Mental health and suicide prevention


Budget Review 2021–22 Index

Melanie Conn

The Government’s response to both the Productivity Commission inquiry into Mental Health and the National Suicide Prevention Adviser’s Final Advice was released as part of the 2021–22 Budget, together with $2.3 billion in additional funding. The response is outlined in the National Mental Health and Suicide Prevention Plan (the National Plan).

Productivity Commission’s Mental Health inquiry

Commissioned in November 2018, the Productivity Commission (PC) provided its final report of the inquiry into mental health to the Australian Government on 30 June 2020 with a public release on 16 November 2020.

The PC found that Australia’s mental health system ‘has not kept pace with our needs’. The estimated cost of mental illness and suicide to the Australian economy is about $43–70 billion each year, with a further $151 billion from diminished health and reduced life expectancy (Volume 1, p. 11). To address this, the PC made a series of recommendations ‘to set Australia on a path for sustainable, generational reform’ (Volume 1, p. 4). The report presents the PC’s vision for ‘a mental health system that places people at its centre’ and makes wide-ranging recommendations across five key areas (Volume 2, p. 165):

  • prevention and early intervention
  • recovery focused healthcare
  • services beyond health
  • training and work and
  • enablers of change (Volume 2, pp. 166–7).

The recommendations include some 103 actions, with several identified as priority reforms to be started as soon as possible.

Full implementation of all recommended reforms costed by the Commission was estimated at $3.5‍–‍4.2 billion (across all Australian governments) but lead to savings of up to $1.7 billion, estimated economic benefits of up to $1.3 billion per year and improvements in quality of life the equivalent of up to $18 billion per year (Volume 2, p. 172–173). The figures are striking, though costs and benefits do not accrue to parties equally.

National Suicide Prevention Adviser’s Final Advice

In July 2019 the Prime Minister announced a commitment to working ‘towards zero suicides’ and the appointment of Ms Christine Morgan as the National Suicide Prevention Adviser.

In this role she engaged broadly with stakeholders to better understand the needs of people who experience suicidal distress and identify potential changes to better meet their needs. She provided her Final Advice to the Prime Minister in December 2020, and it was publicly released in April 2021. The Final Advice (comprising an Executive Summary, three reports and appendices) included eight recommendations relating to:

  • leadership and governance to drive a whole of government approach
  • lived experience knowledge and leadership
  • data and evidence to drive outcomes
  • workforce and community capability
  • responding earlier to distress
  • connecting people to compassionate services and supports
  • targeting groups that are disproportionately impacted by suicide and
  • policy responses to improve security and safety (Executive Summary, pp. 6–8).

Government response

The National Plan outlines the Government’s response to the recommendations of the PC and National Suicide Prevention Adviser:

  • of the 21 PC recommendations—one is supported, 14 are supported in part and six are supported in principle (pp. 25–30)
  • of the eight Final Advice recommendations—two are supported, two are supported in part, and four are supported in principle (pp. 31–33).

The response focuses on immediate actions the Government is taking to address recommendations, rather than providing a detailed response against all actions for each recommendation. The response is therefore silent on a number of actions. In most cases this relates to actions for or involving parties other than the Australian Government. Where recommendations are supported in principle, the Government may pursue alternate actions to deliver on the intent and thrust of the recommendation.

As shown in Figure 1, the Government’s response provides additional funding of $2.3 billion over four years from 2021–22 across five pillars:

  • $248.6 million (10.8%) for prevention and early intervention
  • $298.2 million (13.0%) for suicide prevention
  • $1.4 billion (62.8%) for treatment
  • $107.0 million (4.7%) for supporting the vulnerable
  • $202.0 million (8.8%) for workforce and governance.

Figure 1: National Mental Health and Suicide Prevention Plan funding across the five pillars

Figure 1: National Mental Health and Suicide Prevention Plan funding across the five pillars 

Source: Department of Health, National Mental Health and Suicide Prevention Plan, May 2021.

The National Plan makes clear that many activities depend on partnership with state and territory governments. On 11 December 2020, the National Federation Reform Council, comprising the Prime Minister, Premiers, Chief Ministers, Treasurers and President of the Australian Local Government Association, met and ‘agreed to collaborate on systemic, whole-of-governments reform to deliver a comprehensive, coordinated, consumer-focussed and compassionate mental health and suicide prevention system to benefit all Australians’. This is to be achieved through a new National Agreement on Mental Health and Suicide Prevention to be negotiated by the Health National Cabinet Reform Committee by the end of November 2021. The PC emphasised the importance of such an agreement to clarify responsibilities and specify funding contributions across governments (Volume 3, pp. 1145–49).

Stakeholder response

Stakeholders have broadly welcomed the announcements, with Beyond Blue describing it as ‘an important first step towards the reform the community desperately needs’, the Consumers Health Forum of Australia saying ‘there are promising measures that if implemented well will deliver services where people are most comfortable and best supported’ and Mental Health Australia stating ‘there is no doubt this is real action’. Several stakeholders note with caution that the involvement of states and territories is yet to be resolved. Additional reaction from stakeholders to specific measures is included below.  

Overview of significant measures

The Mental Health measure in Budget Measures: Budget Paper No. 2: 2021–22 provides $2 billion over four years from 2021–22 for the National Plan (pp. 117–120). There is also $288.5 million for a related initiative under the Primary Care measure (p. 122).

Pillar 1: Prevention and early intervention

The Government has announced new measures to help people access supports early in life and early in illness: 

  • $111.2 million for digital mental health services, including:
    • $11.6 million to turn the existing Head to Health gateway into a comprehensive national mental health platform
    • $77.3 million to continue support for existing digital mental health services
    • $13.1 million for ReachOut Australia to continue delivering digital mental health services and
    • $2.8 million to implement the National Safety and Quality Digital Mental Health Standards.
  • $77.1 million for the National Legal Assistance Partnership to support those experiencing mental illness and for mental health workers in Domestic Violence Units and Health Justice Partnerships
  • $47.4 million for perinatal mental health, including:
    • delivering universal perinatal mental health screening in conjunction with states and territories
    • developing a perinatal mental health minimum data set and
    • expanding services provided by Perinatal Anxiety and Depression Australia.
  • $6.3 million to increase support services for fly-in fly-out and drive-in drive-out workers and
  • $5.7 million to support trialling further expansion of the Individual Placement and Support program to assist people with mental illness to participate in the workforce (Health Portfolio 2021–22 Budget Stakeholder Pack, pp. 155–6).

Pillar 2: Suicide prevention

To prevent suicide, the Government intends to take a whole of government approach which responds earlier to distress and is informed by lived experience.

A new National Suicide Prevention Office

As recommended by the National Suicide Prevention Adviser, the Government will establish a National Suicide Prevention Office, with $12.8 million in funding over four years (Budget Paper No. 2, p. 118). Suicide Prevention Australia has welcomed this as signalling ‘a major step towards significant system change that could lead to a meaningful reduction in lives lost to suicide’.

Services to be delivered in partnership with states and territories

Budget Paper No. 2 outlines funding of $211.8 million for services to be provided in partnership with the states and territories:

  • $158.6 million for aftercare services for every Australian discharged from hospital following a suicide attempt
  • $22.0 million to provide national postvention services to support those bereaved or impacted by suicide and
  • $31.2 million to establish Distress Intervention trials in each jurisdiction and to develop national standards for safe space services (p. 118).

It is unclear what level of contribution the Australian Government expects from states and territories for these services. Also unclear are the timeline for delivery, and the appetite of state and territory governments to participate. These would be among matters to be resolved through the National Mental Health and Suicide Prevention Agreement.

Australia-wide programs and local services

There is also funding for whole-of-population and local programs:

  • $61.6 million to expand the National Suicide Prevention Leadership and Support Program, which supports whole-of-population suicide prevention activities and services and
  • $12.0 million to continue the delivery of local suicide prevention initiatives in National Suicide Prevention Trial sites (p. 118).

Pillar 3: Treatment

Nearly two-thirds of the $2.3 billion in funding is directed towards treatment.  

Age-based multidisciplinary mental health treatment centres

The centrepiece of this pillar is $820 million for a network of multidisciplinary mental health treatment centres based on three models:

  • $487.2 million for Head to Health adult mental health treatment centres, to establish eight new centres, 24 new satellite centres and continued funding for eight existing trial centres, as well as fund a dedicated support phone service
  • $278.6 million to increase the number of headspace youth treatment centres for those aged 12–25 and work with states to boost clinical capacity at existing services and
  • $54.2 million for Head to Health Kids, working with states and territories to establish up to 15 new centres for children aged 0–12 years (National Plan, pp. 14–15).

These services are intended to contribute to addressing the ‘missing middle’ in services for those whose needs are not severe enough to require hospital treatment but are more than can be met by the general primary care system.

The concept of age-based services aligns with recommendation 3 of the Royal Commission into Victoria’s Mental Health System, which recommended an infant, child and youth system (divided into an infant, child and family stream and a youth stream (12–25 years)) and an adult and older adult system (pp. 23 and 39). Mental Health Victoria has welcomed the investment in multidisciplinary centres as a ‘stand-out’ budget initiative.

The National Plan makes clear the anticipated involvement of states and territories (pp. 14–15), specifically, to expand the planned network (adult centres), boost clinical capacity at existing centres (headspace youth centres) and work jointly to establish centres (Head to Health Kids).

Group therapy and Better Access

Budget Paper No. 2 provides $111.4 million over three years from 2022–23 to support take up of group therapy sessions and participation of family and carers in treatment provided under the Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS (Better Access) initiative. 

The National Plan also states that the Government is undertaking an evaluation of Better Access (p. 27). The PC had recommended a rigorous evaluation of this initiative, describing it as ‘long overdue’ given its size and cost; in 2019 about 1.3 million Australians accessed services at a cost to Government of $630 million and with patient co-payments of more than $230 million (Volume 2, pp. 558–9).

Additional measures

Budget Paper No. 2 also includes:

  • $288.5 million to provide Medicare subsidised access to repetitive Transcranial Magnetic Stimulation therapy for those with medication-resistant major depressive disorder
  • funding to continue psychosocial support for people with severe mental illness who do not qualify for the NDIS
  • Funding for parenting education and support, and to develop national guidelines to include social and emotional wellbeing and indicators in early childhood health checks
    • Budget Paper No. 2 refers to $46.6 million for these two activities (p. 119), while the media release refers to $42.3 million and $0.5 million respectively (pp. 5–6)
  • $34.2 million to expand and implement the Initial Assessment and Referral tool to help primary care practitioners to consistently assess and refer consumers in the mental health system
  • $26.9 million to provide additional support for people with eating disorders and their families, including by establishing a National Eating Disorder Research Centre and
  • $4.0 million in 2021–22 to continue counselling sessions for those impacted by the bushfires (pp. 118–‍119). 

Pillar 4: Supporting the vulnerable

This pillar includes measures providing targeted services to meet different needs, including:

  • $79.0 million for initiatives under the renewed National Aboriginal and Torres Strait Islander Suicide Prevention Strategy
  • $16.9 million to fund mental health early intervention supports and preventive measures for migrants and culturally and linguistically diverse people, and address the cultural competence of the broader health workforce and
  • $11.1 million to improve outcomes for people with complex mental health needs, including people with cognitive disability and autism (National Plan, pp. 18–19).

Pillar 5: Workforce and governance

The final pillar commits $202.0 million for mental health workforce and governance measures.

Workforce

There is $58.8 million to grow and upskill the mental health and suicide prevention workforce, including:

  • $27.8 million to increase the number of nurses, psychologists and allied health practitioners working in mental health settings through up to 280 scholarships and 350 clinical placements
  • $11 million to grow the psychiatrist workforce by offering 30 additional training places by 2023, supporting regional and remote training pathways and promoting psychiatry as a career pathway
  • $8.3 million to increase the number of Aboriginal and Torres Strait Islander mental health workers through 40 additional scholarships, and train healthcare workers to deliver culturally safe care and
  • $3.1 million to grow and support the mental health peer workforce through up to 390 scholarships and opportunities for professional collaboration (National Plan, p. 21).

There is also $15.9 million for specialised training and resources for primary mental health care practitioners, including:

  • subsidies for around 3,400 GPs to undertake training to provide focused psychological therapies
  • developing a nationally recognised Diploma in Psychiatry for medical practitioners and
  • reviewing prescribing practices and developing new prescribing guidelines for appropriate and safe use of antidepressants in young people and children (National Plan, p. 22).

The Royal Australian and New Zealand College of Psychiatrists has welcomed the initiatives promoting psychiatry as a career pathway but said ‘it doesn’t sufficiently address the immediate workforce shortages we are seeing’. 

Improving evidence

There is $117.2 million over four years from 2021–22 to improve the evidence base, including:

  • $38.5 million to enhance national data systems and fill information gaps
  • $23.0 million for a national evaluation strategy and evaluation fund
  • $20.3 million for forecasting population mental health needs and a national framework for mental health regional planning
  • $13.6 million for a longitudinal child mental health and wellbeing study
  • $12.7 million to monitor populations’ risk of suicide and self-harm and
  • $9.2 million to measure mental health in the Aboriginal and Torres Strait Islander population (Portfolio Budget Statements 2021–22: Budget Related Paper No. 1.7: Health Portfolio, p. 25).
More resources for the National Mental Health Commission

The National Plan includes $7.3 million to enhance the capacity of the National Mental Health Commission to support the reform agenda (p. 23). Agency Resourcing: Budget Paper No. 4: 2021–22 shows the Average Staffing Level for the Commission increasing from 33 in 2020–21 to 47 in 2021–22, a 42.4% increase (p. 161).

The PC recommended that the Commission, currently an executive agency within the Health portfolio, be given statutory independence to allow it to take on a broad-ranging role leading the evaluation of mental health and suicide prevention programs across governments (Volume 3, pp. 1120–22, p. 1131). The Government response is silent regarding consideration of this recommendation.