Executive Summary

This National Report 2020 shows that mental health and suicide continue to be significant issues for Australia. The events of late 2019 to 2020 have highlighted both strengths and weaknesses in many of our health and mental health systems. While an ambitious reform agenda has been set, many challenges remain to be overcome by governments, the mental health sector and the community before we can collectively achieve our vision of a system that delivers better outcomes via an integrated, person-led approach to mental health and wellbeing.

Before the outbreak of the COVID-19 pandemic, many communities across Australia were already experiencing long periods of stress following severe drought, widespread bushfires and floods. Although the economic and mental health impacts of containing the COVID-19 pandemic are likely to be long term, Australia responded to the COVID-19 emergency through rapid collaboration between all governments to maintain the health and wellbeing of Australians.

The crises have presented opportunities for innovation in future reform, and Australia has demonstrated that adaptability and rapid response are possible. The greater use of digital health services and telehealth helped mitigate the loss of community engagement provided by face-to-face support during the pandemic and opened up service access to a number of cohorts, particularly rural communities. This innovation expands options for service delivery of mental health support in the future.

Furthermore, during the pandemic, government agencies and the research sector responded quickly to establish new collaborations and data collections, or pivot existing collections to rapidly produce relevant data. These rapid responses demonstrate the capacity for change and improvements in system and data processes when the impetus is present. This approach needs to be embedded into practice over the longer term in sector reform.

In the midst of these positive changes, the past year has also presented considerable additional challenges for our mental health and resilience. It has tested the capacity of many support systems, such as the health and social services systems, and the economy in general to deal with complex crises and respond rapidly in innovative ways. Some people with new presentations of mental health concerns sought help for the first time, and many found that the systems they encountered lacked connected pathways of care. Rapid access to assessment, treatment and support for individuals and their carers was missing across the spectrum of mental illness at the level that was required by the consumer.

Despite the challenges of 2019-20, progress has been made in the mental health sector. Of the 30 recommendations made in the National Mental Health Commission's (the Commission) Monitoring mental health and suicide prevention reform: National Report 2019 (National Report 2019), four have been completed and the majority have progressed.

The release of the report of the Productivity Commission inquiry into mental health has been welcomed, with the priority reforms focused on a person-led mental health system. The report highlights that the current mental health system has evolved as part of the health system rather than a system focused on how mental health is experienced by consumers. It calls for a nationally consistent, comprehensive mental health and suicide prevention system that is broader than health and encompasses the social determinants that can impact on our wellbeing. It recommends a mental health approach that spans a person's life, from early childhood to the later years of life, and includes housing, families, education, workplaces and the justice system. This aligns with Vision 2030, which is currently being developed by the Commission.

Other reports released in the past year will also inform mental health reform going forward: the Royal Commission into Victoria's Mental Health System, the Royal Commission into Aged Care Quality and Safety, the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability and the National Suicide Prevention Adviser's interim advice to the Prime Minister on suicide prevention. The recommendations in these reports reflect different elements of what makes an efficient and effective system that meets the needs of, and improves outcomes for, people with lived experience, their families and the community more broadly.

The key message of 2020, as we consider the findings of the above-mentioned inquiries and the comprehensive feedback received from people with lived experience, is that any rethinking of the mental health system needs to take into account this new environment to ensure that the system is capable, and responsive to immediate, short-term and specific needs of people impacted by unexpected or major changes in their lives, as well as to their medium and longer-term needs. It also needs to acknowledge that different people have been, and will continue to be, impacted in different ways.

Throughout this report, the Commission highlights areas that require further work to improve the mental health system and ensure that it meets the needs of all consumers and carers. From this analysis, the report makes four recommendations that the Commission views as priorities for the coming 12 months:

• • The Australian Government should develop a National Older Persons Mental Health and Wellbeing Strategy.
• • The Australian Government should develop a National Mental Health Workforce Strategy Implementation Plan.
• • The Australian Government should develop a National e-Mental Health Strategy.
• • The Australian Government should develop a National Regional and Remote Mental Health Strategy.