Predictive modelling indicates that among the most adverse impacts of the Covid-19 pandemic will be significant increases in mental ill-health and suicide. These bad outcomes extend well beyond the human costs and are likely to include an additional $110bn hit to productivity over the next five years. Consequently, we urgently needed a budget designed to protect and then grow our collective “mental wealth”.
In the 21st century, the concept of mental wealth is one that should sit alongside other national indicators such as gross domestic product (GDP), and unemployment and workforce participation rates. Mental wealth is not simply a generic measure of wellbeing, happiness or other very broad composite measures. It is a more focused measure of our collective cognitive and emotional resources that links directly to real economic and social benefits.
So in evaluating the 2020 budget, we must ask to what extent the concept of growing Australia’s mental wealth has been addressed by each of the economic, social or health policy initiatives. The positive budget elements include maintaining employment support through continuation of jobkeeper until March 2021. However, modelling suggests that this support (appropriately adjusted over time) will be required for a much longer period. Sadly, while jobseeker has provided additional funds to those most at risk, this will cease. Continued real and substantial financial support for almost one million Australians who are now out of work remains critical to our collective mental wealth.
More recently, there has been clear recognition by the government and the Productivity Commission that young people are disproportionately harmed by the Covid-induced economic crisis. Modelling again supports the economic, health and social value of an immediate focus on investments in education, training and employment support for those under the age of 25 years. Consequently, the focus in this budget on direct employment support for young workers and supported employment for young people with mental ill-health is smart.
With regards to education support, which is one of the major determinants of our future mental wealth, the government response is confused. Increased investments in the vocational education and training sector for skills development in young people are most welcome, but these need to be closely linked with place-based and real job opportunities. Sadly, the Morrison government has continued our long-standing reduction of national public investment in higher education. As most clearly stated by Senator Jacqui Lambie, these measures will exacerbate socio-economic and geographical inequities in educational opportunity.
To grow our collective mental wealth, other areas still require substantive support. Of particular note is the transformation of early childhood care to early childhood education, which appears to have stalled. Overcoming early disadvantage through more targeted and sustained interventions to those social groups that are most disadvantaged, as well as those with specific neurodevelopmental or emotional difficulties, is crucial.
Other essential services that underpin mental wealth, most notably in mental health and aged care, have been found wanting during Covid-19. Real and substantive investments, along with structural reforms, are urgently required. Although he has been in possession of the final report of the Productivity Commission report on mental health since 30 June (and the draft report since October 2019), the treasurer, Josh Frydenberg, has indicated that our national government is still formulating its response. What was required, but was not delivered by Tuesday was a large, strategic and swift response.
The budget papers predict that the commonwealth will spend $5.7bn on mental health in 2020 (alongside more than $6bn by states and territories). As national health spending is well over $180bn, mental health spending will not increase substantially above its long-term average of 7%. In fact, given the additional expenditures urgently required in the physical health and aged care sectors, real mental health spending may fall.
The health minister, Greg Hunt, has focused on the doubling of Medicare-subsidised sessions for psychological services from 10 to 20, and the estimated additional $50m cost of these services per year for two years. For those who require this additional care (estimated by the PC as less than 10% of those who access it) and are actually bulk-billed, this may be welcome. However, as highlighted by the PC in October 2019, this “better access” program may be ineffective, poorly targeted, inflexible and not provide enhanced access for those in greatest need, particularly those with more severe needs living in rural and regional Australia.
This latest very minor modification of “better access” does nothing for those who cannot afford the out-of-pocket expenses (often in excess of $50 per session), or those who live in those outer urban, poorer or rural and regional areas that are grossly underserviced. Further, it doesn’t tackle the much-needed financial support required to provide evidence-based and multidisciplinary team-based care for those with more complex or persistent disorders.
The prime minister, Scott Morrison, has emphasised the need to instil “hope” and “optimism” in the face of the national challenges presented by Covid-19. At this point, our future mental wealth will depend less on such encouraging sentiments and more on genuine confidence that our governments will choose economic, social and health policies that have the greatest likelihood of delivering better cognitive and emotional outcomes for all Australians.
Crisis support services can be reached 24 hours a day: Lifeline 13 11 14; Suicide Call Back Service 1300 659 467; Kids Helpline 1800 55 1800; MensLine Australia 1300 78 99 78; Beyond Blue 1300 22 4636
• Prof Ian Hickie is co-director of health and policy at the Brain and Mind Centre, University of Sydney