Mentally ill patients not getting assistance as health ministers set to meet

A landmark health meeting will be presented with shocking figures on the number of people with severe psychiatric conditions who are receiving few or no services in the community.

Homeless sleep rough in an underground Hyde Park walkway in Sydney. Many homeless people are sufferers of severe mental illness but receive little support. Picture: Richard Dobson

A landmark health meeting will be presented with shocking figures on the number of people with severe psychiatric conditions who are receiving few or no services in the community, as ministers come together to formulate a national response to the nation’s growing mental health crisis.

The federal government has presented the states with a key commonwealth analysis of the number of people who are falling through the cracks of health and social service provision – which previous state analysis has indicated may be as many as three-quarters of those considered to be severely mentally ill.

Health and mental health ministers from all states will consider the data in a key meeting on Friday. Federal Health Minister Mark Butler has acknowledged the extent of the under-servicing of some of the nation’s most vulnerable citizens and is negotiating a national plan with the states to address the crisis, following decades of neglect of community healthcare.

“There is clearly a large number of Australians with very severe and ongoing mental illness who are not getting the supports that they need to manage their illness, as well as the support to participate in a meaningful way in their community,” Mr Butler said.

“That is a huge challenge. There’s been a pretty vigorous public debate about primary care level supports for people with more mild to moderate levels of mental distress, but the tragedy at Bondi Junction really did refocus a lot of attention on the adequacy of supports for people with far more severe and chronic mental illness.”

An Analysis of Unmet Need for Psychosocial Support – a report drafted by the specially formed Psychosocial Project Group led by the federal health department and including senior bureaucrats from most states – will be presented at Friday’s meeting. It reveals that the numbers of people falling through the cracks has exploded since the last estimate of the problem.

The extent of the numbers mean it may require close to $1bn a year to address.

The last time such unmet need was estimated nationally by the Productivity Commission five years ago, it was assessed there were at least 154,000 people with severe mental illness who were not receiving any community services or support and that $610m a year was required to meet the need.

“It’s clear to me this analysis is going to show a more significant gap that the Productivity Commission identified, probably by a fair margin,” Mr Butler said.

“I think we will find that the numbers are a fair way north of the last estimate.”

The health and mental health ministers’ meeting follows the publication of a major global report in the Lancet Psychiatry this week led by Melbourne psychiatrist Pat McGorry, which found the incidence of mental ill-health in young people in Australia, especially among teenage girls, has risen by 50 per cent in the past 15 years, with a particularly alarming rise since the Covid-19 pandemic.

Almost 50 per cent of girls and women aged between 16 and 24 now report experiencing a mental health disorder.

Youth mental health will be on the table at Friday’s meeting, which will also progress a nationally co-ordinated system of mental health orders.

Mental health groups have united to call for the national response to the crisis to extend further than just the care of people who are severely mentally ill but not on the NDIS. They want a national accord to co-fund a system of supports bridging primary and acute care, jointly funded and provided for in the National Health Reform Agreement.

The federal and state government moves to establish the beginnings of a functional national response to mental illness comes a decade after a federal system of psychosocial supports was first set up. The creation of the NDIS meant many of those programs nationally were rolled into the NDIS. But the people with severe mental illness who were not eligible for the NDIS were then left out in the cold.

The problem is clear on the streets of every city in the nation with rising homelessness plain to see. It has been a rising catastrophe ever since the mothballing of psychiatric institutions that once housed the severely mentally ill were mothballed and not replaced by a proper system of community supports.

“Making sense of these different systems is a challenge; it didn’t emerge this year, but over the 30-year journey of trying to build post-deinstitutionalisation supports,” Mr Butler said.

“I think it’s a truism to say that deinstitutionalisation, which was a really important reform, was not followed up by the level of community-based supports that that group in the community really required.”

The expansion of a national system of psychosocial reports comes amid a review of the NDIS and policy work to develop a national system of foundational supports for those living with mental illness.

Health and social care for people with mental illness is under severe pressure amid overloaded hospitals, private bed shutdowns, rising homelessness, a workforce crisis in psychiatry, and lack of community supports.

Nationwide, only about half of the severely mentally ill can access a psychiatrist.