The trend in mental health-related mortality rates in Australia 1916-2004: implications for policy.

Darrel P Doessel,Harvey Whiteford,Ruth Fg Williams

doi:10.1186/1743-8462-7-3

Abstract

BackgroundThis study determines the trend in mental health-related mortality (defined here as the aggregation of suicide and deaths coded as "mental/behavioural disorders"), and its relative numerical importance, and to argue that this has importance to policy-makers. Its results will have policy relevance because policy-makers have been predominantly concerned with cost-containment, but a re-appraisal of this issue is occurring, and the trade-off between health expenditures and valuable gains in longevity is being emphasised now. This study examines longevity gains from mental health-related interventions, or their absence, at the population level. The study sums mortality data for suicide and mental/behavioural disorders across the relevant ICD codes through time in Australia for the period 1916-2004. There are two measures applied to the mortality rates: the conventional age-standardised headcount; and the age-standardised Potential Years of Life Lost (PYLL), a measure of premature mortality. Mortality rates formed from these data are analysed via comparisons with mortality rates for All Causes, and with circulatory diseases, cancer and motor vehicle accidents, measured by both methods.ResultsThis study finds the temporal trend in mental health-related mortality rates (which reflects the longevity of people with mental illness) has worsened through time. There are no gains. This trend contrasts with the (known) gains in longevity from All Causes, and the gains from decreases achieved in previously rising mortality rates from circulatory diseases and motor vehicle accidents. Also, PYLL calculation shows mental health-related mortality is a proportionately greater cause of death compared with applying headcount metrics.ConclusionsThere are several factors that could reverse this trend. First, improved access to interventions or therapies for mental disorders could decrease the mortality analysed here. Second, it is important also that new efficacious therapies for various mental disorders be developed. Furthermore, it is also important that suicide prevention strategies be implemented, particularly for at-risk groups. To bring the mental health sector into parity with many other parts of the health system will require knowledge of the causative factors that underlie mental disorders, which can, in turn, lead to efficacious therapies. As in any case of a knowledge deficit, what is needed are resources to address that knowledge gap. Conceiving the problem in this way, ie as a knowledge gap, indicates the crucial role of research and development activity. This term implies a concern, not simply with basic research, but also with applied research. It is commonplace in other sectors of the economy to emphasise the trichotomy of invention, innovation and diffusion of new products and processes. This three-fold conception is also relevant to addressing the knowledge gap in the mental health sector.

Highlights

This study determines the trend in mental health-related mortality, and its relative numerical importance, and to argue that this has importance to policy-makers
Burden of disease studies indicate that the impact of mental disorders is considerable [1,2,3], while the latest Australian Institute of Health and Welfare (AIHW) report on relative health expenditures by disease groups
In order to extract data on mental health-related mortality, annual data were summed across the relevant ICD codes for “suicide” and “mental/behavioural disorders”, by five year age-groups, from the AIHW [23] and for the years prior to 1968, from Australian Bureau of Statistics (ABS) historical data [46,47,48,49]

Summary

Introduction

This study determines the trend in mental health-related mortality (defined here as the aggregation of suicide and deaths coded as “mental/behavioural disorders”), and its relative numerical importance, and to argue that this has importance to policy-makers. Burden of disease studies indicate that the impact of mental disorders is considerable [1,2,3], while the latest Australian Institute of Health and Welfare (AIHW) report on relative health expenditures by disease groups with almost all mental disorders [8] Another approach– that of the psychological autopsy–has found that about 90 per cent of people who die by suicide have at least one mental disorder at the time of death [9]. The PYLL metric subsequently achieved prominence in the burden of disease work of Murray and Lopez [21] It is routine practice for the Australian Bureau of Statistics (ABS) [22] and the Australian Institute of Health and Welfare (AIHW) [23] to report both headcount and PYLL measures of suicide. These studies show the added information gained by applying both headcount and PYLL metrics

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