A better deal for mental health

This honour brings with it a huge responsibility. The mental health field is only just emerging from the shadows. I believe these are the shadows from the mountains of stigma that we have overcome and we are heading into the light. Yet people with mental ill-health all around the nation are experiencing a very raw deal in our lop-sided health system. I intend to work this year with the constructive forces who will drive transformational change. The large diaspora of people with mental ill-health throughout the Australian community, up to 30 per cent past or present, are awakening. I will be focusing strongly on them during the course of this year.

Ninety per cent of people with physical illness gain ready access to quality care, while only 35 per cent of those with poor mental health obtain access, typically to care of variable quality. This figure drops as low as 15 per cent for young men and people in rural and remote areas, especially indigenous people. Yet we now have compelling evidence showing that early intervention for young people is highly cost-effective, costing a third as much as standard late intervention. Mental ill health is the major health problem contributing to 60 per cent of the disease burden in emerging adults. Yet until Orygen and headspace we have lacked a system of care to respond. As the Prime Minister has recently emphasised, Australia must increase its productivity as a nation if it is to care for the ageing baby boomers and maintain living standards. We cannot afford to allow another generation of young people to end up on the scrap heap through untreated or poorly treated mental illness.

What is the solution? We need transformational change. We need to create a system of care which privileges early diagnosis and quality care in just the same way that we see in cancer, cardiovascular medicine and diabetes. This means a major investment in children and young people, with a strong system of youth mental health care. Yet our current mental health system is little more than a combination of acute risk management and palliative care, marooned within a beleaguered acute health system and poorly linked to primary care. Our politicians and senior bureaucrats, and ultimately the community, have been let down by internal professional advisers who have set expectations far too low, in true “Yes Minister” style. We have seen our much vaunted National Mental Health Policies become increasingly dilute and diffuse since version 1, with little respect for the latest evidence. We can tell a much more confident story of the huge benefits of investing in evidence-based care. For example, according to Access Economics, the cost-effectiveness of youth mental health care, already high, will improve by a factor of 10 if we extend the coverage to all young people who need intervention.

Despite the best endeavours of State governments, notably Victoria and the ACT, I am increasingly pessimistic that this problem can be solved at a State level. Victoria has recently produced a visionary 10-year reform framework which outlines a pathway for the whole nation. However will the State be able to devote the resources needed to translate this vision into reality? I estimate we would need to at least double in real terms the share of the State health budget devoted to mental health. Incidentally this would finally bring it into line with the proportion of the burden of disease which is caused by mental ill health. At last, a fair deal for the mentally ill. We also need a fair deal on research funding and this goes way beyond the “futures market” of neuroscience, which has been equated by some to “mental health”. While we of course need to continue to invest in this future, neuroscience is one small part of mental health research. Clinical and translational research is seriously underfunded (not only in mental health) yet it has the most immediate pay-off in health gain for the society. We may need to look at the National Institute of Mental Health model to overcome this barrier. In Victorian mental health we need to invest in “mother ships” similar to the comprehensive cancer centre model where specialist clinical care of the highest quality is embedded with large clinical research facilities. This is occurring in other States and internationally and we must maintain and grow our competitive edge as we grow new professional fields and bodies of knowledge.

The obvious and topical alternative would be for the Federal government to assume responsibility for the mental health system. Either as a Repatriation-style parallel system of hospital and community care or at the very least for the various elements of community mental health care. It needs rescuing and expansion. As the Victorian Reform Plan proposes, the mental health system should move to a system of governance independent of both acute health and from primary care. My experience with the highly successful headspace model has helped me to see how this could be achieved. It is even more important in those States with an even less well-developed system of mental health care.

Australia is the home of innovation in mental health care but typically drops the ball while other countries benefit from our R & D. Yet I do sense we are at a tipping point with the health care reform process delicately poised and a successful national prototype for youth mental health care, namely headspace, up and running in all States and Territories. Can we achieve widespread transformational change to move Australia to a much better level of mental health? 2010 is shaping as a watershed year.

My selection as the 2010 Australian of the Year is a huge honour but it reflects a positive climate change in Australia over the past decade in mental health. I am in this position thanks to the vision and determination of so many of my mentors, long-term colleagues, and the courage of all those who have fought for this neglected and hitherto stigmatised field of human endeavour – the true believers. It validates the vision of the Victorian Health Promotion Foundation, led by Sir Gustav Nossal and Rhonda Galbally, who gave us our first real research grants, the Colonial Foundation through its huge support of our shift to the full spectrum of mental ill health in young people, the University of Melbourne’s decision to establish a Chair in Youth Mental Health and the renewed support of Melbourne Health and the Department of Human Services for Orygen’s clinical program and our Statewide role. Early intervention and youth mental health remain a world first for Melbourne and Australia.

Professor Patrick McGorry, Victorian Australian of the Year 2010, is Executive Director of Orygen Youth Health (OYH), a world-renowned youth mental health organisation. He is also Professor of Youth Mental Health at the University of Melbourne, and Director of the National Youth Mental Health Foundation (headspace). OYH comprises Australia’s largest youth mental health research centre and a clinical service targeting the needs of young people with emerging serious mental illness, including first-episode psychosis. Professor McGorry and OYH have put Australia at the forefront of research and innovation in the prevention and treatment of mental illness. OYH has become the model upon which many other youth mental health services around the world are based. With an emphasis on early intervention and a commitment to educating the community to the early signs of mental illness, Professor McGorry’s extraordinary 27-year contribution has transformed the lives of tens of thousands of young people the world over.