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The kids are not all right: Australia’s mental health system is struggling and so are our young | Omar Khorshid

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We’ve all been affected by the pandemic, but there are signs a mental health crisis among young people has arrived and is getting worse.

The latest Australian Institute of Health and Welfare data show in any given year, one in five Australians, or 20% of us, experience mental ill health.

But the last 18 months have not been “any given year” and we don’t need new stats to know it’s far worse under Covid.

It’s our young people who are struggling most, experiencing challenges unthinkable for their parents at the same age.

Even before the pandemic, three quarters of Australians with mental ill health were under 25, and our 16- to 25-year-olds were experiencing a higher prevalence of mental ill heath than their friends and families in any other cohort. Now, Covid has compounded the problem significantly.

Enduring lockdowns at an important stage in their development, children and young people are suffering a loss of freedom, extended social isolation, lack of connection with peers from remote learning, increased screen use and a denial of celebrating milestones such as the end of year 12. Meanwhile, all around them, their world has transformed into a restrictive and unpredictable place defined by a global public health emergency.

It’s no wonder anxiety and fear prevail; it’s understandable. This generation will inherit the post-Covid world we create, a world also impacted by climate change and increased public debt in Australia.

So we owe it to the inheritors of this world to do everything possible to look after their mental health.

We need to repair and prepare our mental health system to fight the oncoming demand from all Australians, but particularly for the young who will be dealing with the impacts of the pandemic longer than any of us.

Even before Covid-19 hit, our mental health services were struggling to cope with demand, but its arrival has shone a light on existing inequities in our system. Mental health presentations are the fastest growing of any hospital admission. Once there, people stay up to twice as long as those with heart conditions – a clear sign of scant options for treatment and care elsewhere in the system.

Serious investment is urgently required not only to address these inequities and inadequacies in the system (repair) but also to seriously bolster prevention and early intervention (prepare).

The federal government’s recent announcement of funding for 10 pop-up mental health clinics for Covid-affected areas in and around greater Sydney is an acknowledgement that we’re now in crisis.

It’s a welcome response to an emergency situation, but emergency announcements have a habit of creating more fragmentation in the system, as resources are re-directed to administer them, often shunting aside carefully crafted programs and plans. This Band-Aid response was necessary, but let’s make it the starting point of the repair and prepare plan, with a long-term financial commitment to a whole-of-system reform, which is what is really required.

The 2020-21 budget provided a substantial total investment of $2.3bn for mental health and suicide prevention and, while the funds are welcome, the AMA believes the money is not being spent in the right areas. We want to see investment that addresses the fracturing of care within the mental health system.

The budget included significant investment into new digital mental health assessment and referral platforms. The AMA is concerned this shift towards digital self-assessment and referral ignores well-established, evidence-based clinical mental healthcare.

A digital platform can never replace face-to-face attention from clinical experts and it will be the tech-savvy young people – the very people we need to catch who may be anxious or unwell – who are inclined to use these platforms, but who are in danger of falling through the cracks if used independently of clinical oversight from a GP.

The AMA believes funds should go to bolster existing mental health and other community support services such as drug and alcohol and domestic violence support services, which will also see increased demand arising from the pandemic but which contribute to supporting mental health.

We also need to urgently invest heavily in the mental health clinical workforce.

Psychiatrists are particularly in short supply, especially in rural areas and public hospitals, but demand for their care will continue long after the pandemic has passed. It’s also now harder to get appointments with psychologists.

Australia also has a serious shortage of child and adolescent child psychiatrists and we need to grow this cohort of the mental health workforce, but it takes time.

The budget’s $11m for just 30 new psychiatry training places by 2023 is woefully inadequate. It means waiting two years for these places to be created and that’s before the training – which can take from four to nine years – even begins. That’s a serious generational lag to delivering what we need right now. Funding needs to commit long-term to increasing training places by 3.3% each year to meet demand. That would create 269 places by 2025.

The AMA often repeats the need to have GPs at the heart of the health system. We say the same thing for mental health, and this is because we know what works, and we make calls to fund what works. GP clinics have the capability and potential to deliver integrated mental healthcare coordinating with psychologists; mental health nurses; psychiatrists; counsellors; drug, alcohol and gambling support staff; and other services – they just need the right resourcing to do it.

Anchoring GPs at the heart of Australia’s mental health response not only addresses patients’ needs more quickly and smoothly, it relieves pressure on other areas of the health system. But, crucially for our young people, it can prevent their problems escalating and needing more intensive, specialist mental healthcare or hospitalisation.

The federal government has an opportunity to reform the broader mental health system and place GPs front and centre of that reform while improving access to psychiatrists, psychologists and other mental health professionals.

The mental health crisis among the young is upon us. Repair and prepare is the best way to tackle it. It needs to happen now for the benefits to flow down and permeate our future. It needs to happen for all our sakes but, most importantly, for the sake of our children; to build their resilience, to strengthen their mental health and ensure they and successive generations flourish in a word shaped indelibly by this latest pandemic.

Dr Omar Khorshid is president of the Australian Medical Association

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