Mental illness covers a range of disorders including anxiety disorders, affective disorders, eating disorders, psychotic disorders, personality disorders and substance use disorders. However, mental health is a much broader concept of wellbeing and is impacted by other determinants including a person’s access to services, living conditions and exposure to adverse childhood experiences and trauma.1 For Aboriginal and Torres Strait Islander peoples, wellbeing is a holistic concept that encompasses the importance of connection to land, culture, spirituality and ancestry and how these affect the wellbeing of the individual and the community.2
It is estimated almost half of all Australians will experience a mental health disorder at some point in their life.3 In 2017–18, approximately 20% of Australians aged 16–85 years reported experiencing a mental health disorder. Anxiety-related conditions are the most common, affecting 13.1% of Australians, followed by affective disorders which affected 6.2%.3-5 Medicare data shows 10.7% of Australians accessed Medicare-subsidised mental health-specific services in 2019–20, up from 6.2% in 2009–10.6 Children and adolescents are significantly affected by mental illness with one in seven four- to 17-year-olds having had a mental health disorder in the last 12 months.7
The burden of mental health concerns in Aboriginal and Torres Strait Islander peoples is 2.4 times the rate of non-Indigenous Australians, with risk factors including socioeconomic disadvantage, trauma, discrimination, widespread grief and loss and separation from culture.8-10 While rates of mental illness in rural areas are similar to those across the country, self-harm and suicidality increases with remoteness.11 Access to services can be limited in rural and remote areas and stigma relating to mental illness and reluctance to seek help may be higher.12 Stressors in rural areas include fewer employment opportunities, lower incomes, less financial security, housing instability and greater exposure to natural disasters.11
The COVID-19 pandemic has seen an increase in stress and anxiety in the general population and an exacerbation in symptoms for those with pre-existing mental health concerns. There have been increases in calls to Lifeline (up 18.4%), Kids Helpline (up 10.5%), and Beyond Blue (up 30.7%) in April 2021 compared to April 2019, and an increased demand for Medicare Benefits Schedule-subsidised mental health services.13
Mental illness contributes a high proportion (23%) of the non-fatal burden of disease in Australia and in 2019 there were 3318 deaths in Australia attributed to suicide.12,14 People with mental illness are more likely to develop physical illness with higher rates of arthritis, asthma, back problems, cancer, chronic obstructive pulmonary disease, cardiovascular disease, kidney disease and osteoporosis.15 This is a result of lifestyle, socioeconomic and system-level factors including social stigma, lack of health service integration, a lack of physical health monitoring and medication side effects.15 Adverse social experiences and trauma in childhood including the trauma associated with parental mental health disorders, domestic violence, abuse and neglect and childhood mental illness have been linked to poor physical, mental and socioeconomic outcomes in later life. However, early intervention with children and families can help prevent these adverse outcomes.16
Much of the care for patients with mental health disorders, particularly for high prevalence disorders such as anxiety and depression, falls to general practice. The 2020 RACGP Health of the Nation survey found that psychological issues, including depression, anxiety and sleep disturbance, are the most commonly seen presentations in general practice with 64% of general practitioners (GPs) reporting it as one of the three most common reasons for patient presentations.17 GPs see people throughout their lifecycle and play a critical role in psychoeducation, prevention, case finding, early intervention, support and treatment for patients with mental health conditions and the physical health conditions and associated social issues that often accompany them.