Why is it important?:Mortality rates for mental health and behavioural disorders are one and a half times as high for Aboriginal and Torres Strait Islander peoples than for other Australians (1.8 times as high for men and 1.3 times as high for women, see measure 1.25). Aboriginal and Torres Strait Islander people are more than two times as likely to die from suicide. Hospital admissions rates for intentional self-harm are twice as high as those for other Australians (measure 1.03). For Indigenous Australians, the intergenerational effects of colonisation and continuing social and economic disadvantage contribute to high rates of physical and mental health problems, high adult mortality, high suicide rates, child removals and incarceration rates which in turn lead to higher rates of grief, loss and trauma (see measure 1.16).
Most mental health services address mental health conditions once they have emerged rather than the underlying causes of that distress. Nevertheless, early access to effective services can help diminish the consequences of these problems and help restore people’s emotional and social wellbeing. Therefore, the accessibility of mental health services for Aboriginal and Torres Strait Islander peoples is an important issue.
Mental health services include non-specialist services such as community-based health services, Aboriginal and Torres Strait Islander primary health care services and GPs; and specialist services such as private psychiatrists, state mental health teams, and designated psychiatric services both in general hospitals and in specialist facilities.
Reforms for mental health services were agreed by COAG in 2006. Aboriginal and Torres Strait Islander peoples were identified as a priority group in those reforms.
Findings:In 2009–10, the rate of ambulatory mental health services claimed through Medicare was lower for Indigenous Australians than for non-Indigenous Australians (202 per 1,000 compared to 320 per 1,000). This includes private services for: psychiatric, psychological, GP and other allied health care. For the period 2004–05 to 2008–09, mental health problems were reported in an estimated 14% of GP encounters for Aboriginal and Torres Strait Islander people and 12% of GP encounters for other Australians.
In 2008–09, Aboriginal and Torres Strait Islander primary health care services reported 109,094 client contacts with emotional and social wellbeing staff or psychiatrists, representing 4% of the estimated total contacts. This is down from 124,211 client contacts in 200–06.
In 2007–08, state/territory-based specialised community mental health services reported 362,429 service contacts for Aboriginal and Torres Strait Islander clients, representing 6% of all client contacts. Rates of community mental health care service contacts for Aboriginal and Torres Strait Islander peoples were are almost three times the rates for other Australians. Rates were higher across all age groups.
Access to specialist psychiatry in rural and remote Australia is particularly problematic (Hunter 2007). In 2007 there were 4 full-time equivalent psychiatrists per 100,000 persons in remote and very remote areas compared with 23 per 100,000 in major cities. In 2009-10, Indigenous Australians were less likely than non-Indigenous Australians to have claimed through Medicare as private patients for psychologist care (81 compared with 135 per 1,000) and also psychiatric care (45 compared with 87 per 1,000).
In the two years to June 2008, hospitalisation rates for Aboriginal and Torres Strait Islander men for mental health issues were 2.2 times higher than the rates for other men, whilst rates for Aboriginal and Torres Strait Islander women were 1.5 times higher than for other women. Hospitalisation rates tend to be lower in the Northern Territory for both Aboriginal and Torres Strait Islander peoples and other people.
Hospitalisations of Aboriginal and Torres Strait Islander people for mental health issues have remained relatively constant since 2001–02 using trend data from four jurisdictions. Adding figures for New South Wales and Victoria, there has been a slight, but significant, increase (0.5% per annum between 2004–05 and 2007–08).
Rates of ambulatory equivalent hospital separations for mental health-related conditions for Aboriginal and Torres Strait Islander peoples were lower than for other Australians, particularly for specialised psychiatric care (rate ratio of 0.2). Other hospitalisations for these conditions were more than twice those for other Australians (1.8 times as high with specialised psychiatric care and 3.3 times as high without specialised psychiatric care).
The average length of stay for non-ambulatory care equivalent hospitalisation was 11.2 days for Aboriginal and Torres Strait Islander patients compared with 13.2 days for other Australians.
Implications:These findings suggest that access to primary care-level and specialist mental health services is patchy. Initiatives by COAG represent a major opportunity to address current deficiencies. Under National Health Reform, the Australian Government is working to improve the mental health system for Australians, including for population groups that may be missing out on services or are hard to reach. To improve outcomes for individuals at risk, the Government will continue to support prevention and early intervention activities.
The Fourth National Mental Health Plan: an agenda for collaborative government action in mental health 2009-2014 was endorsed by the Australian Health Ministers’ Conference in September 2009. It includes the development of coordinated actions to implement a renewed Aboriginal and Torres Strait Islander Social and Emotional Well Being Framework. An Implementation Strategy for the Fourth Plan was endorsed and released by AHMC in December 2010 and the Mental Health Standing Committee (an AHMAC subcommittee) is currently considering an implementation approach for the 34 actions of the Fourth Plan.
Key issues to be considered in addressing gaps include ensuring services are culturally accessible (see measure 1.16), ensuring services are well linked into the system of primary health care, and that Aboriginal and Torres Strait Islander peoples are able to access effective treatment including specialist treatment through psychiatrists and psychologists.
Figure 161 – Age-standardised rate per 100 encounters, mental health-related problems managed by GPs, by Indigenous status of the patient, 2004–05 to 2008–09
Source: AIHW analysis of BEACH survey of general practice, AGPSCC
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Figure 162 – Community mental health care service contacts per 1,000 population, by Indigenous status, 2007–08
Source: AIHW analysis of National Community Mental Health Care Database
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Figure 163 – Age-standardised hospitalisation rates from mental health-related conditions, Qld, WA, SA and NT, 2001–02 to 2007–08 ; NSW, Vic., Qld, WA, SA and NT, 2004–05 to 2007–08
Source: AIHW analysis of National Hospital Morbidity Database
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Figure 164 – Age-standardised hospitalisation rates for principal diagnosis of mental health–related conditions by Indigenous status by state/territory, NSW, Vic., Qld, WA, SA and NT, July 2006 to June 2008
Source: AIHW analysis of National Hospital Morbidity Database
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