“People have qualities beyond the diagnosis of a mental health issue. People are members of the community. They’re the neighbour that gives you a wave as you’re driving out the gate or walking out the gate. You know, they’re like anyone else.” – Carer
The Mental Health Coalition of South Australia commissioned Price Waterhouse Cooper to review the evidence and outline the case for investing in psychosocial supports to end our mental health crisis.
Psychosocial supports are mental health services delivered in the community that work with people to manage their day to day activities and build a life meaningful for them while keeping them out of acute care. Most people do not know what these services are or that they even exist yet they are vital in helping people manage their illness and live well in the community. This is often referred to as ‘recovery’.
“I went to an NGO and I met people who really understood what I was experiencing, and I can’t talk highly enough about the impact that had. I still needed medication. I still needed clinical help. But, I had people who I could identify with.” – Consumer
People with mental illness are entering our hospital system too often – especially for short-term, repeat admissions – and there are not enough services available to support people to stay well and reduce their reliance on acute hospital-based services.
“A lot of the system is about diagnosis and prescribing, and that’s only one aspect. Things like transition to employment and to study, and those things don’t get the effort and the time. The person is left to do those things, pretty much alone.” – Carer
What we found was;
- The current average costs to provide care in the hospital setting in South Australia are higher than the national average. Across Australia, the average cost per inpatient bed day in a psychiatric hospital (non-acute wards) was $953.78,compared with a cost per day of $1,554.25 for South Australia.
- 51.4% Of people in metropolitan Adelaide receiving a psychosocial support program said it helped them avoid hospital admission. This is even higher in regional South Australia, with 60.7% of participants avoiding admission.
- Not enough people are connected to psychosocial supports that would enable them to better manage their illness on a daily basis, overcome stressors in their lives and address other factors that can undermine their mental health.
- About 30% of mental health hospital inpatients could potentially be discharged if appropriate clinical and accommodation services were available in the community.
- By 2018-19 just 6.4% of the SA mental health budget was allocated to community services provided by NGOs – a 30% reduction in real terms from 2014-5.
- South Australians with mental illness currently spend more time in emergency departments and other hospital-based services than they would need to if there was adequate access to psychosocial supports that support them to stay well in their homes and needing less support from our hospital system.
- People with lived experience of mental illness have expressed concern about insufficient psychosocial supports available in community settings and those that are available are hard to get into.
“In those first months for people, especially those who had a real crisis of admission or, you know, have attempted suicide or you’ve had a long admission. They have no tangible support, regular tangible support for the person to really get back into a rhythm of life after admission.” – Carer
South Australia needs a mental health strategy that:
- Reduces demand at the crisis end of health care, by addressing unmet psychosocial support needs and helping people to stay well in the community more of the time.
- Reduces unnecessary reliance on emergency departments and other hospital-based services by diverting people to alternative care settings and improving discharge pathways to better connect people to psychosocial supports they need-especially addressing the critical shortfall in appropriate housing options.
Unfortunately, for patients discharged from hospital,15% of people are readmitted within 28 days of being discharged. This cycle causes harm to people with mental illness, distress.
“I have a big fear of getting unwell as I have been and particularly needing hospital because I don’t want to ever go back to hospital…I feel pressure that I can’t become unwell because of how it will be perceived.” – Consumer
What needs to be done?
Significant further investment into community based support and care is required to fill gaps in the availability and delivery of psychosocial services. This is further highlighted by SA Health’s Mental Health Services Plan, which acknowledges that services provided under the current mental health system work in isolation, resulting in confusion and potential gaps.
“I think that it’s no secret that the system, especially the Government mental health system, is a traumatised system and that goes for the people who use the services, as well as the people who are working within Government mental health. And I think that is not only crisis driven, but it’s in crisis. And when you have people who are working in the mental health system who are constantly in crisis, constantly under pressure and stress, you’re not going to get the best outcomes for the people using the system.” – Consumer
You can read the full report here.