The state of our mental health: Addressing quality of care in mental health

The 2019 Royal Commission into Victoria’s Mental Health System provided “chilling and detailed documentation of the poor quality of care provided to people with serious mental illness in our state”, says Monash Pro Vice Chancellor and Professor of Psychiatry, David Copolov, AO.

Victoria’s Premier Daniel Andrews has promised to implement all of the Royal Commission’s recommendations. The commission received more than 3000 submissions - the final report is due in October 2020.

In the meantime, the State Government will set about introducing the recommendations, part of the interim report released late last year. These include administering a special levy, or tax, to fund improved mental health services in the state, adding 170 acute mental health beds for young people and adults, and expanding follow-up care for people who have attempted suicide.

The Royal Commission coincided with the Productivity Commission’s report into mental health, which is taking a national perspective. Together the close examination of mental health care being undertaken by the two overlapping commissions represents an historic opportunity to reform mental health services, Professor Copolov said.

He strongly endorsed the Royal Commission’s recommendations in its Interim Report.

The new state of mind

Victoria has seen “a dramatic increase in the emergency department presentations of people with mental illness”, he said.

Half of these patients must wait more than eight hours to be admitted only to be “discharged from hospital much too early, and that’s because, among other reasons, there just aren’t enough mental health beds”.

Professor Copolov said people are more open about mental disorders than they once were, which is obviously a very good thing. “But it may lead to the impression that there’s some sort of contagion, or major increase, whereas the data shows that although there might be some increase in depression and anxiety, especially in younger people, on the whole the figures don’t point to that”.

Head of the Monash Department of Psychiatry Professor Suresh Sundram also endorsed the Royal Commission’s interim recommendations.

The mentally ill are over-represented in courts and prisons, homeless shelters and among the Indigenous population, he says.

“We need to be able to provide much more holistic and comprehensive treatment programs.” (One of the interim recommendations is that a centre focused on culturally appropriate care for Aboriginal Victorians be established, to work closely with community-run organisations.)

Moving forward with care

Professor Sundram said that because mental illnesses are not as stigmatised as they once were, our society was now ready to “dedicate itself to achieving the sorts of advances that will ultimately lead to prevention and cure”.

While survival rates for cancer have improved greatly during the past 30 or 40 years, the most severe mental illnesses – including schizophrenia, bipolar disorder and major depression – have not received the same research focus as cancer and deserve to do so, Professor Sundram says.

He described these conditions as “chronic persistent lifelong disabling illnesses”.

“The interventions that we have for them are relatively limited,” he says. “All that links them is the fact they are illnesses which principally affect the brain and we don’t know what their underlying pathology is.”

These severe mental disorders affect about 3.5 per cent of the population. They also contribute to the high rate of suicide in Australia, with schizophrenia patients, for example, about eight to 12 times more likely to commit suicide than the general population.

“Half of those suicides occur within the first three years of diagnosis,” Professor Sundram says. “They realise all the potential that they’ve lost as a consequence of their illness … people think it’s better to be dead.”

Fortunately, the majority of Australians affected by mental illness do not suffer from these chronic illnesses, but from more treatment-responsive commonplace disorders such as mild or moderate anxiety or depression.

According to the Productivity Commission’s Draft Report and several other data sources, 20 per cent of Australians experience some form of mental ill-health each year. But much of “that 20 per cent involves people who have disorders that are not severe,” Professor Copolov says.

The good news is that most psychiatric treatments, including non-pharmacological ones, for such patients are very effective, he says.

“We may not cure people, but we can certainly help them … having or having had a psychiatric disorder is usually entirely compatible with leading a good, productive and enjoyable life.”

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