed to tackling this issue by investing in research, programs and services that will provide the help our communities need and deserve.
We’re providing more than $100 million to better support the mental health of older Australians. Last year, around 1.6 million Australians were aged over 75 years and it’s suggested up to a third of older people experience loneliness. So we’ll be investing $20 million to improve mental health services for Australians over 75 years of age whose mental and physical health is at risk because of social isolation and loneliness, which will include a two year trial. GPs and mental health nurses will play a key role in this trial.
We’re investing $82.5 million to provide new mental health services for people with a diagnosed mental disorder living in residential aged care facilities. Currently, these people aren’t eligible for Medicare-supported primary mental health services, and this funding will ensure they get the support they need. This could help an estimated 83,000 older Australians living in residential home care.
Our Million Minds Mental Health Research Mission, funded with $125 million over 10 years through the Medical Research Future Fund, will help a million people who might otherwise not be part of mental health research and clinical trials to access new ways of diagnosis, treatment and recovery. Million Minds will be looking at a range of areas including eating disorders, suicide prevention, Aboriginal and Torres Strait Islander people’s mental health, depression, anxiety, bipolar disorder, and other areas of critical importance to national mental health and wellbeing.
This is a game-changing development for mental health care in Australia. It gives me particular pleasure to announce today that the Million Minds Mission Advisory Panel will be co-chaired by Professor Kapur and Professor Helen Milroy. Professor Kapur brings with him a wealth of domestic and international experience in psychiatry, neuroscience, brain imaging, and the treatment of schizophrenia.Professor Milroy is a descendant of the Palkyu people of the Pilbara region of Western Australia. She is a Child and Adolescent Psychiatrist, with expertise in Aboriginal mental health and child and youth mental health.
I am also delighted to announce the first two members of the Advisory Panel, Professor Pat McGorry who brings world-renowned expertise in youth mental health, and Professor Tracey Wade, the nominee of both the Butterfly Foundation and the Australia & New Zealand Academy for Eating Disorders, and Australia’s leading expert in Eating Disorders. The skills of these four great research leaders mesh perfectly with the three initial priorities of the Mission – eating disorders, youth mental health and Aboriginal and Torres Straits Islander mental health.
Supporting ongoing reform and improvement
In addition to advancing our understanding of mental health, it is important that we continue to support ongoing improvement in and transformation of mental health care services in Australia. We are making great strides, but there is still more to be done. With this in mind, we’re investing $12.4 million in funding to bolster the National Mental Health Commission to oversee mental health reform nationally, and to have an expanded role under the Fifth National Mental Health and Suicide Prevention Plan. This will ensure that the momentum of transformation initiated by the Turnbull Government continues, and that we keep the light of hope burning for better prevention, treatment and recovery in future.
Mental illness causes unbearable pain and suffering for the millions of Australians who live with it as well as their loved ones. I am committed to ensuring people with mental health challenges get the support and treatment they need whether their problem is mild or severe, temporary or chronic. Our Fifth National Mental Health and Suicide Prevention Plan is deliberately ambitious. But I am confident we can work through it and reach its 2021 goals.
If we are able to do that, it will greatly improve the lives of people living with mental illness, as well as the lives of those around them, families, friends, carers and communities. At the same time, I am confident our very strong investment in mental health research will pay dividends, leading to better interventions and treatment, enabling people to be as happy and productive in their lives as they can be. Let me conclude by re-iterating my deeply-felt passion to improve the lives of the millions of Australians who suffer mental illness. Almost 3000 Australians take their own lives each year. That’s more than seven Australians every day who choose to end their lives rather than live with the intolerable pain that exists inside their heads.
We can and must do more to stop this national tragedy and the Government recognises this and is implementing a comprehensive plan to do just this. Together we can usher in the dawn for millions of Australians. Thank you.