Mental health reform in Australia

The Hon. Julia Gillard AC presents to the Committee for Economic Development of Australia (CEDA), 23 September 2021.

Good afternoon and thank you for that generous welcome.

I start by acknowledging the Traditional Owners of the lands you are on today, and in a spirit of reconciliation pay my respects to elders past, present and emerging.

I also extend my respects to any First Nations peoples joining this webinar.

I’m joining you from London, where I’ve been testing virtual chairing duties for Beyond Blue, starting my work with the Wellcome Trust and continuing my work with the Global Institute for Women’s Leadership.

I want to begin by reflecting on the extraordinary times we’re all living through.

There is not a single Australian who has been left untouched by the challenges of this pandemic.

Economically, psychologically, and socially, we are being sorely tested as a nation.

But we must not lose heart.

With vaccination rates increasing rapidly, brighter days are ahead of us.

I was personally very relieved to get jabbed and I am grateful to the scientists who created the vaccines in record time.

Here in the UK, we’ve seen life return to something resembling normality, as vaccinations break the link between infection and serious illness or death.

As Australia forges its path towards co-existing safely with COVID of course there will be challenges.

But we also have a chance to use this as an inflection point to shape a stronger nation that prospers by prioritising the mental health and wellbeing of its people.

As the renowned author Arundhati Roy observed:

“Historically, pandemics have forced humans to break with the past and imagine their world anew.

“It is a portal, a gateway between one world and the next. We can choose to walk through it. Ready to imagine another world.”

Today I want to talk to you about how Australia can step into that reimagined future.

I know that many of you as employers are already doing your own re-imagining as you reflect on the impacts of this period of turbulence on your own workforce and your business future.

No doubt you are keenly aware that both opportunities and challenges present as you define and measure productivity differently; radically alter thinking about what a ‘workplace’ now is; and change the nature of the way we work – with flexible conditions and enhanced technology.

If the new normal is designed with the objective of enabling both better work life balance and creating a more mentally healthy workplace, then the benefits will be felt for many years to come.

In the same way as our nation draws up the blueprints for our post-pandemic future, a key design element must be creating an Australia where we prevent suicide and help all people achieve their best possible mental health.

Taking this perspective, it’s encouraging to see recent commitment from all governments to implement recommendations of landmark reviews into Australia’s mental health and suicide prevention systems.

This commitment, along with record budget announcements, is welcome.

But it must be delivered with urgency and ambition.

And it will need to be enduring.

If we are to finally secure wholesale structural reform and build the nation’s resilience for future shocks, we must look beyond election cycles and turn words into action.

Otherwise, there’s a real possibility we will squander this opportunity, and nothing will change.

Today I will share with you some of Beyond Blue’s perspectives on what we must do differently to prepare the nation for the challenges ahead.

The challenge

Firstly, let me outline the scale of need.

Through the pandemic, we’ve seen people with pre-existing mental health challenges slip further into distress, and others struggle for the first time.

At Beyond Blue – like so many other organisations – it has been our busiest period on record.

Our Coronavirus Mental Wellbeing Support Service – a Commonwealth-funded digitally-led service – has had more than more than 1.4 million visitors since launch in April 2020.

To September this year, demand for our counselling services is up 53 percent on 2019. In 2020, demand increased up to 60 per cent.

Young people are some of the biggest users of our services. Since the most recent lockdowns, 60 per cent of all contacts have been from people aged 15 to 34.

Small business owners, Aboriginal and Torres Strait Islander peoples, older Australians, people from culturally and linguistically diverse backgrounds, those with no job, in insecure work and housing, LGBTIQ Australians and others have also struggled.

So far, coronial data shows there has been no significant change in suicide rates across the board.

This is encouraging. But we can’t be complacent.  

July figures from the National Suicide and Self-Harm Monitoring System[1] show an increase in ambulance attendances for suicidal thoughts and self-harm in both NSW and Victoria.

We know that mental ill-health and suicidality can lead to incalculable social and emotional costs.

Life trajectories are interrupted, hopes and aspirations put on hold, and plans thrown off course.

I was particularly struck by the many personal stories told through the Royal Commission into Victoria’s Mental Health System.

Stories of challenge, resilience and recovery, like Teresa’s.

The first time Teresa attempted to take her life she was 15. She had access to mental health services but never found the combination of support that worked for her.

Instead, she learned to cope by “pretending everything was ok”.

Over the years, she was hospitalised for more suicide attempts.

She described this as being stuck in a cycle of reaching out for help and being sent back to the same things that hadn’t worked in the past. “It was easy to build up a mistrust of the mental health system”, she said.

Despite the efforts of many people who work tirelessly in them, Australia’s mental health and suicide prevention systems are not systems at all.

They are patchy, piecemeal and crisis-driven.

Which makes Teresa’s story all the more remarkable. I will return to her insights later.

Now, I turn to the economy and mental health.

Economic cost

Every episode of mental ill health can put a ‘dint’ in a person’s unique potential. Left unaddressed, these individual dints also stifle our collective prosperity.

The Productivity Commission calculated that mental illness costs the Australian economy at least $200 billion a year – in healthcare costs, lost productivity, economic participation, carers costs, disability, and premature death.

That equates to more than one tenth of Australia’s entire economic production in 2019 – more than $550 million every day.

These are pre-COVID estimates. Given the rising distress in the community, costs are likely to now be much higher.

It’s a toll borne by the whole community – families, health and social services, and businesses small and large.

The 2021 Intergenerational Report tells us that to be economically strong and support an ageing population, we must build a high-functioning, diverse, and innovative workforce.

People who are mentally well are more likely to get a job, stay in a job and perform well in their roles.

And a good job provides protective mental health factors, through financial security, social connection, and purpose.

The Productivity Commission sets out the challenge: “Unless there are successful interventions to address the mental ill health of young people the overall mental health of the workforce could decline in future”.

Meaning lower participation, more absences from work, and higher rates of presenteeism.

A substantial investment now in proper mental health reform is a critical down-payment on Australia's future prosperity and innovation, and a step towards the hopeful future set out by Arundhati Roy.

A portal to a more mentally healthy Australia for all of us.

Seizing the moment

With rising need, and the full effects of COVID-19 on mental health yet to fully emerge, we must act with urgency.

COVID has merely served to amplify pre-existing problems in our mental health system.

It’s confusing to navigate, fragmented, unbalanced, chronically underfunded and does not work for the people it’s there to support.

Too many Australians are told they’re either too sick, or not sick enough.

We know this because we’ve been told by those who live it.

The latest landmark reports and budget commitments have offered us both the political momentum and the money to get started.

The public expect it.

Business and industry are behind it.

Beyond Blue's vision

Change is within our grasp if we get the building blocks of reform right from the start.

At Beyond Blue, we believe there are several key principles that must inform the road ahead.

1. Whole of government

The first is a national, whole of government approach.

To use the Productivity Commission’s language, the ‘back office’ must be redesigned.

And there is much to learn from the lessons gained through the COVID crisis.

When the pandemic hit, we saw decisive, collaborative efforts from all levels of government to protect Australians.

Cumbersome layers of governance were set aside to ensure the rapid flow of money from the Commonwealth to the states, or directly into the pockets of businesses, families, and individuals in need.

Billions of dollars to prevent, test, and treat COVID were shared in a new National COVID-19 Partnership Agreement developed and executed by all governments in days, not the usual months or years.

The speed of this deal was enabled by two key things.

• One is obvious – the clear and urgent need to protect Australian lives.
• The second is less so – there was already a well-designed back office.

That back office was Australia’s nationally coordinated and funded system for health and hospital care.

A system where the roles and responsibilities of all governments are clear.

Where data and funding flows are agreed and linked to clear objectives.

Where independent agencies, like the National Health Funding Body, are charged with improving transparency of public hospital funding.

When there is a national system laid out in an agreement between all governments, it can be scaled up and down, where and when it is needed.

Contrast this with the mental health and suicide prevention system, which has no similar agreement.

In her testimony to the Royal Commission, Teresa explained that “in comparison to maintaining my mental health, managing and navigating how to get the care I need to meet my health and wellbeing goals resulting from having diabetes has been much easier.”

Long waitlists, high out-of-pocket costs, workforce shortages, not knowing where to get help, or not being able to access support early enough to prevent distress from escalating. These issues existed before the pandemic and persist today.

A series of pop up and patchwork solutions in response to lockdowns helped to respond to immediate need.

But more is required to address the pandemic’s long mental health tail.

2. Independent body

Another area we must prioritise is transparency.

We need to be able to see through the cracks to the areas of greatest need.

Unlike other areas of health, we have no regulator to robustly monitor and evaluate the mental health system’s performance.

We collect a lot of activity data, but it’s not linked or traced back to shared national outcomes.

Beyond Blue believes a key focus must be redesigning the National Mental Health Commission as a stand-alone, statutory body to provide this function.

It must be independent, providing frank and fearless advice and regular report cards to governments, ensuring all jurisdictions meet their commitments.

Its role and powers should be outlined in the new National Mental Health and Suicide Prevention Agreement and linked to agreed outcomes and priorities.

3. Embedding lived experience

The third priority – and the most important of all – is to create a compassionate system that works for and is co-designed by the people who use it.

We must harness the wisdom of those living with mental illness, and their support networks.

They know better than anyone what support they need to survive and thrive.

Too often we fail to see the whole person, treating them as a collection of symptoms in need of a quick fix rather than understanding their unique life circumstances.

What has become abundantly clear through the pandemic is the causes of mental ill health are often structural and multi-faceted, and our response must reflect that.

Secure work, a safe and stable place to call home, food on the table, and meaningful connection are every bit as important as access to services.

These social structures are the foundational pillars of mental wellbeing and suicide prevention.

When one or more of these pillars is removed, things can quickly fall apart.

Reform must centre the experiences of people living with mental illness or suicidal distress and embed consumer and carer voices in governance structures.

As Christine Morgan, the National Suicide Prevention Adviser stressed in her final advice to the PM, a system that fails to do this is one that is fundamentally flawed.

National agreement

Beyond Blue would like to see the three priorities I’ve outlined set out in the new National Mental Health and Suicide Prevention Agreement – due to be finalised by First Ministers in November.

The Agreement must establish a more strategic, cross-portfolio approach to reform that prioritises prevention, early intervention, and recovery and goes beyond costly clinical and crisis-driven responses.

Other critical features include:

• Agreed national outcomes that measure things that matter to people.
• Clear roles and responsibilities and agreed priority actions.
• Workforce innovation and diversity – we need to think differently and diversify our workforce, given the long lead time to bring specialist professionals into the system.
• A long-term spending plan, with investment jointly planned and rigorously tracked and monitored.

We know that Australia, like governments around the world, will emerge from the pandemic with increased debt and competing funding priorities.

That’s why it’s imperative we address mental health reform now – investing wisely in a system which is better designed and consequently uses every dollar more efficiently and effectively.

If governments don’t start working together differently, and co-investing differently now, then when?

I was heartened to read a statement signed by First Ministers in December 2020 at the National Federation Reform Council that shows our political leaders understand the urgency.

They agreed that building a comprehensive, coordinated, consumer-driven and compassionate mental health and suicide prevention system not only benefits individuals, families, and communities, it’s also critical for Australia’s social and economic recovery.

And for people like Teresa.

She says: “You matter, and it can get better. It is worth waking up tomorrow. Whilst it might be hard, keep reaching out. Our system might not be what you need right now but you deserve a system that responds to you and allows you to reach your human potential. We will only get the system we need if your voice is there to be heard.”

What can you do?

But governments can’t do it alone.

To business leaders, I urge you to reflect on your role in being part of the solution.

The economic prosperity of your own business, and that of the nation, will be maximised by getting the national mental health reform settings right.

The cost of inaction is borne by businesses, and it is substantial – up to $39 billion a year in lost participation and productivity, coupled with high workers compensation claims.

Improving population mental health is good for Australians, your business, our communities, and the national economy.

Everyone has a stake in this and stands to benefit from reform.

In your discussions with government decision makers, I urge you to emphasise the need for ambitious, wholesale change with a long-term outlook.

Our nation needs your enterprise, your influence, your compassion – we need your help.

Because this has been, and will continue to be, one of the most psychologically bruising periods we have ever faced.

The generations in front of us will need more support than ever before.

Reimagining and reforming our mental health system is critical to creating a mentally health future for Australia.  

I’m confident we can get there.

As a nation we have faced the greatest adversity, but we have shown that together, we can do hard things.

If we unite with conviction, clear heads, and a collective purpose, we can do it again with mental health reform.

Thank you.