News

Mental health reform outside the office, consulting room and health system

1 September 2018

myPHN Conference Keynote speech

Mackay, Queensland

 

Introduction 

I acknowledge the traditional owners of the land on which we meet and in a spirit of reconciliation pay my respects to Elders past and present.

I would like to also acknowledge:

  • The Deputy Leader of the National Party and Minister for Regional Services, The Hon. Bridget McKenzie
  • Dr Steve Hambleton, Conference Chair and former State and Federal AMA President.

It is quite some time since I was last in Mackay and I am delighted to be back. 

Even though I have moved back to my home town of Adelaide since leaving politics, I have flown from Perth to join you. There, I was able to discuss action on mental health with the Deputy Premier and Minister for Mental Health, Roger Cook. 

The day before meeting Roger, I was in the Barossa Valley, talking to workers at Penfolds about looking after their own and their mates’ mental health. And the morning before I flew to see Roger, I helped present awards to amazing contributors to our mental health community at a national conference being held in the heart of Adelaide.

When you have that kind of week, visiting different parts of the country, flying over the enormous continent we call home, you can’t help but reflect on the things that unite us, as well as the unique aspects of each part of the country.

I am increasingly confident that one of the things that unites us is a preparedness to talk about, think about and act on mental health.

I felt that strongly when being asked questions about suicide prevention by a working man in a high vis vest on Tuesday, in the same way that I felt it at a meeting of CEOs in Melbourne the week before when, unexpectedly, a business leader shared a story about a time in his life that he had really lost his way.

But while the individual and community desire to better address mental health is growing right around our vast country, every region of our nation is so different that there is no one size fits all solution.

For example, my home, South Australia, is the most urbanised state in Australia with more than 75 per cent of the population living within Adelaide’s metropolitan boundary.

Quite the opposite to North Queensland with 80 per cent of your diverse population living in regional areas spread across half a million square kilometres.

For those of you lucky enough to call these parts home, I suspect that sense of space, of being able to look to the far horizon, is part of the connection you feel, but it is also a great challenge.

Especially when it comes to delivering services to the 675,000 inhabitants of the North Queensland PHN district – an area seven times the size of Tasmania.

You not only service a huge geographic area, but also an incredibly diverse population including:

  • city, rural, remote communities;
  • Aboriginal and Torres Strait Islander people;
  • South Sea Islanders;
  • graziers and their families;
  • FIFO workers;
  • migrant groups and their descendants;
  • aged citizens;
  • defence forces and veterans;
  • and our precious young people.

Each with their own needs, cultures, perspectives and priorities.

Mind-bogglingly you commission and deliver services across 31 local government districts – each with their individual governance and compliance requirements – all the while staying abreast of the decisions made by bureaucrats and politicians in far-away capitals.

For that alone, you have my respect.

At beyondblue we are working alongside Primary Health Networks such as yours to tailor services to meet the needs of local communities.

We see you not just as health professionals and managers, but also as advocates for the people you serve.

Your voice is vital in sharing a vision of your communities’ needs and pressing for a fair share of resources.  Understandably, you focus on the shortage of specialists.  We know that:

  • Despite about a third of Australians living regionally, around 90 per cent of psychiatrists and two-thirds of mental health experts live in metropolitan areas; and
  • Only three psychiatrists and 30 psychologists per 100,000 of population are employed in remote and very remote areas.

Even getting access to primary mental health is tough. The Australian Institute of Health and Welfare reports that mental health-related GP encounters in outer regional, remote and very remote communities occur at far lower levels than in more populated centres.

The Queensland Alliance for Mental Health has also highlighted the lack of bulk-billing GPs in rural and remote areas, which limits access by those on a low income to mental health plans.

Yet access to care and support is vitally needed given the suicide rate is higher in outside major cities with graziers and farmers – even when they are not in a drought-declared area – having suicide rates 1.5 to 2 times higher than the national average.

So, the questions beg:

How do we ease the burden on our hard-working, over-stretched health professionals?

How do we ensure equitable and affordable access for all Australians seeking support for their mental health?

You can’t answer these questions alone.

None of us can.

These are questions we must answer together because they matter to every Australian.

And, at beyondblue, these are questions that we discuss and debate constantly as we strive to keep changing, keep improving to better meet the needs of individual Australians and the very different communities that make up our nation.

Working with PHNs

And make no mistake, the beyondblue of today is a service innovator. We view our role as identifying a need, using non-government money to prove up a new service model, and then, when we have evaluated it and know it works, advocating for it to be made available right around Australia. Then we exit to move to the next area of profound need.

In design, piloting, evaluation and most importantly in scaling up, PHNs are our natural partners and collaborators. Put simply, beyondblue wants to work with you.

I want to highlight to you today, two key areas where we are in scaling up mode and keen to work with you right now.

The Way Back

The first is a service we call The Way Back, which has been designed to address the lack of consistent follow-up support for people discharged from hospital following a suicide attempt.

No group is at greater risk of dying by suicide than those who have attempted suicide.

Up to 25 per cent of people who have attempted suicide will re-attempt, and 5-10 per cent will die by suicide.

The period of highest risk is in the three months following a suicide attempt.

So, we developed and piloted The Way Back Support Service – starting in Darwin – with donations to beyondblue and a grant from The Movember Foundation.

The service is designed to drive continuity of care – providing non-clinical, assertive outreach, follow-up care and practical support to people directly after a suicide attempt or suicidal crisis.

People told us that one of the risks for them was being discharged back into the environments that had contributed to their suicidality.

We know that half of people discharged from hospital following a suicide attempt do not attend follow-up treatment. Of those that attend, around 38 per cent stop within three months.

The Way Back has been designed to address these points – support coordinators connect with people before they leave hospital and work with them for up to three months – during that time of elevated risk.

The number one priority is to create a safety plan, and then it can be anything from assisting people to get to appointments, engaging with community and health services, reconnecting with friends and family and employment.

We know The Way Back works.

It has almost four years of operational experience in the seven sites currently operating around Australia.

Nineteen hundred people have been referred to the service to date.

And suicide by people who have been engaged with the service is less than one per cent, a dramatic reduction from the usual rates.

And so, we were delighted when the Australian Government announced in the 2018 Budget a commitment of $37.6 million over four years to expand beyondblue’s the Way Back Support Service to up to 25 sites.

In doing so we will collaborate with Primary Health Networks, State and Territory Governments and local service providers.

We are excited about the potential to work with you and your teams on the Way Back Support Service for the benefit of the people of North Queensland.

NewAccess

Another service innovation we want to work with you to scale up is our NewAccess model of cost-effective early intervention.

NewAccess is designed for people with mild to moderate depression and anxiety; it does not replace clinicians but complements their work.

It is creating a new workforce of coaches, local people who are specifically trained and supported to deliver low-intensity cognitive behavioural therapy.

It’s reaching people who haven’t been in touch with mental health services before. It’s getting to them earlier, before their symptoms become more acute and they need more specialist support.

New service models, such as NewAccess, are critical in filling gaps in the mental health system, and empowering local communities.

It’s not an either or, but through NewAccess, we aren’t just waiting for more health professionals to arrive. Instead, we are expanding workforce by training and supporting local community members to deliver evidence-based services that work.

And we know it is effective: an independent evaluation of NewAccess during its trial phase showed that almost 70 per cent of people who completed all six free NewAccess sessions recovered.

NewAccess coaches are not required to have any pre-requisite skills and they are trained at no personal cost.

They come from diverse backgrounds – including those who’ve worked in the health sector to former cinema managers and farmers.

beyondblue now supports PHNs and their commissioned service providers to deliver NewAccess in 21 sites around the country. We already have 12 sites in rural and remote Australia with six in Queensland and another eight in New South Wales.

More recently, we have been working alongside a number of PHNs to develop cohort-specific services, including:

  • a NewAccess service for people from culturally and linguistically diverse backgrounds;
  • another for Aboriginal and Torres Strait Islander people;
  • and a third for people living in residential aged care facilities.

The 2015 Commonwealth mental health reform package provided for the design of stepped-care mental health models by PHNs to give the public access to low-intensity support with the option of moving on to specialist and higher intensity services if required. We think NewAccess absolutely fits that bill.

Working with your communities

The mental health continuum

As we strive to work hand in glove with you, beyondblue is also reaching out directly to the communities you represent. In doing so we are now seeking to push beyond awareness raising and getting people to talk about depression or anxiety or suicide into giving them the tools to act on improving their own mental health or reaching out to support others.

We are advocating people think about their own mental health and that of those around them as a continuum, that each of us can slide up and down over the course of our lives because our mental health changes constantly.

We ask people to think about this like a traffic light indicator.

When we are well, thriving, we are in the green.

But your mental health can ebb and flow through yellow and orange.

It can track through irritability, lapses in concentration, anger and move toward negative self-talk when you become withdrawn, over-tired and work or study is affected.

By the time you reach red you are in crisis and possibly having suicidal thoughts. You have lost hope.

However, we all know that it doesn’t have to be like this.

With the right support most people who develop mental health conditions, such as depression and anxiety, will recover.

They can move back into the green.

And many will never experience that condition again.

Understanding this is the first step towards mental health literacy. In your own efforts to improve your community’s understanding of mental health, you may want to share this continuum model. We truly find it helps people.

The National Education Initiative

In a former life I constantly travelled the length and breadth of Australia and visited many regional, rural and remote communities.

Chances were that my whistle-stop tours would involve a visit to a local school.

The reasons are obvious: schools are the beating hearts of our communities and all our futures are shaped to some extent by our experiences there.

In small communities the school may also be the only local meeting place: the hub of family and cultural and sporting connections.

Delightfully, I am still getting to focus on Australian schools because in 2017 beyondblue won a Commonwealth Government tender to design, build and implement a national mental health initiative free to every early learning service and school.

The premise was simple: prevention is better than cure.

And the mental health needs of young Australians are great.

Depression and anxiety can develop early in life with most issues emerging well before somebody turns 25.

In fact, half of all adult mental health conditions will have emerged by age 14.

In Australia, one in 7 children aged between four and 17 experiences a mental health condition every year.

If left untreated these conditions can dramatically reduce a young person’s chances of leading a happy, healthy, contributing life.

It also increases their chances of developing chronic physical diseases with reduced life expectancy because we know that mental health and physical health go hand in hand.

Tragically suicide is the leading cause of death for Australians aged between 15 and 44.

Of the 2,866 suicides in Australia in 2016… 403 were people aged 15 to 24.

For all these reasons and more, beyondblue is now developing the National Education Initiative to give every school and early learning service the tools they need to create a mentally healthy culture that can respond to their community’s needs.

The result will be an online professional training package for early learning services staff and teachers, backed by a highly experienced team of over 70 staff around the country.

The initiative will give educators the ‘how to’ to promote good mental health, know what to look out for, what to do and where to go to get help for kids who are struggling.

It will link educators to programs and resources that tackle bullying, help them support a troubled young person or colleague, promote good mental health across their school community, and learn how to look after their own mental health and wellbeing.

It will be part of a child’s learning journey from the moment they enter childcare to the end of year 12.

It is about making mental health awareness and practices part of the daily routine; like brushing your teeth, eating properly and getting enough exercise.

To help us deliver the program beyondblue has partnered with two experienced organisations:

Early Childhood Australia and headspace.

Good mental health – just like good physical health – means that kids have an increased likelihood of staying at school, can concentrate better in class, socialise happily and achieve their academic best.

Our goal is no less than producing the most mentally healthy generation of young Australians ever.

Many of you would also be connecting with your local schools around mental health and we are keen to have the National Education Initiative work well alongside your efforts.  So watch this space and please give us your feedback.

Suicide

Mass behavioural change takes time.

Hardly anyone talked about mental health and suicide when Jeff Kennett launched beyondblue back in 2000.

But 18 years later beyondblue has joined with six other leading mental health organisations to launch a social media suicide prevention initiative #youcantalk.

You Can Talk explains that you don’t have to be a mental health professional to talk safely to someone about suicide.

It attracted national media attention and trended on Twitter for over 24 hours and is on-going.

It is a great start to support the community to have this conversation.

But we still have a long way to go and the needs are great:

  • Almost half of us will experience some form of mental health issue in our lifetime.

  • Anxiety is the most common mental health condition in Australia, affecting one in three women and one in five men. And two million Australians are living with anxiety right now.

  • Depression affects one in eight Australian men and one in five Australian women and we know that untreated depression is a high-risk factor for suicide.

  • On average, eight Australians lose their lives to suicide every day.

  • And for each of those who die, we know that another 30 will have attempted suicide.

  • That is about 240 people who feel desperate enough to take their own lives, every single day.

To tackle these statistics in any meaningful way we need to understand the social determinants that are behind them.

We must address mental health everywhere that Australians work, learn, live and play.

In schools and on sporting grounds. In homes and in workplaces. On our streets and in our communities.

And in aged care facilities where the rates of depression are twice the national average.

Today more than ever, the people we are here to serve are expecting more and different things of us.

We are keen to see you join in and amplify the #youcantalk campaign.

Innovations

At beyondblue we believe talking is the foundation stone of action and change.

As our communities become more literate about mental health, we believe they will be more prepared to reach out for help when they need.

Our Support Service is one way of doing that all important first ask for assistance and we continue to evolve it in response to community needs.

The Support Service is now staffed by mental health professionals 24/7 and provides telephone, webchat and email support and advice to individuals and their families affected by depression, anxiety and suicidality.

It provides free, immediate, short-term, solutions focused support and offers referral services.

Nearly 170,000 people contacted the Support Service last year, the majority of whom were first time users.

These conversations often prove to be the impetus for someone to make an appointment – to see their Aboriginal Health Service, GP or mental health professional – or to talk to a trusted family member or friend and get the support they need.

It’s another way we work with your communities.

BeyondNow App

Talking on the phone or on line, can close that sense of isolation. Indeed, just as globalisation and modern communications are leapfrogging the physical barriers that once separated us from the rest of the globe, new opportunities are emerging to allow us to narrow the gap between metro and rural Australia.

Making the most of these opportunities, beyondblue developed the BeyondNow smartphone app.

The idea is that you have a suicide safety plan in your pocket, to be accessed whenever you need.

Safety plans, as the name suggests, let people note down the things that keep them safe when they feel unwell.

It encourages them to connect with people they can trust for support.

It creates personalised lists of warning signs, coping strategies, reasons for living and ways to make an environment safe.

And it can be shared – with health professionals, carers, family or friends.

Since it was launched in March 2016, this free app has been downloaded more than 45,000 times.

We would like to see all health professionals integrating the app into their practice, promoting it to their patients. We ask that you think about how you can promote BeyondNow.

It costs nothing and could save a life.

Online Forums

beyondblue’s Online Forums are another space where people can talk freely, safely and anonymously with others who have similar experiences of depression, anxiety, suicidality or other life events.

All posts are monitored by a team of clinical moderators and 18 ‘community champions’ – who are regular forum visitors recruited to provide peer support.

The champions ensure visitors remain safe, supported and connected to help in the event of a crisis.

Around 110,000 people now come to the Online Forums every month.

When we ask people why they come to the forums, more than a quarter report they initially visited because they were feeling suicidal.

Importantly, after joining the forums, a third of users say they are more likely to:

  • Seek help from a health professional;
  • Talk to family and friends about how they’re feeling;
  • And find out more about mental health conditions.

There’s also a significant improvement in people’s symptoms after using the Online Forums:

  • 56 per cent described themselves as ‘less depressed’;
  • and 60 per cent as ‘less anxious’.

Two thirds of forum users report making positive lifestyle changes based on the advice and support they received; such as exercising more, using mindfulness and connecting more often with friends and family.

The forums don’t replace mental health treatment or professional support, but they are a powerful supplement.

Users come from diverse backgrounds, but increasingly, belong to groups that have higher rates of suicide than the general community including greater numbers of people in rural and remote areas:

  • while metro users made up 54 per cent of the online community;
  • non-metro users made up 46 per cent.

When you consider that nearly 7 in 10 people in Australia live in a capital city, this is substantial.

And this skew to rural and regional users has continued to grow over the last few years.

I would like to read you a brief note from one forum user:

"I received some fantastic responses to my post that helped me reframe the situation that I was/am in. It's so important to me as I live in a regional area to be able to reach out in an anonymous fashion and be able to have others relate to my issues. It's a great comfort knowing that being diagnosed with depression/anxiety that I can interact with others who are kind, empathetic and understanding, and can offer their advice and experiences. Knowing that I'm not alone means a great deal to me and the forums are a great way to reach out whilst staying anonymous."

While I am in that online realm, I would also like to touch on social media.

While we often discuss the evils of social media, there are also benefits such as the #youcantalk campaign I mentioned earlier.

Social media is also:

  • enabling people to share experiences and express feelings;
  • it’s non-stigmatising;
  • it’s accessible – most people in the community are already using it;
  • giving an ability to help and be helped;
  • opportunities for early intervention if someone expresses suicidal thoughts or feelings online.

Of course, it comes with risks, but

  • you can operate safe and effective interventions online;
  • At beyondblue we do it by moderating all our social media communications; We have clear practice and ethical guidelines.

Our forums may be another option you want to promote to your communities.

DRIVING CHANGE

Rural and remote communities are often lead the way in innovation. Put simply, they have to do things differently to the capital cities to meet needs.

Many of you are showing that leadership and the conference program includes great examples of new evidence-based supports that are altering the service environment, questioning the status quo.

We need to think differently – to think ‘outside of the office’, ‘outside of the consulting room’ and ‘outside of the health system’ – about how to take mental health supports to the people and into their comfort zones, rather than expecting them come to us.

We need mass cultural and behavioural change in how we think about, and expect to receive and provide support for mental health.

Many of you will be familiar with the ‘contributing life’ concept, developed by the National Mental Health Commission, through their consultations with thousands of people and families right around the country.

This framework shows us that what people want, and need, for good mental health and for recovery, is largely outside the health system – it’s where they live, learn, work and play.

What matters most to people is having something meaningful to do, somewhere safe to live, and somewhere they belong.

Yes, having access to good quality, affordable, mental health services is also vital. But it’s equally, if not more important, to build thriving communities, where people are connected to others, have a strong sense of purpose and identity, and come together during times of adversity.

I think this is where the rest of us can all really learn from those living in rural and remote Australia.

Closing out

Not only do Australians want our thinking about mental health to go beyond the health system, the workforce challenges require us to think beyond today’s status quo.

A ‘business as usual’ mental health system, across rural and urban regions, would require at least 8,800 additional mental health professionals, at a cumulative cost of 9 billion dollars over the next 15 years.

I’m sure you’d agree – this is unlikely to eventuate.

So, to fill the gap, a broader approach is required; one that allows prevention and early intervention to ease the pressure on limited resources. One that considers how we can re-tool the system to have the right skills and capacity to meet need.

This requires nurturing and growing new local workforces – peer workers, low intensity mental health coaches, and non-clinical support coordinators – to work alongside you in multidisciplinary teams and ensure people get the right level of support when and where they need it.

If we succeed, we will not only change the lives of those experiencing mental ill health.  Our reach will be much broader.

Because if it happens to parents, it impacts the development of children.

If it happens to employees, it impacts productivity and participation.

If it happens to anyone it makes them predisposed to chronic diseases and increases the burden on the entire health system.

So any win in mental health is big win.

And, as primary care professionals, you have the chance to create that win not only in your own practices but by directing your patients to the smorgasbord of options I have spoken about today – things they can access out of hours, when the clinic is closed, from home, from the truck, from the school.

On that I look forward to working with you as we all strive to win for our communities.

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