1. Introduction

Overview

1.1
Approximately one in five Australians and nearly half of all adults will experience a mental or behavioural condition in their lifetime.1 Mental illness such as schizophrenia, eating disorders, anxiety and depression, bipolar mood disorder, personality disorders, and trauma may be episodic, acute or chronic and can significantly affect how a person feels, thinks and behaves, and impacts on relationships with family, friends, colleagues and the wider community.
1.2
People living with mental health problems may also experience times of homelessness, poverty, isolation, poor physical health and unemployment.
1.3
Often people who have a mental or behavioural condition are stigmatised and defined by their illness leading to discrimination, making their mental health condition worse and stopping a person from getting the help they vitally need.
1.4
This can all significantly affect a person’s capacity to care for themselves and others, and to participate in social, family, educational and vocational roles.
1.5
Over 65,000 Australians make a suicide attempt each year; over 3,000 Australians end their lives every year; 75 per cent of those that take their own life are male; the suicide rate in Aboriginal and Torres Strait Islander peoples is twice that of their non-Indigenous counterparts; people in rural populations are two times more likely to die by suicide; LGBQTI+ community members experience significantly higher rates of suicide than the rest of the population; same-gender attracted Australians are estimated to experience up to 14 times higher rates of attempted suicide than their heterosexual peers; and suicide was the main cause of death for Australians aged 15 to 49 years in 2019.2
1.6
Lifeline Australia estimates that for ‘each life lost to suicide, the impacts are felt by up to 135 people, including family members, work colleagues, friends, first responders at the time of death.’3
1.7
The COVID-19 pandemic and significant natural disasters such as bushfires, floods, cyclones and drought, global and local economic shifts, and numerous personal traumas took a personal toll on all Australians, heightening feelings of stress in our day to day lives and livelihoods.
1.8
The Australian Institute of Health and Welfare highlighted that the mental health and wellbeing of young Australians has been particularly impacted by the pandemic:
While COVID-19 affects people in different ways, the social and economic impacts on young people have been substantial. Compared with older age groups, young people have experienced high rates of psychological distress, loneliness, educational disruption, unemployment, housing stress and domestic violence.4
1.9
The Committee acknowledges the sense of urgency required to improve services and outcomes for anyone affected by mental ill health and those that support and care for them. The COVID-19 pandemic and recent natural disasters have emphasised this point.

Other recent reports and strategic reviews

1.10
The Committee acknowledges that a number of reports and strategic reviews of the mental health system have been undertaken, or are underway. Most notably these works have focussed on veterans, people with a disability, and aged care sectors as well as people affected by family, domestic and sexual violence.
1.11
The completed reports have undertaken a thorough examination of the mental health impacts on those individuals and have made a number of significant recommendations.
1.12
The Committee is cognisant of not overlapping or duplicating this vital work. It looks forward to the outcomes of these inquires and the subsequent responses from government. A brief overview of these reports and strategic reviews is included below.

Veterans

1.13
On 8 July 2021, the Governor-General, His Excellency General the Honourable David Hurley AC DSC (Retired) issued Letters Patent establishing the Royal Commission into Defence and Veteran Suicide.5
1.14
The Royal Commission is required to produce an interim report by 11 August 2022 and a final report by 15 June 2023.
1.15
On 5 February 2020, the Prime Minister announced that the Australian Government would establish a National Commissioner for Defence and Veteran Suicide Prevention to inquire into, and support the prevention of, the deaths by suicide by Australian Defence Force members and veterans.6
1.16
On 29 September 2021, the Interim National Commissioner for Defence and Veteran Suicide Prevention tabled an interim report in Parliament. The report made 41 recommendations including:
Defence should commission an external review and evaluation of the culture within the Australian Defence Force (ADF) associated with mental ill health and help-seeking behaviour. Following this, Defence should implement a cultural change and de-stigmatisation program throughout the ADF to normalise early access to mental health services.7

Violence, abuse, neglect and exploitation of people with disability

1.17
On 18 February 2019, the Prime Minister, the Hon Scott Morrison MP, announced the establishment of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (People with Disability Royal Commission).8
1.18
On 4 April 2019, the Letters Patent containing the Royal Commission’s terms of reference were issued after extensive consultation with people with disability and the disability sector.9
1.19
The Royal Commission has a significant focus on the mental health of individuals with disabilities, and mental health service systems that people with disabilities require for life-long care.
1.20
The People with Disability Royal Commission published an interim report on 30 October 2020, and four progress reports between December 2019 and 30 June 2021.
1.21
The interim report noted that while initiatives to improve mental health services were being introduced, evidence that they had received called for substantial additional resources to ‘ensure that the initiatives significantly improve mental health services for people with an intellectual disability and a mental illness’.10
1.22
The Letters Patent for the Royal Commission require it to submit the final report to the Governor-General by 29 April 2022.

Aged care quality and safety

1.23
The Royal Commission into Aged Care Quality and Safety was established on 8 October 2018 by the Governor-General, His Excellency General the Honourable Sir Peter Cosgrove AK CVO MC (Retired).11
1.24
The Final Report of the Royal Commission into Aged Care Quality and Safety was presented to the Governor-General on 26 February 2021. It was tabled in Parliament on 1 March 2021.
1.25
The report included a specific focus on mental health services provided to aged persons, and recommended increasing access to older persons’ mental health services.12

Substance abuse

1.26
In May 2021, the Parliamentary Joint Committee on Law Enforcement completed its inquiry on public communications campaigns targeting drug and substance abuse.
1.27
The Committee’s report noted the intersection between mental health, addiction and the justice system, and recommended that the Australian Government support research, potentially by the Australian Institute of Criminology, into the efficacy of addiction treatment programs in reducing drug-related crime recidivism.13

Family, domestic and sexual violence

1.28
On 4 June 2020, the House Standing Committee on Social Policy and Legal Affairs (SPLA) adopted an inquiry into family, domestic and sexual violence. The Committee published its report on 1 April 2021.14
1.29
As part of the inquiry, the SPLA Committee examined the complex interactions between family, domestic and sexual violence and mental health and wellbeing services.
1.30
The SPLA Committee recommended:
… that the Australian Government, in conjunction with state and territory governments, resource additional research regarding the intersection between mental health and family, domestic and sexual violence. There should be a particular focus on the lived experiences of victim-survivors and the children of victim-survivors who have experienced both family violence and mental health issues.15

Scope of the inquiry

1.31
On 10 December 2020, the House of Representatives resolved to establish a Select Committee on Mental Health and Suicide Prevention (the Committee) to inquire into the findings of recent reports and strategic reviews of the mental health system in light of events such as the 2019 bushfires and COVID-19.
1.32
In addition, the Committee was asked to inquire into and report on a range of other specific matters spanning approaches to early intervention, workforce roles, training and standards, funding arrangements, and the use of telehealth and digital services. The terms of reference for the Committee’s inquiry can be found on page xvii of this report.
1.33
The broad terms of reference enabled the Committee to explore a wide range of matters throughout its inquiry. The Committee notes that there are several aspects of mental health, suicide prevention, and social and emotional wellbeing that require further inquiry or ongoing review, noting the substantial investments underway.
1.34
While acknowledging there is a House Standing Committee with responsibility for health, suicide prevention and social and emotional wellbeing are not solely health issues. It is also important to recognise mental health on the same footing as physical health.
1.35
The Committee therefore considers there should be a House Standing Committee on Mental Health, Suicide Prevention, and Social and Emotional Wellbeing established to undertake this policy work and review relevant annual reports, including the National Mental Health Commission annual report.
1.36
Areas the Committee believes require further investigation include:
the National Suicide Prevention Office, its aims and objectives, and any barriers to its progress
mental health, suicide prevention, and wellbeing in the workplace
the impact of the COVID-19 pandemic on substance use and abuse and the intersection with mental health
the role of medication and novel treatments for mental illness
the capacity for social and emotional wellbeing initiatives and community-building programs to reduce loneliness and improve social connection
the cumulative consequences of climate change on mental health and mental illness.

Recommendation 1

1.37
The Committee recommends that the Australian Government propose the appointment of a House Standing Committee on Mental Health, Suicide Prevention, and Social and Emotional Wellbeing, at the commencement of the next parliamentary cycle.

Conduct of the inquiry

1.38
A media release announcing the inquiry was issued on 25 February 2021, calling for submissions from interested individuals and organisations on the terms of reference.
1.39
The Committee also directly invited submissions from industry bodies, agencies, institutions, academics, think tanks and individuals.
1.40
The inquiry received 232 submissions and 47 exhibits, which are listed at Appendix A and B respectively.
1.41
The Committee held 17 public hearings. A list of those hearings and the witnesses and organisations that appeared at the hearings may be found at Appendix C.
1.42
COVID-19 restrictions prevented interstate travel and meant that all the public hearings had to be undertaken in Canberra or by videoconference. The Committee had planned to conduct hearings at various locations across Australia, including Perth, Brisbane, Melbourne and Sydney.
1.43
The Committee thanks all those who participated in the inquiry for giving their time to provide evidence of their experiences to the Committee. The Committee acknowledges that it has been a challenging time for all Australians and that it can be difficult to provide details of these experiences, particularly as part of a public inquiry.
1.44
The first-hand experiences, including from those who have a mental health condition or those who care or have cared for someone with a mental health condition, gave the Committee invaluable insight into understanding Australia’s mental health system and the steps necessary to improve mental health, suicide prevention and wellbeing services in Australia.

Structure of the report

1.45
In April 2021 the Committee presented an interim report which provided an update on work undertaken to date, emerging themes and plans for the remainder of the inquiry.16
1.46
This final report of the Committee investigates further some of the major themes identified in the interim report.
1.47
Chapter 2 examines the impact the COVID-19 public health emergency and natural disasters have had on the mental health and wellbeing of Australians.
1.48
Chapter 3 considers the accessibility of mental health services available.
1.49
Chapter 4 discusses the role that telehealth and digital services are playing in expanding accessibility and developing virtual mental health care.
1.50
Chapter 5 details the workforce constraints and the various roles that contribute to mental health and suicide prevention beyond the medical model.
1.51
Chapter 6 outlines the value of coordinated approaches to investment, and how funding reform can support access, workforce, service delivery and holistic care.
1.52
Chapter 7 identifies the current gaps in reporting and data collection on mental health and suicide prevention, and how proper evaluation and research can improve treatment and service systems.
1.53
Chapter 8 defines the value of wellbeing supports and accommodating the social determinants of mental health in system design and treatment.

  • 1
    Australian Bureau of Statistics, ‘National Health Survey: First results’, www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/2017-18, viewed 20 September 2021; Department of Health, ‘Mental health and suicide prevention’, www.health.gov.au/health-topics/mental-health-and-suicide-prevention, viewed 20 September 2021.
  • 2
    Department of Health, ‘Mental health and suicide prevention’, www.health.gov.au/health-topics/mental-health-and-suicide-prevention, viewed 20 September 2021; Lifeline, ‘Lifeline Statistics’, www.lifeline.org.au/resources/data-and-statistics/, viewed 24 September 2021.
  • 3
    Lifeline, ‘Lifeline Statistics’, www.lifeline.org.au/resources/data-and-statistics/, viewed 24 September 2021.
  • 4
    Australian Institute of Health and Welfare, ‘COVID-19 and the impact on young people’, www.aihw.gov.au/reports/children-youth/covid-19-and-young-people, viewed 22 September 2021.
  • 5
    Royal Commission into Defence and Veteran Suicide, ‘About the Commission’, defenceveteransuicide.royalcommission.gov.au/about, viewed 30 September 2021.
  • 6
    Interim National Commissioner for Defence and Veteran Suicide Prevention, Preliminary Interim Report, 29 September 2021, page 1.
  • 7
    Interim National Commissioner for Defence and Veteran Suicide Prevention, Preliminary Interim Report, 29 September 2021, pages 296-306.
  • 8
    Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, Interim Report, 30 October 2020, page 3.
  • 9
    Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, Interim Report, 30 October 2020, page 3.
  • 10
    Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, Interim Report, 30 October 2020, page 244.
  • 11
    Royal Commission into Aged Care Quality and Safety, Final Report: Care Dignity and Respect, Vol 1 – Summary and Recommendations, 1 March 2021, page 3.
  • 12
    Royal Commission into Aged Care Quality and Safety, Final Report: Care Dignity and Respect, Vol 1 – Summary and Recommendations, 1 March 2021, page 249.
  • 13
    Joint Committee on Law Enforcement, Public Communications Campaigns Targeting Drug and Substance Abuse Report, May 2021, Recommendation 4, page ix.
  • 14
    House of Representatives Standing Committee on Social Policy and Legal Affairs, Inquiry into Family, Domestic and Sexual Violence Report, March 2021.
  • 15
    House of Representatives Standing Committee on Social Policy and Legal Affairs, Inquiry into Family, Domestic and Sexual Violence Report, March 2021, Recommendation 76, page xliii.
  • 16
    House of Representatives Select Committee on Mental Health and Suicide Prevention, Mental Health and Suicide Prevention - Interim Report, April 2021.

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