How the mental health system is failing our young people

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Mental health issues are a difficult enough subject without our medical system making things even more complicated, writes Prashant Bhatia.

JULY'S INCIDENT in Ellenbrook, WA, involving the killing of a mother and her two children by her 19-year-old son with a history of mental illness, showed how people are falling through the gaps in our mental health system. Hours before the incident, the young man reported at a local hospital’s emergency department in a psychotic state. His condition was not diagnosed as a medical problem.

Since 2016, when the Government decided to scrap funding for the Early Psychosis Youth Services (EPYS) Program, conditions like psychosis have become too complicated for primary care and not serious enough for the state system.

Back then, Dr Patrick McGorry, the former Australian of the Year who helped establish the EPYS Program, warned the Government’s decision would almost certainly lead to lost lives. At higher risk were young people aged 12-25. He was right.

There is no doubt the existing system is plagued with unnecessary complexity. I suspect this leads to ineffective services. No amount of funding and awareness campaigns will help patients and their families if essential facilities, affordable access to a clinician and regular psychological support continue to remain unavailable.

It is important to establish that mental illnesses are not like other ailments. With no physical signs, it is difficult to spot their symptoms without timely specialist intervention. What might easily be mistaken as a bad mood or anger issues could well be the early onset of depression and anxiety for instance. It can happen to anyone, irrespective of gender, age, occupation or ethnicity.

In fact, research has now emerged showing nearly half of all Australians aged 16-85 will experience a mental illness in their lifetime. Anxiety disorders are the leading cause of ill health among girls and women aged five to 44. Meanwhile, suicide and self-inflicted injuries arising from mental illnesses are the most common reasons for death in boys and young men.

This is yet another example of the failure of the existing mental health system.

Part of the reason it fails is its sheer complexity. Those who have been through it will vouch for how difficult it is to navigate. What has made things worse is the transition of certain mental health facilities to the National Disability Insurance Scheme (NDIS). This move was intended to consolidate existing services. Upon completion of the rollout, patients and providers would have four options available to them:

  • clinical mental health services (for severe assessment and treatment);
  • NDIS (for functional impairment);
  • primary health network (low intensity and complex care); or
  • GP (for psychological services).

If this sounds too good to be true, it is.

What we have today is a system so complicated, it is virtually impossible for a patient and their family to map out for which service they are eligible. Each of these four programs uses different inclusion criteria and language. Medical health professionals find it hard to fully understand the system — imagine what it would be like for someone experiencing poor mental health.

What adds to the complexity is the fragmentation of clinical and psychological support. Both are equally important parts of a treatment plan. Under the current system, they have been assigned to different programs, which means different funding options apply to them. Patients may be able to access a given number of psychological sessions per year (up to ten), which may be bulk-billed. But, they will have to incur a substantial out-of-pocket-fee for clinical support.

From a patient’s perspective, this level of uncertainty in getting medical support is unnecessary. Many end up waiting for long periods of time – up to a year – for proper care.

The system also does not account for episodic and changing needs of mental health patients. I have personally come across people whose anxiety symptoms worsened because they had to wait for long durations or constantly shift providers to address their changing symptoms. This inconsistency is not conducive to proper recovery.

It might be easy to blame medical practitioners, but they are challenged by the complex compliance requirements of different programs. In fact, many paramedics and first-responders have developed mental health issues owing to their stressful work conditions. A Senate Inquiry was launched last month into the nature and reasons of mental illnesses among them.

What is needed now is a comprehensive plan looking at mental health reform. Until now, policymakers and government entities have been cherry-picking parts of mental health policies. This needs to be replaced by a strategic task force involving all stakeholders at community, state and national level. We can no longer simply rely on creating awareness through community organisations.

There are no easy solutions, but the lives of young people are too valuable to not be working on the harder ones.

Prashant Bhatia is a Melbourne-based media professional and speaker for Beyondblue, a national not-for-profit working to reduce stigma around mental health conditions.

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