The ACT Mental Health and Wellbeing Framework 2015-2025

The ACT Mental Health and Wellbeing Framework 2015-2025:

Evidence Base

Suggested Citation:

ACT Health. (2015). The ACT Mental Health and Wellbeing Framework 2015-2025: Evidence Base. Canberra, Australia: Author.

Table of Contents

Introduction and Policy Context

Combining mental health and wellbeing promotion with suicide prevention...... 8

Why Invest in Mental Health and Wellbeing and Suicide Preveniton...... 9

Person-in-Environment...... 13

Promotion Prevention and Early Intervention...... 16

Glossary

Development, Governence, Implementation and Evaluation

References

Introduction

The ACT Mental Health and Wellbeing Framework 2015-25: Evidence Base is a companion document to the ACT Mental Health and Wellbeing Framework 2015 – 2025. This document sets out the rationale for combining the previous suicide prevention and mental health promotion, prevention and early intervention plans, discusses the need to invest in mental health and wellbeing, identifies groups within the community at increased risk of mental ill-health and provides the theoretical underpinnings to the objectives in the Framework.

The ACT Mental Health and Wellbeing Framework 2015-2025 (the Framework) is being launched at a time of unprecedented diversity and uncertainty for mental health and wellbeing in the ACT and in Australia. At present in the ACT mental health and wellbeing promotion and prevention and treatment services are delivered by a mix of ACT Government services; ACT and Commonwealth Government and privately funded community organisations; Commonwealth funded primary health providers such as GPs and practice nurses; and private providers such as private psychiatrists and private allied health workers. Some of these services, such as mental health services, drug and alcohol services and suicide prevention organisations, work directly in the mental health arena. Other services, such as cultural organisations, sporting clubs and schools, work in areas that affect people’s mental health and wellbeing even though that is not their primary role. The roll-out of the National Disability Insurance Scheme (NDIS) over the first years of the Framework, while bringing a welcome boost in funding, will further complicate this picture as new services emerge to meet the needs of ACT residents in receipt of NDIS packages.

The Framework is also being launched at a time of change regarding policy for mental health and wellbeing. At an ACT Government level the Framework itself combines the aspirations of the previous suicide prevention plan and mental health and wellbeing promotion Framework. The Framework sits beside other ACT Government policies that affect mental health and wellbeing such as the Human Services Blueprint, the Canberra Social Plan, theACT Alcohol and Other Drug and Mental Health Comorbidity Strategy and the ACT Strategic Plan for Positive Ageing. Other plans being developed by the ACT Government that will influence the work of the Framework include the ACT Aboriginal and Torres Strait Islander Wellbeing Plan and the ACT Children and Young People’s Commitment. At a Commonwealth level we are awaiting the next iteration of the National Mental Health and Suicide Prevention Plan.

As a strategic, outcomes oriented document, the Framework articulates the ACT community’s aspirations for mental health and wellbeing, including suicide and self-harm prevention, over the next 10 years. The outcomes of the Framework will depend on the combined efforts of all levels of government, community and private sector organisations, consumers, families, carers and the community as a whole. It also must be acknowledged that social and economic factors beyond the control of the ACT and Australian Governments will influence the outcomes.

In order to accommodate potential changes in the mental health and wellbeing landscape and to remain relevant over its 10 year life, the Framework has been written with flexibility in mind.

In order to track the progress of the Framework the Mental Health and Wellbeing Snapshot will be updated in 2019, 2022 and 2025. The current indicators will be updated and any new indicators, developed through robust evidence based research will be added as they become available. The ACT, as a small jurisdiction, does not have the scope to develop and maintain new nationally comparable indicators. The ACT Government however supports the National Mental Health Commission’s first strategic priority to “Champion the adoption, measurement and reporting of national targets and indicators as long term, consistent and persistent goals for mental health reform”[1] and is committed to reporting these indicators as they become available.

All ACT Government Directorates are committed to the objectives of the Framework. Each Directorate will provide information to ACT Health in 2019, 2022 and in 2025 which will update the Mental Health and Wellbeing Snapshot and form the basis of reports that will be presented to the Legislative Assembly regarding the progress of the Framework.

This approach allows the ACT Government to maintain a clear strategic direction for its work in mental health and wellbeing while allowing Directorates to respond to changing circumstances in shorter term operational documents.

Implications for the ACT Government

The Framework aims to provide a coordinated whole-of-government and whole-of-community approach to enhance mental health and wellbeing and reduce suicide and self-harm in the ACT. This broad approach seeks to align existing community resources and to provide a clear direction for future activities.

The Framework is relevant to all ACT Government Directorates. It addresses a broad range of factors such as housing, level of physical activity, transport options, utilisation of green space and other issues that are not typically covered by the health portfolio but are important social, physical and economic determinants of mental health and wellbeing. The Framework is also relevant to community sector organisations and will allow organisations and Directorates to align their efforts to meet the Framework’s objectives through their funding arrangements.

Each ACT Government Directorate will develop and commit to a response to the Framework through their strategic planning or business plans. Each Directorate will also include the activities of the community organisations that they fund. All funding decisions will be addressed in Directorate plans rather than in this Framework.

ACT Health will report on mental health and alcohol and drug services; general health and support services; suicide and self-harm and mental illness prevention; and mental health promotion.

Canberra Institute of Technology will report on mental health and wellbeing activities as they relate to the students and staff of the CIT.

Chief Minister, Treasury and Economic Development Directorate will report on whole of government actions as well as economic decisions and investments that affect mental health and wellbeing.

Community Services Directorate will report on progress in the spheres of multicultural affairs; housing; children, young people and family services; disability; homelessness; and community services as they affect mental health and wellbeing.

Education and Training Directorate will report on actions relating to schools, students and broader school communities as they affect mental health and wellbeing.

Environment and Planning Directorate will report on developments connected with climate change; sustainable development; environmental protection; urban design; and transport planning as they relate to mental health and wellbeing.

Justice and Community Safety Directorate will report on activities and services in the areas of justice; the law; emergencies; and commercial practices as they affect mental health and wellbeing.

Territory and Municipal Services Directorate will report on issues around public spaces such as libraries, parks and recreational facilities; ACT national parks; transport infrastructure; and public transport as they impact on mental health and wellbeing.

ACT Policy context

The Framework continues the work of Building a Strong Foundation: A Framework for Promoting Mental Health and Wellbeing in the ACT 2009-2014[2] and Managing the Risk of Suicide: A Suicide Prevention Strategy for the ACT 2009-2014[3]. Evaluations of these two plans were presented to the Legislative Assembly on a yearly basis between 2010 and 2014. The final evaluation reports noted that there had been significant progress in raising the profile of mental health and wellbeing and suicide prevention and that a significant number of positive activities had been undertaken. The final evaluation reports also noted that the quality of the data collected was inconsistent, often this was noted to be because programs or modes of delivery of programs changed, while the actions listed in the plans were fixed between 2009-2014. A significant problem for these plans was that while they tracked the actions of the government and community organisations in the mental health and wellbeing and suicide prevention domains (for example number of training sessions delivered), there was no link to outcomes (for example rates of mental illness).

In order to address this issue the Framework will operate in conjunction with other ACT Government documents such as the Mental Health Services Plan, the Human Services Blueprint and the Aboriginal and Torres Strait Islander Agreement. Some of these documents, such as the ACT Mental Health Services Plan, will detail the actions that the ACT Government is taking in their various areas of operation. In order to ensure that ACT Government outputs relating to mental health and wellbeing are coordinated the Framework will establish a coordinated cross-Directorate consultation and collaboration mechanism that will break down silos between Directorates and increase efficiency.

ACT Human Rights Act

Since 2004 the ACT has operated in accordance with the Human Rights Act 2004. The Human Rights Act binds the ACT Government to respect, protect and promote civil and political rights irrespective of differences in gender, disability, nationality, race or religion[4]. As with all ACT Government policy the Framework acknowledges and upholds the Human Rights Act.

Commonwealth Policy context

The Framework, while focused on the ACT population, also aligns with Commonwealth policies on mental health and suicide prevention. These include:

A Contributing Life: the 2013 National Report Card on Mental Health and Suicide Prevention[5]

The National Action Plan for Promotion, Prevention and Early Intervention for Mental Health 2000[6];

Fourth National Mental Health Plan, 2009-2014[7];

Living is For Everyone: A Framework for prevention of suicide in Australia (2007)
(LIFE Framework)[8];

The National Aboriginal and Torres Strait Islander Suicide Prevention Strategy[9];

The Hidden Toll: Suicide in Australia[10];

Commonwealth response to The Hidden Toll: Suicide in Australia Report of the Senate Community Affairs Reference Committee[11];

National Disability Strategy 2010-2020[12]

Combining mental health and wellbeing promotion with suicide prevention

Traditionally in Australia there have been separate policies addressing suicide prevention8 and mental health promotion, prevention and early intervention[13]. This is also true for the ACT23. Despite this historical separation, there is significant overlap of determinants for mental health, suicide and self-harm. A combined approach is logical because most actions that promote wellness for suicide prevention also promote wellness for mental health and vice versa.

In addition to overlapping social, physical and economic determinants, there are well established connections between suicide, self-harm and mental illness. A 2013 meta-analysis of international psychological autopsy studies showed that up to 60% of suicides were by a person with mental illness[14]. Other meta-analyses, with a focus on western countries, tend to show a greater association between diagnosable mental illness and suicide, one showed up to 90% of suicides were related to mental illness[15], another showed that up to 88% were related to depression alone[16]. It is also well established that many mental illnesses; particularly depression, bipolar disorder, schizophrenia, anorexia nervosa and borderline personality disorder, carry with them a significantly increased risk of suicide and self-harm[17].

Considering that the common factors between promotion, prevention and early intervention are greater than the differences, the ACT Government hascombined the strategies to promote mental health and wellbeing and to prevent suicidal and self-harming behaviour. The combined approach allows a more efficient use of resources. However, it is acknowledged that there are some areas of difference and the Framework also supports specific interventions where different approaches are required.

Why invest in mental health and wellbeing and suicide prevention?

Poor mental health negatively impacts on the individual, family, community and economy. It can cause distress and lead to isolation and discrimination. Mental illness is common and affects around one in five Australians every year. As such approximately 76,400 Canberrans will experience a mental illness each year[18]. Between 2004 and 2013, 328 Canberrans died by suicide, this means on average there are 33 Canberrans who die by suicide each year[19]. In addition many friends, family members and colleagues are indirectly affected by mental illness, suicide and self-harm.

There are compelling reasons to invest in mental health and wellbeing and to reduce the risk factors associated with mental illness, suicide and self-harm. Research has shown that half of all serious mental health and substance use disorders commence by the age of 14, and three quarters before the age of 25[20]. Mental health promotion and mental ill-health prevention can significantly reduce the impact of mental illness, suicide and self-harm[21][22]. Treatment interventions alone cannot significantly reduce the enormous personal, social and financial burdens associated with mental health problems and mental illnesses13.

Research indicates that:

• In Australia, around 327,000 years of healthy life are lost each year due to mental illness[23].
• In 2010, about 13 per cent of Australia’s total burden of disease was attributed to mental health issues, this is a combination of premature mortality and years lived with disability23.
• In 2013, the total cost, both direct and indirect, of suicidal behaviour to the Australian economy was assessed as being $17.5 billion per year[24].
• Investing in promotion, prevention and early intervention makes economic sense. A study, in 2011, examining the cost-benefit analysis of 15 promotion, prevention or early interventions found that the return on investment was on average $17.70 for every $1 expended[25].
• A further study on creating a mentally healthy workplace suggested that mental ill health can present substantial cost to organisations and if they invested in creating a health workplace, for every dollar they spend on successfully implementing an effective programme they would gain $2.30 in benefits[26].

Mental illness and suicide and self-harming behaviour can affect anyone in the community. The peak onset of mental illness is between the ages 15-25 and mental illness is the most common illness affecting people of this age[27]. People in this age group are also less likely to receive treatment for their mental illness, with only around a quarter having any treatment compared to over a third of all the people who have a mental illness.

The risk of suicide is increased at both ends of the age spectrum with younger people aged 15-25 more likely to die by suicide than any other cause of death. Older people 75 years and over experience suicide around 4 times the rate of the general population19.

The promotion of mental health and wellbeing is a whole of community priority and involves:

• improving mental health literacy
• reducing stigma and discrimination attached to mental illness, suicide and self-harm
• promoting physical and emotional safety at school, at home and at work
• promoting healthy behaviours such being socially connected and having a healthy lifestyle

How mental ill-health and suicide affect different populations

Aboriginal and Torres Strait Islander Peoples are around twice as likely to die by suicide (22 per 100 000 general population) as the general population (11 per 100 000) and are more than twice as likely to be treated in hospital for self-harm, 350 per 100 000 compared to 140 per 100 0009. Nearly a third of Aboriginal and Torres Strait Islander Peoples experience high or very high levels of psychological distress at around 2.5 times the rate of the general population[28].

People who have a substance use disorder are more likely to have an anxiety (31% compared to 14%) and affective disorder (20% compared to 6%) than the general population. They also have an increased risk of suicide. Substance abuse is present in between 25 – 55% of deaths by suicide[29].