In the early months of 2020, as the scale of the Covid-19 disaster was starting to hit home, mental health advocates began sounding alarm bells. For years, the ‘silent pandemic’ of suicide had been killing twice as many young Australians as road accidents. Now a convergence of economic pressure and social isolation threatened to take many more lives.
But a multi-headed response from government, business and the community brought about a result few could have predicted: The number of suicides decreased.
John Brogden, Chair of Lifeline and a long-time advocate for mental health awareness and suicide prevention, says despite a massive increase in calls to the free crisis and support service–some days as high as 25 per cent–there was ultimately a reduced rate of suicide between March and December 2020 in the largest jurisdictions of New South Wales and Victoria.
“What we’ve come to learn is that it is a good thing that people have reached out rather than suffering in silence,” Brogden told an online digital roundtable hosted by Investment Magazine and AIA Australia recently, adding that the increase in calls demonstrates people are reaching out more than ever before.
The roundtable was discussing ways the country’s largest insurers and superannuation funds could address mental health post-pandemic, following on from a series of roundtable events on the topic held this time last year.
Participants reflected the full gamut of stakeholders including superannuation funds, insurers, not-for-profit organisations, state governments, medical and mental health experts and, importantly, those with lived experience.
Australia has seen an unprecedented number of government-initiated inquiries into mental health, and roundtable participants looked at what the industry could learn from some of their key findings. These included the Productivity Commission’s report into mental health, the Royal Commission into Victoria’s Mental Health System, and National Suicide Prevention Adviser Chistine Morgan’s report to government.
Despite the good news, there is a lot of work still to be done, notably in workplaces. And these are places where superannuation funds and insurers can make real inroads, said Margo Lydon, CEO of SuperFriend which partners with 24 superannuation funds and seven life insurers concerned about mental health and well-being and the suicide rates of their members.
SuperFriend’s 2020 Indicators of a Thriving Workplace Report–based on Australia’s largest and longest-running annual workplace mental health and well-being survey–found a nine per cent increase in the number of people who identified as having a mental health condition, either previously or currently, to 60 per cent of the Australian workforce. “This demonstrates mental health should no longer be viewed as something that only affects a minority”, Lydon said.
Of those people, 43 per cent said their work or workplace has either caused or exacerbated their mental health condition. Troublingly, 55 per cent of respondents said their workplace was doing nothing in relation to workplace mental health. SuperFriend only deems 5 per cent of workplaces are “thriving” in terms of the way they address mental health and wellbeing.
The role of workplaces in prevention, early detection and early intervention cannot be understated, she said. Industry needs to invest further in uplifting the capability of staff, particularly frontline staff as well as people leaders, by supporting them with training and education.
“Awareness education will only take you so far,” Lydon said. “We need behaviour change. We’ve got enough awareness off the back of the pandemic. We actually need to be skilling people in [holding] appropriate conversations, how to de-escalate [when facing] distress, and so on.”
The Hon. Emma Davidson, Minister for Mental Health in the ACT Government, said a strong commitment to improving mental health in workplaces needs to include having a greater awareness of the challenges of working from home, which can be isolating and exacerbate mental health issues. For those who are experiencing domestic and family violence, the home can be the least safe of all workplaces.
“These issues indicate a need for employers to look at how their workplace health and safety policies and procedures apply to mental health and well-being in work environments, [and] they may not have had to consider before including the home workplace,” Davidson said.
Reforming the workplace
Noel Lacey knows all about the hazards to mental health that can come from workplaces. As the head of insurance at CBUS Super, his fund represents the construction sector which is known for its relatively high incidence of suicide.
Suicide is the second highest cause of death claims at the fund, behind cancer, Lacey said. In the 2019/20 financial year, Cbus paid out roughly $300 million of benefits related to mental health, totaling 3000 claims or around 30 each week. Disturbingly, half of those were death claims.
He remains concerned that social upheaval and financial pressure will lead to increased lives lost to suicide before the end of the pandemic.
“Whilst construction was one of the areas where employment is growing really strongly the last six months, which is fantastic, construction did have a very high representation in JobKeeper,” Lacey said, referring to the Australian federal government’s support for people who lost their jobs due to the impact of Covid-19.
Kathryn Forrest, executive general manager of operations at Telstra Super, is charged with looking after all insurance claims as part of her portfolio. She said internal statistics found the majority of people accessing the fund’s mental health services were over 52, which surprised Forrest who had imagined it would be mostly younger employees.
At Telstra Super, which manages the retirement funds of participating employers including Telstra, Foxtel and Sensis, there is a dedicated well-being team which encourages employees in distress to take mental health leave. Importantly, this leave is referred to as mental health leave rather than carer’s leave or sick leave in an effort to de-stigmatise mental health by addressing it directly.
“It’s a small nuance, but it actually makes a big difference,” Forrest said. “Initially we found people were reluctant to call it mental health leave because they didn’t know whether people were going to be recording statistics on how many mental health days they had taken, and those kinds of [concerns]. But that has progressively changed over time.”
But there are still further changes needed to insurance, she said. Insurers “still penalize people for taking care of themselves,” she said, referring to exclusions for people who have taken sleeping tablets or seen a psychologist in the past.
“We have to think differently about the product and we have to think about what sort of options we can provide people that might just need three months off but not have to wait three months for an [income protection claim], and then find out that they can’t get it because they took a sleeping tablet a year ago, or there’s a record that they’ve seen a psychologist,” Forrest said.
The importance of lived experience
Critical to a successful mental health intervention is what is becoming known as a person-centred approach, which refers to elevating the role of people with living experiences of mental health and suicide.
Professor Allan Fels AO is a mental health expert with a list of qualifications too long to list in this article, but which includes currently being the Chair of the Haven Foundation which provides accommodation to mentally ill persons, and board member of Mind Australia. He spoke at the roundtable in a personal capacity as a carer of a close family member with schizophrenia.
“If you look at the reports, the public discussions, the policies, and so on, the whole emphasis now is on giving a bigger voice and the biggest say to people with lived or living experience,” he said, noting this included families and carers.
This was a major focus at the Victorian Royal Commission, he said, in particular going beyond just listening to these people to actually involving them in governance and decision-making. They are able to give the industry a better idea of what is wanted and needed, and are better able to engage with sympathy and understanding with other people with mental illness.
But engaging this cohort is harder than it may sound. “The supply of people with lived experience, who can contribute in these areas is not all that great,” Fels said. “Their training, their background and experience, is not all that great. So…I think you have to make some long-term investments in building up this limited population so that they can be useful.”
Co-designing initiatives with people who have lived or living experience is key to elevating the importance of non-clinical treatments, Lydon said, as the insurance industry has historically relied strongly on the medical approach to treatment when it comes to claims and claims management.
“We know that not everybody who has a mental health condition, wants to go and see and work with a psychologist as an example, or will go and talk to their GP. So, having these alternative Pathways to Recovery to care to support is going to be incredibly helpful. And for this industry, I think the question is…how do we support that?”
One area requiring attention is known as the “missing middle”. The health system can help people with mild mental health conditions to see a GP or psychologist, and has interventions for people facing a serious crisis. But those in the middle fall through the cracks.
“The number of people who say, I can’t get my 17-year-old in because they’re not sick enough is extraordinary,” Brogden said. “There’s a lot of people in between and they get worse and worse every day, they don’t get the care they need.”
Amelia Traino, Executive Director, mental health and wellbeing at Wellbeing SA, said non-clinical efforts at prevention were particularly important in isolated rural areas far from major towns and hospitals. Towns affected by deadly bushfires, for example, could experience poor mental health outcomes that lasted for generations.
“I think that we need to be looking more at building our communities capacity to recognise when someone’s in distress…so that they don’t get to the point that things are so bad that they need a clinician or that they need a hospital bed.”
Another gap that needs to be filled is to make sure that everybody who walks out of a public or private mental health clinic in Australia is followed up, Brogden said, as the health system already does for women who have just given birth.
“So we can do this, we do this all the time, but people walk out of mental health clinics, after having [attempted to take] their own life, with no support in many cases,” Brodgen said. “The greatest indicator of a suicide attempt is a previous suicide attempt.”
Returning to a fulfilling life
The life insurance industry is the biggest non-government funder of mental health–which the productivity commission estimates costs Australia $180 billion a year.
Damien Mu, CEO and Managing Director of AIA Australia and New Zealand, said awareness about mental health is hitting new heights, allowing insurers to build on that support to work towards preventative programs.
AIA Australia’s, AIA Vitality program has had over one million health and wellbeing assessments conducted since its launch, with 49 per cent of these being a mental health-related assessment.
“That statistic alarms me, but in a positive way, because I don’t think that would have happened five years ago,” Mu said.
Mu pointed to a range of AIA support programs like its wellness and work-readiness program RESTORE, along with its Mind Coach program giving psychological support. Both assist AIA’s interaction with people with mental- ill health who are on claim and provide learnings and insights for its customers about how to manage their symptoms so that they can return to wellness.
Simonie Fox, Head of Shared Value Partnerships at AIA Australia, said non-clinical support programs like RESTORE had a crucial role to play. While it was of course good news the Federal Government had extended the number of subsidised sessions a person can see on a mental health care plan from 10 to 20, this had also increased waiting times.
“I think the learnings from those non-clinical support programs are relevant for the whole life insurance industry as well as the healthcare system. Because if we’re looking at some of these other alternatives to just provide psychological support, then that’s not going to stretch the healthcare system as much.”
Megan Bolton, chief financial officer at superannuation fund HESTA, said it was important to quickly identify members who may need additional support and fast-track their journey to social, work or financial rehabilitation services. Members are clearly taking up the RESTORE and MindCoach programs offered by AIA, she said.
“There are people thinking outside of the square to try and prevent a lot of these mental health [problems] before it becomes a bigger issue,” Bolton said.
While Brogden says there is no doubt more funding is needed for mental health, the most remarkable thing to come out of Covid-19 was a strong demonstration that the solutions to mental health and suicide prevention do not simply come out of the health budget.
Australia is one of the best countries in the world to have a mental illness, he said, and an enormous amount of good work was being done in the financial services industries.
“It’s a story of optimism as we look forward to doing better and better,” he said.