Victoria has announced extra funds for counselling, but it's unlikely to improve our mental health

Yesterday, Victorian Minister for Mental Health James Merlino announced additional funding of $22 million for mental health support^[1] in response to the COVID-19 pandemic.

The centrepiece of this announcement was $13.3 million for 20 “pop-up community mental health services” with “around 90 dedicated clinicians providing 93,000 additional hours of well-being checks and counselling”.

This announcement is a small step towards overcoming some of the deficiencies in mental health service provision which were identified by the Royal Commission into Victoria’s Mental Health System^[2]. So it’s not surprising the new funding has been welcomed by mental health advocates^[3].

However, is it likely to make a difference to the effects the pandemic is having on mental health?

Victoria’s mental health has worsened during the pandemic

Early in the pandemic, mental health experts warned there was likely to be a worsening of mental health^[4] and perhaps even an increase in suicide^[5].

They called for increased resources for treatment and prevention of mental health problems to reduce this impact. The predictions of worse mental health have proved to be correct.

Fortunately, however, there has been no increase in suicide^[6].

Recent compilations of data by the Australian Institute of Health and Welfare^[7] and the Australian Bureau of Statistics^[8] have shown depression and anxiety symptoms increased in Australia early in the pandemic, but then decreased back towards pre-pandemic levels.

However, in Victoria, which has been the state most affected by lockdowns, the prevalence of a high level of psychological distress remains much greater than in the rest of Australia (27% versus 18%).

Demand for services is also up

The Australian Institute of Health and Welfare data^[9] also show demand for mental health services has increased substantially.

Victorians have received a much higher rate of mental health services funded under Medicare since the start of the pandemic. Some of this increase was facilitated by the introduction of telehealth services, which weren’t previously available.

There have also been increased calls by Victorians to support services provided by Lifeline (up 37% from 2019 to 2020), Kids Helpline (up 27%) and Beyond Blue (up 65%).

Read more: Lockdowns don't get easier the more we have them. Melbourne, here are 6 tips to help you cope^[10]

Will the additional services make a difference?

Given Victorians’ increasing demand for mental health support, the additional services will be welcomed by people who are on waiting lists and by hard-pressed clinicians.

However, it’s unlikely they will make an impact on the worsening of mental health seen during the pandemic. The reason for expecting no reduction in prevalence is that in recent decades Australia has had substantial increases in the provision of mental health services, but this has had no measurable impact on people’s mental health^[11].

Rather, prevalence remained stable for the two decades leading up to the pandemic.

Australia isn’t unique in this regard. In other high-income countries where the mental health of the population has been monitored over many years, no reduction in prevalence has been found^[12] with increases in treatment.

Why are more services unlikely to have an impact?

One of the reasons increasing services has had no measurable impact is they’re often of poor quality.

In Australia, most people with depression or anxiety disorders who seek help do not receive minimally adequate treatment^[13]. In many cases, the treatment isn’t evidence-based and the number of sessions received is too few to be effective.

Providing more funding for services has increased the number of people with milder problems receiving help. But the people with severe and recurring mental illnesses who are most in need are still not getting adequate help.

Another reason services are unlikely to have a measurable impact is they don’t generally deal with the risk factors that underlie the worsening of mental health during the pandemic.

Important risk factors^[14] are loneliness due to social isolation, financial stress, and juggling the demands of childcare and homeschooling while working from home.

I have argued previously that income and employment support are more important^[15] in addressing the mental health impact of the pandemic than mental health services.

Read more: The government will spend $48 million to safeguard mental health. Extending JobKeeper would safeguard it even more^[16]

While governments can take action to ameliorate these risk factors, the major impact is likely to come with the easing of lockdowns and consequent resumption of social contact, schooling and work.

These benefits require greater vaccination coverage and provide an important motivation for achieving this goal.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

References

1. ^{^} announced additional funding of $22 million for mental health support (www.premier.vic.gov.au)
2. ^{^} Royal Commission into Victoria’s Mental Health System (finalreport.rcvmhs.vic.gov.au)
3. ^{^} welcomed by mental health advocates (www.abc.net.au)
4. ^{^} likely to be a worsening of mental health (theconversation.com)
5. ^{^} increase in suicide (www.ama.com.au)
6. ^{^} no increase in suicide (onlinelibrary.wiley.com)
7. ^{^} Australian Institute of Health and Welfare (www.aihw.gov.au)
8. ^{^} Australian Bureau of Statistics (www.abs.gov.au)
9. ^{^} Australian Institute of Health and Welfare data (www.aihw.gov.au)
10. ^{^} Lockdowns don't get easier the more we have them. Melbourne, here are 6 tips to help you cope (theconversation.com)
11. ^{^} no measurable impact on people’s mental health (pubmed.ncbi.nlm.nih.gov)
12. ^{^} no reduction in prevalence has been found (pubmed.ncbi.nlm.nih.gov)
13. ^{^} do not receive minimally adequate treatment (pubmed.ncbi.nlm.nih.gov)
14. ^{^} Important risk factors (www.aihw.gov.au)
15. ^{^} income and employment support are more important (theconversation.com)
16. ^{^} The government will spend $48 million to safeguard mental health. Extending JobKeeper would safeguard it even more (theconversation.com)