Labor needs to fight the black dog in the bush
Male suicide is two and a half times more likely in remote Queensland than in our cities. Last week Mental Health Minister Mark Butler released the Suicide in Rural and Remote Areas of Australia report, which studies suicide in detail but offers precious few solutions.
It is yet another document launch from a federal government with a patchy record in both rural health and mental health policy.
Mental heath is the challenge of our generation. It costs Australia around $6 billion annually, with the bush bearing more than its fair share. The Government doesn’t even have a regional health portfolio. That leaves the Coalition to doggedly pursue Labor to maintain any focus on mental or rural health.
Those living with mental health issues deserve all the support we can provide. So it is disappointing that a breakthrough drug now funded in a number of countries overseas has been refused funding approval here for the third time. The manufacturer has now given up, meaning the drug is only available to the rich on a private prescription.
Agomelatine targets completely different receptors in depression, making it a promising option for those suffering side-effects like sleep interruption. Just ask my Parliamentary colleague, Andrew Robb, who wrote of having to swap between different antidepressants in his book Black Dog Daze (2011). Sleep interruption can turn a productive life into misery.
The rejection was based on comparing the new drug to existing PBS antidepressants. The problem in mental health is that new treatments are so uncommon, the comparators are decades-old post-patent products whose prices are just a fraction of the cost of bringing cutting-edge alternatives to market. The older and cheaper existing drugs are, the harder it is to prove cost-effectiveness.
In cancer for instance, less cost-effective drugs than agomelatine are routinely approved because they compare well against expensive recently released alternatives.
By simply watching on and doing nothing, this government is presiding over an emerging two-tier system in our beloved PBS. On the one hand, our pharmaceutical system pays high prices for new drugs simply because they are replacing other high price drugs. On the other, patients in ‘old drug’ categories like depression either pay out of their own pocket or make do with last generation alternatives.
Knocking back breakthrough mental health treatments hits hardest in the bush. That is because rural incomes are lower and out-of-pockets costs higher. Access to mental health expertise is limited, particularly for those battling side-effects which this treatment avoids.
Labor made matters worse when it won office in 2007 and failed to continue the successful Howard era Mental Health Services in Rural and Remote Australia program. It phased this program out in order to expand the Coalition’s flagship Better Access initiative, which while not ideally suited to rural circumstances was better than nothing. Fast forward to 2011, and Labor gave Better Access the chop as well, in favour of city-centric early intervention centres.
This week’s report contains many other insights into the unique aspects of mental health in rural communities. There are a range of cultural, social and economic risk factors, particularly associated with male identity and masculinity, which result in higher suicide rates in the bush.
Macho attitudes, dangerous alcohol consumption, risky patterns of behaviour and tendencies towards violence often mask depression within rural communities that are in constant flux. The last decade alone has seen record-breaking droughts, floods, bushfires on top of exchange rate and industry deregulation pressures.
The current federal government is banking enormous savings from massive PBS price cuts. So it shouldn’t force around 10,000 Australians to stump up the cash for world-class mental health care which is funded in Germany, Ireland, Spain and France.
As it stands, Labor risks taking mental health patients back to the pre-PBS era, a time when the rich got the best and the rest made do.
If you need to talk to someone call Lifeline on 13 11 14.
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