Around 38% of the Australian community, have some level of mental health need
An understanding of the prevalence of mental illness across the spectrum of severity sets the context for understanding the different service responsibilities across the sector. In total, 9.1 million people have some level of mental health need. Not all require health care or professional treatment, nor will they seek formal assistance; however, when they do, it is imperative that that they receive the right care in the right place at the right time.
The experience of mental health conditions ranges across a wide spectrum. The most common experience is of approximately 5.4 million people ‘at risk’ who do not meet criteria for a diagnosis but who have some mental health need. This includes people who have had a previous illness and are at risk of relapse without ongoing care, as well as those who have early symptoms and are at risk of developing a diagnosable illness.
For these people, prevention and early intervention through primary health care (mainly general practitioners), digital mental health and self-help services are most relevant. These services are predominantly the responsibility of the Commonwealth.
Efficient, effective & mental health care
People with mild mental illnesses, estimated at 2.1 million people, as well as those with moderately severe mental illness, around 1.1 million people, represent the next largest groups. People with mild to moderately severe illnesses are also predominantly managed in the primary mental health care system, with the bulk of services currently being provided through general practice and the Medicare Better Access initiative. Again, this layer of service responsibility rests with the Commonwealth.
At the highest end of the spectrum of need, there are approximately 715,000 people with severe mental illness. For this group, the responsibility for clinical services is shared between the Commonwealth and states, as well as private hospitals. The National Disability Insurance Scheme will provide support to eligible individuals experiencing the most significant disability associated with severe mental illness.
Principles of stepped care across Country SA
By introducing principles of stepped care across the State, we are able to focus on service delivery that matches the needs of individuals and has a particular emphasis on early intervention and self-care. That is, the person presenting to the mental health system is matched to the intervention level that most suits their current need.
They do not have to start at the lowest level of intervention in order to progress to the next step, rather they have their service level aligned to their requirements. Stepped care is defined as an evidence-based, staged system comprising a hierarchy of interventions, from the least to the most intensive, matched to the individual’s needs.
While there are multiple levels within a stepped care approach, they do not operate in silos or as one directional steps, but rather offer a spectrum of service interventions. In a stepped care approach, a person presenting to the mental health system is matched to the intervention level that most suits their current need.
An individual does not generally have to start at the lowest, least intensive level of intervention in order to progress to the next step. Rather, they enter the system and have their service level aligned to their requirements.
Stepped care levels of need based on severity
*Source: Adapted from Figure 8 , COAG Health Council (2017), The Fifth National Mental Health and Suicide Prevention Plan, Commonwealth on Australia