Broken promises and missing steps in mental health reform

We are still seriously failing to resource and integrate mental health into the mainstream of the health care system

A young colleague recently shared his family’s experience of the Australian health system. His older brother has schizophrenia, an illness that is typically serious, persistent and reduces life expectancy by a minimum of 15–20 years.1,2 He was untreated and seriously ill for 2 years before he gained access — as a result of a life-threatening crisis — to a mental health system that could no longer avoid a response. Expert early intervention services (an Australian innovation), which improve health, social and economic outcomes,3,4 were then and now simply not available in his community and remain embryonic nationally. The inexcusable treatment delay cost him his chance of recovery,4 and he has languished for years with severe symptoms and disability. His care now consists of brief general practitioner visits, non-evidence-based support from a non-government organisation, and stress-laden hospital admissions that achieve nothing more than risk management. He has no meaningful access to specialist expertise or the multidisciplinary team-based approach that is essential to remission and recovery. In 2016, his sister was diagnosed with cancer. The contrast was a revelation to the family. The cancer diagnosis galvanised the same local health system, which this time delivered truly exemplary care. Rapid investigation, effective treatment and widespread support followed, leading to full remission. Not only was the medical care high quality, intensive and sustained, but the young woman was even provided with expert mental health care, of much higher quality than that offered to her brother, for as long as it was needed, with no rationing of sessions or barriers to specialist care.