The recent budget has underlined the fact that mental ill-health is the major health issue facing Australians in the early part of the 21st century. Responding to the reality that Australians now regard mental health among the top three national concerns, just behind the economy and climate change, all sides of politics now support substantial growth in investment in mental health care.

The government allocated $2.2 billion as a decent down payment in a tight budget on mental health reform, crucially beginning to build strength in early intervention models for young people, who bear the main burden of onset for the major mental disorders of adult life. Yet even this investment will merely lift the proportion of the total health budget from 7 percent to closer to 8 percent. Most European nations and New Zealand spend 12 to 14 percent. The burden of disease across the lifespan linked to mental illness is indeed 14 percent, number three behind cancer (19 percent) and cardiovascular disease (16 percent). Yet in contrast to serious physical illness, mental ill-health strikes in young people on the threshold of productive life where it contributes not 14 percent but more than 50 percent of the burden of disease.

As the World Bank has said, if a 22-year-old dies from suicide or becomes disabled by depression or psychosis, it is not only a human tragedy but an economic disaster which, when repeated in hundreds of thousands of young Australians, seriously weakens our whole society. Even up to 44 years of age, 36 percent of the burden of disease is caused by mental ill-health and suicide is the leading cause of death in this age group. The reality is that depression, which occurs from puberty through to the mid-20s, remains front and centre in the current surge of mental ill-health.

Most people who experience mental ill-health during this stage of life (26 percent in any given year) receive little or no help. This is partly because it has been assumed that because mental ill–health and distress is common in young people that it is “normal” and acceptable. Poor awareness of the pattern of mental ill-health across the lifespan; plus a fear of “labelling” has meant young people and families have been abandoned to struggle for long periods with disabling and tenacious distress and social and educational impairment.

A recent New Zealand study has shown between 18 and 24 years of age that 50 percent of young people will manifest diagnosable mental disorders, over half the time repeated episodes, which, far from being trivial or “normal”, will significantly affect their social and economic well-being at age 30. Most people who do eventually receive treatment for depression in later life will have suffered with it for many years, having first experienced their first episode in emerging adulthood. Depression and mental ill-health blights lives.

This is why the government’s investment in building the missing element in our system of health care, a youth mental health model, is so welcome. So is the commitment to salvaging people later in life who have been let down in the past and have become marginalised and excluded. Society needs to create and refine new interventions for depression and clarify the timing and sequence of existing treatments. This is particularly so for young people where these issues have become confused in recent times, with the result that doctors are confused about the evidence, which is incomplete. There are exciting opportunities to design and test novel therapies of all kinds in this space.

Australia has been highly innovative in mental health care and, as these reforms scale up, is well positioned internationally to lead and catalyse further growth in knowledge and health gain which will influence the rest of the world.

Robbie Macleod – Senior Consultant

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