A brief survey of emerging issues in Australian mental health care
Article Outline
Whether or not the person is young or an adult, the prevalence and distress burden of mental health problems, mental illness and its related treatments will have far-reaching impacts for individuals, families, carers and others in the wider community. Nurses see people at the very sharp end of their distress and across a range of metropolitan and regional settings. With increased numbers of mental health presentations the nursing workforce must be equipped to deliver services to meet the needs of carers and consumers. Clinical leadership from nursing can and will contribute to State and Territory capacity to promote and deliver national mental health reform by giving leadership direction and confidence to nurses through their continuing education, clinical research and practice development needs.
The Prime Minister, Kevin Rudd, has unveiled plans to create a better mental health system for all Australians. The reform process is well underway with State and Territory leaders announcing new funding for services, infrastructure, education and recruitment. There is no doubt in my mind that our political leaders are committed to improving the lives of people with mental health problems, mental illness and their carers.
With such challenges it is reassuring to see some outstanding exemplars of mental health best practice across Australia. In Queensland, for example, the Queensland Transcultural Mental Health Centre demonstrates excellence in responding to the mental health needs of migrants and refugees. In South Australia, Nurse Practitioner led clinics offer effective non-pharmacological interventions for the treatment of depression and anxiety. The clinics in central and northern metropolitan Adelaide take the recovery model very seriously and such values underpin all therapeutic interventions. Aside from these and many other exemplars of outstanding practice, the 2006 Senate Inquiry into the Provision of Mental Health Services in Australia provides stark evidence to explain what must change when it comes to mental health care. A more recent critique reveals that access to services continues as uneven and continuity of care is fragmented or absent completely (Hopkins, 2008).
But we are far from being the ‘lucky country’ in terms of having an adequate mental health system in Australia. In addition there are some disturbing trends in mental health/ illness that will require maximum effort and cooperation between state and federal governments if they are to be properly addressed.
An emerging global consensus predicts that the incidence of mental illness will continue to increase, particularly among younger people, partly because of the adverse effects of current social and environmental factors (Andrews, 2005). Such factors include increased family breakdown, decreasing participation in community-based structures such as sporting clubs, social clubs and churches, and increased exposure to substances such as cannabis and illicit stimulants.
The treatment of mental health problems and mental illness in young people is built on partnerships between the young person, family, caregivers, schools and health professionals. The recent headspace program across Australia is to be applauded. It calls for early multi-agency intervention, favourably shifting risk and mobilising protective factors such as positive lifestyle changes, positive family and peer support, stress reduction, working models of collaboration with schools, drug and alcohol services, TAFE Colleges and migrant communities, psycho-education and elimination of illicit stimulants. Moreover, modifiable and behavioural risk factors are themselves strongly influenced by factors such as personal economic resources, education, living and working conditions, stress and access to health care and social services.
However, the mental health and wellbeing of young Australians was thrown into focus recently when the Australian Institute of Health and Welfare released its report into injury incidence among young Australians (AIHW, 2008). The report deals with such issues as the frequency and burden of injury, taking into account accidental and non-accidental self harm with or without a fatal outcome.
The report reveals that injury was the leading cause of death among young people aged 12–24 years in 2005–2006, and this accounts for more deaths than all other causes of death combined within this age group. Of particular concern are the high levels of intentional injuries, such as self-harm, suicide and assault. These are now among the leading causes of hospitalisation and death among young people in Australia. In 2005–2006 7299 young people were hospitalised due to intentional self-harm – a rate of 197 per 100,000 young people. Hospitalisation rates for intentional self-harm among young people increased by 43% between 1996 and 2006. The increase was much greater for young women than young men. However the incidence of suicide among young men is about four times that of young women. Young males accounted for the majority (80%) of these suicides overall, with hanging, strangulation and suffocation being most common.
Further careful scrutiny of the data raises co-morbidity issues. There is a link between injury and substance use, with an estimated 6% of 18–24 year olds sustaining their most recent injury while under the influence of alcohol or other substances, compared with 2% of the population aged 25 years or over.
Mental health and substance use disorders in young people can persist in later life with constraints, distress and disability lasting for decades (McGorry et al., 2007). If serious clinical issues persist in young people and antipsychotic medication is required during adulthood, then there is an increased chance of developing metabolic syndrome as a result. If mental health problems in youth progress into serious mental illness during adulthood then antipsychotic medication forms part of what we know as optimal treatment (Killackey and Yung, 2007). And, such treatment is not without risk to physical health and wellbeing.
Metabolic syndrome is an increasingly common side effect of taking antipsychotic medication for treatment of serious mental illness. Metabolic syndrome is characterised by central obesity, insulin resistance, high blood pressure and/or lipid abnormalities, and occurs with increased frequency among people with schizophrenia spectrum disorders, bipolar disorder and psychotic disorder (American Heart Association, 2008). It is associated with an increased risk of coronary heart disease, stroke, and peripheral vascular disease, Type II diabetes and kidney problems. People with metabolic syndrome are two to three times more likely to have a heart attack or stroke, and five times more likely to develop Type II diabetes, compared with those who do not have the syndrome (Melkersson and Dahl, 2004).
There is an urgent need for improved housing and employment options for people with mental illness. At the same time workforce development for nurses in emergency mental health, clinical assessment, stigma reduction and therapeutic engagement with people with mental illness must be addressed in a systematic and timely way. Workforce issues such as recruitment and retention of mental health nurses are pressing issues for all jurisdictions.
References
- AIHW: Eldridge, D. (2008). Injury among young Australians. AIHW Bulletin Series 60, Cat. No. AUS 102, Canberra: AIHW.
- American Heart Association, Inc. (2008). Metabolic syndrome. Retrieved 6th June 2008 from http://www.americanheart.org/presenter.jhtml?identifier=4756.
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PII: S1322-7696(08)00030-9
doi:10.1016/j.colegn.2008.06.001
© 2008 Published by Elsevier Inc.