3.10 Access to mental health services
Why is it important?
Aboriginal and Torres Strait Islander people experience higher rates of mental health issues than other Australians with: mortality rates for mental health and behavioural disorders 1.2 times as high; deaths from suicide twice as high; hospitalisation rates for intentional self-harm more than twice as high; and rates of psychological distress nearly 3 times as high (see measure 1.18). While Indigenous Australians use mental health services at higher rates than other Australians, it is hard to assess whether this use is as high as the underlying need.
Social, historical and economic disadvantage contribute to high rates of physical and mental health problems, high adult mortality, high suicide rates, child removals and incarceration rates, which in turn lead to higher rates of grief, loss and trauma (see measure 1.18). Most mental health services address mental health conditions once they have emerged rather than addressing the underlying causes of distress. Even so, early access to effective services can help diminish the consequences of these problems and help restore people's emotional and social wellbeing.
Mental health care may be provided by specialised mental health care services (e.g. private psychiatrists, and specialised hospital, residential or community services), or by general health care services that supply mental health related care (e.g. GPs and Indigenous primary health care organisations).
In the 2012–13 Health Survey, 27% of Indigenous Australian adults with high/very high levels of psychological distress had seen a health professional about their distress in the previous 4 weeks. Rates were higher for females (30%), and those living in non-remote areas (29%).
The latest available data on Medicare-subsidised mental health care services, (provided by consultant psychiatrists, clinical psychologists, GPs and allied health professionals) are from 2012–13. In that year, 8% of Indigenous Australians accessed Medicare-subsidised clinical mental health care services, as did 8% of non-Indigenous Australians (SCRGSP 2015).
GP survey data from April 2008 to March 2013 indicate that 11% of all problems managed by GPs among Indigenous patients were mental health related. Depression (48%) and anxiety (20%) were the main mental health related problems treated. After adjusting for differences in the age profiles of the two populations, GPs managed mental health problems for Indigenous Australians at 1.3 times the rate for other Australians.
The majority of the 205 Australian Government-funded Indigenous primary health care organisations provided care in relation to social and emotional wellbeing (SEWB) and mental health issues. In 2012–13, these organisations employed 533 FTE SEWB staff (44% Indigenous). These staff provided 205,300 client contacts. Anxiety and stress (78%), family or relationship issues (74%), depression (72%), grief and loss issues (65%), and family/community violence (54%) were the most common issues managed in terms of staff time and organisational resources.
In 2012–13, there were 98 organisations funded by the Australian Government to provide SEWB or Link Up counselling services to Indigenous Australians (84 of which were also funded for primary health care and included above). In 2012–13, these organisations provided 89,100 client contacts to around 17,700 clients (an average of 5 contacts for each client) (AIHW 2014a).
State/territory-based specialised community mental health services reported 597,300 service contacts for Indigenous clients in 2012–13 (11% of client contacts). Rates for Indigenous Australians were 3 times the rates for non-Indigenous Australians and were higher across all age groups, particularly those aged 25–44. Community mental health care contact rates for Indigenous Australians were highest in the ACT (1,711 per 1,000) and lowest in the NT (375 per 1,000) (noting data were not available for Victoria or Tasmania). The rate of residential mental health care episodes in the same period was 41 per 100,000 for Indigenous Australians—1.5 times the rate for non-Indigenous Australians.
Access to specialist psychiatry in rural and remote Australia is particularly problematic (Hunter 2007). In 2012 there were 34 FTE psychologists per 100,000 people in remote and very remote areas compared with 99 per 100,000 in major cities (AIHW 2013a). In 2013–14, Indigenous Australians were less likely than non-Indigenous Australians to have claimed through Medicare for psychologist care (108 compared with 172 per 1,000) and also psychiatric care (48 compared with 94 per 1,000).
In the two years to June 2013, the hospitalisation rate for mental health issues for Indigenous men was 2.3 times the rate for non-Indigenous men, and the rate for Indigenous women was 1.7 times the rate for non-Indigenous women. Indigenous rates were highest in SA (4.6 times the non-Indigenous rate). Between 1998–99 and 2012–13, hospitalisation rates for mental health related conditions significantly increased for Indigenous Australians—by 61% for females and 39% for males (for Qld, WA, SA, and NT). Short-term trends since 2004–05 (for NSW, Vic, Qld, WA, SA and NT) also indicate significant increases (47% for females and 33% for males).
Hospitalisations for mental health care can be divided into two main categories: ambulatory-equivalent (comparable to care provided by community mental health care services) and admitted patient care. In the two years to June 2013, ambulatory-equivalent separation rates were lower for Indigenous Australians than for non-Indigenous Australians where separations involved specialised psychiatric care (rate ratio of 0.3) and 3 times as high for separations without specialised psychiatric care. Separation rates for admitted patient mental health care for Indigenous Australians were more than twice those for non-Indigenous Australians (2 times as high with specialised psychiatric care and 3.3 times as high without).
The rate of available psychiatric beds in public psychiatric hospitals ranged from 10 per 100,000 in major cities to 1.3 per 100,000 in outer regional areas and none in remote and very remote areas. For mental health care provided in hospitals, the average length of stay was 11 days for Indigenous patients and 9 days for non-Indigenous Australians. In 2011–12, 4% of all emergency department presentations for Indigenous patients were mental health related, as were 3% for other patients (AIHW 2014t).Barriers to accessing mental health services include perceived potential for unwarranted intervention from government organisations, long wait times (more than one year), lack of inter-sectorial collaboration and the need for culturally competent approaches including in diagnosis (Williamson et al. 2010).
These findings suggest that Indigenous Australians are accessing primary care level mental health services more readily than specialist services, particularly in comparison to non-Indigenous Australians.
The National Mental Health Commission has reviewed all existing mental health services and programmes across government, non-government and private sectors, assessing whether services are effective, properly targeted, not being duplicated, and not being unnecessarily burdened by red tape. The Commission's final report (submitted 30 November 2014) will inform the government's future decisions on mental health. The Australian Government has in the meantime committed to:
- $18 million over four years for the Orygen Youth Health Research Centre to establish the National Centre of Excellence in Youth Mental Health
- $5 million over three years to the Young and Well Co-operative Research Centre to establish a comprehensive new youth e-mental health platform
- $22 million additional in 2014–15 to maintain Mental Health Nurse Incentive Programme services at current levels (165,000 sessions for people with severe and persistent mental illness)
- expanding headspace to 100 centres across Australia.
Work to renew the Aboriginal and Torres Strait Islander Social and Emotional Wellbeing Framework is also underway, more clearly acknowledging the importance of culture and identity to the health and wellbeing of Indigenous Australians.
Key issues to be considered in addressing gaps include ensuring services are well linked into primary health care, and that Indigenous Australians are able to access effective treatment through specialist psychiatrists and psychologists. Primary mental health care services are available through Access to Allied Psychological Services (ATAPS) and Mental Health Services in Rural and Remote Areas programmes. In 2013–14, 8% of ATAPS services (6,300 clients) were provided to Indigenous Australians (Department of Health unpublished).
In WA, access to mental health services is being addressed through the Statewide Specialist Aboriginal Mental Health Service and delivery of holistic model of care through service-level agreements, art therapy programs, enhancing mainstream mental health service, and partnerships with Aboriginal alcohol and drug services and Aboriginal health services to provide better interagency services. Cultural learning sessions have been provided to more than 400 health professionals and community members. Other mental health care and suicide prevention initiatives are detailed in measure 1.18 and Policies and Strategies section.
Figure 3.10-1 shows the age-standardised rate (per 1000 encounters) of mental health-related problems managed by GPs, among Aboriginal and Torres Strait Islander peoples and other Australians between April 2008–March 2009 and April 2012–March 2013. The figure shows that rates are higher for Aboriginal and Torres Strait Islander people than other Australians.
Source: Family Medicine Research Centre, University of Sydney analysis of BEACH data.
Figure 3.10-2 shows the age-standardised rate of community mental health care service contacts (per 1,000 population) among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians in 2012–13. The figure shows that rates for Aboriginal and Torres Strait Islander peoples are three times as high as for non-Indigenous Australians.
Source: AIHW analysis of National Community Mental Health Care Database
Figure 3.10-3 shows age-standardised hospitalisation rates for mental health-related conditions (rate per 1,000). Data are presented annually for Indigenous Australians in QLD, WA, SA and NT between 1998-99 and 2012–13; Indigenous Australians in NSW, Victoria, QLD, WA, SA and NT between 2004-05 and 2012–13; non-Indigenous Australians in QLD, WA, SA and NT between 1998-99 and 2012–13; and non-Indigenous Australians in NSW, Victoria, QLD, WA, SA and NT between 2004-05 and 2012–13. Rates for Indigenous Australians have increased over time, with an accelaration in the change in rate since 2009-10.
Source: AIHW analysis of National Hospital Morbidity Database
Figure 3.10-4 shows age-standardised hospitalisation rates (per 1,000 population) for mental health–related conditions among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians between July 2011 and June 2013. Data are presented separately for each jurisdiction and Australia overall. With the exception of Tasmania, rates are higher for Aboriginal and Torres Strait Islander people than for non-Indigenous Australians across jurisdictions.
Source: AIHW analysis of National Hospital Morbidity Database