Mental health

Inquiry report

Released 16 / 11 / 2020

The report discusses some key influences on people's mental health, examines the effect of mental health on people’s ability to participate and prosper in the community and workplace, and implications more generally for our economy and productivity.

It makes recommendations to the Australian and State and Territory Governments, to improve the mental health of people of all ages and cultural backgrounds, working with people who have experience of mental illness, and with their families and carers.

Recommended reforms extend across workplaces, schools and universities, the justice system, community groups and services for healthcare, psychosocial support, and housing.

The inquiry final report was handed to the Australian Government on 30 June 2020 and released publicly on 16 November 2020.

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Mental health - Inquiry report (PDF - 15 324 Kb)

Government responses

At a glance
Contents
Supporting data

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Key points

Australia’s mental health: we would all benefit from an improved mental health system

Mental ill-health affects all Australians either directly or indirectly. Almost one in five Australians has experienced mental illness in a given year. Many do not receive the treatment and support they need. As a result, too many people experience preventable physical and mental distress, disruptions in education and employment, relationship breakdown, stigma, and loss of life satisfaction and opportunities.
Reform of the mental health system would produce large benefits. These are mainly improvements in people’s quality of life — valued at up to $18 billion annually. There would be an additional annual benefit of up to $1.3 billion due to increased economic participation. About 90% of the benefits — about $17 billion — could be achieved by adopting identified priority reforms, requiring expenditure of up to $2.4 billion and generating savings of up to $1.2 billion per year.

To create a person centred mental health system, Australia needs reforms that…

Focus on prevention and early help: early in life and early in illness.

The mental health of children and families should be a priority, starting from help for new parents and continuing through a child’s life. Schools should have a clearly defined role in supporting the social and emotional wellbeing of students, with effective pathways to care.
Prevention and early intervention should continue through tertiary education and employment. Mentally healthy workplaces that focus on psychological safety as much as physical safety, and access to early treatment funded through workers compensation schemes, are part of our reforms.

Provide the right healthcare at the right time for those with mental illness.

People should have real choices in managing their own mental health and be empowered to choose the treatment and supports that are right for them.
Technology should play a larger role by improving assessment and referrals, and increasing access to, and the range of, treatments and supports. For people who choose face-to-face treatment and support, these should be affordable and in line with clinical evidence.
The cycling of people in and out of hospital at great personal cost and cost to taxpayers, should be addressed. Emergency departments – or alternatives – should be adapted to work for those experiencing mental illness, and hospital discharges into homelessness should be avoided.

Make sure effective services support recovery in community.

Community treatments and supports should be expanded for people who do not require hospital care but do require more care and support than provided by a GP. Seamless care between hospital and community services for people recovering from a suicide attempt should be a priority, as should reducing the life expectancy gap for people with severe mental and physical illness. And the consideration and involvement of families, kinship groups and carers, wherever possible, would be expected of providers to improve outcomes.
Housing, employment services and services that help a person engage with and integrate back into the community, can be as, or more, important than healthcare in supporting a person’s recovery. Clinical and community services should be coordinated to create a system of care that promotes recovery, with care coordinators to help people with complex needs.

Provide seamless care, regardless of the level of government providing the funding or service.

The ‘back office’ to our mental healthcare system needs redesigning with local planning to meet local needs. Providers and governments should be held to account through the transparent monitoring, reporting and evaluation of what works, with meaningful input from those with lived experience of mental illness, and their carers.

Fact sheet: Consumers and carers

Fact sheet: Consumers and carers (PDF - 534 Kb)

Mental ill-health affects all Australians, either directly or indirectly through our families, colleagues or friends. But our current mental health services and supports have not kept pace with demand for services. The Productivity Commission’s Mental Health Inquiry has provided the Australian Government with a series of recommendations to create a mental health system that:

places people at the centre of the design and delivery of all community and clinical mental health support services
adopts a whole-of-life approach based on early intervention and prevention that empowers consumers and their families and carers, and supports them to maintain their health and recover within their community
improves access to the right services at the right time — local-level planning for what services are required, better use of technology, and strategies to grow the workforce are key factors in improving access for people, especially in regional and remote Australia
recognises that the value of a service is the value of the outcome to the person using the service, and ensures that services are monitored and evaluated on the basis of these consumer-centred outcomes.

Australia needs a mental health system that places people at its centre. In a person-centred system, people would be empowered to choose the services that are right for them across a full spectrum of clinical and non-clinical needs. (volume 2, p. 163)

Building a person-centred mental health system

We recommend a number of changes to shift the focus of our mental health services and supports so that they become centred around the needs, preferences and aspirations of people.

Key recommended actions include:

Reducing the gap between the low-intensity healthcare services that are needed by individuals, and what is currently available:
- Consistent assessment and referral processes that are based on robust clinical evidence and are accessible either through a GP or directly by individuals (action 10.4).
- Increased access to online treatment that is supported by clinicians, and to group therapy and telehealth, where these are preferred by the consumer (action 11.1).
Reducing the ‘missing middle’ gap between mental healthcare services needed by people with moderate to high needs, and what is currently available:
- Evaluating MBS-rebated psychological therapy (the ‘Better Access’ program) to assess its effectiveness as a program and to trial an increase in the number of sessions available (action 12.3).
- Providing a formal coordination service to link up care services for people with severe and complex mental illness (action 15.4), and implementing single care plans for people with moderate to severe mental illness who receive services from multiple providers (action 15.3).
- Publishing information about the shortfall in funding for non-hospital mental healthcare services, and increasing the funding over time to meet this shortfall and expand access to services in the community (action 12.4).
- Governments providing more alternatives to emergency care for people with mental illness, including peer- and clinician- led after hours services and mobile crisis services (action 13.1).
Making sure that support services within local communities are available for the people who need them:
- Governments to commit to not discharging people from care (including from hospitals and correctional facilities) into a situation of homelessness (action 20.2).
- Psychosocial support services help people live within their communities — publishing information about the regional funding shortfall for psychosocial supports, and increasing the amount of funding over time to meet this shortfall to make sure that people who need these supports can receive them (action 17.3).
- Providing legal representation for people who are facing mental health tribunals (action 21.8).
Providing more consideration, inclusion and support for families and carers within specialist mental healthcare services and support services at a regional level (actions 18.1 and 18.3).
Making sure that people have access to timely and effective aftercare following a suicide attempt (action 9.1).
Implementing a national long-term stigma reduction strategy (action 8.1) that focuses on the experiences of people with those mental illnesses that are poorly understood by the wider community.
Increasing consumer, family and carer participation and advocacy in all aspects of the mental health system.

Mental health is important to everyone. Although it means different things to different people at different points in their life, the capacity to enjoy life, cope with and be resilient in response to stress, set and fulfil goals, and build and maintain relationships are key aspects of being mentally healthy and participating in the community. (volume 2, p. 88)

Fact sheet: Children and young people

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Fact sheet: Children and young people (PDF - 544 Kb)

Mental health underpins children’s and young people’s social and emotional development and their sense of wellbeing. Investing in the mental health of children and young people delivers significant returns, for them, their family and the community.

The Productivity Commission’s Mental Health Inquiry presents a long-term plan for a person-centred mental health system that prioritises prevention and early intervention. This includes a number of recommended actions to improve the social and emotional wellbeing of children and young people. At present, young Australians at risk of mental ill-health and their families often face many difficulties accessing the support they need.

We make a number of recommendations to better support the social and emotional wellbeing of children in schools and early childhood education and care by improving early identification of risk factors, and making the education system more effective in supporting their wellbeing. For those children and their families who need additional care, we are recommending changes to the mental health system to make sure that there are better links between services and that the right services are available at the right time, regardless of how people enter the system.

New parents

The mental health of parents affects the social and emotional wellbeing of their children. To help both parents and their children, governments should improve screening for mental ill-health among new parents, including improving the collection of data and monitoring of screening rates (action 5.1). Parents requiring support would also benefit from other recommendations made in the report (see ‘Consumers and carers fact sheet’ for more information).

Early childhood

Additional funding should be provided to help early childhood education and care services to support children’s social and emotional development. Voluntary early childhood checks should be expanded to make sure that children’s social and emotional development is assessed before they enter pre-school (action 5.2).

School-age children

To monitor how schools are supporting students of all ages over time, all schools should measure student wellbeing. This includes:

specific targets and nationally consistent measures of student wellbeing (action 5.3).
national guidelines for social and emotional learning programs delivered in schools (action 5.5).
schools being required to report on their progress against wellbeing outcomes, with school principals being accountable for these outcomes. Schools should be able to apply for dedicated funding to strengthen their wellbeing policies (action 5.6).

Teachers should be supported to improve the social and emotional wellbeing of children. Initial teacher education and professional development programs should be accredited using nationally consistent guidelines (action 5.3), and ongoing learning about child social and emotional development and wellbeing should form part of the ongoing professional development requirements for all teachers (action 5.4).

The National School Reform Agreement, which sets out governments’ expectations for the education system, funding structures, and reporting requirements, should be updated to include student wellbeing as one of its outcomes. This would place wellbeing on an even footing with academic progress and student engagement as an important goal that schools across all sectors of the education system must work towards, and report on their progress. (volume 1, p. 19)

Young adults and tertiary students

People with mental illness who are disengaged from education and work should have increased access to Individual Placement and Support services to help them work in regular jobs, supporting their recovery (action 19.4).

Institutional support for tertiary students with mental ill-health needs improvement:

Tertiary education institutions should be required to have a student mental health and wellbeing strategy — including staff training — as a condition for their registration (action 6.3).
Online services for student mental health should be expanded to meet student needs (action 6.1).
Institutions should arrange for international students to have health insurance that covers any required mental health treatment (action 6.2).

Fact sheet: Aboriginal and Torres Strait Islander people

Fact sheet: Aboriginal and Torres Strait Islander people (PDF - 668 Kb)

The Productivity Commission’s Mental Health Inquiry Report presents a long-term plan to improve mental health services in Australia. While this is a responsibility for all, key to this is the role and leadership of Aboriginal and Torres Strait Islander people within mental health policy and services, to support people in positively shaping and controlling their futures.

What does this mean for Aboriginal and Torres Strait Islander people?

We make a number of recommendations to the Australian Government that focus our mental health system on the needs, preferences and aspirations of the people who rely on its supports and services. Several of the recommended actions relate specifically to empowering Aboriginal and Torres Strait Islander people to make decisions about their social and emotional wellbeing:

Designating Indigenous-controlled organisations as preferred providers of mental health services for Aboriginal and Torres Strait Islander people (action 23.6).
Empowering Aboriginal and Torres Strait Islander communities to prevent suicide though self-determination and local leadership by:
- implementing a renewed Indigenous-led National Aboriginal and Torres Strait Islander Suicide Prevention Strategy and Implementation Plan to guide suicide prevention in Indigenous communities (action 9.2)
- ensuring Indigenous organisations are the preferred providers of suicide prevention activities for Aboriginal and Torres Strait Islander people (action 9.2)
- providing culturally capable aftercare to anyone who presents to a hospital, GP or community mental health service following a suicide attempt (action 9.1).
Undertaking an evaluation of programs that use traditional healers in partnership with conventional mental health services (action 8.3).
Expediting and resourcing the development of an implementation plan for the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017–2023. Development of this plan should be led by Gayaa Dhuwi (Proud Spirit) Australia (action 22.2).
Engaging Aboriginal and Torres Strait Islander people should be engaged in discussions to develop any targets for key mental health and suicide prevention outcomes that may affect Aboriginal and Torres Strait Islander people (action 24.4), including targets to reduce the gap in life expectancy between people with severe mental illness and the general population (action 14.1).

Services that are culturally capable

We also recognise that mainstream services — within and beyond the healthcare system — need to be able to provide support that better meets the needs of Aboriginal and Torres Strait Islander people. This includes:

aligning the cultural capability of mental health practitioners with the needs of individuals through the National Mental Health Workforce Strategy (action 16.1)
making sure that all people with mental illness who leave hospitals, correctional facilities or institutional care have access to short-term housing when they need it (action 20.2)
additional support for police responding to mental-health incidents should be tailored to meet the needs of Aboriginal and Torres Strait Islander people (action 21.2)
making sure that services within correctional facilities and post-release care are culturally capable (actions 21.4 and 21.6).

Making our mental health system focus on the people who need it

These recommendations are part of a broader plan to make our mental health services and supports more responsive to the needs of all people who need care and assistance. We have provided the Australian Government with 22 recommendations, including around 100 actions, across a wide range of mental health services and supports. Our goal is to create a mental health system that:

adopts a whole-of-life approach based on early intervention and prevention that empowers individuals and their families, kinship groups, and carers, and supports them to maintain their health and recover within their community
places people at the centre of the design and delivery of all clinical and community-based mental health support services
improves access to the right services at the right time — local service planning, better use of technology, and strategies to grow the workforce are key to improving access for people, especially those in regional and remote Australia
recognises that the value of a service is the value of the outcome to the person who receives the service, and makes sure that services are monitored and evaluated on the basis of these outcomes.

Fact sheet: Health professionals

Photo of health professional comforting a patient

Fact sheet: Health professionals (PDF - 546 Kb)

The Productivity Commission’s Mental Health Inquiry presents a long-term plan for the sustainable reform of Australia’s mental health system. The report contains 22 recommended reforms encompassing around 100 actions, across a wide range of mental health services and supports.

We have made a number of recommendations to make sure that health professionals are equipped to meet the mental health needs of people in urban, regional and remote locations who rely on them — now and into the future.

Low intensity care

A national digital mental health platform should be developed to assist GPs with mental health assessment and referrals, to allow people to access clinician-supported online treatment and to replace Mental Health Treatment Plans. The platform should be co-designed with consumers and clinicians, and should be developed and maintained by the Australian Government (action 10.4).

GPs should be encouraged to refer patients to a greater range of low-intensity care options, with recommended increases in the provision of supported online treatments (action 11.1) and adjustments made to Medicare to encourage the provision and uptake of group therapies (action 12.1).

Linking individuals and services

We recommend that single care plans be developed for use by GPs with consumers with moderate to severe mental illness who receive services from multiple providers (action 15.3).

Formal care coordination services should be used to link up care services for people with severe and persistent mental illness (action 15.4).

Mental health workforce

Maintaining a well-trained and responsive workforce that embraces evidence-based approaches is crucial to building a mental health system centred around the needs, preferences and aspirations of the people who rely on its supports and services.

The Australian Government should use the forthcoming National Mental Health Workforce Strategy to align the skills, costs, availability and location of mental health practitioners with the needs of all consumers, including those in regional and remote areas (action 16.1).

Medical training and continuing professional development requirements for GPs should incorporate person‑centred approaches that emphasise the importance of personal recovery (that is, going beyond just clinical recovery) (action 16.3).

To support an increase in the number of mental health nurses, the Australian Government should support the development and implementation of a new curriculum for a three-year direct-entry undergraduate degree in mental health nursing (action 16.4).

Changes to Medicare

Recent changes made by the Australian Government that broaden access to psychological care delivered by telehealth (video or phone call) should be made permanent (action 12.2).

Evaluation of current MBS-rebated therapies would enable evidence-based improvements in psychological care. Complementing such an evaluation, the extension of MBS-rebated Better Access sessions from 10 to up to 20 per year should be trialled for those people assessed as likely to require additional therapy (action 12.3).

New Medicare items should be introduced to allow GPs and paediatricians — including from regional and remote areas — to access advice from psychiatrists to assist with the provision of healthcare (action 10.3) and to enable ready inclusion and consultation of families and carers by psychologists and other allied mental health professionals (action 18.1).

Helping people make informed decisions about their care

The ability of individuals to make informed decisions would be supported by requiring all mental health referrals to include a statement about people’s ability to choose their care provider and by including on prescriptions a reminder that clinicians should have discussed with the individual the possible side-effects of medication, and proposed evidence-based alternatives where available (actions 10.1 and 10.2).

Emergency and aftercare

Governments should provide more alternatives to emergency care for people with mental illness, including peer- and clinician- led after hours services and mobile crisis services (action 13.1).

We recommend that all people who present to a hospital, GP or community mental health service following a suicide attempt should be provided with access to timely, effective and culturally capable aftercare (action 9.1).

Comorbidities

Governments should set a target to reduce the life expectancy gap between people with severe mental illness and the general population, and develop a clear implementation plan with annual reporting against this target (action 14.1).

Fact sheet: Culturally and linguistically diverse people

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Fact sheet: Culturally and linguistically diverse people (PDF - 753 Kb)

With almost half of all Australians either born overseas or having a parent who was born overseas, an effective mental health system must be able provide care to people that is appropriate to their cultural background and the language that they speak.

The Productivity Commission’s Mental Health Inquiry presents a long-term plan to improve Australia’s mental health system, and make sure that it can meet the needs of people from a range of cultural and linguistic backgrounds.

For this to happen, the cultural responsiveness and inclusiveness of services need to be prioritised — there is substantial room for improvement. We have provided the Australian Government with a number of recommendations to develop mental health services that meet people’s needs, regardless of their cultural background.

People needing mental health support, and their families and carers, need to be able to access information that is culturally relevant and presented in their own language. The recommended national digital mental health platform includes a tool for mental health assessment and referral (action 10.4). This platform should be designed with input from people who use mental health services and should be tailored to make it an effective gateway into mental healthcare for people from different cultural backgrounds.
It is also recommended that the Carer Gateway be evaluated to make sure that it works for carers from different cultural backgrounds (action 18.2).
The national digital mental health platform should be used to provide supported online treatment (action 11.1). This would benefit people in regional and remote Australia, as well as people in urban areas who have difficulty accessing culturally capable care, and those who may prefer to seek care anonymously. Online supported treatments should be adapted to meet the cultural and linguistic needs of consumers.
Recommended expanded access to treatments via phone or video will allow people to link up with a psychologist or care provider located anywhere in Australia who suits their needs, increasing the care options available (action 12.2).
Significant changes are recommended to the planning, funding and delivery of community mental health services. Community organisations are crucial to the social participation and inclusion of migrants. Better service planning would lead to more culturally-relevant psychosocial services, and longer contract lengths would enable providers to develop and maintain stable, trusting and therapeutic relationships with consumers (actions 17.1 and 17.3).
The cultural capability of mental health professionals is a key element needed to address cultural and health literacy barriers. Recommended reforms to workforce planning would better align the cultural capabilities of mental health practitioners with the needs of consumers (action 16.1). Greater use of bilingual and bicultural peer workers can also help overcome these barriers, and the Productivity Commission makes recommendations intended to support peer workers as a growing part of the mental health workforce (action 16.5).
All mental health service providers should be aware of people’s cultural context and needs. There are data gaps related to mental health services and outcomes for culturally and linguistically diverse people. More effective collection and use of data as well as co-design practices by policymakers would encourage more person-centred care (actions 22.4 and 24.3).
For some people who face barriers to accessing early support, their first contact with services is with police. The recommended additional supports for police responding to mental-health incidents should be tailored to meet the needs of culturally and linguistically diverse people (action 21.2).
To reduce psychological distress among international students, tertiary education providers should make arrangements with insurers providing Overseas Student Health Cover to their international students to ensure there is adequate coverage for any required mental health treatment. Universities should also ensure their counselling services are able to meet the language and cultural diversity needs of their international students (action 6.2).

Consistent with a person-centred approach, we want a mental healthcare system that allows people to choose and access care options that are right for them, given their needs and circumstances. This means that there needs to be a range of different ways that services are delivered, to be accessible as and when people need them, that are not just clinically effective and culturally relevant, but impose minimum burden on the individual seeking care. People are more likely to choose, persist with, and benefit from, treatment that matches their needs (volume 1, p. 29)

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