Spotlight falls on ‘forgotten people’ of mental health care

As GPs grapple with high mental health presentations, a series of devastating case studies in The Australian, alongside new research, have highlighted stark systemic and financial gaps – particularly for those living with severe mental illness.
 
An Australian National University (ANU) policy report, due to be published this week, has quantified the funding shortfall for dealing with Australia’s burden of severe mental illness at more than $8 billion, The Australian reports.

The study, ‘Don’t Walk By: Unmet Need in Chronic Severe Mental Health Conditions’, also highlights increasing inequities in life expectancy for people with severe mental illness, who die on average 18 years before the rest of the population researchers found.
 
The situation is driven by the gaps in care, stark disparities in physical health as well as high suicide rates, as ‘huge numbers of patients are locked out of accessing psychiatry and primary care’.
 
Chair of RACGP Specific Interests Psychological Medicine Dr Cathy Andronis says she has been raising the alarm for years, warning that the burden of care for the most vulnerable patients with severe mental illness frequently falls on general practice.
 
‘GPs see the most disadvantaged and neglected patients who are forgotten by other services, especially state health services whose main contribution is to provide brief crisis care and discharge the patient as soon as possible,’ she told newsGP.
 
‘GPs are then left to try to manage these patients as best we can with limited resources including the absence of adequate team care despite the fact that they are severely mentally unwell, often with psychotic illnesses causing them to be isolated, disconnected from friends and family, and poorly motivated to seek help or to trust others.
 
‘These are the forgotten people that Australia has let down.’

For RACGP President Dr Michael Wright, the findings reflect the experience of many GPs.

Citing the RACGP’s 2024 Health of the Nation report in which 71% of GPs found psychological issues among the top reasons for presentations – up from 61% in 2017 – Dr Wright said there is an urgent need for reform.

‘We can’t address Australia's mental health crisis without adequate funding,’ he told newsGP.
 
The RACGP has long advocated for increased funding for longer Level C and Level D consultations to help GPs meet the demand for mental health presentations, as well as a 20% increase in Medicare rebates for GP mental health items.
 
‘We know that complexity is growing, but the current Medicare schedule acts as a disincentive for spending more time with patients,’ Dr Wright said.
 
‘GPs are ready and able to identify issues early and provide the support our patients need – but greater funding for those longer, more complex consultations is crucial so that we can spend the time with patients that they need and help reduce their rebates and the impact of this cost -of -living crisis.’

According to the Australian Institute of Health And Welfare (AIHW) mental illness and substance abuse is now ranked as causing the second-biggest burden of disease in Australia, with only cancer accounting for a larger impact.
 
The series in The Australian chronicles the experience of patients with severe mental health conditions and the struggle for appropriate care faced by them and their families.
 
One example describes the experience of one woman, whose parents are both medical doctors, who spent around 1000 days in public hospital psychiatric wards before her 18th birthday – and is now determined to prompt mental health reform.
 
Another tells the story of a young man whose mental health disorder, substance abuse and insecure housing were all factors in his death earlier this year – an outcome that eventuated despite the desperate interventions of his family.
 
The reporting highlights a lack of supported housing, shortages of mental health workers, and a shortfall of more than 10,000 psychiatric ward beds. It also shines a light on failures of the mental health system to co-ordinate with substance-abuse and housing services, as well as the complexities of the NDIS.
 
For Dr Andronis, the workings of the National Disability Insurance Scheme (NDIS) are a particular concern.
 
‘Unfortunately, government programs including the NDIS and numerous mental health initiatives have failed to address the complex needs of these patients,’ she said.
 
‘Even when GPs advocate and write reports for the NDIS they are often ignored and on occasions patients are given supports that are contraindicated for their condition.
 
‘The NDIS often bypasses the GP who may be the patient’s only advocate.  
 
‘And GPs are not paid adequately for all their work related to NDIS. This does not support quality care, especially of the most needy and vulnerable people. 
 
‘Our Medicare system does not support this quality care. Medicare does not support our efforts and so we suffer together alongside our patients.’
 
The ANU report – co-authored by former AMA Chair Professor Steve Robson and ANU psychiatrist  Associate Professor Jeffrey Looi –  will highlight a shortage of about $8 billion a year for healthcare, social services and housing for those with severe mental health illnesses.
 
The crisis has its roots in a failure to cover the gaps ‘left by the closure of asylums’, The Australian reports, with researchers saying there is ‘enormous potential’ for savings on ineffective care particularly if enough secure housing is provided.
 
According to the forthcoming report, the biggest workforce shortage is among psychiatrists, with GPs, psychologists, nurses, Aboriginal and Torres Strait Islander health workers, peer workers and occupational therapists also in short supply.
 
Around $1 billion a year would be needed to address those workforce gaps, it suggests.
 
For Dr Wright, general practice has a central role to play in solutions to the growing burden of mental illness, including as a cost-effective means of healthcare.

‘GPs often treat physical and mental health conditions, along with social and family issues all in the same appointment,’ he said.
 
‘This is highly efficient in treating these multiple conditions, and a great saving to our health system in terms of avoiding later health costs such as hospitalisations.’
 
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