Gary Humphries (ACT, Liberal Party) Share this | Hansard source

It gives me great pleasure today to be able to share in the task of putting this important report before the Senate. Hopefully it starts a debate in this place, in the broader community and in particular in the governments of Australia on solutions to what is an enormous problem facing our community. Mental illness is Australia’s great invisible epidemic. Of all of the diseases in our community, it exhibits the grossest mismatch between the cost of the disease, the disease burden, and the amount that is spent collectively by the community to address that cost.

In excess of about 60 per cent of mental illness goes undiagnosed and untreated. We would not accept that level of untreated illness in any other area of medical help. It is a disease which is little understood and, compared with other diseases, little talked about. If one’s Aunt May suffers from, say, cancer, we can be sure that she will be flooded with sympathetic cards, phone calls to inquire about her health, and other attentions. If our Aunt May suffers from bipolar disorder, the chances are that people will look the other way.

It is difficult to know exactly how much mental illness there is in the Australian community. We do not fully understand the physiology of mental illness: the causes and the pathway that those types of illnesses follow. Sadly, much mental illness eludes complete cure. One witness said that it is better to speak of recovery from mental illness rather than a cure. Of course, most profoundly, those who suffer from mental illness in Australia today do not talk about that illness in many situations for the very reasons that Senator Forshaw just alluded to. Indeed, in some cases it is difficult to define what mental illness is. Mental illnesses are juxtaposed to mental dysfunction, ranging from florid psychosis all the way through to eccentricity.

Much mental illness is internalised or privatised—that is, people suffer in silence because of the crushing weight of social stigma. But, conversely, when a person does not react in that way to their illness, there is a huge potential impact on the people around them—not just on their immediate family and friends but on the whole community. It is in this form that mental illness becomes in some ways the most socialised of illnesses, in that we all bear a cost for the failure to adequately address it. This point is made clear when we understand that many experience mental illness and self-medicate to deal with that reality. That is difficult to quantify because so much is unknown about the course of this illness, but a great deal of alcoholism and drug use, both licit and illicit, in the Australian community is attributable to the phenomenon of people self-medicating an undiagnosed or untreated mental illness. Of course, that phenomenon occasions an enormous cost on the Australian community.

For example, a death in a car accident caused by a person who is heavily alcoholic may not be put down to mental illness but, in fact, can be linked very clearly to that problem. It follows, of course, that to adequately deal with mental illness, to bring it under the umbrella of treatment and care, we need to engineer the reduction of stigma which inhibits so many people in this community from seeking treatment. We simply have to stop looking the other way when mental illness manifests itself in our community.

When Kylie Minogue announced some 12 months ago that she was suffering from breast cancer, there was a huge wave of public sympathy. I have to doubt whether that same kind of sympathy would have been exhibited had the announcement been that Kylie Minogue suffered from schizophrenia or bipolar disorder or manic depression.

The committee found that the failure to diagnose and treat mental illness early and effectively has huge downstream costs for the community. We talk a lot in this place about the benefits of early intervention, but it is here that we find the most powerful example of the costs that are occasioned to us all by the failure to deliver early intervention.

Typically, a person with mental illness will find themselves with enough insight to see that they are slipping into an episode of serious illness. They will seek help. Most commonly, that help will not be available. Their condition will deteriorate. They will either conduct themselves in a way that brings them to the attention of crisis services or end up in an accident and emergency department where, quite often, they will be turned away unless they are actually threatening harm to other people. Even the threat of self-harm does not constitute, in some cases, an adequate reason for being admitted to care in public hospitals in this country. By the time they are admitted, the level of illness is very serious and often necessitates very long bed stays. The medical costs to the community can be very significant, but the costs are even greater where an illness spirals into destructive behaviour which can ripple out into the rest of the community and is sometimes, in fact, no more than an appeal for help.

It is the committee’s clear view that we must establish an effective community based safety net designed and funded to give the mentally ill timely and effective treatment at an early stage of an illness. We suggest in our recommendations that that safety net should constitute a network of community based mental health centres employing a combination of general practitioners, psychiatrists, psychologists, psychiatric nurses and allied health professionals. Those services should focus on the high-prevalence low-acuity conditions which are largely overlooked in contemporary treatment arrangements, such as depression, which goes largely untreated. In case you think it is wasteful to focus major attention on illnesses such as depression which are widely experienced, bear in mind that depression generates the highest burden of disability of any disease in Australia today. More than 500,000 Australians each year are severely affected by depression. It has a massive impact on the quality of life of Australians.

Much mental illness must necessarily be treated with drugs, and indeed the Commonwealth government has dramatically increased spending on drugs to treat mental illness in recent years. Regrettably, the reliance on drugs does overshadow the fact that a great deal of good can be effected with respect to mental illness by the use of lower level therapies, or talking therapies, as they are often described. That is the kind of focus which we believe the mental health system needs to acquire in order to provide effective interventions.

In other words, we believe that the centre of gravity of our response to mental illness in Australia needs to come down from acute-care wards in hospitals, where people so often end up when they are severely ill. Instead, our response should be delivered in the community by those with a sympathetic approach to the problems that are experienced by the mentally ill, in a way which provides the best kind of care. Very often, a person with severe mental illness may need, most appropriately, a bed and compassionate assistance—someone to listen, someone to talk to, someone to keep them on a medication regime. That kind of intervention can so often be very effective and prevent a great deal of illness as well as reduce the cost to the rest of the community.

This report contributes to an important debate at an important time in the development of better services for the Australian community. It is very important too that this report is a unanimous report, as Senator Forshaw noted. It is an example, I think, of Senate committees working at their best. We have taken evidence throughout this country and we have heard many hitherto unheard stories—that was itself a very cathartic experience for many people. We have conducted an exhaustive exploration of this issue and we have produced some consensual bipartisan recommendations which we believe the Council of Australian Governments, most immediately, can readily look at, pick up and adopt as solutions to these problems.

I want to thank the other members of the committee for their contribution to the spirit of this inquiry. I want to thank the committee secretariat, who worked under exceptionally difficult conditions to produce a report in very short order. I strongly commend this report to the Senate and hope it will be the basis of much important and immediate action in the future.