“Working together, we can build a mental health and suicide prevention system that is genuinely joined up, properly resourced and provides for all Australians the most simple but powerful comfort: that they matter” –The Hon Scott Morrison MP, Prime Minister of Australia on releasing the National Mental Health and Suicide Prevention Plan in 2021
Last year saw the largest investment in mental health and suicide prevention by a national government in Australia’s history—AU$2.3 billion. This was a sweet victory for those who have long been advocating for service reform.
The plan includes cooperative agreements between state and federal governments, lived experience leadership and a commitment to equal participation, digital developments, strengthening workforce capacity and capability, joined-up systems of compassionate care and support, and targeted programs for those disproportionately affected by suicide and addressing the social determinants of health.
What remains to be seen is how this investment will be used and leveraged to deliver the “joined-up system” that so many people crave when affected by mental ill-health and mental illness.
Professor Ian Hickie, director of the Brain and Mind Centre, is one of those long-time advocates. As a professor of psychiatry at the University of Sydney, he welcomes the investment as an important contribution to the “mental wealth” of the nation. But, at the same time, he’s cautious of the government’s ability to deliver 21st- century services.
He points out that a joined-up system of care requires real reform in Australia with technology at its foundation, but, at present, digital advances are little more than the digitisation of current referral patterns in the crisis systems. “This is not system reform,” he says. “Digital health isn’t telehealth. It’s about empowering, connecting people, and putting the decision-making power in the hands of the individual.”
Perhaps even more important than direct government investment, Hickie says governments need to create a regulatory environment that enhances digital technology and ensures safety and transparency.
Hickie is a member of the World Economic Forum’s Global Future Council on Digital Mental Health. In 2019, the WEF produced a critical white paper called Empowering 8 Billion Minds Enabling Better Mental Health for All via the Ethical Adoption of Technologies. The report called for eight actions that offer solutions that could improve—and indeed save—the lives of millions of people:
- Create a governance structure to support the broad and ethical use of new technology in mental healthcare
- Develop regulation that is grounded in human rights law and nimble enough to enable and encourage innovation
- Embed responsible practice into new technology designs
- Adopt a “test and learn” approach in implementing technology-led mental healthcare services
- Exploit the advantages of scale
- Design in measurement and agree on unified metrics to ensure efficacy and to inform the “test and learn” approach
- Build sustainable technology solutions
- Prioritise low-income communities and countries as they are the most underserved today
According to the report, technology is already being widely used in mental healthcare. And consumers are open to this: 65% of workers in a UK study (and 75% of the youngest workers) were positive about the role of technology in managing their mental health. Three interdependent technologies, in particular, are having a tangible impact on mental healthcare: mobile technology, the internet, and AI (including machine learning and big data). These three technologies are being used to:
- Monitor and measure behaviours and (self-reported) feelings
- Deploy interventions by phone and web
- Enhance the effectiveness of mental health workers
- Build relevant data lakes
Australian researchers have been at the forefront of tackling one of the most significant barriers to implementing effective mental health services and treatment at scale: the lack of robust, evidence-based data. Professor Hickie and his colleagues have been developing predictive models through gathering data on behaviours like sleep patterns, cognitive function, activity, and speech. They’re combining data and insights from thousands of people to develop predictive and diagnostic tools that could change the way mental health is managed.
However, the World Economic Forum report cautions that while big data provided by these technologies hold the key to so much insight, it comes with the privacy issues associated with the collective use of sensitive personal data. Therefore, finding the correct, ethical way forward is essential.
Professor Jane Burns is Chief Strategy Officer at TogetherAI, a mental health and wellness app for families, questions whether this large-scale investment is going to the correct place. Like Hickie, she believes digital development is not simply taking a face-to-face service and putting it online. Instead, innovation is about system change that improves outcomes for people. “We need to explore what role technology can play in early identification of behaviours that are prevalent and likely to lead to adverse outcomes,” she says. The data can help identify systemic failures, and digital innovations like artificial intelligence can be instrumental in the early identification of health challenges. “For example, virtual reality technology can help identify early signs of ocular degeneration,” says Burns. “These technologies allow for targeted responses by curating content relevant to the context of the individual.”
Burns notes that people’s experiences and needs vary and technology can identify trends among populations. For example, a 40-year-old living in rural New South Wales who has dealt with an onslaught of recent challenges, including fires, floods, and the pandemic, will probably have different needs than someone in metropolitan Adelaide who hasn’t been similarly affected. “Digital innovation allows you to curate tailored content that makes sense for them, and that’s just from an information provision perspective,” she says. Burns points out that people often see technology as an adjunct to care when it should be “embedded into the service system model.”
Another of Australia’s new innovations is the first-ever National Suicide Prevention Office, which was established in May 2021. It’s part of the government’s $2.3 billion investment and centers on developing a government approach to suicide prevention. In doing so, this will bring into focus social determinants of health, particularly employment, education, financial stressors, and relationships—all of which the Covid pandemic has exacerbated. Burns and Hickie hope digital innovations will be a key feature of the newly created office’s work.
Both Hickie and Burns agree that the new office is a game-changing opportunity but are skeptical that it will live up to expectations. “If the system is broken, we need to be brave enough to fix it, but this is a real challenge that many aren’t willing to face,” says Burns.
The principle of intervening early to prevent any further advancement of distress should be standard practice. This is especially important for young people and means the skilled workforce needs to focus on early-stage prevention. As “Prevention Compassion Care,” the National Mental Health and Suicide Prevention Plan, is rolled out along with the high-level investment, many will watch to see the reforms take place. A start has been made with regionally-based Head-to-Health centres, Safe Haven Cafes, and similar non-medical approaches which people in crisis can choose to attend. Early evidence shows that these centers support and stabilise people experiencing a mental health crisis, diverting them from hospital emergency departments. Hickie says this is “good for the person and good for the hospital” as it can concentrate its attention on other emergencies that do require medical intervention.
Burns highlights that solely investing more in mental health services isn’t the solution. “The world is more complex,” she says, “and there are more stress evoking anxieties—the pandemic, war, and natural disasters.” That means that any approach which includes the existing mental health system must focus on prevention instead of waiting until a person becomes unwell and “then step in to help.”
Sue Murray, International Correspondent
A health promotion advocate in Australia dedicated to improving the health and well-being of all people. Throughout her career, she has focused on health for the community and has expertise in communications, education, and organisational development.
Sue currently leads the Zero Suicide Institute of Australia, which aims to support the healthcare system to understand and more effectively manage those who are vulnerable to suicide and suicidal behaviour.