Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012
Tier 3—Responsive—3.10 Access to mental health services
Why Is It Important?:Mortality rates for mental health and behavioural disorders are 1.4 times as high for Aboriginal and Torres Strait Islander peoples as they are for other Australians (1.7 times as high for men and 1.3 times as high for women) (see measure 1.23). Aboriginal and Torres Strait Islander peoples are twice as likely to die from suicide. Hospitalisation rates for intentional self harm are more than twice as high as those for other Australians (see measure 1.03). For Indigenous Australians, the intergenerational effects of colonisation and continuing social and economic disadvantage contribute to high rates of physical and mental health problems, high adult mortality, high suicide rates, child removals and incarceration rates which in turn lead to higher rates of grief, loss and trauma (see measure 1.18).
Most mental health services address mental health conditions once they have emerged rather than addressing the underlying causes of distress. Nevertheless, early access to effective services can help diminish the consequences of these problems and help restore people’s emotional and social wellbeing. Therefore, the accessibility of mental health services for Aboriginal and Torres Strait Islander peoples is an important issue.
Mental health services include non-specialist services such as community-based health services, Aboriginal and Torres Strait Islander primary health care services and GPs; and specialist services such as private psychiatrists, state mental health teams, and designated psychiatric services both in general hospitals and in specialist facilities.
Findings:In 2009–10, the rate of ambulatory mental health services claimed through Medicare was lower for Indigenous Australians than for non-Indigenous Australians (202 per 1,000 compared to 320 per 1,000). This includes private services for psychiatric, psychological, GP and other allied health care (SCRGSP 2011a). BEACH survey data collected from April 2006 to March 2011 suggest that 11% of all problems managed by GPs among Indigenous Australians were for mental health problems. After adjusting for differences in the age structure of the two populations, GPs managed mental health problems for Indigenous Australians at 1.4 times the rate that they did for other Australian patients.
In 2010–11, Aboriginal and Torres Strait Islander primary health care services reported around 187,000 client contacts with emotional and social wellbeing staff or psychiatrists, representing 7% of the estimated total contacts.
In 2009–10, state/territory-based specialised community mental health services reported 430,894 service contacts for Aboriginal and Torres Strait Islander clients, representing 7% of all client contacts. Rates of community mental health care service contacts for Aboriginal and Torres Strait Islander peoples were three times the rates for other Australians. Rates were higher across all age groups, particularly in the 25–44 year age group. Rates for Indigenous Australians were highest in the ACT (1,767 per 1,000) and lowest in the NT (217 per 1,000). In 2009–10, the rate of residential mental health care episodes was 25 per 100,000 for Indigenous Australians.
Access to specialist psychiatry in rural and remote Australia is particularly problematic (Hunter 2007). In 2007 there were 4 full-time equivalent psychiatrists per 100,000 people in remote and very remote areas compared with 23 per 100,000 in major cities. In 2009–10, Indigenous Australians were less likely than non-Indigenous Australians to have claimed through Medicare as private patients for psychologist care (96 compared with 153 per 1,000) and also psychiatric care (46 compared with 88 per 1,000).
In the two years to June 2010, hospitalisation rates for Aboriginal and Torres Strait Islander men for mental health issues were 2.2 times as high as rates for non-Indigenous men, whilst rates for Aboriginal and Torres Strait Islander women were 1.5 times as high as non-Indigenous women. Hospitalisation rates tend to be lower in the NT for both Aboriginal and Torres Strait Islander peoples and other people.
There was a significant increase of 12% in mental health related hospitalisations for Indigenous females, with no significant increase for males between 1998–99 and 2009–10 in Qld, WA, SA and the NT combined. Since 2004–05, however, rates have increased significantly for both Indigenous males and females (9%) in NSW, Victoria, Qld, WA, SA and the NT combined.
Rates of ambulatory equivalent hospital separations for mental health-related conditions for Aboriginal and Torres Strait Islander peoples were lower than for non-Indigenous Australians for specialised psychiatric care (rate ratio of 0.2) and higher for hospitalisations without specialised psychiatric care. Non-ambulatory hospitalisations for these conditions were more than twice those for non-Indigenous Australians (1.6 times as high with specialised psychiatric care and 3.2 times as high without specialised psychiatric care). The rate of available psychiatric beds in public psychiatric hospitals ranged from 11 per 100,000 population in major cities to 1.3 per 100,000 in outer regional areas and none in remote and very remote areas. The rate of available psychiatric bed in psychiatric units or wards in public acute hospital ranged from 24 per 100,000 in major cities to 3.2 per 100,000 in remote and very remote areas.
The average length of stay for non-ambulatory care equivalent hospitalisation was 9.6 days for Indigenous patients compared with 8.9 days for other Australians. A recent study in Sydney identified barriers to accessing mental health services including perceived potential for unwarranted intervention from government organisations, long wait times (more than one year), lack of intersectorial collaboration and the need for culturally competent approaches including in diagnosis (Williamson et al. 2010).Top of Page
Implications:These findings suggest that access to primary care-level and specialist mental health services is uneven. COAG initiatives represent a major opportunity to address current deficiencies. Under National Mental Health Reform, the Australian Government is working to improve the mental health system for Australians, including for areas and communities that need it most, such as Indigenous communities and socioeconomically disadvantaged areas. Investments totalling $2.2 billion have been committed over the next five years from 2011–12, including $1.5 billion in new measures. For example, investments are being made in Headspace, better coordination of services, and the Taking Action to Tackle Suicide program which includes $6 million in funding for Indigenous initiatives. $205.9 million is also provided over 5 years to fund more psychological services through an expansion of the Access to Allied Psychological Services (ATAPS) program, which will provide treatment for an additional approximately 185,000 people over five years.
The Fourth National Mental Health Plan: An agenda for collaborative government action in mental health 2009–2014 includes 34 actions aimed at improving outcomes for people with mental disorders. The plan takes a whole of government approach, acknowledging that many of the determinants of good mental health and of mental illness are influenced by factors beyond the health system. One of the actions is ‘the development of coordinated actions to implement a renewed Aboriginal and Torres Strait Islander social and emotional well being framework’. A consultant has been engaged to progress the development of the framework.
Key issues to be considered in addressing gaps include ensuring services are culturally competent, ensuring services are well linked into the system of primary health care, and that Aboriginal and Torres Strait Islander peoples are able to access effective treatment through psychiatrists and psychologists.
NSW Health has established the Aboriginal Mental Health Workforce Program which aims to build a workforce of Aboriginal mental health workers across NSW to increase the capacity of mental health services to respond to the needs of Aboriginal people. The Program has three components including the Aboriginal Mental Health Workforce Training Program; the Aboriginal Clinical Leadership Program, including six Aboriginal Clinical Leader positions in key former Area Health Services across the state; and positions in Aboriginal Community Controlled Health Services (ACCHS).Top of Page
Figure 172—Age-standardised rate per 100 encounters, mental health-related problems managed by GPs, by Indigenous status of the patient, April 2006–March 2007 to April 2010–March 2011
Source: AIHW analysis of BEACH survey of general practice, AGPSCCTop of Page
Figure 173—Community mental health care service contacts per 1,000 population, by Indigenous status, 2009–10
Source: AIHW analysis of National Community Mental Health Care DatabaseTop of Page
Figure 174—Age-standardised hospitalisation rates for mental health-related conditions, by Indigenous status
Source: AIHW analysis of National Hospital Morbidity DatabaseTop of Page
Figure 175—Age-standardised hospitalisation rates for mental health–related conditions, by Indigenous status and jurisdiction, July 2008 to June 2010
Source: AIHW analysis of National Hospital Morbidity DatabaseTop of Page