TRANSCRIPT
A warning from one of Australia's leading psychiatrists.
"You'll see a whole generation of young people continue to be thrown on the social and economic scrapheap with ballooning welfare costs, underachievement of potential. You'd be losing a big chunk of that next generation to untreated or poorly treated mental health problems so it's not actually a tenable position to ignore it."
That's Professor Pat McGorry, Executive Director of youth mental health organisation Orygen.
This week, he's taken that message to Canberra, where he's attempting to secure policy commitments from across the political spectrum.
"I absolutely want to see the colour of the money if I can put it that way. I want to see public commitments and announcements in this election period once it really gets going. We're having very good discussions both with the government and the opposition and with the crossbench."
The renewed plea comes as the architecture of public mental health across the country crumbles under pressure.
With that, there are growing fears young people are being left behind.
"There's a big cohort of these nearly close to a million young people who need more specialised mental health care and the state systems are collapsing as we speak. New South Wales public mental health is falling apart. Victoria had a Royal Commission because it was so broken. The same pattern is true of every state and territory. The state governments are not going to be able to address this problem."
That criticism extends beyond emergency care.
National Youth Mental Health Foundation headspace is the subject of a new report from the Brain and Mind Centre at the University of Sydney.
It calls for a structural shake up, after finding young people with complex psychological needs are slipping through the cracks.
This is lead author Professor Ian Hickie.
"The public sector has retreated to the most severe and often older populations. Headspace is retreated or trying to retreat to younger but less severe populations. The people who need the most care, who are in the middle, the so-called missing middle, they're the ones turning up, they've got nowhere to go and nobody is responding to that."
headspace was established in 2007 when Australia committed to developing a national network of primary care-based mental health centres for young people experiencing psychological distress.
But, almost two decades on, demand looks very different.
Australian Bureau of Statistics figures show that as of 2020, 39 per cent of people aged 16 to 24 years had a 12-month mental disorder, up from 26 per cent in 2007.
CEO of headspace Jason Trethowan says those numbers can be attributed to an emphasis on early intervention.
"We're really proud of so many young people who are reaching out for help and support – not always for mental health challenges but sometimes for general and physical health issues, sexual health – but a lot of it is around mental health. They're reaching out in large numbers. What we're seeing now is obviously post-COVID, we're seeing a real uptick in the number of young people with more higher needs. We're working well with them but like all parts of the mental health system, we're certainly trying and doing our best with the resources that we have."
With increased demand comes increased strain.
The Brain and Mind Centre report finds that of all episodes of care provided through headspace, around one-third recieved just a single occasion of service.
What's more, only around one-third of clients improved after receiving care, and two-thirds either remained the same or deteriorated.
The report says that's consistent with a strategy to expand access – which in turn means resources are more thinly distributed.
As a result, Professor Hickie says headspace has become a victim of its own success.
"There's an idea that young people are coming along and I think increasingly marketed with fairly minor problems. Concerns that are generally broadly social but not major mental health problems. Our work indicates that's not true. What's happened is headspace's has capacity to respond to that as more and more people are coming in. headspace has lost about 50 per cent of its clinical staff in the last five years. It's got fewer and fewer trained mental health professionals to respond to those needs. And in fact, endlessly reporting, it's sending people away with more significant needs in the belief that they can get care elsewhere. They can't."
Mr Trethowan says headspace needs more support in order to attract and retain clinical staff.
"We are looking to see if we can have headspace, particularly in large metropolitan areas and regional areas to have parity, if you like, with the Medicare mental health centers, which are funded basically three times the amount of money than what a headspace center is. We think given the need to support young people at that earlier stage 12 to 25, we think, and we know that if we were better resourced, we would be able to attract and then retain valuable clinicians and other staff that work within headspace."
That, he says, will better equip headspace to address the missing middle.
"We are talking with government in relation to the need to step up more support for young people who are presenting with more complex needs. So we've certainly got an accessible, very youth friendly offering for young people to reach out via e-headspace or through our 169 services across the country. But absolutely, we know that there is an increasing gap between what we would call primary care and more tertiary services. But yeah, more needs to be done, and that's obviously really important for us to keep representing the needs of young people."
Professor Hickie says the solution is bigger than increasing funding.
He's calling for a structural reform of headspace clinics on a national level, to achieve more personalised and effective care.
"It's a very effective front door, but it has to be much, much more than an effective front door. It has to be a really functional part of that system. And a lot of those services and additions won't be provided by headspace or headspace alone. So simply pumping more money into headspace itself won't fix the problem. So there're going to be much greater accountability within headspace, but across the whole system."
