The Growing Crisis: Mental Health Problems in Australia Essay

This essay provides a comprehensive overview of mental health problems in Australia, addressing the critical issues of suicide and self-harm within the healthcare system. It explores the prevalence of mental illnesses such as anxiety, depression, and substance use disorders, highlighting their impact on individuals, families, and the broader community. The essay delves into the statistical data, including the alarming rates of suicide among adolescents and the economic burden associated with mental health issues. It examines the factors contributing to the crisis, such as lack of access to healthcare and discrimination, and discusses the implications for nurses and healthcare professionals. Furthermore, the essay reviews the interventions and economic consequences of suicide and self-harm, emphasizing the need for effective prevention strategies and a more robust mental health architecture in Australia. The findings underscore the urgent need for comprehensive mental health support and resources to address the growing crisis.

Running head: MENTAL HEALTH PROBLEM IN AUSTRALIA
MENTAL HEALTH PROBLEM IN AUSTRALIA
Name of the student
Name of the university
Author note

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Introduction
Suicide and self-harm constitute one of the most severe safety issues within the mental
health setting in Australia. The issue has gained and continues to gain considerable attention in
the health care sector because it directly indicates the catastrophic failure of the system. Such a
failure could result in the loss of confidence of the people from the mental health care system. In
Australia, the health ministers have agreed that suicide and self-harm within inpatient units
amount to sentinel incidence in health care and should be publicly reported. Suicide has an
impact on not just the person suffering from mental illness but also on families and friends along
with the community as well (Www1.health.gov.au, 2019). Apart from suicides occurring in the
inpatient units, these occurring while the health receivers are on leave or absent without leave or
on days following immediate discharge also are counted within suicides in a mental health care
setting.
People with mental health issues are at a greater risk of committing suicide or indulge in
self harm than those with physical illness, as Singhal et al. (2014) argue. The authors found in
their study that psychiatric illnesses such as depression, anxiety, bipolar disorders, substance
abuse and schizophrenia have remarkably high rates for self harm and suicide. Tofthagen,
Talseth and Fagerström (2014) on the other hand, conducted study on the experiences of the
nurses looking after inpatients with self-harm tendency. The study found that mental health
nurses (MHNs) could promote patient care in mental health care setting to stop them from
harming self. Suicides within mental health care settings have been found to be preventable and
that occurred because of the negligence of the caretakers making omissions in care such as not
taking a follow-up of the patient or continuing care post-discharge. Some also argue that the
suicides that occur for periods of more than a year after the discharge from health care setting

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also amount to serious events especially when consumers are within the care of mental health
services of the community. These events are considered overall failure of the health care system
by the community members. Silmi et al. (2016) argue that understanding the ways to “confront,
intervene, and manage episodes of patient deliberate self-harm is extremely important, and can
be life-saving”. The authors suggest that in order to prevent deliberate self-harm in the metal
healthcare setting, previous episodes of the events have to be the main predictor.
These studies prove the fact that suicide and self-harm within the mental health setting is a
concerning issue of healthcare safety.
Background
The mental health issue is a widespread problem in Australia as recognized by the
Department of Health, Government of Australia. The problem has considerable effect at the
“personal, social and economic levels” in the country ("Department of Health | The magnitude of
the problem", 2019). According to the Australian Bureau of Statistics (ABS) reports, one in
every five people between the age of 16 ad 85 years suffer from any one form of mental illness
that might include anxiety, depression, mood disorders and substance use disorders amongst
others (Abs.gov.au, 2019). The rate of prevalence varies across the lifespan and it is the highest
during early adult years. The rate is highest in this age because this is the period when
individuals usually focus on establishing their careers and families and living an independent
life. Anxiety and affective disorders are the most prevalent in adults who are affected by it each
year. Around one-third of the population has more than one mental disorder. Known commonly
as “high prevalence” illnesses, such mental health disorders could include post-traumatic stress

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disorder (PTSD), bipolar disorder, obsessive compulsive disorder (OCD) and depression. All
these illnesses have different treatment requirements (Abs.gov.au, 2019).
According to the recent reports, child and adolescent males constituted the largest share
of population suffering from a mental health problem. They made up 16.3% of the total
population in the last one year particularly. Mental disorders could range from severe to episodic
in nature (Aihw.gov.au, 2019). In one of the recent reviews on mental health illness, it has been
found that around 615,000 people as per the 2017 population suffer from severe mental
disorders. This section of the population is not confined only to people with psychotic disorders
but also includes people having serious forms of anxiety and depression. Around one million
people constituting 4 to 6% of the population are found to suffer from moderate disorder while
about 2.5 million people are diagnosed with mild disorders. The Australian Burden of Disease
Study of 2015 revealed that 12% of the total burden of disease was due to the mental and
substance use disorders (Aihw.gov.au, 2019). This placed it fourth in the list of diseases with
most burdens after cancer, cardiovascular diseases and musculoskeletal conditions.
As evident from the above discussion, mental health in Australia is a significant problem,
which has not received adequate attention. Australia currently lacks “overarching mental health
architecture” as there is no structure or national design that could facilitate prevention and proper
treatment for people with mental illness.
The implications of health outcomes are the Suicide and self-harm, according to the
Australian Institute of Health and Welfare. These are significant issues of public health in the
country and its gravity could be fathomed from the fact that more than 2000 Australians have
lost their lives owing to this since the mid-1980s. With the turn of the century, the rate increased

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and more than 20,000 Australians have been admitted to mental health care setting every year.
Perera et al. (2018) found that when it comes to suicidal ideation and self-harm or intentional
poisoning, the adolescents constituted the majority group with 13.8% cases of suicide and self-
harm in a year. The study also revealed several other factors that are a cause of concern for the
mental healthcare practitioners and experts as well as the administration. Suicide is the leading
cause of death in Australia especially amongst adolescents. During the period between 2010 and
2014, the mental health admissions in the emergency departments in Australia’s New South
Wales (NSW) region increased remarkably. The national rate of 2.3 deaths per 100,000
populations in Australia during the 2012-2016 amongst adolescents shows an alarming picture of
the current status of mental health care in the country (Aihw.gov.au, 2019). Weiland et al. (2014)
further assert that the clinicians have the crucial role to play in assessing the mental health
condition of the patients in the mental health care setting especially those with a tendency to self-
harm he clinicians and suicide. The authors found that the confidence of the clinicians in making
disposition decisions for patients with self-harm and suicidal tendencies depended on the
decision support factors, clinicians, patients and context relevant to the emergency decisions in
the Australian context.
The prevalence of suicide and self-harm in Western Australia is significantly high than in
many regions of the country. As per the recent reports on suicides in Western Australia, 60%
women and 35% men who committed suicide had one or the other psychiatric disorder in the
preceding one year between the years 1986 to 2006. Amongst those who committed suicide, over
one-third of them were undergoing treatment at a private or public mental health care hospital
during their lifetime (Health.wa.gov.au, 2019). Out of the said patients 15% of men and 20% of
women died by committing suicide on the day of their discharge from the hospital. One-third of

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them committed suicide within one month of discharge. The prevalence of suicide amongst
Aboriginal and Torres Strait Islander people in Western Australia is thrice the rate of suicides
amongst non-Aboriginal Australians. In more recent studies, it has been found that mental illness
was present in around 90% of the population especially in countries with higher socio-economic
status. Schizophrenia, bipolar disorder, major depression, anorexia nervosa and borderline
personality disorder have been found to be the major conditions depicting a greater risk of
suicidal and self-harm behavior. The Western Australian government protects the rights of the
people with mental illness through the Mental Health Act 1996 that includes ensuring people
with mental illness receive the finest care and treatment (Ombudsman.wa.gov.au, 2019). This
has to be done with least restriction and interference on the freedom and rights and dignity of the
patients. The act also mentions ensuring the protection of not only the patients but the public as
well and minimizing the negative effects of mental illness on the family life of the patients.
These facts clearly demonstrate that mental health issue and the problem associate with it is quite
prevalent in Western Australia.
Mental health challenges among the Australians have perpetuated the issue due to the
factors of colonization, lack of proper access to health care facilities by most of the country
people suffering from illness and the factor of discrimination that is faced by most of the
population of Australia.
According to Shaw and Sandy (2016), self-harm and suicide is an old problem but has
grave implications for the individuals as well as the healthcare system. They argue that the issue
of self-harm not only impacts the patient but also the health of the nurses. The nurses become
exhausted with the rigorous care they have to take in trying to protect the patients from self-
harming. Suicide and self-harm also has implications on the health of the families of the patients.

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Spillane et al. (2017) found in the study that suicide of a close one results in the occurrence and
reoccurrence of grief causing severe health reactions. Furthermore, it also results in extreme
depression owing to the struggle in coping with the loss. Morken et al. (2019) however focused
their study on the effects of the interventions that aim to prevent self-harm and suicide in
adolescents and children. The results of their study revealed that there is “moderate certainty
evidence suggesting school-based interventions to prevent suicidal ideation and attempts short
term, and possibly with long term effects on suicide attempts”. The results also indicated that the
community-based intervention effects are not certain. Kinchin et al. (2017) on the other hand,
tried to evaluate the economic implications of suicide of the youth in Australia. The costs
included the direct costs such as police, coronial inquiry, ambulance and funeral expenses and
indirect costs like the economic productivity, intangible costs such as bereavement. The results
indicated that more than 2 million dollars – around 9700 dollars in direct cost and 2, 788, 245
dollars as productivity loss including 86,000 dollars as the cost of bereavement – comprise the
total cost of youth suicide. In terms of the total economic loss bore by Australia due to suicide
stood at an estimated 22 billion dollars in a year. The study brings forth the gravity of the issue
and the need to come up with effective strategies for suicide prevention. Kinchin and Doran
(2017) nonetheless, tried estimating the economic implications of self-harming behavior. They
find that the admissions in Australian hospitals owing to self-harm cost around 55 million dollars
in a year. It also led to the loss of loss of potential and productive years of life. According to their
results, average 60 years of life is lost due to self-harming behavior every year. Approximate
0.6% cases of self-harm lead to full incapacity that cost around 243 million dollars. The
multiplication of “the estimated average cost of a suicide by the average number of suicides
equates to 1.35 billion dollars every year”, the authors found (Kinchin and Doran, 2017). This

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brings the total estimated cost of self-harm and suicide to 1.65 billion dollars a year in
Australians between the age of 15 and 29.
The problem of suicide and self-harm especially within the mental health care has huge
implications on the health of the nurses especially the nurse managers. The duties of a nurse
manager demand interacting with patients with psychiatric conditions and their families. This
leads to increased risk of burnout and other physical and emotional risks for the nurses. As
Awenat et al. (2017) found, apart from the suicide attempts or complete suicides, the
contributing factors leading to suicidal ideation also make the job of the nurse manager
extremely difficult and important for mitigating the suicide attempts by the patients. The nurses
in Australia have the added complexity of dealing with patients from Aboriginal and Torres
Strait patients as this is culturally sensitive as well. It has been found that the rate of suicides
amongst the Indigenous people is the highest in Australia as compared to non-Indigenous
Australians (Www1.health.gov.au, 2019). According to the report of the Royal Commission into
Aboriginal Deaths in Custody, the interrelated issues of personal trauma, cultural dislocation, the
continuing stress of disadvantage, alienation, racism are all contributors of the heightened danger
of mental health issues, substance use and suicide amongst Indigenous people. The nurses have
to be extremely sensitive and knowledgeable about these issues while dealing with patients
belonging to the Indigenous community. Robinson et al. (2016) talk about the prevention of
suicide and self-harm amongst Aboriginal people especially in inpatient units. The authors claim
that suicidal behavior is the most common in acute psychiatric wards. Around 940 youth suicides
were recorded in the study in the inpatient psychiatric wards. They further found that around
10% of the suicides took place in the psychiatric inpatient units and prisons. Suicide amongst
Aboriginal people has been reported in these settings. This further makes the job of the nurses

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extremely difficult as they have to bear the brunt of witnessing suicides being attempted and
committed within their care.
Slemon, Jenkins and Bungay (2017) find that although the aim of the mental health care
for the consumers has to be “treated within the community”, some cases require inpatient care
equipped with facilities. Their study revealed that nurses in Australia tend to concentrate more
on the physical and safety needs of the patients rather than their mental health needs. The nurses
have greater resources and they are more educated as well but they often fail to utilize these to
their advantages. This demonstrates the need of strong nursing leadership where the role of the
nurses could be expanded to look after the mental health needs of the patients as well.
Furthermore this health challenge has captured the interest for analysis due to the increasing
death rates among the Australian population due to mental challenges and the publication of the
sufferings of the mentally challenged people who are furthermore being socially isolated, also
from their family members.
Description of solutions
Suicide and self-harm constitute issues that are alarmingly increasing with each passing
day and that have raised doubts over nursing practice and leadership. Mental health patients and
their families have started to lose faith on the mental health care practitioners owing the steadily
growing rates of suicides under their care. As the discussion in the previous sections have
revealed, suicide and self-harm amongst psychiatric patients in Australia is on the rise. The
discussion also revealed the various psychiatric disorders that are prevalent in the country and
that lead to self-harming tendencies. The situation is more alarming in case of Aboriginal and
Torres Strait Islander people. Saurman et al. (2014) report that the prevalence of mental illness is

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equivalent to those in the major cities but the difference lies in the access to mental health
services. The report finds that Aboriginal and Torres Strait Islander people living in rural areas
have limited access to mental health services than in other major cities. According to the data
present in the government record, in remote and very remote areas, only 5 to 2 mental health
professionals are available. In terms of the availability of mental health nurses as well, the
figures are quite less. While there are 73 nurses available for every 100,000 people in major
cities, only 29 are there in very remote areas (Aihw.gov.au, 2019). In an article published by The
Conversation, it was stated that the best intervention for the problem would be to “listen rather
then tell”. This means that the nurses must pay heed to and value the views of the Aboriginal
people while intervening in the problem (Theconversation.com, 2019). Owing to the lack of
mental health professionals and nurses, the cases of suicide and self-harm are registered at a
higher rate. Suicide and self-harm within the mental health care setting is something that has
concerned nurses across countries. However, despite being such a concerning issue, the
interventions to tackle it is few in the nursing literature.
Despite the limited availability, several interventions have been suggested to address the
issue of suicide prevention especially in the mental health care setting. Hogan and Grumet
(2016) presented a model named “Zero Suicide” to prevent suicides in health care settings. The
model identifies the patients in a better way by incorporating “new tools for screening, treatment,
and support”. The authors argue that the model has been successful in deploying promising
results especially in primary care settings. On the other hand, Slemon, Jenkins and Bungay
(2017) argue that the most effective way to help the patients within psychiatric units is for the
nurses to provide “individualized, flexible care that incorporates safety measures while also re-
evaluating the risk management culture that gives rise to and legitimizes harmful practices. They

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argue that the use of risk management strategies such as close observations, door locking,
seclusion and defensive nursing practice have been found largely to be ineffective and even
demonstrating harm. As evident, it is important for the nurses to indulge in practices that are
aligned with the needs of the patients.
Goldstone and Bantjes (2017) conducted a study on effectiveness of suicide preventions
strategies amongst those with substance use disorders. The authors argued that strategies for
suicide prevention must be “culturally sensitive and specific to particular populations and socio-
cultural and economic contexts”. In their study, the authors found that training provided to
mental health care providers in suicide prevention should be enhanced. They also suggested that
optimizing accessible health care resources use, “increasing service provision for suicidal people
with substance use disorder (PWSUDs) and improving policies and regulations for the treatment
of substance use disorders” are effective in addressing the issue (Goldstone and Bantjes, 2017).
The strategies as mentioned by the authors have been suggested by the mental health care
providers and hence, it does have some credibility. It is however essential for the mental health
care providers to deviate from the biomedical approaches and include a better contextual
perception of suicide prevention. In contrast to this, Zalsman et al. (2016) argue that it is difficult
to ascertain the effectiveness of all the prevention interventions. According to the authors,
“clinicians and practitioners often face difficulties in assimilating the evidence base for suicide
prevention interventions”. In their views, it is important to include innovative research designs
for addressing the knowledge gap “as it will facilitate optimal allocation of resources for suicide
prevention”.
The role of nurses and nurse leaders in particular is considered crucial in proposing and
implementing effective interventions for preventing suicide and self-harm in mental health care

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setting. Karman et al. (2015) assert that the capability of the nurses determines the status of the
patients admitted in health care settings demonstrating suicidal ideation. They found that the
nurses in the Australian emergency departments (EDs) have demonstrated a lack of proper
training in dealing with patients vulnerable for suicides. They also found that the interventions
involving seclusion and restraints by the nurses have been considered unethical and the nurses
too become emotionally exhausted by this. In order to tackle this, Mann, Bradley and Sahakian
(2016) present the suggestion of human rights based approaches to curb suicide and self-harm in
mental health setting. The authors argue, “human rights violations in mental health care across
nations have been described as a global emergency and an unresolved global crisis” (Mann,
Bradley and Sahakian, 2016). The violations mostly occur in the form of interventions to prevent
the patients from demonstrating self-harming behavior or attempting suicide. Thus, the authors
provide human rights based approach (HRBA) in mental health care settings to help patients
recover from the problem. As per their views, although the approach did not demonstrate any
high level of methodological intervention, it was found effective in providing low-cost
intervention. Nonetheless, it could be stated that the HRBA might be effective in ensuring no
human rights are violated, it could not essentially provide an effective solution to the problem.
Sakinofsky (2014) further provides suggestion on preventing suicides in the mental
health care settings. According to the author, “it is possible to reduce suicide risk on the ward by
having a safe environment, optimizing patient visibility, supervising patients appropriately,
careful assessment, awareness of and respect for suicide risk, good teamwork and
communication and adequate clinical treatment”. The author talks about teamwork and
communication as being important for addressing suicide and self-harm behaviors in mental
health care settings. For the nurses and health practitioners, teamwork and communication is