Ten per cent of Australians live in regional and remote areas – that’s 2.6 million people who can’t easily access the mental health services they desperately need. How can rural businesses help? I recently asked a friend from Brisbane if she would pack up her family and move to a rural town in Australia if she knew that cancer rates were twice as high than those in the city? She looked aghast and said no, of course she wouldn’t.  I then asked, “what if your son had a chronic condition and you knew that 75% of the specialists he would need were based in major cities, would you move to a rural town then?” Her answer, as expected, was another emphatic no.  And yet, this devastating reality is what we ask of regional and rural Australians suffering from mental health issues. Between 2010 and 2017, the rate of suicide in remote areas was almost double that of major cities, and in 2015 VicHealth reported that 88% of psychiatrists, 75% of mental health nurses and 75% of registered psychologists were employed in major cities, leaving the remaining workforce to serve all other rural and regional areas. Is this truly the best we can do? SPECIALISED ACCESS Last week the results of a review of the Australian Government’s Better Access mental health scheme were released, and the results showed that the scheme is inequitable in its current format, especially for those in rural and regional areas. In fact, a 2015 study found the delivery of Better Access services was typically greater in more advantaged urban areas. In order to combat this inequity, the Australian Psychological Society (ASP) is recommending to the government that a new certification for regional and rural psychologists be created as a recognition of the unique skills required to work in remote areas. By creating a regional psychology speciality there is hope that access and delivery of rural mental health services will receive more focus and funding from the government in years to come. But, until such provisions are up and running, where can people turn for help today? OFFERING OPTIONS With limited access to qualified and specialised psychologists within a reasonable distance from their home or workplace, many rural Australians are struggling on a day-to-day basis. This impacts their productivity, increases their likelihood of absenteeism from work and creates problems in their personal lives. In small and remote communities, one person’s struggle soon affects everyone.  Often people who live in small rural communities are reluctant to seek treatment because of a perceived lack of anonymity and confidentiality - walking into a psychologist’s office in a large city is nerve-wracking enough, but knowing that your entire community is witnessing you take that step can be downright terrifying.  Plus, in urban centres you have the option of finding a mental health professional that is right for you - there are numerous choices available - but in regional areas you likely have only one option, and if that person isn’t a good fit there may be no realistic alternative available.  Until the government manages to provide modern and forward-thinking regional mental health services, rural businesses can help fill the chasm the government is unable to close. Businesses that offer digital and online mental health services to employees allow them to access the immediate help they need, on their terms, and in complete anonymity. The range of mental health professionals available on platforms such as Cyber Clinic means people can find someone who understands their unique circumstances as someone living in a regional or remote community, and who has an approach that works for them.  The positive effects of providing online mental health support will not only be felt in the workplace, where an employee’s work satisfaction and morale will increase and hence business productivity, but in the wider community. Regional and rural Australians are known for being tight-knit and supporting those in their communities during tough times – offering access to online mental health services may be the most important support there is.

The terms of reference have been finalised and the commissioners announced but will Victoria’s Royal Commission into Mental Health actually deliver on its promise to improve mental health outcomes? On the announcement of the Royal Commission into Victoria’s Mental Health System just before the state election last year, I was equally sceptical and hopeful. The first of its kind in Australia, the commission couldn’t be more needed, but I felt unease at mental health issues being used for political point-scoring.  One in five Victorians will experience mental health problems this year, and yet, currently the state government only funds enough mental health services to cater for one per cent of the population, not 20 per cent. In fact, it’s the lowest per capita spend on mental health services of any state in Australia.  But funding is only one indicator of how well mental health services are functioning to meet demand, and according to the 8,000 Victorians who made online submissions for the initial phase of the commission (eight times more than the number of people who made submissions to Victoria's family violence royal commission) the system is clearly broken. The demand for change is overwhelming.  By the government’s own admission, despite the number of people who experience mental health issues in the state, only about half receive treatment. Why, in one of the most developed countries in the world, are people not getting the level of access they need? We can, and must, do better, but will the royal commission listen?  A SYSTEM FOR THE FUTURE Our current mental health system is fragmented, difficult to navigate and, most alarming of all, dehumanising to people at the very moment in time they need the most human connection.   In our modern world, there is often outcry about the dehumanising nature of digital technologies, and yet, time and again, those same technologies have brought us closer together. We connect with loved ones on the other side of the world, or doctors’ who are hours away from home, at the click of the button. Human connection is not lost because of technology, it is lost due to bureaucracy.    We live in the 21st century, and yet our mental health system is severely outdated, without any understanding of how to meet the changing needs of our society. We need to invest in digitizing mental health delivery – actually funding service provision and access in a modern way – rather than simply raising awareness and funding education programs.  A strong digital infrastructure is the backbone of every part of contemporary society – mental health should be no different. Unless the royal commission looks for solutions grounded in the future, too soon any recommendations it gives will once again leave our mental health system in the past. WHAT HAPPENS NEXT? Now that the first phase of the commission is over, the terms of reference have been finalised (which can be found in full here). These include how to effectively prevent mental illness and suicide, how to help people navigate the system, how to help families and those with mental illness and how best to support people with mental illness and drug and alcohol issues. In coming months, the commission is expected to release information on how the inquiry will be conducted, including how the community can contribute to its work. The commission is scheduled to produce a preliminary report by 30 November this year, and a final report in October 2020.  I encourage everyone to work with the royal commission if they can and push for radical change – anything less will be a heavy indictment that politics comes before people.

Australia has launched its first ever Productivity Commission on mental health – and as far as solutions go, digital health needs to be front and centre. There was a time in Australia when construction workers didn’t wear hard hats onsite, factory workers had to work 12-hour days, and no one had even heard of an OH&S safety demonstration.  Government regulations and workplaces evolved over the past 100 years for two important reasons – to protect workers and to protect the economy. It simply wasn’t good business to have once productive employees laid up in bed with broken bones or exhaustion – safe and supportive workplaces meant better productivity for companies and a better Australian economy overall. In 2019, our ‘lucky country’ now has some of the most stringent workplace safety laws in the world. But, the nature of work has changed dramatically in the 104 years since the Australian industrial relations system began. While physical health and safety must always be a primary concern, the mental load workers are placed under in our highly pressurised society is taking a toll – on them, and our economy.  AN INVISIBLE CRISIS Just last month the World Health Organisation (WHO) estimated that the loss of productivity resulting from depression and anxiety is costing the global economy US $1 trillion each year. Here in Australia, four per cent of our GDP is lost every year due to productivity losses as a result of workers’ mental health issues – that’s at least AU $60 billion! However, in an extremely welcome and encouraging move, the government has established Australia’s first-ever Productivity Commission to ‘examine the effect of mental health on people’s ability to participate in and prosper in the community and workplace, and the effects it has more generally on our economy and productivity’.  Initial submissions are open until 5 April this year, and I encourage everyone to make their voices and concerns heard during this important process.  But, given the staggering economic impact of mental health on Australia’s economy why has this commission taken so long to be convened? Well, recognising and diagnosing mental health issues is much more difficult than identifying physical hazards in the workplace – we struggle as people to fix what we can’t see. And, importantly, solutions for improving the mental health of employees aren’t as easy to come by as clearly marking fire exits and limiting work hours.   REMOVING BARRIERS In 2014, an IBIS report on the Employee Assistance Program (EAP) sector suggested that the usage rate of EAP services in certain industries could be as low as five per cent. The research indicated that employees generally don’t trust EAP services, are concerned about the confidentiality of such programs, and that they are perceived to have a poor quality of care – practitioners are inexperienced, or not well-matched with their clients.  In this environment, many businesses are increasingly looking to alternative solutions. Digital health is easy for employees to access, especially remote workers or those in rural areas, and can be used at their convenience, so after hours or even on weekends.  Most importantly, digital health platforms like Cyber Clinic use sophisticated algorithms to better match practitioners with patients, measure quality of care, and ensure trust and confidentiality are the foundation of all practitioner-patient relationships.  A 2019 report identified that a barrier to using telehealth in Australia was the perception of the loss of the ‘human touch’ aspect of care – only 14 per cent of the population said remote appointments using hologram doctors in their home would have the most impact on improving healthcare today. But we don’t need to beam doctors into homes or workplaces to see positive outcomes – the digital health platforms that connect patients and practitioners via video can be just the right mix of technological innovation and human care. Digital health can change lives, improve productivity and increase Australia’s GDP, and my hope is that one day mental health support in the workplace will be as clearly visible as a well-marked fire exit.