One of few positives to come out of the Covid-19 pandemic has been the focus it has generated towards the issue of mental health. Government interventions like JobKeeper, and the hard work of crisis support centres such as LifeLine, have helped prevent a predicted increase in suicide rates and mental health-related insurance claims, despite the upheaval that has occurred to many peoples’ lives.
But a whole-of-government approach–and a lot more funding–is needed to bring meaningful change to the increasing rates of mental illness in Australia and around the world, experts say.
Speaking at a virtual mental health roundtable hosted by Investment Magazine and sponsored by life and health insurer AIA Australia, Professor Patrick McGorry AO – a psychiatrist and renowned mental health reform advocate – praised Treasurer Josh Frydenberg for announcing around $2.5 billion for mental health in May.
Australia is doing better than other countries in the area of mental health, spending around 7per cent of its health budget on mental health compared to about 2 per cent on average by governments around the world according to the Lancet Commission on global mental health and sustainable development published in 2018.
But Frydenberg’s announcement is a “piecemeal” initiative rather than the fundamental reform that is needed, McGorry said. The Australian Government’s work on mental health is still an underspend, as the burden of the disease is between 15 and 20 per cent of the health budget. By comparison, around 20 to 30 per cent of the health budget is spent on cancer.
McGorry cited the Dunedin Birth Cohort Study from New Zealand which followed a large cohort of primary school children through to the age of 45. The study found 86 per cent of a cohort of 1013 participants developed a period of mental ill-health by mid-life.
The study showed the majority of people experience mental ill-health, just as people do with physical limitations, McGorry said. But compared with cancer which has a high level of awareness in the health system, people with mental ill-health are getting a “raw deal”, he said.
“[Almost] everyone gets mental health problems at some point,” McGorry said. “It doesn’t mean everyone needs intensive, professional help, but probably about two-thirds of people do need professional help for these problems, but very few of them actually get it, and certainly [not] in the quality that’s needed.”
McGorry founded Headspace, the flagship mental health service for Australians aged 12-25 which will have 164 centres across the country by the end of this year. This is a model of how mental health interventions can be scaled across the country, he said, as many of these centres came about from communities lobbying their local MP.
But while 35 per cent of young people aged 12 to 25 coming into primary care at Headspace will recover, 65 per cent do not, as they need more specialised and sustained care, McGorry said. This gap in the system, known as the “missing middle”, includes people at all stages of life but particularly young people.
The only platform of care available to these people is private psychiatry which is inequitable due to its high financial barriers, and isn’t the right model as these people need a multidisciplinary team to help them get evidence-based care and recover, McGorry said.
“We actually have the solutions in both the adult and the youth area, and even the child area for these problems, but we haven’t had the political will, and the reform appetite to build and scale them up.”
A growing problem
In recent years, the superannuation industry has played a growing role in raising mental health awareness through its insurance propositions, member services and relationships with employers. One organisation at the coalface is Superfriend which partners with superannuation funds, insurers and employers to reach over half of the Australian working population–around 7.5 million Australians and 750,000 employers–to bring about positive change in mental health and a reduction in suicide rates.
Superfriend CEO, Margo Lydon, said Superfriend’s Thriving Workplaces study found 53.5 per cent of the Australian working population experienced a mental health condition in the last 12 months, which was a significant increase
“We used to use stats like one in five Australians every year,” Lydon said. “We can no longer be using those statistics. And again, I just want to reinforce this is workers, this doesn’t include a lot of the amazing work that Pat [McGorry] is doing with young people, or older people who are in our aged care facilities and so on, who are also experiencing increased prevalence of mental health conditions.”
Alison Tanswell, head of customer strategy at Commonwealth Superannuation Corporation–the $50 billion fund for Commonwealth public servants and the defence force–said about 45 per cent of all insurance claims are for a mental health condition and about 30 per cent develop a secondary condition which is related to mental health.
These claims were particularly prevalent in people working on the front lines where they are dealing with difficult conditions and people “not always in their best sort of space”. Additionally, 45 per cent of military invalidity claims and 44 per cent of retrospective claims have a mental health aspect, she said.
Defence force personnel also have trouble adjusting to civilian life after they leave, and working with the government to develop the Joint Transition Authority to help veterans going through this transition promised greater assistance to this unique cohort of people.
Simplifying the claims process
The superannuation industry and its group insurers are increasingly looking at preventative measures to provide support long before a claim has been lodged. Early intervention can be key to preventing the development of lifelong medical conditions, including mental ill-health.
The figures on secondary conditions are “pretty staggering”, said Jorden Lam, general manager of member services and operations at superannuation fund HESTA. More than half of those with a severe injury or illness or disability will have an associated secondary mental health issue, she said.
Lam said the volume, length and complexity of mental health claims had increased, and so had dispute resolution which involved working with the Australian Financial Complaints Authority. Following AFCA’s replacement of the Superannuation Complaints Tribunal, there had been a “settling-in phase…where they weren’t interpreting policy terms necessarily in the way we would expect them to.” This had seen some claims end up in court, she said.
Lam said initiatives to bring down the length and complexity of the claims process were playing a strong role in better mental health outcomes, pointing to steps insurers can take to simplify the claim process and shorten assessment timeframes. Alleviating the financial uncertainty that a customer is experiencing while off work due to illness or injury can reduce the risk of development of a secondary mental health condition.
More could be done, but first the industry needs to be clear about its role and the role of group insurance, Lam said.
“My personal view is, I think there is so much more we can do, but you’re juggling that with your role as a superannuation trustee as well. So, where do you draw that line? Where can we jump in more to offer more of that support?”
In the last 12 months, REST has paid out $36.5 million in benefits solely for mental health as the primary cause of claim, and mental health claims as a primary or secondary cause make up 24 per cent of claims, according to Nat Binns, REST’s general manager of insurance.
Binns said REST was focused on prevention and return-to-work outcomes, and much of this came from looking at the claims process itself. Having multiple ways clients can engage during the claims process–whether it be on the phone, talking through writing or engaging online–was important as people have different preferences for how they communicate, she said.
The fund had also saw it as “our responsibility and our job to get the information we need rather than bombarding customers…with what feels like an interrogation process.” Empathy was important, as well as having the ability to listen and a human-centred design.
“If you’ve got a mental health condition, you’ve probably gone to see lots of different doctors,” Binns said. “You may have lodged a worker’s comp claim. You may be going to see a GP. So, what other things are these people going through where we just become another cog in the wheel or potentially perceived as another barrier to the process?”
Workplace culture starts at the top
Kathryn Forrest, executive general manager of operations for Telstra Super, said workplace culture that put employees’ wellbeing first is critical to good workplace mental health. Telstra had recently told its employees it had no expectation they would return to the office following the pandemic, she said, allowing people to decide how much time they would spend at the office.
This allowed employees more time to exercise in the morning instead of their commute, or to eat healthy food at home rather than buying pre-made food near the office.
Stuart Whitbread, director of health and benefits at Aon Australia, said organisations need to lead from the top on mental health in order to champion the organisational culture to support it. For example, Aon’s CEO during the height of the Covid crisis, James Baum, had taken a firm view on mental health, being vulnerable to employees and telling them to do what they needed to do to take care of themselves and their families, he said.
“And I think that was really impactful and the commentary from employees has been really strong around how the narrative shifted,” Whitbread said.
There had been a sharp increase in mental health claims as part of workers compensation claims, particularly for frontline workers, he said, rising from 5 per cent to 9 per cent of claims over the last couple of years.
And a major area of concern was the wellbeing of children and teenagers forced to stay at home during this period. Employers needed to be flexible to allow parents and guardians to care for people who depend on them, and insurers also could look at the possibility of building in protections and financial assistance for people to better support their children.
Unlike many countries which had seen a wave of resignations as Covid-19 restrictions ease, Aon isn’t expecting this wave to hit Australia as intensely, Whitbread said.
“But we certainly do see employees being probably a lot louder about their expectations of their employers and probably putting them a little bit on notice, in relation to that.”
The way forward: more funding, more policy cohesion
Damien Mu, CEO and managing director of AIA Australia and New Zealand, agreed with McGorry and said that a broader plan and a blueprint is needed to provide to the government. Mr Mu noted that it’s important that the large group of stakeholders are aligned as it can be difficult for the government if they are receiving numerous requests and varying information on what is best the best course of action.
Mu referenced the great work from many organisations, and said that this needs to continue, highlighting however, that if would be helpful if key pieces of work were consolidated into one plan. In terms of developing a solution, Mu said that both digital and analog strategies would be needed.
Mu said, “We cannot wait for some magical moment or time to appear before national action with government support happens. It won’t happen overnight, but like building a wall, it needs to be done one brick at a time and getting started is the key.
In July, AIA Australia launched its 5590+ report which focusses on preventable non-communicable diseases and the lifestyle factors that can reduce their incidence. The report now includes mental health as one of the five major non-communicable diseases, alongside cancer, diabetes, respiratory disease and heart disease- which account for more than 90 per cent of preventable deaths in Australia each year.
“Things like the number of steps people take per day, the amount of sugar in their diet, how much sleep they get, and the amount of time spent on devices have clear correlations with mental health issues.” Mu said, demonstrating how much room there is for a multi-faceted approach to have a real impact on mental health.
“If we can help people to make small steps to improve their physical and mental wellbeing, as well as normalise conversations about mental health, then I think we can do some real good,” Mu said.
McGorry singled out state governments as generally having done an “appalling job” in mental health in the decades since getting rid of 19th century mental asylums but failing to build systems at scale and quality to replace them.
The Victorian Royal Commission had been a landmark case in putting $3.8 billion dollars into rebuilding the state system over the next four years, “which is a start”, McGorry said.
Psychiatry is looked down upon in the medical profession, in part because of the poor quality of under-funded systems psychiatrists are forced to work in and the challenges of helping people in crisis day after day, he said.
“We’ve got awareness coming out of our ears these days, but we haven’t had the fundamental prejudice and discrimination issues dealt with,” McGorry said. “Even within the Health Professions, it hasn’t been dealt with properly.”
The obsession over the pandemic had given governments tunnel vision to the detriment of other issues such as mental health, he said.
“If a Covid-19-related worker in hospital is overwhelmed with demand, there’s tremendous sympathy for those people–and support, and back up, and some reinforcements. But the mental health workers have been in that position forever.”