Indigenous Australians are three times more likely to experience high levels of psychological distress, and twice as likely to be hospitalised for mental illness than non-indigenous Australians.

And most tragically, Indigenous Australians are twice as likely to die by suicide.

Unspeakably, Aboriginal and Torres Strait Islander youth, are 14 times more likely to die by suicide than other young Australians.

The most shocking thing about these statistics from the Productivity Commission report last week is that they are not shocking: they are consistent with what weve known for years.

And so I acknowledge the traditional owners of the land on which we meet and pay my respects to their elders past, present and emerging.

But we must do more than that. We have to recognise that the cause of this disparity in mental health between our first Australians and non-indigenous Australians is deep seated but that this cannot be an excuse for failing to tackle it at its cause as well as service provision and we must commit to do so.

I acknowledge my colleague and friend, the Shadow Assistant Minister for Mental Health Emma McBride.

Ive had cause to seek out Emmas advice and counsel in our time in Health portfolio and her experience as a health care professional, specifically a pharmacist specialising in psychiatric care has been invaluable. If you havent met Emma yet, I encourage you to seek her out and get to know her.

I also acknowledge your Chair Mick Reid, whom I have known for many years and indeed worked with in previous lives for both of us, and your CEO Tony Stevenson and thank them for the invitation to join you tonight.

Ive been asked to speak about the intersection of mental health policy and economic policy, an area of interest to me.

But the Productivity Commission has beat me to the punch, because much of its draft report released almost two weeks ago was focussed on this very intersection.

It found that mental ill-health and suicide cost Australia up to $180 billion a year nearly $500 million a day.

Some of that is the direct cost of providing health care to people with mental ill-health.

Some of it is the direct costs that are borne in other sectors like education, housing and justice

But the Productivity Commission also did excellent work to quantify the less obvious impacts of mental ill-health across our economy and our society.

Of that $180 billion, $15 billion is borne by families and friends who provide informal care a contribution that is rarely recognised or remunerated

Up to $17 billion is borne by employers through lost productivity.

And the lions share $130 billion is borne by individuals in the form of diminished health and reduced life expectancy.

So its clear that theres an economic imperative for mental health reform, alongside the obvious social and moral imperatives

As we think about reform including in light of the Productivity Commissions draft report and its final report next year I think we need to ask three questions

Theyre questions that Ive taken to asking across health in my first months in the portfolio, but I think theyre particularly relevant in mental health and suicide prevention

First, can Australians access affordable health care when and where they need it?

Second, do all Australians have a fair shot at a healthy life?

And third, are we reforming our health system to improve outcomes and meet the demands of the future?

Let me address each of those briefly.

First access.

Mental Illness Fellowship of Australia members do crucial work to expand access to services and supports for Australians with mental illness.

Your members support over 20,000 Australians every year.

And Im particularly impressed that over 60 per cent of the workforce you represent has lived experience, either of mental illness or caring for someone with mental illness.

I think thats a vital perspective, and I was pleased to see the Productivity Commission recognise the importance of listening to consumers and carers too.

But despite your hard work, and that of thousands of others, we all know that Australia is not meeting demand for mental health and suicide prevention services.

Of the 3.9 million people with mental illness in Australia, 1 million dont access services thats 1 in 4.

And even those who do access services often arent able to follow them through to recovery.
Under the Medicare Better Access program, for example, 1 in 3 people only attend one or two sessions, dropping out due to out-of-pocket costs or difficulty finding providers.

So I think access needs to be a key focus of our reform discussions.

So does my second question, on equity.

In one sense mental illness is ubiquitous and doesnt discriminate.

1 in 5 Australians experience mental ill-health in a given year, and 1 in 2 do so over their lifetime.

But while mental ill-health can affect anyone, we know that the social determinants of health swing into action in relation to mental health just as much as they do for physical health.

Ive already spoken about Aboriginal and Torres Strait Islanders, and there are a range of other groups that are disproportionately affected by mental illness and suicide such as young Australians and those who live in the bush
Addressing these inequities will depend partly on access to services my first point.

For example, people in our capital cities are nearly twice more likely to access mental health services

Thats one reason why regional communities have a 54 per cent higher rate of suicide than capital cities.

But its only one reason.

Even if we could address service gaps tomorrow, we wont achieve equity in mental health and suicide prevention until we tackle the social determinants of health.

And so I welcome the Productivity Commissions recognition of the importance of non-health services, including psychosocial supports, housing services, the justice system, workplaces, social security and education

If anything, we need a much greater consideration of mental health in all policies and the social determinants.

Afterall, the opening line in Sir Michael Marmots magisterial The Health Gap is about his epiphany as a medical student at the University of Sydney, when he observed a clinician simply change the medication of a woman who was suffering depression and then send her back to the very same life circumstances that were making her depressed.

Thats the moment he realised There must be a better way.

Which brings me to my third question: whether were reforming our health system and indeed other systems to improve outcomes and meet the demands of the future.

Thats the challenge that we face over the coming months and years.

Its good that the Government has ordered the Productivity Commission inquiry and appointed a National Suicide Prevention Advisor.

And its good that theyve implemented some changes, like the recent expansion of Better Access sessions for people with eating disorders.

But I think youd agree that so far weve seen evolution, when I think we need revolution or as the Productivity Commission calls it, a generational shift in mental health

If the Government takes on that challenge and leads a national process to improve the mental health of all Australians, theyll have my full support.

If not, they should expect my condemnation, and the proposal for a better way from me and the alternative government.

I look forward to working with you in the months and years ahead.