The Hon Julia Gillard AC addresses the Committee for Economic Development of Australia

19 September 2019

Philosophers say that the value of human life is incalculable.

Romantics believe each of us is priceless, even irreplaceable…

But economists… and I am sure there are plenty here today…economists would probably say we have an inflated view of our own importance.

Instead the economist might calculate that a statistical life based on a willingness to pay the estimated value of reductions in the risk of physical harm… values each of us at $4.5 million.

Or perhaps an economist would prefer the method that estimates the value society places on reducing the risk of premature death by saving one statistical life year. Based on this calculation, a year of life is worth $195,000.

Putting a price tag on human life may appear insensitive but it is also practical… some would say necessary… and it has been done for centuries by businesses, governments, public authorities, courts and insurers.

Could we ever put a dollar figure on the value of a happy life? Probably not, but we do have some numbers that help us see the economic differential between a lifetime of good mental health and participation, compared to one of poor mental health and lost opportunity.

Deficit model numbers are everywhere, of course. It is headline economics.

Poor mental health imposes costs estimated at $60 billion annually on individuals and their families, workplaces, the health and welfare systems, and has economic consequences in the areas of justice, aged care, housing and education.

The annual cost of poor mental health to the economy is about 4 per cent of GDP.

Eight million working days are lost due to mental ill health in Australia each year.

And while we are doing the maths:

  • Around one million Australians aged between and 16 to 85 are currently living with depression. One million.
  • Diagnosable anxiety conditions – Australia’s most common mental health issue – affect two million. Included in this number are problems like social anxiety, debilitating phobia or PTSD.
  • One in five Australian workers will experience a mental health condition in any 12-month period.

But we also have some benefit numbers.

Very recent economic modelling by Deakin Health Economics, commissioned by the National Mental Health Commission, shows investment in mental health prevention initiatives yields substantial positive returns.

The study looked at 10 interventions with lifespans of 3 to 11 years, targeting workplaces, e-health for anxiety disorders in young people, depression in new mothers, and loneliness in seniors.

Nine of these interventions produced positive returns on investment, with savings in productivity and health care costs estimated at almost $290 million overall.

KPMG’s 2018 Investing to Save report, commissioned by Mental Health Australia, found investing $50 million in prevention and early intervention priorities could achieve $442 million in long-term savings to the national economy.

These are numbers we should all get behind.

At Beyond Blue we are certainly motivated by them. Prevention and early intervention are our watchwords. 

We seek to prevent the onset or development of common conditions such as anxiety and depression through literacy and skills building; tackling stigma and discrimination so people seek help; and incubating new early intervention options.

We offer expert and peer-led 24-hour support, advice and information and receive over 14 million contacts annually via our website, apps, social media and phone services.

We fund research to build evidence for better support and treatment. Design new initiatives and low-intensity service models that are free, and importantly, are easy to access. Then we aim to get them funded and scaled up for national delivery to the places where people work, live and learn.  One such key initiative we are scaling up right now is called New Access.

We continue to educate people about symptoms so that they know to act early and seek support from a GP or a mental health expert.

Because we know people with mild to moderate anxiety or depression who get the right support at the right time can and do recover and stay well.

Their symptoms won’t progress to a level of psychological distress that leads to ambulance call outs and hospital emergency departments.

To break it down for all the economists in the audience…

At any one time:

  • 60 per cent of us are mentally well;
  • 23 per cent will be at risk of developing a mental health condition;
  • 14 per cent will have mild to moderate symptoms of a mental health condition, most likely anxiety or depression;
  • And 3 per cent will have a severe mental illness – they are more vulnerable, may be more at risk of financial difficulties, unstable work or housing, possibly experiencing suicidal thoughts – and requiring on-going support and treatment.

But about half those with diagnosable anxiety or symptoms of depression never seek treatment or spend years struggling before they reach out.

It may be because they don’t recognise that they have a condition that will respond to treatment.

Or they think being angry all the time, not sleeping, worrying excessively, feeling sad and isolated, or not participating in social activities are just part of who they are.

People in this situation might adapt their lives so they can live with these conditions rather than get the support they need to recover.

Others won’t talk about how they are feeling because they are paralysed by self or social stigma and the real threat of discrimination; fearing they will be judged by others as weak, incapable of coping, or worse – be thought of as a burden to those around them.

Nobody is immune to these issues. If you are not personally affected, you will know somebody who is.  It might be a family member, a friend, or a colleague.

For this audience, I want to particularly stress the benefits of prevention and early intervention at work.

A mentally healthy workplace supports its one in five people who will be affected by a mental health issue in any given year, especially when they are not coping. Their careers will not be jeopardised. They won’t be shunted off to ‘special projects’.

Instead there are conversations about flexibility and reasonable adjustments to keep them connected and at work; or if it’s necessary, encouragement to take the time they need to recover.

This makes good business sense: PwC research shows that creating mentally healthy workplaces can result in an average return on investment of $2.30 for every dollar spent.

But when depression and anxiety go unrecognised, they remain untreated and can become disabling. 

In fact, depression is now the leading cause of disability worldwide.

The World Health Organization predicts that by 2030 depression will be the largest contributor to the global burden of disease.

And, of course, it is one of the known risk factors for suicide. Some more numbers – and these numbers are distressing:

  • In 2017, 3128 Australian’s took their own lives...more than double the national road toll.
  • More than eight Australians die by suicide on average each day, six of whom will be men.
  • Suicide is the leading cause of premature death in Australia, and it is on the rise in young people, especially in our Aboriginal and Torres Strait Islander communities.

And let’s not forget - behind all of these statistics are people – the bereaved and grieving husbands, wives, sons, daughters, dads, mums, brothers, sisters, friends and colleagues.

The scale of the challenge these numbers describe is daunting.

But we should not allow it to become dispiriting.  Good evidence-based policy can and should make a radical difference to these numbers.

Already, we have shaken off the silence that used to surround mental health in the policy space.  Every parliamentarian I meet from all sides of politics is eager to learn more about mental health policy and willing to tackle the challenges of designing better solutions.

Already much is happening.

At Beyond Blue we are grateful for the significant investment the Commonwealth has been prepared to make in Be You, which aims to strengthen mental health literacy, resilience, self-care and help-seeking within school communities and early childhood settings.

We are also pleased to see increasing Commonwealth and State uptake of The Way Back, a Beyond Blue designed support service for those who have tried to take their lives.

We are delighted that in the last Budget, during the election campaign and now in office the Government has committed to:

  • Make youth suicide prevention a national priority and invest $461 million in Australia’s youth mental health and suicide prevention strategies, including 30 new headspace centres.
  • A network of adult mental health centres around the country to be designed with input from the mental health community, including those with lived experience and delivered in conjunction with the states and territories.
  • Increase mental health support for expectant and new parents through a Perinatal Mental Health and Wellbeing Program, including support for those experiencing grief after the death of a child.

But now is the time to do the deeper dive and wholly reform our national system of mental health, which today has all the problems of fragmentation which come when different Commonwealth and State funding streams do not work together to create an integrated whole.

In addition, like in other areas of health, there is an underinvestment in prevention and early intervention coupled with both workforce shortages and the need to innovate on how, where and from whom help is available.

Fortunately, the mood is for change.

I believe Australia is ready for these big-picture structural reforms that will set the foundations of better mental health for all.

To this end, the Federal Government’s commitment to a system that takes an ‘equally well approach’ to physical and mental health is welcomed.

And there is considerable hope and expectation that the contemporaneous Productivity Commission Inquiry and Victorian Royal Commission will work together and reach integrated, complementary recommendations that lay the foundations for the system and supports that people need.

In Victoria, Premier Daniel Andrews has said he will accept all findings of the Royal Commission into the Victorian Mental Health System which is due to file an interim report by November.

Nationally, the Productivity Commission’s sweeping inquiry into mental health has a mandate to examine every corner and every level of government, and all factors that influence our mental health, resilience, connectedness and opportunities to live contributing lives.

Prime Minister Scott Morrison nominated mental health and suicide prevention services as a key priority for his government and set “zero suicide” as its goal.

In July he appointed National Mental Health Commission chief executive Christine Morgan to be his suicide prevention adviser: an important first.

We also welcome the announcement by the Federal Minister for Health Greg Hunt in his recent National Press Club address that Australia will have its first National Children’s Mental Health Strategy to be delivered by the National Mental Health Commission.

As we also welcome his re-establishment of the National Survey of Mental Health and Wellbeing – the last survey was done in 2007.

Very significantly, he also committed to strike a new mental health agreement with the States and Territories.

I know from my former life in this place that windows of opportunity like this don’t stay open for long.

So now is the time to be delivering clear messages about priorities in the reform agenda.

At this stage of the discussion, I want to highlight the following three headline points.

First, we need to design the system around people, not build a new system and then hope they will come. 

Consider a farmer who finds himself increasingly thinking about suicide as he shoots starving stock on a drought ravaged run or a female city office worker who has the same kind of thoughts during what she had hoped would be the happiest time of her life following the birth of her first child; from a clinician’s point of view both individuals would be in a similar state. 

But we all know that the best way to get help to these individuals is very different. 

We can learn a great deal by genuinely listening to people as they tell us what they need.

Then in rolling out tailored supports we must overcome the inequity between the prevalence of mental health conditions and provision of services.

We require more e-health and telehealth initiatives to reach out from regional, rural and remote regions where access to support is often patchy, or non-existent.

Second, there is a need for more low-intensity or community care options to expand prevention and early intervention before the intensity of a hospital emergency department is required.  It is unsurprising that this is a problem given the Federal Government generally funds primary care and State Governments administer our public hospitals, leaving no clarity about who should be doing what in the space in between.

Let me give you one example of what we are missing:  We would have a much better system if people in suicidal crisis, who do not have life-threatening injuries, could be diverted from hospital emergency departments when appropriate.  Instead, with expanded community-based care options, ambulance services could have alternative destinations such as clinically supervised programs and ‘safe spaces’ staffed twenty-four hours a day by non-clinical employees and peers who have the empathy, time and training to support people in psychological crises. 

Third, we must think differently about workforce and equally value clinical and non-clinical or psychosocial services that are easily accessed and appropriately funded.

This will require a shift and re-imagining of our structures to look beyond hospitals and health services.

It’s about GPs, allied health professionals, psychologists and psychiatrists, peer workers and coaches, workplaces and schools working in collaboration to design programs for individuals, families, communities.

If these reform directions were pursued, we would be able to build an agile system that acknowledges the ebbs and flows of an individual’s mental health over a lifetime, so the level of care can be stepped up or down; can be matched to the nuance of need.

A continuum of needs approach which encompasses promotion, prevention and early intervention, community, peer-led, clinical interventions and crisis support.

A coherent, integrated system that works across all levels of government.

How do we get to this kind of profound change?

Fortunately, the Commonwealth has already indicated its willingness to work with the states and territories on system reform over the next two years, an openness to collaboration that is welcome.

COAG has agreed that individual jurisdictions would take a lead on piloting specific initiatives and sharing best practice. They committed to working together to develop practical options to ensure that the right support is available to individuals, families and communities, at the right time and in the right place, drawing on existing community expertise.

COAG’s focus on mental health and suicide prevention is a step in the right direction.

But we must ensure we don’t get lost yet again in individual initiatives at the risk of missing the opportunity for coordinated and broad-ranging national reform.  For structural system reform that will change the face of mental health policy in Australia for generations to come. 

Such reform is complex, but this is no excuse for inaction.

Great reform takes time, but it can be done.

As a nation, we have done it before. We can do it again.

And we must. The cost of failure is too great.

Here in this room we have gathered people who can make a difference to the public attention, policy insight and intensity of political attention this reform drive attracts.

I urge you to be informed and involved.

And I thank you for your kind attention.