Abstract
SANE Australia recently attracted broad media attention and comment in Federal Parliament with the release of two major research reports on the cost of schizophrenia, and on the state of mental health services in Australia.
‘Address mental illness or pay a heavy price, says study’ says The Sydney Morning Herald, and ‘Mental health bill to hit $1b’, from The Canberra Times, were typical of the media response to the first report, Schizophrenia: Costs, launched on August 5. The second report, the SANE Mental Health Report launched two weeks later, prompted The West Australian to print ‘Mental services under fire’ while The Mercury said, ‘Care for mentally ill lashed’.
The reports revealed a mental health system in disarray right around the country and largely operating in crisis mode. Untreated mental illness was identified as a leading contributor to Australia's suicide rate. Among people with schizophrenia, suicide is a prominent cause of premature death and the rate has risen dramatically over the past years. In the coming decade, the direct health costs alone of schizophrenia may needlessly spiral to $1 billion per annum unless governments act to improve services.
According to SANE, Australia's mentally ill are missing out on proven treatments and there is an urgent need for action to match funding with comparable countries such as Canada, the United Kingdom and New Zealand. The acclaimed National Mental Health Strategy and the excellent work that is being done in some areas are being seriously undermined by the funding shortage.
The first report, commissioned by SANE from Access Economics, looked at the human and economic costs of schizophrenia. The study used a number of data sources including the Low Prevalence Disorders Study, part of the 1997 National Survey of Mental Health and Wellbeing, the Australian Bureau of Statistics National Health Survey 1995 data for psychoses and the Australian Institute of Health and Welfare.
It found that the direct and indirect costs of schizophrenia and associated suicide are enormous. The real financial costs of illness totalled $1.85 billion in 2001 (about 0.3% of GDP), and nearly $50 000 on average for each of the 37,000 Australians with the illness. Direct health system costs such as hospitals and community mental health services were $661 million, indirect costs such as lost earnings, carer costs and premature death were $772 million and transfer costs such as lost tax and welfare payments were $464 million.
The enormous cost was directly linked to the growing number of people with schizophrenia who are not getting effective treatment and care. Over one third of the cost was ‘carried’ by people with the illness and their carers.
More than 22,000 years of healthy Australian life were lost to the illness in 2001, including 3,323 years lost due to suicide and self-inflicted injury. The burden of disease was borne by males (55 per cent) and by young people aged 15–34 (74 per cent).
The report highlighted the alarming 400 per cent increase in suicide among people with schizophrenia over the past 40 years showing that they are 12 times more likely to die by suicide than the general population. Suicide was the major cause of premature death among the group.
People unable to work due to schizophrenia lost $488 million in earnings during 2001, with a further $88 million in carers costs. The direct health system costs in the same year, of $661 million, were six times the spending on the average Australian's health care.
In a comparative analysis with other illnesses, the report found that the pain, suffering, disability and death associated with schizophrenia was greater than ovarian cancer, rheumatoid arthritis or HIV/AIDS, and similar to melanoma and leukemia.
In SANE's media release, Executive Director of SANE Australia, Barbara Hocking, said: ‘The report highlights a dangerous void in the treatment of people with a mental illness. Currently, we have a situation where one third of all people with schizophrenia still receive older medications, with distressing and disabling side effects. Nearly two-thirds do not receive any psychological treatment and fewer than one-in-five attend rehabilitation programs.’
Of the 200,000 Australians who will be affected by schizophrenia, more than 40 per cent will attempt suicide at least once and 70 per cent will think about ending their lives on a regular basis.
‘Helping to reduce the suicide rate amongst people with schizophrenia, as well as the profound suffering and costly disability, requires a combination of early diagnosis with ongoing treatment and support in the community,’ said Professor Carr, Professor of Psychiatry of the University of Newcastle and a major contributor to the report.
‘This is particularly important following discharge from psychiatric care as the risk of suicide is especially high at that time,’ he said.
Launching the report, SANE called on governments to ensure access to intervention, support and treatment programs or risk a rise in direct costs estimated to top $1 billion (currently $661 million) in the coming decade.
The SANE Mental Health Report 2002–03
In mid-August 2002, SANE also released a major report, which concludes that the mental health system has not met the promise of the National Mental Health Strategy – nor does funding match that of comparable countries.
The SANE Mental Health Report 2002–03, is based on a research study of what thousands of Australian think about the mental health services they receive. This involved almost 200 interviews, analysis of 6,000 calls to the SANE Helpline and data supplied by the World Health Organization (WHO), Commonwealth and State governments, and Access Economics.
The Report examined how the National Mental Health Strategy has performed against the four fundamentals of the SANE Charter: access to effective treatments, support in the community, help for carers and action to end stigma.
Australia spends only 6.5 per cent of its annual health budget on mental health – almost half the amount of comparable countries such as Canada and New Zealand, which spend 11 per cent and the United Kingdom, which spends 10 per cent.
The major findings of the report are:
mental health services are crisis-driven, throughout the country
proven effective treatments such as CBT (cognitive behaviour therapy) and family group education and training, are not routinely available under Medicare
mental illness that was left untreated was a leading contributor to Australia's suicide rate
the cost of schizophrenia alone will increase dramatically this decade unless governments act to improve services
The current Mental Health Plan is faltering, and there is an urgent need for action to maintain the impetus of the National Mental health Strategy.
Recommendations are for a third National Mental Health Plan that gets ‘back to basics’ by focusing on core clinical and community support services and effective treatments that are currently unavailable. The Plan should look to the Victorian model as a valuable framework to be adapted to suit other States and Territories. The Strategy should include a commitment to increase the mental health proportion of the Australian health budget and bring it in line with comparable countries.
The report also gives a ‘snapshot’ of each State and Territory, noting good and bad news in each and makes recommendations for action.
Commenting at the launch of the report Barbara Hocking, said: ‘The best mental health plan in the world will not work without the necessary funding. Australia only spends the same proportion of its health budget on mental health services as The Republic of Moldova. This urgently needs to be lifted to the same level as countries such as Canada and the United Kingdom.
‘Although Australia boasts some of the best mental health programs in the world, they are – sadly – isolated exceptions rather than the rule.
‘SANE calls on the Federal Health Minister and her state colleagues to show leadership, compassion and boldness by doubling the mental health budget in a new strategy,’ she said.
The media coverage of both reports has helped put mental illness on the public agenda 10 years after the Burdekin report and the introduction of the National Mental Health Strategy. Launching the reports closely together helped to build up much needed momentum and has stimulated long term media interest in the issues.
Both reports are available from the SANE website – www.sane.org — in pdf format.