The following is a transcript of the speech Beyond Blue Chair The Hon. Julia Gillard AC delivered at the 2018 Public Health Prevention Conference in Sydney:
Public Health Prevention Conference
2 May 2018
I acknowledge the Traditional Owners of the land on which we meet – the Gadigal [Gadi-gall] people of the Eora [Ee-or-rah] Nation – and in a spirit of reconciliation, acknowledge Elders, past and present.
Before I start, I want to congratulate the Public Health Association of Australia for establishing this conference.
It is meeting a real need for collaboration and knowledge sharing. It will help us take the best of evidence in to action.
I wish you every success this year – and in the years to come.
I also want to thank the Association for making the words of the late Fiona Richardson the theme of your inaugural conference.
The words – “We can do more and we must” – typify the Fiona I knew.
That’s because, in politics and in life, Fiona Richardson was a woman who said what she meant – and did what she said.
That’s why – when I ran for pre-selection for the seat of Lalor in the western suburbs of Melbourne – I was delighted to have Fiona’s support.
Of course, Fiona being Fiona, she did more than just shake my hand.
Fiona basically ran my local preselection campaign and my good result there helped me through the organisational gauntlet of the Labor Party.
In doing so, Fiona was one of the people key to getting me to Canberra.
Of course, this was well before Fiona became a politician – and a national figure on family violence prevention.
As a state MP – and the nation’s first Minister for Family Violence Prevention – Fiona became an inspiration for many Australians.
I count myself among those Fiona inspired.
I was – and remain – inspired by her courageous decision to talk about growing up with a violent parent.
I was – and remain – inspired by her leadership on gender equality and family violence prevention.
I was – and remain – deeply saddened by her loss at the age of 50.
Fiona left us too soon but her legacy is substantial.
And this Conference is now connected to that legacy, to her fierce determination to always to do more.
It is in that spirit that I want to talk to you about the Beyond Blue of today and the future we are helping to build.
We are continuing the work we have become so known for under the tremendous leadership of Jeff Kennett – raising awareness, improving understanding, smashing stigma and independent, bipartisan advocacy.
But on this strong foundation, we are building new capabilities.
Beyond Blue is now squarely in the business of service innovation.
And we are determined to work on the prevention of mental health conditions in the places where people live, work, play and learn.
‘A Generation of Hard Work’
Let me provide some context about the size and scope of the challenges and opportunities we face.
Think about the fact that:
Every year, one-in-five Australians experiences a mental health condition.
Every week, it’s estimated 1,400 Australians attempt to take their lives.
Every day, nearly eight people do die by suicide.
Think about the fact that mental ill-health costs an estimated $28.6 billion a year in direct and indirect costs, with lost productivity and job turnover costing a further $12 billion a year.
That’s $40 billion a year, or more than two per cent of Australia’s GDP.
Mental illnesses are the leading cause of the non-fatal disease burden – years of healthy life lost through illness and disease.
Anxiety and depression, alcohol abuse and personality disorders account for almost three-quarters of this toll.
On the positive side of the ledger:
Mental health is on the community’s radar, people are more prepared to discuss and act on their own mental health than ever before.
Thanks to the work of incredible researchers, we now know more than ever before about how the brain works.
Over the past decade and a half, thanks to a bipartisan policy approach, the range and accessibility of mental health supports has improved in Australia.
There have been major investments in universal primary mental health care and early intervention – especially for young people.
We are also seeing a greater focus on integrated clinical and psychosocial approaches.
But there is still an alarming gap.
Around half of Australians with a mental-health condition do not access support or treatment.
And when we consider that people with a mental-health conditions are predisposed to chronic diseases – and vice versa – the need to bridge that gap becomes even more urgent.
To close the gap, we need to think about the whole-of-life needs of people – rather than just waiting until things go wrong.
The National Mental Health Commission, in its 2015 national review of mental health investment and services, concluded that the way our ‘system’ is designed and funded means that:
“…help often is not available until a person has deteriorated to crisis point… Along the way they may have lost their job, their family or their home…”
“…the biggest inefficiencies in the system come from doing the wrong things — from providing acute and crisis response services when prevention and early intervention services would have reduced the need for those expensive
services, maintained people in the community with their families and enabled more people to participate in employment and education…”
As you all know too well, shifting focus and funding towards population health, prevention, early intervention, recovery and participation approaches can balance the books and ease the pressure on limited resources.
Eighteen years ago, as an NGO-startup, Beyond Blue focused on raising awareness and reducing the stigma of depression.
As the organisation grew it broadened its mission to include anxiety conditions and suicide prevention.
By the time I joined the Board in 2014, Beyond Blue was ranked as one of Australia’s most reputable charities.
By the time Jeff Kennett asked me to take his place as Chair, we were the top ranked not-for-profit in the Australian Financial Review’s list of the most innovative companies.
We are proud of that and proud of Jeff’s leadership and determination. Beyond Blue has helped lessen the discrimination and stigma associated with depression and anxiety.
But we know we need to do more.
‘Constantly Striving for Innovations’
That is why Beyond Blue has branched out and is applying the three themes of this Conference:
- systems thinking
- translation of research and evidence into action
- focused advocacy and stewardship
to strengthen prevention, and to help shape public policy and service design.
Our mission now is to promote good mental health through behaviour change, which is much more than raising awareness.
We want to give all Australians the knowledge and skills to achieve their best possible mental health.
We want to continue to bring anxiety, depression and suicide out of the continuing shadows and into everyday conversations.
And most of all, we want to prevent mental ill health and suicide in every corner of the community.
All that means we want to strengthen prevention.
And because we understand that public health is about the public, we are determined to provide help with prevention in all the settings of people’s lives.
Four years ago, we launched Heads Up – offering free, online resources to help businesses create mentally healthy workplaces where staff, leaders and owners are encouraged to talk openly about how they are really doing and to be supported when they reach out.
We also launched Healthy Families…
… giving mums, dads, grandparents, aunties, carers…
online information, checklists, quizzes and links to help families identify, talk about and find support for everything from post-natal depression and parental stress to childhood anxiety and suicide prevention for young people.
These are just a few of the preventative approaches we’re taking.
None of them are in a clinical setting but in the settings where people go about their daily lives.
‘Getting in Early’
We’ve also shifted our focus to the early years – the naught to twelves – where we can make a profound difference in prevention.
We know that:
560,000 Australian children, that’s 1 in 7, experiences a mental health condition a year
Up to 10 per cent of 14 and 15-year-olds self-harm and up to 5 per cent attempt suicide each year
We know that half of all adult mental health conditions emerge before the age of 14.
And that around 40 percent of parents believe schools are the best place to identify children who might need mental health support.
Later this year we will launch, with Commonwealth Government leadership and funding, a new, integrated national initiative to improve the mental health outcomes of generations of young Australians.
Targeting educators, the initiative will support schools and early learning services to foster resilience, and to know what to look out for and what to do to support students who are struggling.
It doesn’t have a beginning or an end…
You can’t create behavioural or cultural change with a 12-month package or a single program.
The initiative will be continuous.
It will be with children and their families from the time they start kindy to the end of year 12.
It will support our educators with continuous professional development from teacher training at Uni and throughout their careers.
It will span all needs – from promotion and prevention to early intervention, right through to specialist support for schools in the tragic event of a suicide.
An on-line platform will be supported by 70 staff around the country, employed by our delivery partners Early Childhood Australia and headspace.
These frontline staff will guide educators to the support they need and the resources they require – whether it be programs, lesson content, self-care information, critical incident support or knowing when and how to make referrals to health services.
‘A Game Changer’
It has the potential to be a game changer.
We see this an opportunity to give a generation of Australian children the mental-health equivalent of an inoculation.
Of course, there will still be kids who experience mental health challenges and conditions.
But over time this National Education Initiative will boost the wellbeing of children and young people, help break down lingering stigma and discrimination, and reduce the public health burden.
This work of prevention and early intervention is just one of the transformations happening at Beyond Blue.
Indeed, our biggest transformation has been in stepping into developing new service models that challenge the status quo – and give people earlier access to more affordable support, centred on their real life needs and backed with evidence.
We identify a gap and then attract funding from non-government sources to research, co-design, incubate and pilot new services.
Once we have the evidence they work, we advocate to have them scaled up, commissioned by governments and embedded into the system.
And then we plan to exit.
So that we can move on to the next area of profound need.
We designed, trialled and evaluated NewAccess – a low intensity service.
Trained coaches – with oversight by clinicians – provide early intervention support for people with mild to moderate symptoms of anxiety and depression.
An independent evaluation found NewAccess:
- is both clinically successful and economically viable – there was a 67.5 per cent recovery rate
- appeals to Australians – for every person to make an initial appointment, 88 per cent proceeded to treatment and 72 per cent completed treatment.
- overcomes stigma – it is free, it requires no medical referral, sessions are delivered face-to-face or over the phone, there is no labelling and practical exercises appeal to those who don’t traditionally seek help.
The model is now being commissioned by many Primary Health Networks and is available in regions populated by six million Australians.
At the other end of the spectrum, we have designed what we call the Way Back Support Service, which provides psychosocial support to people for up to three months following their suicide attempt.
Let me give you some facts:
- Around 200 Australians attempt suicide every day. In approximately 96 percent of cases, the attempt does not result in death. But that doesn’t mean people are out of danger because no group is at greater risk of dying by suicide than those who have attempted suicide.
- Up to a quarter of those who have attempted suicide will try to kill themselves again.
- Their risk is highest in the first three months following an attempt.
- Yet half of people discharged from hospital after a suicide attempt do not attend follow-up treatment and 38 per cent of those who attend follow-up treatment terminate it within three months.
The simple facts are that:
We know who these people are – and that they are at elevated risk of another attempt or dying by suicide.
And that intensive follow-up care during the days and weeks after discharge reduces suicide reattempts and deaths.
Yet there is no guaranteed, systematic follow up support offered to keep these people safe, connected to support and motivated to live.
The Way Back Support Service can change this:
It links people to treatment and help each person to make and keep to a safety plan.
It also helps the person identify and resolve the factors that contributed to their suicide attempt – employment and relationship challenges, isolation and loneliness.
What started as a small trial in Darwin is now a service saving lives in six sites around the country, with four more coming on line.
The Way Back model is built on compelling evidence, has three years of operational experience, and robust and proven clinical governance and risk management arrangements.
It is ready to scale.
This simple model should be available to every person discharged from hospital after a suicide attempt.
And I am heartened that the federal Minister for Health, Greg Hunt, has shown a great interest in and support for this proposition.
But the Commonwealth cannot do this alone.
Reducing Australia’s suicide rate requires a commitment from every one of us: from the community, health and community services and governments at every level.
All Australian Health Ministers recently signed up to the Fifth National Mental Health and Suicide Prevention Plan.
In this plan they committed to action on “consistent and timely follow-up care for people who have attempted suicide or are at risk of suicide.”
And that’s why Beyond Blue is appealing to all governments to back The Way Back Support Service.
Addressing suicide can be complicated.
It’s bigger than any one government.
But now is the time to think big, keep the momentum rolling and systematise new services that are working.
I call on all Health Ministers and every political leader to get together and deliver change.
As the veteran of many of a COAG meeting and ministerial council, I know achieving joined up national approaches is never easy.
But with determination and good will it can be done. And in this area, it should be.
Historically, there has been a tyranny of silence surrounding mental illness and suicide.
Depression and anxiety were something to be ashamed of – and that silence has stolen countless lives.
Suicide was a criminal act.
Growing up in Adelaide, I witnessed the human cost of that tyranny of silence.
You see, my father, John Gillard, was a psychiatric nurse.
Dad worked at Glenside Hospital for more than two decades.
When he started, Glenside was very regimented – with the doors locked and the nurses wearing suits and ties.
By the time he finished the doors were open, the suits were gone, and it was hard to tell the nurses from the patients.
I went to Glenside with Dad.
I’ve never forgotten the place or the people.
That’s why I was so pleased when – during my time in Canberra – both sides of politics started talking about and backing prevention and early intervention.
Times have changed since my father wore those Glenside suits.
So much progress has been made.
But the current narrative is still dominated by talk of acute services and treatment.
Let’s change how we invest in mental health by preventing conditions from occurring in the first place, in communities, schools and workplaces. By preventing suicide attempts.
In the words of Fiona Richardson, we can and must do more.
I look forward to working with you as we strive to live up to her words.