Wednesday, August 12, 2015
If you think the odd unnecessary $5000 helicopter ride constitutes the worst of the wastage of our money – or that it makes much difference to the $430 billion the federal government spends each year – you haven't done enough thinking.
As several people reminded me at the Byron Bay Writers' Festival at the weekend, such matters as politicians' pay and perks pale into insignificance compared with the threat to our way of life posed by climate change and other continuing environmental damage.
My conscience tells me that, for as long our response to that threat remains so inadequate – including our inadequate contribution to the success of the Paris climate change conference in December – I shouldn't be writing about anything less consequential.
But we ought to be able to juggle more than one problem at a time, and although climate change is our most pressing problem, it's far from our only one.
One combined threat and opportunity that 'coptergate prevented from getting the attention it deserved last week is one we should have been on to long ago. It was raised in a noteworthy speech to the National Press Club by Professor Allan Fels, now chairman of the National Mental Health Commission (and with a family interest in the topic).
Fels' point was that we've been making a hash of mental health for ages, but that if we got our act together, we could not only reduce the misery of up to 3.7 million Australians, but eventually do everyone else a favour.
Fels is, of course, a professor of economics. So he spoke with authority when he argued that mental health is not just a significant social issue – although that should be enough to make us pay attention – it's a significant economic problem as well.
"Mental health is a significant problem for our economy – as significant as, often more significant than, tax or micro-economic reform," he says. (More significant than tax? Not possible.)
"Many people do not get the support they need, and governments get poor returns on substantial investment. The economic or gross domestic product gains from better mental health would dwarf most of the gains – often modest ones – being talked about in current economic reform debates."
The Organisation for Economic Co-operation and Development estimates that the average overall cost of mental health problems to developed countries is about 4 per cent of GDP. In Australia, this would equate to more than $60 billion a year, or about $4000 for each person who lodges a tax return, or more than $10,000 a family.
Those costs include the direct costs of treatment, plus the indirect costs, such as disability support pensions, imprisonment, accommodation and so on, plus the costs of lost production and income, plus the costs to carers and families and their reduced participation in the workforce.
But just what is the mental illness we're talking about? Of the 3.7 million Australians estimated to have mental health problems in any year, 3 million have a mild to moderate condition, such as anxiety or depression at a clinical level.
It's because so many people with "common" mental disorders are employed – and unemployed – that mental ill-health has such big implications for economic production and productivity. It causes about 12 million days of reduced productivity each year, arising from absenteeism and "presenteeism" (being at work but not getting much done).
The remaining 700,000 people have persistent complex and chronic illness, such as schizophrenia or severe depression.
Seven people die every day from suicide, about double the road toll. But while the number of deaths on our roads has diminished substantially, there has been no major reduction in the suicide rate over the past decade, we're told.
Death from suicide among Aboriginal and Torres Strait Islander peoples is twice that of non-Indigenous Australians.
Fels says there are excellent examples of suicide prevention, treatment, follow-up and "postvention" in Australia.
Even so, the government review conducted by Fels concluded that much of the $10 billion a year the feds spend on mental health "is neither effective nor efficient".
Almost 90 per cent of it is spend on "downstream programs", such as income support for sufferers, payments to support state hospitals and mental health-related medical and pharmaceutical benefit payments.
"Much of this is payment for failure, payment for failure to treat the problems early and cost-effectively," Fels says.
"I believe this heavy expenditure could be reduced with greater emphasis and investment in prevention, early detection, a focus on recovery from mental ill-health and the prevention of suicide."
If we enable people to live contributing lives – to have relationships, stable housing, and to maximise participation in education, employment and the community more broadly – we will help build economically and socially thriving communities and a more productive Australia, Fels says.
I'm not a believer that things we should be doing for social or cultural reasons must first be asked to justify themselves on economic grounds. We're rich enough to afford to look after those among us with problems, and to pursue knowledge for its own sake.
But the argument that doing better on mental health would improve economic outcomes seems unassailable.