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Task: Students are required to submit a response to the following question:

Compare the Mental Health of TWO population groups e.g., ATSI and the Homeless. Provide examples to support your answer.

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Mental health is the state of your well being, whether that may be emotional, psychological and social. Among adolescents one in seven 10-19 year olds reported experiencing a mental disorder, with most being untreated or unrecognized. Young people with mental illnesses are prone to social exclusion, discrimination, stigma, educational difficulties and including of many more. Mental illnesses can negatively impact an individual as it may lead to harsh parenting and socioeconomic problems. On the other hand, more than 20% aged 55 and over reported to have some type of mental illness. Elderly are also negatively impacted by mental illnesses as it prevents them from doing daily living activities, impacts their quality of life and many more.

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Mental Health includes our emotional, psychological, and social wellbeing. Mental health conditions can cause difficulties in various aspects of life, such as relationships with family and community, it affects a wide range of people. As an example, the elderly and people with disabilities. They are two of the most impacted population groups and some of their mental conditions are caused by similar factors. According to the WHO, approximately 14% of adults aged 60 and over live with a mental disorder and their mental disorders account for 10.6% of the total years lived with disability and some of the factors for mental health conditions include loneliness and social isolation and dementia. These conditions were likely caused by abuse from their carers and poor health conditions. Therefore, the elderly people is one of the most impacted population groups as a big percentage of that group suffers from a mental health condition.

While according to the CDC, 32.9% adults with disabilities have mental conditions, some of this mental health conditions encompass depression, anxiety disorders and psychological distress, some mental disorders such as anxiety can create conflicts in a relationship. These conditions were likely caused by poor health conditions, acitivity limitations, mobility and self-care. To add on, according to the NHS, 48% of people with disabilities self reported anxiety disorders in 2022. Thus, people with disabilities is one of the most impacted groups as a big percentage of their population suffers from mental conditions.

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Mental health is a state of mental wellbeing that enables people to cope with stress, work well and contribute to their community. For instance elderly and homeless citizens struggle with their declining mental health, Mission Australia says that 54% of homeless individuals struggle with mental health conditions such as trauma, anxiety, depression, and abuse. As a result of financial constraints, healthcare is hard to come by for these groups of people, impacting their already terrible mental health. The WHO reports that about 14% of the older generation live with mental disorders, driven by factors such as loneliness, isolation, and chronic health problems. Due to their lack of a safe place to live they are treated unfairly and biased towards others, further decreasing their mental wellbeings.

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Mental Health is a rising predicament that can have drastic affects on a wide range of individuals, for instance the Homeless and the Elderly, two major impacted population groups that had a severe decline in their overall wellbeing. According to Mission Australia, 54% of homeless individuals experience mental health conditions such as depression, anxiety, and substance abuse, often exacerbated by the trauma, abuse, and instability associated with homelessness. Due to their circumenstances in terms of finicial constraints, the lack of healthcare only perpetuates the cycle of deterioating mental health. Likewise, the WHO reports that 14% of older adults live with mental disorders, primarily depression and anxiety, driven by factors like loneliness, social isolation, and chronic health problems. Whilst they do have lots of health care access conversly to the homeless, they are encourted with an unfair biased against them and an underrecgonition of their mental well being with their physical being more of a priority.

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Mental health is a common problem that affects millions of people and whole populations across the world such as disabled people and youth.

Almost 48% of people with disabilities self reported anxiety disorders in the 2022 NHS. This is most likely caused by their distress over not being able to perform common tasks as well as others. Mental disorders like anxiety can also give them a hard time when it comes to their personal relationships.

Mental health conditions were one of the things that contributed the most burden for young people aged 15-24. Suicide and self-inflicted injuries were the leading specific cause of total burden among males and anxiety disorders were the leading specific cause among females in 2023. These conditions were most likely caused by the stress of sudden responsibilities and changes that happen during that chaotic time of life. Mental health conditions can drastically affect how youth cope with the challenges of life and how they view it. This may cause them to make hasty or uneducated decisions that may bite them in the back some time later.

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Mental health is a state of mental well-being, people with disabilities also experience mental health in a negative way. Adults with disabilities report experiencing frequent mental distress almost 5 times as often as adults without disabilities. Which indicates that people with disabilities experience more than people with disabilities. On the other hand, youth also experience this, and research shows that globally, one in seven 10-19-year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group. This informs us that many people ages 10-19 have issues with their mental health.

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Australian Institute of Health and Welfare

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Coronary heart disease (see Glossary) was the leading individual disease contributing to burden among Indigenous Australians in 2018, responsible for 5.8% of total burden. The burden due to coronary heart disease has fallen substantially since 2003, driven by a decrease in fatal burden. Considerable effort has been made to improve cardiac care for Indigenous Australians in recent years through the Better Cardiac Care measures for Aboriginal and Torres Strait Islander people.

Comparison of burden of disease results for Indigenous and non-Indigenous Australians shows that, overall, Indigenous Australians experience burden at 2.3 times the rate of non-Indigenous Australians, but that the absolute gap narrowed between 2003 and 2018.

Social and emotional wellbeing is the foundation of physical and mental health for Indigenous Australians. It 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 (Gee et al. 2014).

Indigenous Australians' experience of social and emotional wellbeing varies across different cultural groups as well as across individuals. The concept of social and emotional wellbeing also recognises that a person's wellbeing is influenced by the social determinants of health, engendered through the inequity of government policies, institutional racism, the effects of colonisation and other past events. See Determinants of health for Indigenous Australians for more information.

Social and emotional wellbeing is not the same as mental health and mental illness, but they can interact and influence each other (PM&C 2017). The National Strategic Framework for Aboriginal and Torres Strait Islander Peoples' Mental Health and Social and Emotional Wellbeing 2017-2023 recognises this distinction and proposes a model of social and emotional wellbeing with 7 overlapping domains (Gee et al. 2014; PM&C 2017).

For many Indigenous Australians, good mental health is indicated by feeling a sense of belonging, having strong cultural identity, maintaining positive interpersonal relationships, and feeling that life has purpose and value (Dudgeon et al. 2014; Dudgeon & Walker 2015). Conversely, poor mental health can be affected by major stressors such as removal from family, incarceration, death of a close friend or family member, discrimination and unemployment, as well as stressors from everyday life (Gee et al. 2014; PM&C 2017).

In 2018-19, based on self-reported survey responses, an estimated 24% of Indigenous Australians reported having a diagnosed mental health or behavioural condition and 3 in 10 (31%) Indigenous adults reported 'high or very high' levels of psychological distress (ABS 2019).

Furthermore, disruptions to family and kinship connections, including inter-generational trauma, have been linked to increased suicide and suicidal behaviour in Indigenous communities (Dudgeon et al. 2021).

For further information on the Framework and social and emotional wellbeing, see the Indigenous Mental Health & Suicide Prevention Clearinghouse.

Reducing deaths by suicide and suicidal behaviour among Indigenous Australians is an issue of major concern for many Indigenous communities and a public health priority for all Australian governments. Data from 2016-2020 show that the rate for suicide of Indigenous Australians is almost twice the rate of non-Indigenous Australians, with the differences being greater for people aged under 45 (AIHW 2021a). Suicide was the fifth leading cause of death among Indigenous Australians in 2020, accounting for 5.5% of all deaths, and the 14th leading cause of death for all Australians (1.9% of all deaths). It was also the leading cause of death for Indigenous children aged 5-17 (ABS 2021a).

Suicide and self-harm behaviours arise from a complex web of personal, social and historical factors (Dudgeon et al. 2017), but they can be prevented. More about suicide prevention among Aboriginal and Torres Strait Islander people can be found on the Indigenous Mental Health and Suicide Prevention Clearinghouse.

Oral and hearing health problems are two issues that particularly affect Indigenous children, especially those living in remote areas.

Otitis media (inflammation and/or infection of the middle ear) is the main condition contributing towards hearing loss in Indigenous children. Experiencing hearing loss in childhood can affect speech and language development, and may lead to behavioural problems, early school leaving, limited employment options and increased contact with the criminal justice system (Burns & Thomson 2013).

Indigenous children are more likely than non-Indigenous children to experience tooth decay and to be hospitalised for dental problems (AIHW 2020). Several factors contribute to the poorer oral health of Indigenous children, including social disadvantage and lack of access to appropriate diet and dental services.

Specific programs such as the Northern Territory Remote Aboriginal Investment Oral Health Program, the Northern Territory hearing health outreach program, and the Queensland Deadly Ears program aim to diagnose and treat these problems and reduce their impact on the Indigenous community.

Vision loss has a profound impact on a person's quality of life and ability to perform everyday activities, for example, by limiting opportunities for physical mobility, work, education and social engagement (Razavi et al. 2018). Preventable vision problems, such as trachoma, diabetic retinopathy and cataracts (see Glossary), affect Indigenous Australians aged 40 and over at much higher rates than non-Indigenous Australians of the same age. The Indigenous eye health measures annual report provides an evidence base for monitoring changes in Indigenous eye health, identifying inequalities and highlighting potential gaps in service provision.

On average, Indigenous Australians living in remote areas having higher rates of disease burden and lower life expectancy compared with those in non-remote areas. Key contributors to this include differences in educational and employment opportunities, in access to health services, in housing circumstances, and in other factors that support healthy behaviours (such as the availability and cost of fresh fruit and vegetables). But areas of relative advantage and disadvantage also exist within these regions. Local areas and communities may experience different issues and outcomes to others and have different needs and priorities. Looking at variations across smaller geographic areas can help to highlight specific areas of need, so that programs and services can be directed where they will be of most benefit.

Local insights for local needs

The Regional Insights for Indigenous Communities (RIFIC) website brings together a range of regional statistics about the health and wellbeing of Aboriginal and Torres Strait Islander people and communities. It aims to help communities set priorities and participate in joint planning with governments and service providers.

The Stolen Generations and their families are a particular group of Aboriginal and Torres Strait Islander people who experience greater disadvantage than other Indigenous Australians. Analysis of data from the 2014-15 National Aboriginal and Torres Strait Islander Social Survey showed that people who reported being removed from family were more likely than those who did not to have been imprisoned or arrested in the previous 5 years, to have low income, to have poor self-assessed health, to have poor mental health, and to have experienced homelessness in the previous 10 years. This disadvantage persisted through the generations, with adult descendants and co-resident children also experiencing poorer health and wellbeing outcomes compared to other Indigenous Australians (AIHW 2019a, 2019b).

What about the burden due to COVID-19?

The analyses done for the most recent burden of disease study produced estimates for the year 2018, and therefore did not include COVID-19.

For more information on the impact of COVID-19 on Aboriginal and Torres Strait Islander people, see 'Chapter 1 The impact of a new disease: COVID-19 from 2020, 2021 and into 2022' and 'Chapter 3 Changes in Aboriginal and Torres Strait Islander people's use of health services in the early part of the COVID-19 pandemic' in Australia's health 2022: data insights.

For more information on Indigenous health and wellbeing, see:

Visit Indigenous Australians for more on this topic.

References

ABS (Australian Bureau of Statistics) (2018) Life tables for Aboriginal and Torres Strait Islander Australians, 2015⁠-⁠2017, ABS website, accessed 8 March 2022.

ABS (2019) National Aboriginal and Torres Strait Islander Health Survey, 2018-19, ABS website, accessed 20 March 2022.

ABS (2021a) Causes of death, Australia, 2020, ABS website, accessed 20 March 2022.

ABS (2021b) Deaths, Australia, 2020, ABS website, accessed 8 March 2022.

AIHW (Australian Institute of Health and Welfare) (2019a) Aboriginal and Torres Strait Islander Stolen Generations and descendants: numbers, demographic characteristics and selected outcomes, AIHW, Australian Government, accessed 8 March 2022.

AIHW (2019b) Children living in households with members of the Stolen Generations, AIHW, Australian Government, accessed 8 March 2022.

AIHW (2020) Aboriginal and Torres Strait Islander Health Performance Framework, AIHW, Australian Government, accessed 8 March 2022.

AIHW (2021a) Aboriginal and Torres Strait Islander Stolen Generations aged 50 and over: updated analyses for 2018-19, AIHW, Australian Government, accessed 22 March 2022.

AIHW (2021b) Deaths by suicide amongst Indigenous Australians, AIHW website, accessed 22 March 2022.

AIHW (2022) Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018, AIHW, Australian Government, accessed 22 March 2022.

Burns J and Thomson N (2013) 'Review of ear health and hearing among Indigenous Australians', Australian Indigenous Health Bulletin, 13(4):1-22.

Dudgeon P, Blustein S, Bray A, Calma T, McPhee R and Ring I (2021) Connection between family, kinship and social and emotional wellbeing. Produced for the Indigenous Mental Health and Suicide Prevention Clearinghouse, AIHW, Australian Government, Canberra.

Dudgeon P, Calma T and Holland C (2017) 'The context and causes of the suicide of Indigenous people in Australia', Journal of Indigenous Wellbeing, 2(2):5-15.

Dudgeon P, Cox A, Walker R, Scrine C, Kelly K, Blurton D, Bolardaras J, Brackness C, Brennan T, Butorac A, Charles A, Collard L, Duffin W, Grogan G, Hams K, Hansen C, Holland C, Ingram D, Mascall C, Mia T, Miller D, Mcguire V, Murray B, Mcgrady G, Peckham M, Riley B, Ryder A, Swift S and Taylor N (2014) Voices of the peoples: The national empowerment project research report 2015, Perth: National Empowerment Project, University of Western Australia.

Dudgeon P and Walker R (2015) 'Decolonising psychology: discourses, strategies and practice', Journal of Social and Political Psychology, 3(1):276-297.

Gee G, Dudgeon P, Schultz C, Hart A and Kelly K (2014) 'Social and emotional wellbeing and mental health: an Aboriginal perspective', in Dudgeon P, Milroy H and Walker R (eds) Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd edn), Department of the Prime Minister and Cabinet, Australian Government, Canberra.

HREOC (Human Rights and Equal Opportunity Commission) (1997) Bringing them home, Spinney, Sydney.

PM&C (Department of the Prime Minister and Cabinet) (2017) National Strategic Framework for Aboriginal and Torres Strait Islander peoples' mental health and social and emotional wellbeing 2017-2023, PM&C, Australian Government, accessed 9 March 2022.

Razavi H, Burrow S and Trzesinski A (2018) ' Review of eye health among Aboriginal and Torres Strait Islander people', Australian Indigenous Health Bulletin, 18(4), accessed 29 March 2022.

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Indigenous health and wellbeing - Australian Institute of Health and Welfare

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Coronary heart disease (see Glossary) was the leading individual disease contributing to burden among Indigenous Australians in 2018, responsible for 5.8% of total burden. The burden due to coronary heart disease has fallen substantially since 2003, driven by a decrease in fatal burden.

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Australian Institute of Health and Welfare

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Older adults with a mental health condition are more likely to experience disability and reduced health-related quality of life (Porensky et al. 2009). In addition, men aged 85 years and older record the highest age-specific suicide rate of any group (Australian Institute of Health and Welfare 2024).

Mental health in aged care service users

The Australian aged care system offers a range of services to meet the needs of older adults. Services range from supports to remain living independently at home through to full-time care in a residential setting.

There are 3 main types of services in the Australian aged care system:

Home support (Commonwealth Home Support Programme), which provides entry-level services focused on supporting individuals to undertake tasks of daily living to enable them to be more independent at home and in the community.

Home care (Home Care Packages Program), which is a more structured, more comprehensive package of home-based support, provided over 4 levels ranging from basic care (Level 1) to more intensive care (Level 4).

Residential aged care, which provides support and accommodation for people who have been assessed as needing higher levels of care than can be provided in the home, and the option for 24-hour nursing care. Residential care is provided on either a permanent, or a temporary (respite) basis.

There are also several types of flexible care and services for specific population groups available that extend across the spectrum from home support to residential aged care. For more information on aged care services in Australia see the Report on the operation of the Aged Care Act, or visit the Department of Health and Aged Care website.

Older individuals accessing aged care services may be susceptible to poorer mental health because of the health and functioning limitations that lead them to access these services. In addition, approximately half of older adults using residential aged care services have dementia (Harrison et al. 2020), and many experience loneliness (Ogrin et al. 2021).

These changes in circumstances, health conditions and other factors increase older individual's risk for poor mental health (Dijk and Mierau 2023). Understanding mental wellbeing, the presence of mental health conditions, and incidence of self-injury in aged care service users is important to establish needs and plan for policy and service delivery.

This web report provides a snapshot of what data is available about mental health in aged care. It describes what is known about mental health needs at the time of assessment for aged care services (that is, prior to receiving care) and of deaths due to suicide while accessing aged care.

Full details of the methods used for this analysis can be found in the Technical notes.

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Mental health in aged care , Mental health in older people

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Understanding mental wellbeing, the presence of mental health conditions, and incidence of self-injury in aged care service users is important to establish needs and plan for policy and service...

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Australian Institute of Health and Welfare

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Health of people experiencing homelessness - Australian Institute of Health and Welfare

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Homelessness can result from many factors, such as whether a person is working, experience of family and domestic violence, ill health (including mental health) and disability, trauma, and...

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About this topic

For many Aboriginal and Torres Strait Islander (First Nations) people, good mental health is indicated by feeling a sense of belonging, having strong cultural identity, maintaining positive interpersonal relationships, and feeling that life has purpose and value (Dudgeon & Walker 2015; Dudgeon et al. 2014). Conversely, poor mental health can be affected by major stressors such as removal from family, incarceration, death of a close friend or family member, discrimination and unemployment, as well as stressors from everyday life (PM&C 2017; Gee et al. 2014).

The legacies of colonisation and the ongoing trauma experienced by First Nations people also affect mental health. Dispossession from land, forced removal of First Nations children from families, and institutionalised racism have enduring effects on social and emotional wellbeing (Dudgeon & Walker 2015).
Connection to mind and emotions
Connection to mind and emotions is one of the 7 domains of social and emotional wellbeing for First Nations people.

Social and emotional wellbeing is a holistic way of looking at relationships between individuals, family, kin and community in the context of land, culture, spirituality and ancestry. Cultural groups and individuals each have their own interpretation of social and emotional wellbeing (Gee et al. 2014).

Factors that support the connection to mind and emotions are education, agency and strong identity. Conversely, mental illness, development or cognitive impairments and other disability, trauma, racism and unemployment can negatively affect the connection to mind and emotions (PM&C 2017).

Good mental health is a positive state of wellbeing in which a person can manage their thoughts and feelings to cope with the normal stressors of life and reach their potential in the context of family, community, culture and broader society. Mental health problems are 'diminished cognitive, emotional or social abilities but not to the extent that the criteria for a mental illness are met', such as psychological distress (AIHW & NIAA 2020).

Mental illnesses are diagnosed according to criteria and range from high‑prevalence disorders such as anxiety and depression, through to low‑prevalence disorders such as psychosis, schizophrenia, and bipolar disorder (AIHW & NIAA 2020).

There are cultural differences to be considered by practitioners when identifying and treating mental health conditions in First Nations people. Symptoms such as a weakened spirit and community disconnection may require cultural resolution and healing with culturally appropriate counselling services (Gee et al. 2014). Additionally, expressions and perceptions of mental health conditions such as depression may differ between First Nations people and non-Indigenous Australians (Brown et al. 2012; Vicary & Westerman 2004).

In 2020, all Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations worked in partnership to develop the National Agreement on Closing the Gap- external site opens in new window (the National Agreement), built around 4 Priority Reforms. The National Agreement also identifies 19 targets across 17 socioeconomic outcome areas. One of these targets directly relates to mental health, monitored annually by the Productivity Commission.
National Agreement on Closing the Gap: mental health-related targets
Outcome area 14: Aboriginal and Torres Strait Islander people enjoy high levels of social and emotional wellbeing

Target: Significant and sustained reduction in suicide of Aboriginal and Torres Strait Islander people towards zero (from an age-standardised rate of 25.1 per 100,000 people in 2018).

Status: In 2021, the suicide age-standardised rate for Aboriginal and Torres Strait Islander people was 27.1 per 100,000 people (for NSW, Queensland, WA, SA and the NT combined). To measure progress toward this target, a trajectory of a 75% reduction is presented on the Closing the Gap information repository. The 2021 rate is above the trajectory rate of 20.8 per 100,000 people.

Source: Closing the Gap information repository.

Key statistics

Mental health problems and mental illness are distinct from social and emotional wellbeing problems, although they can interact and influence each other (PM&C 2017). Mental illness (mental health conditions) can still affect people who have good social and emotional wellbeing. Mental health problems are 'diminished cognitive, emotional or social abilities but not to the extent that the criteria for a mental illness are met', for example psychological distress (PM&C 2017). Mental health conditions are diagnosed according to certain criteria. They range from high prevalence disorders such as anxiety and depression, through to low prevalence disorders such as psychosis, schizophrenia, and bi-polar disorder.

The Indigenous Mental Health and Suicide Prevention Clearinghouse (the Clearinghouse) has used 3 social and emotional wellbeing measures - psychological distress, level of mastery and perceived social support - from the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2018-19 to identify relationships between mental health conditions, drug and alcohol use, unfair treatment and SEWB. For more information about these scales, see the topic page on Social and emotional wellbeing.

Prevalence of mental health conditions

The data presented here is sourced from the NATSIHS 2018-19 and is for persons aged 18 and over. Estimates are calculated using a sample selected from a population rather than all members of that population. See the data tables in the Download data section for notes related to these data.

In 2018-19, over a third of First Nations people (37%) reported having a current mental health condition. The proportion was higher among females (42%) than males (30%) (Figure 1, Table MH.1). Most people who reported ever being diagnosed with a mental health condition also reported having a current condition (190,100 and 178,400, respectively) (Table MH.1).

Almost a quarter of all First Nations people (24%) reported having a current, long-term mental health or behavioural condition (ABS 2019). More than one in 10 individuals reported having long-term diagnosed Anxiety (17%) or Depression (13%) (ABS 2019) (Figure 1; Table MH.2).

People aged 35-44 had the highest proportion of people reporting a current, long-term mental health or behavioural condition (32%), followed by people aged 45-54 (31%) and 25-34 (30%). It was lowest among people aged 0-14 (15%) (ABS 2019) (Table MH.3).

Social and emotional wellbeing and mental health

The data presented here is sourced from the NATSIHS 2018-19 and is for persons aged 18 and over. Estimates are calculated using a sample selected from a population rather than all members of that population. See the data tables in the Download data section for notes related to these data.

First Nations people ever diagnosed with a mental health condition were more likely to report High/Very high psychological distress (53%), Low mastery (49%), which is the level of control a person feels over their own life, and Low perceived social support (13%) than people without a diagnosed mental health condition (18%, 23% and 6.2%, respectively). These proportions were similar among people with a current mental health condition (Table MH.4).

Levels of social and emotional wellbeing varied by mental health condition. The proportion of people reporting Low/Moderate psychological distress was greatest among people with Depression (43%) and smallest among people with Behavioural/emotional problems (23%) (Table MH.4).

The proportion of people reporting High mastery and High perceived social support was greatest among people with Anxiety (48% and 49%, respectively). People with Harmful use/dependence on alcohol or drugs had the smallest proportions of High mastery and High perceived social support (35% and 35%, respectively) (Table MH.4).

Social and emotional wellbeing and alcohol and other drugs

The pathways between alcohol consumption and mental health and social and emotional wellbeing are complex. Harmful consumption of alcohol may cause or exacerbate mental health conditions. On the other hand, harmful levels of alcohol may be used to cope with poor mental health, as a form of self-medication (Gray et al. 2018; Nadew 2012; Wilkes et al. 2014).

The data presented here is sourced from the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2018-19 and is for persons aged 18 and over. Estimates are calculated using a sample selected from a population rather than all members of that population. See the data tables in the Download data section for notes related to these data.

First Nations people are more likely to abstain from alcohol than non-Indigenous Australians; however, those who do drink are more likely to do so at dangerous levels (ABS 2019). The Clearinghouse has used the frequency of consuming 3 or more standard drinks in a day as a proxy for the current alcohol guidelines, released in 2020. These guidelines state that healthy adults should not consume more than 10 standard drinks per week, or more than 4 drinks in a day (NHMRC 2020).

Caution should be taken in ascribing the direction of relationships using the Clearinghouse analysis. While the analysis found associations between variables, it cannot determine the direction of the relationships nor the causal factors/variables.

Low/Moderate psychological distress was most likely to be reported by First Nations people consuming 3 or more standard drinks in a day 1 to 2 days a week, 13 to 51 times in a year and people who had Never consumed alcohol (73%, 73% and 71%, respectively). It was least likely to be reported by people consuming 3 or more drinks on 3 or more days a week (Table MH.5). The proportion of people reporting High mastery was greatest for people consuming 3 or more drinks on 1 to 2 days a week (74%) and was smallest for people drinking on 3 or more days in a week (61%) (Table MH.5).

The proportion of people reporting a mental health condition was greatest among people consuming 3 or more drinks in a day 12 or fewer times in a year (42%) or 3 or more days a week (42%) and smallest for people who reported drinking 1 to 2 days a week (28%) (Table MH.6).

High/Very high psychological distress (44%) and Low mastery (44%) were more likely to be reported by First Nations people who used substances for non-medical purposes in the last 12 months than people who did not use substances (27% and 30%, respectively). People who used substances were less likely to report High perceived social support than people who did not (52% compared with 63%) (Table MH.7). Almost half (48%) of people who reported using substances in the previous 12 months also reported having a current diagnosed mental health condition (Table MH.6).

Among people who reported using substances in previous 12 months, people who used Analgesics were most likely to report High/Very high psychological distress (62%), compared with people who used other drug types (Figure 3; Table MH.7).

Unfair treatment and mental health

Experiences of racism and racial discrimination are common for First Nations people in Australia, regardless of gender, age and geographic location. Experiences of racism among First Nations people are associated with negative impacts on mental health and wellbeing outcomes including psychological distress, stress and depression (Truong & Moore 2023).

In 2018-19, among First Nations people who had a diagnosed mental health condition, 34% experienced unfair treatment in the past 12 months, compared with less than 20% who did not have a diagnosed mental health condition (Table MH.8). Twenty-one per cent of people with a diagnosed mental health condition avoided situations due to past unfair treatment compared with 10% without a diagnosed mental health condition (Table MH.8).

Burden of disease from mental and substance use disorders

The following data was sourced from the AIHW Australian burden of disease study.

In 2018, mental and substance use disorders were the leading cause (23%) of total disease burden for First Nations people. Within this disease group, the leading causes of burden were:

23% Anxiety disorders

19% Alcohol use disorders

19% Depressive disorders

9% Drug use disorders (excluding alcohol)

7% Schizophrenia (AIHW 2022) (Figure 4; Table MH.9).

Data tables

Table number and title

Source

Reference year

Table MH.7: Social and emotional wellbeing among First Nations people, by substance use and type, 2018-19

AIHW analysis of ABS NATSIHS

2018-19

Table MH.8: Unfair treatment among First Nations people, by presence of mental health conditions, 2018-19

AIHW analysis of ABS NATSIHS

2018-19

Download data

Related Publications

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Australian Institute of Health and Welfare

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This horizontal bar chart shows the top five leading causes of total burden among young people by sex for 2018. The leading cause of burden for females was anxiety disorders (11%), followed by: depressive disorders (8.7%), eating disorders (6.8%), asthma (5.6%), and suicide/self-inflicted injuries (5.6%). For males, the leading cause of burden was suicide/self-inflicted injuries (14.3%), followed by: alcohol use disorders (7.1%), depressive disorders (5.3%), road traffic injuries/motor vehicle occupant (5.2%), and asthma (5.0%).

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Health of young people - Australian Institute of Health and Welfare

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This horizontal bar chart shows the top five leading causes of total burden among young people by sex for 2018. The leading cause of burden for females was anxiety disorders (11%), followed by: depressive disorders (8.7%), eating disorders (6.8%), asthma (5.6%), and suicide/self-inflicted injuries (5.6%).

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Australian Institute of Health and Welfare

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Health of people with disability - Australian Institute of Health and Welfare

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Disability and health have a complex relationship@long-term health conditions might cause disability, and disability can contribute to health problems. The nature and extent of a person@s...

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Helen* describes moving into an aged care residence last year as "a very sudden trauma".

There's nothing wrong with the institution itself or the people there - both are "very nice", Helen, a 90-year-old former clinical psychologist, tells ABC RN's Life Matters.

"But it's not home," she says.

"Moving from a two-bedroom unit into a one-room home is really quite confronting ... I'd left behind my furniture, many of my clothes, my keepsakes, my books.

"[There] was a terrible sense of abandonment, of grief, of loss, of having left behind my personhood, my independence and my ability to make decisions for myself."

Helen experienced depression after moving to the aged care residence, and she's noticed others there displaying "various signs of depression", too.

"There are many people who sit quietly and cry for days after they arrive," she says.

"I see it every day here."

Helen and her co-residents are part of a cohort of Australians facing some of the highest risks of depression in the country.

"Currently, around half of all aged care residents have substantial symptoms of depression," says psychologist Tanya Davison, the lead researcher of a new Cochrane review, into psychological therapies in aged care.

"That's about four times higher than the rate that we see in the general population of older people," she says.

"And six in 10 people living in aged care at the moment are prescribed an antidepressant medication."

It's an approach that's "clearly not" working, Professor Davison says.

Alternatives that have been shown to improve mental health outcomes do exist. So why aren't they more widespread?

Why the high levels of depression

Multiple factors put people entering aged care at risk of depression, Professor Davison explains.

"People with complex medical conditions, people who've experienced a loss or bereavement, people who may have cognitive impairment or dementia [or] frailty - all of those factors are the reasons why people require aged care, but they're also important risk factors for depression."

Another big problem isthe way many older people make the move into an aged care residence.

"That's very difficult for many people," Professor Davison says.

"It's often not well planned. Often people have very limited time or input into their relocation and that's associated with poor adjustment to aged care."

Day-to-day life in residential aged care presents further risk factors, including social isolation and loneliness.

"[People] have been removed from their communities and previous sources of social engagement. They often report feeling bored, that they don't have activities to do [that are] personally meaningful for them," Professor Davison says.

"It's not uncommon to see people just sitting in their room staring at a television for much of the day."

Therapy works

When she moved into aged care, Helen felt surrounded by strangers and struggled to find someone to talk to.

"It's very hard to find any sort of shared history among the people that you're with. And I found that really difficult," she says.

She enlisted and paid for support from her own psychiatrist, and she says it was very helpful to "give expression to some of the grief and loss that have been part of what's overcome me".

She says she's now "come though" the depression since initiating sessions with the psychiatrist.

Professor Davison says the recent study into psychological therapies in aged care, which included reviewing randomised trials with 873 older people with depression, echoes Helen's experience.

"It showed people who had had access to psychological therapy had less depression than people who receive just the usual care approaches," she says.

Sunil Bhar is the director of Swinburne University's Wellbeing Clinic for Older Adults support service and a co-author of the NHMRC study.

He says, while there were limitations to the study, including that the "methodological rigour wasn't as strong" in some historic research that was reviewed, the message to emerge from it is clear.

"Psychological therapies were much more effective than usual care ... We absolutely need to be offering more therapies," he says.

"We know from this review and the experience that we've had over decades, psychological therapies do work.

"The review that we've conducted found that between two and 12 sessions might be sufficient to bring up an improvement, and that speaks to the feasibility of this particular approach."

What's the hold-up?

There are several reasons why psychological therapy isn't more accessible to older people.

One is funding.

"For a long time, people living in residential aged care didn't have access to the same funding to receive psychological therapy as others. And there's still a disparity there around funding," Professor Davison says.

Residents in aged care can access Medicare-subsidised therapy through a mental healthcare plan "only under quite specific circumstances".

"You need to be referred by a psychiatrist and ... unfortunately, very few people have access to a psychiatrist."

Indeed, between 2012 and 2017, less than 3 per cent of Australian aged care residents with a mental health condition accessed Medicare-funded mental health services, including GPs, psychiatrists and allied health.

"There are some other [mental health] schemes available, but it's very much at a small scale currently," Professor Davison says.

"So we do need to look at how we can provide more funding and improve the access."

Ageism presents another hurdle.

"There's a misperception out there that older people aren't interested in psychological therapy; [that] maybe they don't have the psychological insight or the cognitive flexibility to benefit," Professor Davison says.

"But of course, this research and lots of research has found that that's certainly not the case. Psychological therapy is just as effective with older people."

She argues there's a need for "better training of the mental health workforce in working with the older population, to increase the pool of specialists available to respond" and that "we also need to look at the skills within residential aged care facilities to detect and respond to residents with depression".

"The aged care workforce has very poor training in mental health currently," she says.

'A desperate need'

Helen wants other aged care residents to have access to the same professional help she sought out for herself.

"I've felt very strongly that there is a desperate need for some sort of counselling ... for people coming into aged care," she says.

More stories from Life Matters:

She believes there should be a national provision of counselling for people both before and after they move into an aged care residency.

She says for residents like her, depression has become normalised.

"It shouldn't be normal," she says.

Since the 2018 Royal Commission into Aged Care Quality and Safety, Professor Davison says there is "good awareness of the problem" of mental health among aged care residents.

In 2018 the federal government introduced the Improved Access to Psychological Services in Aged Care Facilities initiative, which Professor Davison says was "highly welcome and a step in the right direction", but she notes "this is only providing services to around 3,000 Australians per year".

She says the government is doing a huge amount of work to improve the quality of aged care and maintain staff.

"We're in a period of major reform right across the whole aged care sector," she says.

But there are potential shortcomings to that work, Professor Davison says.

"I haven't seen a lot of focus around mental health."

She says there are "some indications" that mental health will be a higher priorityin the new set of quality standards that the government is currently developing for the aged care sector.

"The detail is not there yet. But, clearly there's much more of a focus [on mental health] in these new proposed standards than we've seen before.

"So I'm hopeful that we're on the right [path]. What a great opportunity right now, given the major reforms underway, to really get this right."
The Minister for Health and Aged Care, Mark Butler, and the Minister for Aged Care and Sport, Anika Wells, were approached for comment. *Last name omitted to protect privacy.
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Half of all Australians in nursing homes experience depression. These experts say there's a simple solution to that

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Experts argue the aged care system isn't adequately addressing elderly residents' mental health, but that government-funded sessions with a psychologist could help them feel happier and more at ease.

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Uncover the stark reality of homelessness in Australia with these key facts.

In Australia, homelessness can affect people of all ages, men, women, and children from different circumstances. Most of us do not see the full impact it can have in our communities. To uncover the reality of homelessness here are key statistics and facts about homelessness in Australia.

What is homelessness?

The Australian Bureau of Statistics defines homelessness as affecting a person who does not have suitable accommodation alternatives, and their current living arrangement:

is in a dwelling that is inadequate; or

has no tenure, or if their initial tenure is short and not extendable; or

does not allow them to have control of, and access to space for social relations

A home is not just somewhere with roof walls and a roof. It is a place where people can feel safe and secure. Access to safe and secure housing is a basic human right but unfortunately many people in Australia live in temporary dwellings such as refuges, crisis accommodations or motels.

This definition of homelessness emphasises a lack of core elements of a 'home' including a sense of security, stability, privacy, safety, and the ability to control living space.

What is hidden homelessness?

Realistically in Australia, most people experiencing homelessness are hidden from sight. They could be sleeping in a car, couch surfing or enduring the night on public buses. They may have shelter but no permanent place to make a home. These are the "hidden homeless".

Did you know 'rough sleepers' only make up approximately 7% of Australia's homeless population? (ABS, 2016)

Five shocking stats about homelessness in Australia:

1. There are over 116,000 people experiencing homelessness on any given night 1

2. Only seven percent of people who are homeless sleep on the streets ¹

3. Domestic and family violence is one of the main reasons why people experience homelessness ²

4. In Australia, one in six people experiencing homelessness are over 55 years ¹

5. Over 15,800 children younger than 12 years are homeless ¹

What causes homelessness?

Life can be unexpected and is full of circumstances outside of our control. People who do not have strong support systems or are in financial, emotional or physical strain can be more vulnerable to losing their homes.

Common causes of homelessness are;

Domestic and family violence

Sudden life changes that trigger homelessness

Lack of affordable and social housing

Mental health challenges

Learn more about the common causes of homelessness.

What is the leading cause of homelessness in Australia?

In Australia, domestic and family violence (DFV) is one of the main drivers of homelessness in Australia.

Sadly, many children, women and men have experienced or have witnessed abusive and violent behaviour towards a partner, former partner or family member. DFV extends beyond physical violence, and can involve actions intended to control, humiliate or scare the other person or people in the household.

When victim/survivors decide to leave a violent household, it often means leaving their home and belongings behind. After years of control and abuse their capacity to find new housing is limited. Take action against DFV by learning about the common facts.

Domestic and family violence statistics in Australia:

One in three people seeking assistance from homelessness services stated domestic and family violence was the most common main reason they needed help One in six women, compared to 1 in 16 men, have experienced physical or sexual violence by a current or former partner 41% of people seeking help from specialist homelessness services in 2019-20 had experienced domestic and family violence On average, one woman a week and one man a month is killed by a current or former partner Indigenous people were 32 times more likely to be hospitalised for family violence as non-Indigenous people Approximately 2.5 million Australian adults (13%) experienced abuse during their childhood; the majority knew the perpetrator and experienced multiple incidents of abuse³ ² ² ² ⁴ ⁵

What causes homelessness in older people?

Homelessness among older people is a growing problem in Australia. With an ageing population and the increased cost of home ownership this problem is expected to get worse. Factors such as domestic violence, relationship breakdown, financial difficulty and limited superannuation can make people more vulnerable to homelessness.

Certain groups may be at a higher risk of homelessness, such as veterans, Indigenous people and people from culturally and linguistically diverse backgrounds.

Facts about older people facing homelessness:

One in six people who were homeless on census night in 2016 were aged 55 and over. Older women are the fastest growing group to experience homelessness in Australia. On any given night, around 18,600 people aged 55 and above are homeless. Aboriginal or Torres Strait Islander people make up eight percent of older people experiencing homelessness. ¹ ¹ ¹ ¹

Why are young people homeless?

For young people, homelessness is not a choice but can feel like the only option. Unstable home environments can force young people to leave their family home without a safe place to go.

Neglect, family breakdown, substance abuse, poor living conditions, unemployment, death of a guardian or loved one, or lack of support when leaving state care can hinder their ability to maintain housing and thrive in their adult lives.

Homelessness has long term effects on a young person's health and wellbeing and impact their mental health, education, and connection with community.

Youth homelessness facts:

Young people aged 15-24 made up 21% of the homeless population One in six young people surveyed in Mission Australia's 2019 Youth Survey have experienced homelessness ⁶ ⁷ Top reasons young people sought assistance from homelessness services were:
17% Family and domestic violence 17% housing crisis 13% relationship/family breakdown ³

How is Mission Australia ending homelessness?

We believe every person in Australia should have access to safe and secure housing. We offer early intervention and prevention programs for people at risk of homelessness and for those still experiencing homelessness, we offer emergency, transitional and supported accommodation.

How can I help end homelessness in Australia?

¹ABS, (2018): Census of Population and Housing: Estimating homelessness, 2016
²AIHW, (2018) Family, domestic and sexual violence in Australia, 2018.
³AIHW, (2020): Specialist homelessness services annual report, 2020
⁴AIHW, (2019): Family, domestic and sexual violence in Australia: continuing the national story 2019: in brief, 2019
⁵ABS, (2017): Characteristics and outcomes of childhood abuse, 2017
⁶AIHW, (2021): Homelessness and overcrowding, 2021
⁷ Mission Australia Youth Survey, 2019-20

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Uncover the stark reality of homelessness in Australia with these key facts. In Australia, homelessness can affect people of all ages, men, women, and children from different circumstances. Most of us do not see the full impact it can have in our communities.

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Non-binary Australians are experiencing mental health issues at more than double the rate of men and women, new data from the Australian Bureau of Statistics shows. And three in four lesbian, gay, bisexual or otherwise non-heterosexual Australians have experienced a mental illness at some point in their lives.

As Sydney's Gay and Lesbian Mardi Gras takes place this week, the latest ABS statistics paint a grim picture of the higher rates of mental illness and self-harm across the nation's LGBTQI+ community.

Collected as part of the 2020-2022 National Study of Mental Health and Wellbeing, this is the first set of national data that compares the wellbeing of the LGBTQI+ community to that of heterosexual and cisgender people.

The bureau defined a "mental disorder" as a "clinically significant disturbance in... cognition, emotional regulation or behaviour", noting that this included a range of disorders such as anxiety, affective disorders and substance use.

"Mental health is a key component of overall health and wellbeing. It underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in," the report states, adding that this "community connectedness" can support and affirm identity for LGBTQI+ people.

"At the same time, people in the LGBTQ+ communities often experience stigma, discrimination, bullying, violence and exclusion," it says, listing these factors as contributors to the higher rates of mental health issues.

According to the findings, almost half of all LBG+ Australians noted high or very high levels of psychological distress, and 47.8 per cent of LGB+ people had "seriously thought about taking their own life" at some point in their lifetime.

Four in five non-binary people (79.6 per cent) had "seriously thought about taking their own life at some point in their lifetime". And almost three in four non-binary people (72.8%) had self-harmed in their lifetime.

Seven in ten trans people aged 16-34 years had experienced a mental disorder at some time in their life, and more than one in four trans people had high or very high levels of psychological distress.

Sadly, more than one in four trans people had also "seriously thought about taking their own life at some point in their lifetime".

In regards to seeking professional help for mental health issues, the proportion of LGB+ people who did so was noticeably higher than that of heterosexual people. Almost half of all LGB+ people (46.8 per cent) saw a health professional for their mental health in the last 12 months (compared with 16 per cent of heterosexual people).

LGBTIQ+ Health Australia (LHA) chief executive Nicky Bath told the that the report confirms "adverse mental health outcomes" related to discrimination and abuse" and "highlight the need to foster protective factors" for the queer community's wellbeing.

"The data on trans and gender diverse people needs rigorous analysis to avoid misinterpretation and misrepresentation, especially in the current environment of transphobic rhetoric that has significant negative health and wellbeing impacts," said Bath.

"There is so much more we need to know to develop targeted and effective responses to support people experiencing poor mental health."

Support Services

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LGBTQI+ Australians experience much higher rates of mental health issues, ABS data shows

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The latest ABS statistics paint a grim picture of the higher rates of mental illness and self-harm across Australia's queer community.

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Australian Institute of Health and Welfare

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Around 7 million people live in rural and remote areas, which encompass many diverse locations and communities. These Australians face unique challenges due to their geographic location and often...

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New data from Mental Health Australia and the National Centre for Social and Economic Modelling at the University of Canberra released today, World Mental Health Day, shows alarming disparities in the distribution of mental health services across Australia, with severe inadequacies in rural, regional and remote areas.

The National Rural Health Alliance (the Alliance) calls for increased investment and systemic mental health reform to rectify the disparities shown in the Mapping Mental Health Care research project for people living and working in rural Australia.

"The federal and state governments need to show more commitment to engage with stakeholders to relieve rural communities of the barriers to accessing mental health services," said Susi Tegen, Chief Executive of the Alliance.

"We know mental illness in rural and remote Australia appears more prevalent than in major cities and tragically, rates of self-harm and suicide increase with remoteness. Yet, these communities are the most underserved compared to major cities," said Ms Tegen.

Rural and remote communities experience a range of stressors unique to living outside major cities. They also have the triple disadvantage of poorer health, larger distances to travel and less access to health and medical care providers. Indeed, they also face natural disasters through fire, flood and drought. Lower employment opportunities and less financial stability coupled with housing stress also lead to increased mental ill health. Despite Medicare-subsidised mental health services in regional and remote areas, the data shows a clear pattern of lower use in regional and remote areas.

"We need to address the unique problems faced by rural, regional and remote communities and attend to them with innovative, place-based, flexible models of mental health care and funding.

"The latest data is a wake-up call on World Mental Health Day, to take urgent action to provide care every day for people living outside cities. We have a social contract to do so," said Ms Tegen.

The Alliance has published the following help sheet on rural mental health services for those needing mental health support: https://www.ruralhealth.org.au/sites/default/files/publications/nrha-rural-mental-health-services-help-sheet-2023.pdf

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New data on mental health is a wake-up call for urgent reform

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New data from Mental Health Australia and the National Centre for Social and Economic Modelling at the University of Canberra released today, World Mental Health Day, shows alarming disparities in the distribution of mental health services across Australia, with severe inadequacies in rural, regional and remote areas.

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For too long, Australia's young people have struggled with their mental health.

These struggles have deepened in recent years, following a series of crises - from the COVID-19 pandemic to climate change. At the same time, increased living costs have made getting help more difficult.

Our young people need more widespread, and more effective, support.

That's why the Australian Psychology Society (APS), in our 2024-25 pre-budget submission is urgently calling on the federal government to invest in youth mental health.

The APS proposes two initiatives aimed at both prevention and treatment. The first is the creation of an in-school evidence-based resilience building program, delivered by psychologists. The second is the addition of a youth safety net to Medicare, which would enable young people to access psychology services more affordably.

Why does youth mental health need more support?

The mental health of our youth is one of Australia's biggest and most important challenges - as borne out by the statistics.

Suicide is the leading cause of death for those aged 15-24, according to the Australian Institute of Health and Welfare. Nearly 40% of 16-24-year-old people experience a mental health disorder, reports the Australian Bureau of Statistics.

"We are in the middle of a youth mental health crisis," says Dr Catriona Davis-McCabe, President, APS.

"Psychologists in the past couple of years have seen a huge increase in children and young people presenting to treatment."

During and after the COVID-19 pandemic, three-quarters of adolescents said their mental health had declined. Further, climate change is triggering significant anxiety in young people, particularly those in regional and remote areas.

Yet, 27% of Australians say finances are a barrier to accessing psychology services.

Recommendation 1: An in-school resilience building program

These statistics might sound overwhelming, but they are far from inevitable. In fact, the opposite is true. Early intervention can make all the difference.

"We know that a lot of mental ill-health starts before the age of 14," says Dr Davis-McCabe.

"If we can support and treat a young person, and work with their family, they're less likely to develop further or more complex mental health issues as they get older."

For that reason, school is the best place to start. Furthermore, it is a familiar environment.

"Schools provide opportunities for all young people to access services," says Dr Erica Frydenberg, Associate Professor, University of Melbourne and an educational, clinical and organisational psychologist with a special interest in youth mental health.

"These services are well accepted and there is a reduced likelihood of stigma."

The proposed program would teach children - and their parents and carers - to cope with adversity, manage stress and enhance wellbeing, thereby building resilience, optimism and confidence.
The school program will:

deliver psychology-informed, community-focused knowledge building and skills development;

equip young people to cope with climate change and ongoing natural disasters; and

include thorough, ongoing evaluation, to determine its impact and identify opportunities for improvement and refinement.

To ensure its effectiveness, the program should be executed by school psychologists or psychologist-trained wellbeing officers.

"Psychologists are well-positioned to take a holistic approach," says Dr Davis-McCabe.

"This might include identifying individuals in the school community who need support, drawing on awareness of local needs and vulnerabilities, and ensuring integrated mental health services."

"[Educational and developmental psychologists specifically] are trained as educators and consultants to work in a preventative model... that brings educators and school leaders on a journey to enable system change."

Given the current ratio of students to psychologists in schools is 1:1500, the APS proposes that the government invest to bring the ratio closer to 1:500.

"If we had one psychologist for every 500 students, we would be better placed to provide early intervention services and support more young people presenting with mental health issues at school."

Recommendation 2: A Medicare youth mental health safety net

While an in-school resilience building program would go a long way to helping our youth, it wouldn't happen overnight.

In the meantime, it is imperative that young people can access mental health services immediately and without financial stress.

The APS proposes the addition of a youth mental health safety net to Medicare as soon as possible. This would bring the Medicare Safety Net threshold to $0 for any person aged 14-25 accessing Medicare psychology services.

In addition, young people with severe and complex mental health disorders should receive up to 20 (rather than the current 10) rebateable sessions with a psychologist.

"Dramatically decreasing the cost of care would ensure that all young people can get the services they need, regardless of their financial situation," says Dr Davis-McCabe.

Advice for psychologists working with young people

"Prevention is better than cure," says Dr Frydenberg, whose lifelong research has focused on the development of universal coping skills.

"Rather than just providing ambulances at the bottom of the cliff, we need to prevent people from falling off.

"Coping skills training is not just about helping to fix what is wrong, but what can be done better or differently."

Key to this is establishing a relationship based on trust, so the psychologist and young person can work together.

"Acknowledging stress and despair is the first step," says Dr Frydenberg.

"But, essentially, to go beyond stress and despair to 'treatment' is an educative practice, where you take people on a journey of skill building."

Initially, the young person must see the primary purpose of skill building - to cope with their main concern. Later, the skills developed can be adapted to other aspects of living.

"'Treatment' becomes a source of life skills that can be used in any circumstances - work, study, relationships or concerns about what is happening in the world," says Dr Frydenberg.

Short-term investment for a long-term gain

The APS recommended initiatives would have long-term gains for all young Australians, making the investment socially and economically beneficial.

"If we don't invest now, we're going to see further economic impact down the line," says Dr Davis-McCabe.

"If young people aren't treated and can't access appropriate services, they're going to end up with more difficulties in adulthood, and not be as productive in society as they might want to be.

"We want to be able to help them to move forward to lead successful and fulfilling lives, and psychologists are best placed to do this."

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APS calls for urgent investment into youth mental health

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Advocating for urgent investment in youth mental health by the Australian Psychological Society (APS).

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Disability statistics - Australian Disability Network

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See just how much of society is affected by disability of some kind. You might be surprised.

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Mental health is a key component of overall health and wellbeing. It underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in

Community connectedness and positive relationships can act as protective factors creating a sense of belonging and affirming identify and value for LGBTQ+ people At the same time, people in LGBTQ+ communities often experience stigma, discrimination, bullying, violence and exclusion. As a result, a higher number of people in LGBTQ+ communities experience poorer social, emotional and psychological wellbeing and mental health This may lead to issues with work, relationships, finances, housing and other elements of life

The ABS recognises people who have a lived experience of mental health concerns and that having - or not having - mental health concerns does not define a person. We acknowledge their unique experiences, and those of carers, families and supporters of people living with mental health concerns.

This article presents selected data on mental health for LGBTQ+ Australians from the 2020-2022 National Study of Mental Health and Wellbeing. The Study provides information on a range of mental health-related topics such as prevalence of mental disorders, service use for mental health and psychological distress.

In this article we use concepts and terminology from the ABS 2020 Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables. The National Study of Mental Health and Wellbeing collected data using all variables in the Standard. However, it is not possible to produce reliable data from the Study on mental health for people born with variations of sex characteristics (sometimes referred to as intersex) or for people who reported their sex at birth as another term.

We acknowledge that just as there are variations of the acronym LGBTQ+, there are also differences between the individuals it represents. In this article we use the acronym LGB+ to represent people who described their sexual orientation as gay or lesbian, bisexual, or who used a different term (such as asexual, pansexual or queer).

Readers should note measures of error associated with the results presented in this article. Margins of Error in graphs illustrate the likely range within which a particular proportion lies.

The ABS uses, and supports the use of, the Mindframe guidelines on responsible, accurate and safe reporting on suicide, mental health concerns and alcohol and other drugs. The ABS recommends referring to these guidelines when reporting on statistics in this article.

Some of the statistics in this report may cause distress. Services you can contact are detailed below and in the Mental health resources section near the end of this article.

Support Services

Lifeline: 13 11 14, 24 hours, 7 days

QLife: 1800 084 527, 3pm to midnight, 7 days

Suicide Call Back Service: 1300 659 467, 24 hours, 7 days

Beyond Blue: 1300 224 636, 24 hours, 7 days

13YARN: 13 92 76, 24 hours, 7 days

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Mental health findings for LGBTQ+ Australians

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This article presents selected indicators of the mental health and wellbeing of LGBTQ+ Australians.

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Mental health issues are increasingly concerning, significantly impacting groups like veterans and young adults, who have seen a notable decline in their well-being. According to the National Coalition for Homeless Veterans, approximately 30% of homeless veterans suffer from mental health issues, such as PTSD and depression, exacerbated by their experiences during military service. Limited access to healthcare and social support continues the cycle of poor mental health for these individuals. Similarly, the National Alliance on Mental Illness reports that 20% of young adults experience mental health conditions like depression and anxiety, driven by academic pressures, social media, and economic challenges. Although young adults generally have better healthcare access, they often face stigma and a lack of adequate support, leading to underdiagnosis and inadequate treatment.

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Many indivuals expereience the unsuspecting predicement of mental health throughout many populaiton groups. Two major groups who are serverly impacted by the negative effects of bad mental leath are Homeless and Elderly. Mission Australia states, that 54% of homeless people experience the subtle effects of bad mental health such as scrionzphenia, anxiety, depression and addictive behaviours. The increasing problem of money and a bad state to live in, causes the petryfing effects of bad healh health. The naitonal state of mental health identified 7.9% and 11.1% of men and women who are aged of 65 have experience mental conditions over the past 12 months. Similarities between the two population groups, shows us that both groups experience the same mental conditions despite living in different situaitons. However the major difference we can view is the amount of people that experience mental health homeless people experience mental health on a vastly bigger scale compared to the Elderly.

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Homeless individuals and youth both face significant mental health challenges, though the nature and contributing factors of these challenges differ. Homeless individuals often experience high rates of severe mental illnesses such as depression, anxiety and more They also face significant barriers to accessing mental health services, including financial constraints, lack of transportation, and stigma. In contrast, youth commonly struggle with anxiety, depression, self-harm, and eating disorders, influenced by social media, academic pressure, and bullying. Youth generally have better access to support through schools, families, and community organisations, with early intervention and prevention programs playing a crucial role. While both groups have high rates of mental health issues, homeless individuals often deal with more severe conditions and greater barriers to care, necessitating comprehensive support that includes housing, healthcare, and social services. For example, a SAMHSA study found that 30% of homeless adults report serious mental illnesses, while NIMH data shows that 49.5% of adolescents experience a mental disorder, with 22.2% experiencing severe impairment.

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Did you know that adults with disabilities are 4 times more likely to experience mental health concerns and conditions than those without a disability? You read that correctly, it's not double, or triple, its four times more prevalent within the disability community.

When we look at the prevalence of mental health conditions within the community, unfortunately it is well recognised that some groups experience higher rates of mental illness and psychological distress than others. These include those within the LGTBQI Community, individuals from Aboriginal and Torres Strait Islander heritage, and those with disability.

The Facts and Figures of Mental Health amongst those with disabilities.

As we narrow in more on the prevalence of mental health conditions amongst those with disabilities, lets first understand some of the key findings to come out of the recent research performed by the Australian Bureau of Statistics in 2020. Their research found that: high or very high levels of psychological distress are more likely to be experienced by:

adults with disability (32%) - 4 times as likely as those without disability (8.0%)

adults with severe or profound disability (40%) - compared with adults with other forms of disability (30%)

men with disability (31%) - around 5 times as likely as those without disability (6.8%)

women with disability (32%) - around 3 times as likely as women without disability (9.2%) (Figure STATUS.2).

and that younger adults (aged 18-64) with disability are more likely to experience a higher level of psychological distress than older adults (aged 65 and over) with disability

Does mental health prevalence differ based on the type of disability?

The short answer is yes.

Looking at disability groups, the most likely to experience a high or very high level of psychological distress are adults with:

psychological disability (76%)

intellectual disability (60%)

head injury, stroke or brain damage (55%).

The least likely to experience this are adults with:

sensory disability (sight, hearing or speech) (28%)

physical disability (33%) (ABS 2019).

Why are individuals with psychological, intellectual and cognitive disabilities at a higher risk of mental ill-health?

Let's use the example of an intellectual disability, which often affects a person's ability to learn new information, communicate, cope, and effectively solve problems on their own. These aspects can have a profound impact on an individual's stress and vulnerability levels, leading to much great dependence on other and less independence in their day to day living.

As mentioned above, 60% of those who have an intellectual disability also experience mental health conditions, either consistently or periodically.

Individuals with both conditions may:

have difficulty communicating their wants and needs

not be able to describe their experiences, symptoms, or what they are feeling

have symptoms or experiences that are different to what is expected

use behaviour to communicate their distress.

It is important to remember however that mental health conditions affect everyone differently. This also applies to people with an intellectual disability, and to people where these are coexisting conditions.

Things you can do to Care For Someone With a Mental Illness and Disability.

If you are tasked with looking after a person with a mental illness, there are many ways in which you can help them:

Provide emotional support

Support them with day-to-day tasks

Be there for them during challenging times

Advocate for them

Encourage them to seek help

Promote their confidence in making their own decisions

Support them throughout their treatment

Strategies to Use When Caring for Someone With a Mental Illness and Disability.

There are useful strategies you can implement into your care to provide the best support possible for a person with mental illness:

Be honest, talk openly, and encourage them to be open with you and their loved ones about how they are doing and feeling.

Do research about the illness using reputable sources such as government or health organisations or resources written by specialists.

Encourage them to take an active role in their recovery and to live a healthy lifestyle.

Set limits with them about how far you can go and what you are unable to help them with.

Research local or online training courses for mental health carers.

Join a mental health support group or meet with and speak to other people in similar situations.

Take any talk of self harm or suicide seriously and reach out to a healthcare professional about it immediately.

Make a back-up plan for alternative care in case you have to go away or need leave.

Keep communication channels open when possible, not just with the person you are caring for, but also with family members, healthcare professionals, and medical administrative staff.

If you or a loved one is experienced mental ill-health, seek help:

Mental Health Line: 1800 011 511 Open 24/7

Lifeline: 13 11 14

Kids Helpline: 1800 551 800

Maple Community Services and Mental Health.

Here at Maple Community Services, we provide much-needed disability respite accommodation and support services under the NDIS. We specialise in mental health, cognitive disability, and psychosocial disability supports, working as NDIS short term accommodation providers.

If you have any questions around how Maple can assist you or your loved one through your NDIS journey, please do not hesitate to reach out.

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Mental Health prevalence among those with disabilities.￼ - Maple Services

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The prevalence of mental health conditions in the community reveals that some groups experience higher rates of mental illness.

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Adolescence (10-19 years) is a unique and formative time. Multiple physical, emotional and social changes, including exposure to poverty, abuse, or violence, can make adolescents vulnerable to mental health problems. Promoting psychological well-being and protecting adolescents from adverse experiences and risk factors that may impact their potential to thrive are critical for their well-being during adolescence and for their physical and mental health in adulthood.

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Centers for Disease Control and Prevention

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Adults with disabilities report experiencing frequent mental distress almost 5 times as often as adults without disabilities. Call your doctor if your mental health gets in the way of your daily activities for at least 14 days in a month.
December 3 rd is International Day of Persons with Disabilitiesexternal icon . In the United States, 1 in 4 adults-61 million-have a disability. ¹ Many people will experience a disability at some point during their lives. Disabilities limit how a child or adult functions. These limitations may include difficulty walking or climbing stairs; hearing; seeing; or concentrating, remembering, or making decisions.

Although "people with disabilities" sometimes refers to a single population, this is a diverse group of people with a wide range of needs. Two people with the same type of disability can be affected in very different ways. Some disabilities may be hidden or not easy to see.

Many Adults with Disabilities Report Frequent Mental Distress

A recent study found that adults with disabilities report experiencing more mental distress than those without disabilities. ² In 2018, an estimated 17.4 million (32.9%) adults with disabilities experienced frequent mental distress, defined as 14 or more reported mentally unhealthy days in the past 30 days. Frequent mental distress is associated with poor health behaviors, increased use of health services, mental disorders, chronic disease, and limitations in daily life. ²

During the COVID-19 pandemic, isolation, disconnect, disrupted routines, and diminished health services have greatly impacted the lives and mental well-being of people with disabilities. ³

Call your healthcare provider if stress gets in the way of your daily activities for several days in a row. Free and confidential resources can also help you or a loved one connect with a skilled, trained counselor in your area

It's Okay Not to Feel Okay

Everyone reacts differently to stressful situations. How you respond to stressful situations, such as the COVID-19 pandemic, can depend on your background, your support systems (e.g. family or friends), your financial situation, your health and emotional background, the community you live in, and many other factors.

People with disabilities or developmental delays may respond strongly to the stress of a crisis, particularly if they are also at higher risk for serious illness from COVID-19 (for example, older people and people of any age with certain underlying medical conditions).

Healthy Ways to Cope with Stress

Know what to do if you are sick and are concerned about COVID-19. Contact a health provider before you start any self-treatment for COVID-19.

Know where and how to get mental health treatment and other support services and resources, including counseling or therapy (in person or through telehealth services).

Take care of your emotional health. Taking care of your emotional health will help you think clearly and react to urgent needs to protect yourself and your family.

Take breaks from watching, reading, or listening to news stories, including those on social media. Hearing about the pandemic repeatedly can be upsetting.

Take care of your body.

Make time to unwind. Try to do some other activities you enjoy.

Connect with others. Talk with people you trust about your concerns and how you are feeling. During times of increased social distancing, people can still maintain social connections and care for their mental health. Phone calls or video chats can help you and your loved ones feel socially connected, less lonely, or isolated.

Connect with your community- or faith-based organizations. While social distancing measures are in place, consider connecting online, through social media, or by phone or mail.

Improving the Mental Health of People with Disabilities

CDC provides funding for two National Centers on Disability that focus on improving the quality of life for people living with disabilities.

Special Olympics' Inclusive Healthexternal icon programming focuses on improving the physical and social-emotional well-being of people with intellectual disabilities by increasing inclusion in health care, wellness, and health systems for Special Olympics athletes and others with intellectual disabilities.

Special Olympics' Strong Mindfulness program offers free, 1-hour mindfulness sessions for people with intellectual disabilities and their familiesexternal icon . Participants learn deep breathing techniques, body awareness and progressive muscle relaxation, mindful movement, and guided meditation. They also receive a Strong Minds Activity Guidepdf icon external icon designed to help them develop their coping skills in everyday life.

The National Center on Health, Physical Activity and Disability (NCHPAD)external icon seeks to help people with disabilities and other chronic health conditions achieve health benefits through increased participation in all types of physical and social activities. NCHPAD's M.E.N.T.O.R programexternal icon , which stands for Mindfulness, Exercise and Nutrition to Optimize Recovery, takes a holistic approach to restoring, improving, and protecting health. The program divides health into three domains: physical, mental, and emotional. Through this program, people who have acquired a new disability (e.g., spinal cord injury, stroke, traumatic brain injury), a new diagnosis (e.g., multiple sclerosis, Parkinson's disease), or have a congenital condition (e.g., cerebral palsy, spina bifida) learn the many ways life can be enhanced through health and wellness activities.

Disability and Mental Health Resources

As CDC honors International Day of Persons with Disabilities, we ask that you join us in being a part of the global movement to change attitudes toward, and promote the inclusion of, people with disabilities.

References

1. Okoro CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67:882-887. /mmwr/volumes/67/wr/mm6732a3.htm

2. Cree RA, Okoro CA, Zack MM, Carbone E (2020). Frequent Mental Distress Among Adults by Disability Status, Disability Type, and Selected Characteristics - United States 2018. Morbidity and Mortality Weekly Report (MMWR).

3. International Day of People with Disabilities. Accessed November 17, 2020. https://idpwd.org/external icon

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Learn some tips that people with disabilities can use to cope with stress

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It's no secret COVID is having a drastic impact on people's wellbeing, and has worsened an already a rising trend in mental health problems. The Australian Institute for Health and Welfare 's latest figures indicate some of our most vulnerable are struggling even more than most.

People with disabilities are experiencing very high rates of mental health difficulties and psychological distress. Yet health professionals often don't feel equipped to treat people who are experiencing both disabilities and mental health difficulties.

About one in six Australians have a disability, equating to around 4.4 million people. The latest figures show two-thirds of people with a disability report low to moderate levels of psychological distress, while around a third report high or very high levels of psychological distress.

This compares to 92% of people without disability who report low to moderate psychological distress, and 8% who report high or very high distress. Almost a quarter of adults living with a disability report their mental health has worsened during the pandemic period.

Why the difference?

Research tells us there's a strong link between physical health and mental health. Some health behaviours are likely to have a detrimental effect on wellbeing, such as poor diet and inactivity.

In general, people with a disability are more likely to engage in risky health behaviours than people without a disability. This includes not eating enough fruit and vegetables per day (47% compared to 41%), being overweight or obese according to body mass index (72% compared to 55%), and not doing enough physical activity for their age (72% compared to 52%).

Not only do people with disabilities have higher rates of mental health difficulties and health risk behaviours, they also face significant barriers when it comes to accessing effective and timely healthcare. These barriers include lengthy wait times for healthcare, inaccessibility of buildings, costs and experiences of discrimination, including by health professionals.

Read more: Long COVID should make us rethink disability - and the way we offer support to those with 'invisible conditions'

Be disabled or have mental health problems - but not both

Working across the mental health and disability sectors, it is not uncommon to hear of people falling between the cracks of services. Someone may present to a disability-specific health service, and be turned away due to a co-occuring mental health difficulty. They might then present to a mental health service and be turned away due to having a disability.

A range of factors contribute to this issue. Services are often funded in a way that requires them to have certain criteria for the clients who can be seen. This unfortunately means those who do not meet the criteria are turned away.

Health and mental health practitioners agree people with disabilities have the right to receive good mental heath care and access to services. But clinicians such as psychologists and counsellors report low confidence when working with people with disabilities, and insufficient training in how to best help them.

Read more: 'Sometimes I don't have the words for things': how we are using art to research stigma and marginalisation

Barriers can cause discrimination

For a long time, people with certain disabilities such as intellectual disabilities were excluded from many mental health treatments. It was assumed that due to difficulties with learning and processing information, they did not have the capacity to engage in therapy.

Only in the past decade has this started to shift, with emerging mental health treatment programs developed specifically for people with disabilities.

A lack of training can also result in a form of discrimination called " diagnostic overshadowing". This is when a health practitioner attributes a person's symptoms to an already existing disability or mental illness, rather than fully exploring the symptoms and considering alternate diagnoses.

Often, once a patient has a confirmed diagnosis, there is a tendency to attribute all new behaviours or symptoms to that diagnosis. As a result, diagnoses may be inaccurate or get missed. And treatment might not be adequate or effective.

Read more: Hospitals only note a person's intellectual disability 20% of the time - so they don't adjust their care

Investment and training is needed

If we are to improve the mental health and wellbeing of people living with a disability, greater investment is needed. Doctors and practitioners require specialised training to work with clients with both disabilities and mental illness.

We also need greater collaboration between health, disability and mental health professionals, and increased communication so services work together rather than in isolation. We can look to the University of New South Wales' Department of Developmental Disability Neuropsychiatry, University of Technology Sydney's Graduate School of Health and Westmead Children's Hospital for examples of mental health and disability needs being integrated. Other services should follow this path.

As always, prevention and early intervention is key. While it is important we can effectively treat people who require help, it is also important for us to curb the rising trend of mental illness.

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Mental distress is much worse for people with disabilities, and many health professionals don't know how to help

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People with disabilities experience very high rates of mental health difficulties and psychological distress. Yet health professionals often don't feel equipped to treat them.

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Better access to housing and income support is needed to address an alarming increase in homelessness among people experiencing mental ill-health says Homelessness Australia as World Homelessness Day and World Mental Health Day coincide on 10 October.

In 2019-20, 88,338 people with mental health issues sought homelessness assistance across Australia, almost double the 44,732 Australians needing assistance in 2011-12*. More recent monthly data shows a further 6% increase between June 2020 and June 2021**.

Homelessness Australia Chair Jenny Smith says growing homelessness among people struggling with their mental health highlights gaps in the safety net, as well as inadequate support for people with mental ill health.

"If you're struggling and unable to work it is basically impossible to afford rent on the inadequate JobSeeker payment, and people who need it can't get into social housing," Smith says.

"Many also can't access the mental health care they need, as they can't afford it or face long queues through Medicare or hospitals.
"More people are becoming homeless because they are falling through the gaping holes in the income security, housing and health care safety nets.

"The shocking increase in homelessness among people with mental health issues should sound the alarm bells for Government to increase income support for people struggling with their health, and to provide more social housing.

Some people coming to homelessness services with significant mental health issues also need ongoing support to sustain housing. The dire shortage of Housing First options in Australia, which provide access to long-term affordable housing as well as flexible wrap around support, also means that the most vulnerable people with mental illness who are homeless do not get the housing and support they need.

"Lack of available housing and support means there is a revolving door for the most vulnerable people between homelessness services, acute mental health services, and rough sleeping.

"We know we can end homelessness for people with serious mental health issues with access to stable housing and support, but to make that possible for more people the Federal Government needs to urgently invest in more social housing in partnership with the States and Territories."
*: AIHW, Specialist homelessness services 2019-20, Supplementary Tables - Historical Data 2011-12 to 2019-20. **: AIHW, SHS client groups, by state/territory and sex, July 2017 to June 2021, Specialist Homelessness Service Monthly Data, June 2021.

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Number of Australians with mental health issues needing homelessness help doubled in a decade - Homelessness Australia

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Better access to housing and income support is needed to address an alarming increase in homelessness among people experiencing mental ill-health says Homelessness Australia as World Homelessness Day and World Mental Health Day coincide on 10 October. In 2019-20, 88,338 people with mental health issues sought homelessness assistance across Australia, almost double the 44,732 Australians needing assistance in 2011-12*.

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Mental health is fundamental to every stage of our life, affecting how we feel, the choices we make and our relationship with ourselves and others.

Mental health is determined by our emotional, psychological, and social well-being, helping us realise our full potential, cope with the stressors of life and make a meaningful contribution to our communities.

Many factors contribute to our mental wellbeing and regardless of our age, we can all experience challenges to our mental health at times. Mental health problems are common but when left undealt with, they can contribute to a range of other challenges in life such as homelessness.

What is homelessness?

Homelessness can affect a person who does not have safe or suitable accommodation. The problem of homelessness goes beyond not having a roof. It is also a term used to describe people who may live in overcrowded spaces or temporary dwellings such as refuges, crisis accommodations or motels.

Did you know? In Australia, many people experience 'hidden homelessness', they may be sleeping in cars, couch surfing or living in temporary accommodation.

Mental health and homelessness

Mental health is a leading cause of homelessness in Australia. A deterioration of mental health can trigger additional challenges that a person can experience through no fault of their own, such as:

Job loss or ability to attain or employment

Reliance on alcohol and other drugs

Loss of ability to sustain or qualify for tenancy

Breakdown in relationships and lack of support systems

Feeling of isolation

Deterioration of physical health and/or additional medical expenses.

For people like 28-year-old Roger, a decline in mental well-being triggered a chain of events that eventually led to homelessness.

Roger's story: Overcoming homelessness

When doctors at St Vincent's Hospital told Roger*, 28, he was ready to go home, Roger felt hopeless. Unlike other patients who eagerly waited to return home and sleep in their own bed, Roger had nowhere else to go.

The 28-year-old had never experienced homelessness before but his struggle with mental health and lack of support meant he was extremely vulnerable to homelessness.

With the right support services, Roger had a chance at independence. When we connected with Roger, one of our crisis accommodation facilities had a spare room. During his five-month stay at the Misson Australia Centre in Sydney, Roger accessed our case management support and additional services like our dental clinic and on-site counsellor.

With a helping hand, Roger secured a full-time job with a flexible workplace that also champions his mental wellbeing. Roger loves his new job and with a new focus on his career, is more confident and happier than ever.
Today, Roger can afford to rent a unit close to work and is standing on his own two feet.
Roger not only has a job and a safe place to call home, but he is also thriving!

A decline in our mental health can cause significant setbacks in life and in some situations, can trigger challenges that lead to homelessness. Thanks to our community of supporters, our services can continue supporting people on their journey towards independence.

Read more stories about how we support mental health.

Subscribe for the latest news

Related news and stories

Read about what we've been working on, our stance on important social issues and how you make a difference to vulnerable Australians' lives.

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Understanding mental health and homelessness

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Mental health problems are common but when left undealt with, they can contribute to a range of other challenges in life such as homelessness.

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By 2050, the world population over the age of 60 is expected to reach two billion. A rapid growth of older people will occur in low- and middle-income countries (LMIC) with huge consequences for these vulnerable economies. Many people live a long and happy life without any mental health problems, despite the all too prevalent impression of elderly people being sad, slow and forgetful, mental disorders are not an inevitable consequence of ageing. Nevertheless, one of the possible negative consequences of the rapid ageing of the global population is the increase in the number of people with mental disorders, which will soon overwhelm the mental health systems in all countries.

More than 20% of people aged 55 or older may have some type of mental health problem. Biological changes may interfere with the brain's functioning, social changes can lead to isolation or worthlessness and somatic diseases are often important contributory factors too. Mental disorders may exacerbate the symptoms and functional disabilities associated with medical illnesses and increase the use of healthcare resources, length of hospital stay and overall cost of care.

Mental health problems can have a high impact on an older person's ability to carry out basic daily living activities, reducing their independency, autonomy and quality of life. The first step to reduce these negative consequences is simply to make a diagnosis. Unfortunately, too often mental health problems are undiagnosed and untreated and many older people struggle on without proper help or any help at all.

Today's older adult population is not likely to acknowledge mental illness or to access mental health services. Many stigmas exist regarding the meaning of mental illness. Many elderly people view mental illness as a sign of weakness and are unlikely to admit to experiencing problems, especially when they fear loss of independence. Too many people consider the symptoms of dementia and depression as a normal part of ageing. Many older people also lack the availability of, and access to, services.

Other difficulties concern the workforce: few mental health providers have had specialised training in providing care for older adults and many come with a set of societal-transmitted biases themselves. This therapeutic pessimism of health professionals means they believe that older people cannot change and that it is too late for psychiatric care to be administered. As a result, there are few investments in the development of policies, strategies, programmes and services for older persons with mental health problems.

It will be very difficult for all countries, no matter what their respective income levels are, to assure the development of a specific workforce to treat and care for older people with mental health disorders at the same rate that this group is growing. Other existing resources have to be used; primary care becomes mandatory.

The mental health and wellbeing of older people was chosen by the World Federation for Mental Health as the theme for the World Mental Health Day 2013. This is a very good occasion to reflect on the global situation of older people with mental disorders around the globe. This issue of Mental Health in Family Medicine is a contribution to this reflection and an affirmation that the collaboration between old age mental health professionals and primary care teams is not only possible, it is absolutely necessary.

Shulin Chen et al develop in their article how, in China, and in particular rural China, it is necessary to develop and test approaches to the care for patients with dementia. Evidence-based collaborative care models for dementia, depression and other chronic diseases that have been developed in some Western countries serve as a basis for the discussion of innovative approaches to the management of dementia in China, with particular focus on its implementation in the primary care system.

Research into mental health issues in general practice is often limited by several issues despite the importance of developing knowledge in this field. Recruitment rates of general practitioners (GPs) to carry out research vary widely. This may be related to the ability of studies to incorporate incentives for GPs and minimise barriers to participation.

Chris Fox et al make suggestions to optimise primary care for people with dementia. Authors consider key areas in primary care regarding the diagnosis of dementia. Issues surrounding assessment, policy and incentives are considered. In addition, the relevance of non-medication approaches for dementia in primary care, which aim to enhance or maintain quality of life, is deliberated. Key issues about primary care medication management are considered and relevant therapeutic strategies that improve outcomes by linking primary and secondary healthcare services with social care needs are weighed up. A key aspect of such a collaborative approach is to support informal carers in optimising medication.

Nogueira et al focus on the development of a liaison old age psychiatry (LOAP) facility. Elderly patients occupy up to 65% of acute hospital beds and a significant proportion of them present with a comorbid psychiatric condition such as depression, delirium or dementia. A LOAP service may provide psychiatric consultation in medical and surgical settings, improving at the same time the knowledge and expertise of general ward staff. A LOAP service may play an important role to effectively reduce the overutilisation and consumption of health resources through the early recognition of these conditions, effective management and prevention of adverse outcomes, and articulation with outpatient clinics, community mental health teams and day-care centres.

Syahnaz Mohd Hashim et al develop the role of primary care in the bereavement of older people. This bereavement can lead to psychological illness such as depression. While most people are able to come to terms with their grief without any intervention, some vulnerable people are not. Early recognition of elderly people with bereavement-related depressive illness is a priority. Primary care physicians need to optimise support and available resources prior to, and throughout, the bereavement period in order to reduce the caregiver's burden and suffering.

Henry Brodaty et al used a sample of GPs from the Sydney intervention and control groups from the Ageing in General Practice 'Detection and Management of Dementia' project, as well as GPs who had refused participation, to determine incentives and barriers to participating in research. Authors detected the contributing factors as incentives and barriers to the success of this project and they make suggestions for how to improve future recruitment of GPs.

Boadie W Dunlop et al highlight frequently over-looked aspects of the care of older patients who present with depression and anxiety in primary care. Chief among these aspects is the consideration of a thorough differential diagnosis, particularly bipolar disorder, psychotic disorders, dementia and substance abuse, each of which requires specific treatment approaches. They conclude that judicious use of benzodiazepine and appropriate referrals to psychotherapy can contribute to optimal treatment outcomes.

All these articles confirm that the shifting of focus to the ageing will have profound consequences for the workforce, healthcare systems, informal and formal caregiver capacity and society in general, and will require more and better strategies to ensure good mental health and wellbeing in the growing older population. The negative stereotypes and attitudes regarding ageing and older people must be stopped. The balance between vulnerability and resilience is central to mental health promotion and certain groups with specific burdens face a higher risk of poorer mental health. Older women often face risks that increase their vulnerability, both as sufferers of mental health problems and caregivers. Policies to support them and interventions to prevent mental health problems and isolation in older women must be strengthened.

In conclusion, the promotion of healthy ageing in all its aspects is an important role for all societies. Early recognition, diagnosis and treatment of mental disorders that are common in old age are important to prevent suffering and disabilities. Care for older adults with mental illnesses requires sensitivity and observational and relational skills in order to help the older person achieve and maintain the highest possible level of functioning and wellbeing. Those who care for older people should always be protected and supported in their tasks everywhere. All these interventions can be efficiently realised in primary care.

All these actions together can certainly contribute to better mental health in old age.

Contributor Information

Carlos Augusto de Mendonça Lima, Chair, European Psychiatric Association Section of Geriatric Psychiatry; Secretary, World Psychiatric Association Section of Old Age Psychiatry; Psychiatrist, Centre de Psychiatrie et de Psychothérapie Les Toises, Lausanne, Switzerland.

Gabriel Ivbijaro, Editor-in-chief Mental Health in Family Medicine; Medical Director, Waltham Forest Community and Family Health Services; President Elect, World Federation for Mental Health (WFMH)

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Mental health and wellbeing of older people: opportunities and challenges

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By 2050, the world population over the age of 60 is expected to reach two billion. A rapid growth of older people will occur in low- and middle-income countries (LMIC) with huge consequences for these vulnerable economies.

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Key facts

By 2030, one in six people in the world will be aged 60 years or over.

Loneliness and social isolation are key risk factors for mental health conditions in later life.

One in six older adults experience abuse, often by their own carers.

Approximately 14% of adults aged 60 and over live with a mental disorder.

Mental disorders among older adults account for 10.6% of the total years lived with disability for this age group.

Overview

The world's population is ageing fast. In 2020, 1 billion people in the world were aged 60 years or over. That figure will rise to 1.4 billion by 2030, representing one in six people globally. By 2050, the number of people aged 60 years and over will have doubled to reach 2.1 billion. The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million (1).

Older adults contribute to society as family and community members, and many are volunteers and workers. While most have good health, many are at risk of developing mental health conditions such as depression and anxiety disorders. Many may also experience reduced mobility, chronic pain, frailty, dementia or other health problems, for which they require some form of long-term care. As people age, they are more likely to experience several conditions at the same time.

Prevalence

Around 14% of adults aged 60 and over live with a mental disorder (2). According to the Global Health Estimates (GHE) 2019, these conditions account for 10.6% of the total disability (in disability adjusted life years, DALYs) among older adults. The most common mental health conditions for older adults are depression and anxiety. GHE 2019 shows that globally, around a quarter of deaths from suicide (27.2%) are among people aged 60 or over.

Mental health conditions among older people are often underrecognized and undertreated, and the stigma surrounding these conditions can make people reluctant to seek help.

Risk factors

At older ages, mental health is shaped not only by physical and social environments but also by the cumulative impacts of earlier life experiences and specific stressors related to ageing. Exposure to adversity, significant loss in intrinsic capacity and a decline in functional ability can all result in psychological distress.

Older adults are more likely to experience adverse events such as bereavement, or a drop in income or reduced sense of purpose with retirement. Despite their many contributions to society, many older adults are subject to ageism, which can seriously affect people's mental health.

Social isolation and loneliness, which affect about a quarter of older people, are key risk factors for mental health conditions in later life (3). So too is abuse of older people, which includes any kind of physical, verbal, psychological, sexual or financial abuse, as well as neglect. One in six older adults experience abuse, often by their own carers (4). Abuse of older adults has serious consequences and can lead to depression and anxiety.

Many older people are carers of spouses with chronic health conditions, such as dementia. The responsibilities of such care can be overwhelming and can affect the carer's mental health.

Some older adults are at greater risk of depression and anxiety, because of dire living conditions, poor physical health or lack of access to quality support and services. This includes older adults living in humanitarian settings and those living with chronic illnesses (such as heart disease, cancer or stroke), neurological conditions (such as dementia), or substance use problems.

Promotion and prevention

Mental health promotion and prevention strategies for older adults focus on supporting healthy ageing. That means creating physical and social environments that support well-being and enable people to do what is important to them, despite losses in capacity.

Key mental health promotion and prevention strategies for healthy ageing include:

measures to reduce financial insecurity and income inequality;

programmes to ensure safe and accessible housing, public buildings and transport;

social support for older adults and their carers;

support for healthy behaviours, especially to eat a balanced diet, be physically active, refrain from tobacco and reduce alcohol use; and

health and social programmes targeted at vulnerable groups such as those who live alone or in remote areas and those living with a chronic health condition.

For older adults, social connection is particularly important to reduce risk factors such as social isolation and loneliness. At this stage of life, meaningful social activities can significantly improve positive mental health, life satisfaction and quality of life; they can also reduce depressive symptoms. Example interventions include befriending initiatives, community and support groups, social skills training, creative arts groups, leisure and education services and volunteering programmes.

Protection from ageism and abuse is also critical. Key interventions include anti-discrimination policies and laws, educational interventions and intergenerational activities. A range of carer interventions - including respite care, advice, education, financial support and psychological interventions - can support carers to maintain a good and healthy caring relationship that avoids abuse of older people.

Treatment and care

Prompt recognition and treatment of mental health conditions (and associated neurological and substance use conditions) in older adults is essential. This should follow standards for integrated care for older people, which is community-based and focused on both the long-term care of older adults living with mental health conditions and declines in intrinsic capacity, as well as the education, training and support of carers. A mix of mental health interventions are usually recommended, alongside other supports to address the health, personal care and social needs of individuals.

Dementia is often an important concern. It affects people's mental health (for example, sparking symptoms of psychosis and depression), and requires access to quality mental health care.

Responding to the abuse of older adults is also critical. Promising interventions include mandatory reporting of abuse, self-help groups, helplines and emergency shelters, psychological programmes for abusers, training of health care providers and other caregiver support interventions.

WHO response

WHO works with diverse partners on strategies, programmes and tools to support governments respond to the mental health needs of older adults.

For example, the Decade of Healthy Ageing (2021-2030) is a global collaboration led by WHO to improve the lives of older people, their families and the communities in which they live.

WHO Member States have also endorsed the Comprehensive mental health action plan 2013-2030, which supports improved mental health and mental health care for all populations, including older adults.

WHO's Mental Health Gap Action Programme (mhGAP) provides evidence-based clinical protocols for assessing, managing and following up a set of priority mental, neurological and substance use conditions in non-specialized settings, including depression and dementia. The mhGAP intervention guide includes clinical tips for working with older adults.

During the COVID-19 pandemic, WHO and partners in the Inter-Agency-Standing Committee (IASC) developed the Living with the timestoolkit of illustrated posters to help older adults maintain good mental health and well-being. Other WHO activities to support the mental health of older adults include the development of scalable psychological interventions to address depression and anxiety, research and guidance on interventions to reduce social isolation and loneliness, and cost-effective solutions to prevent abuse of older adults.
References

1. World Population Prospect 2022: release note about major differences in total population estimates for mid-2021 between 2019 and 2022 revisions. New York: United Nations Department of Economic and Social Affairs, Population Division; 2022 (https://population.un.org/wpp/Publications/Files/WPP2022_Release-Note-rev1.pdf, accessed 12 September 2023).

2. Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx). https://vizhub.healthdata.org/gbd-results/, accessed 20 October 2023).

3. Hong Teo R, Hui Cheng W, Jie Cheng L, Lau Y, Tiang Lau S. Global prevalence of social isolation among community-dwelling older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2023 Apr;107:104904. doi:10.1016/j.archger.2022.104904.

4. Yon YY, Mikton CR, Gassoumis ZD, Wilber KH. Elder abuse prevalence in community settings: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(2):e147-e156. doi:10.1016/S2214-109X(17)30006-2.

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Fact sheet on mental health and older adults providing key facts and information on risk factors, dementia , depression, treatment and care strategies, WHO response.

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SAMHSA

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Mental health worsens "dramatically"

A report in 2014 found "dramatic" increases in Aboriginal rates of youth suicide, anxiety and depression, as well as cognitive disability and mental health among offenders, and perinatal mental health [6].

Government programs need to take a long-term view rather than employ quick "start and stop" programmes or provide too narrowly focused and inadequate mental health services.

Aboriginal mental health and suicide still need to be researched more.

Improving mental health outcomes will have a flow-on effect to other areas, including reducing high incarceration and substance abuse rates.

Risk and protective factors for Aboriginal mental health

The following risk factors are interconnected, and a person with mental illness might show any number of them.

Widespread grief and loss. This includes grief about the loss of culture, land, connection, and many more areas, often connected to the history of invasion.

Stolen children. The impact of the past Stolen Generations and ongoing removal of children puts a lot of mental pressure on people, especially when government departments just follow procedures.

Unresolved trauma. Trauma is a huge factor in Aboriginal health and an agent for many health conditions. If unresolved, trauma can debilitate a person and be passed on to the next generation.

Loss of identity & culture. When Aboriginal people are separated from their culture and identity, for example when they don't live on their traditional homelands or don't know where they are coming from, they don't feel complete or search for who they are.

Discrimination and racism. Discrimination based on race or culture, as well as racism, can have a huge impact on any person's mental health.

Few economic opportunities. Due to other factors, many Aboriginal people are economically and socially disadvantaged. If you have to constantly worry about finance or how you are perceived by others, this worry contributes to mental illness.

Poor physical health. Physical health problems contribute to the feeling of inadequacy and exclusion, and some people might stop socialising or exercising. 23% of Aboriginal people reported having both a mental health condition and one or more other long-term health conditions. [10]

Incarceration Being imprisoned has a huge effect on people's mental health.

Culturally inappropriate treatment. Especially the health area is prone to assess Aboriginal people with non-Aboriginal criteria, or expose them to culturally insensitive environments.

Violence. Domestic violence, as well as violence in prisons, for example, contributes to poor mental health.

Substance abuse. When Aboriginal people misuse substances to ease their inner pain, it can lead to follow-on issues, such as depression.

Despite the risk factors, there are also some positive, or protective, factors that help Aboriginal people deal with mental illnesses [9]:

Social connectedness and sense of belonging

Connection to land, culture, spirituality and ancestry

Living on or near traditional lands

Self-determination

Strong Community governance

Passing on of cultural practices

Traditional Aboriginal healing methods can support mentally ill people to recover, for example South Australia's Ngangkari program.

Depression

The 2014-15 National Aboriginal and Torres Strait Islander Social Survey measured psychological distress (mental or emotional pain), which is often linked with feelings of anxiety or depression.

It found that nearly 33% of Aboriginal people aged over 15 years reported having high to very high levels of psychological distress. This was more than twice the levels reported for other Australians. The figure shoots up to 60% if the person has a mental health condition. [10]

68% of Aboriginal people over 15 years experienced at least one personal stressor in last 12 months, such as an illness, accident, overcrowding, death of a loved one or violence. Almost 30% experienced homelessness, and a third felt treated unfairly, e.g. by racial comments or jokes, being called names or ignored while accessing services. [11]

Aboriginal women reported these levels of stress more than men. It is often hard to know how common depression is in the Aboriginal population, however, because of the way people understand depression and their cultural understanding of mental illness.

Video: Racism and depression

Watch Beyond Blue campaign actors share their experiences of racial discrimination and the impact this has had on their mental health.

Dementia

Aboriginal people living in remote communities are 10 times more likely to develop dementia than people living in countries such as Africa, India and Indonesia; and 5 times more likely than non-Indigenous people [1][2]. In the Kimberley region between 13 and 27% of elderly Aboriginal people have dementia., compared to 2.6% amongst non-Aboriginal people aged 45 and over [3].

Other statistics show that remote Aboriginal people are 26 times more likely to develop dementia at a relatively young age (between 45 and 59 years) than the rest of Australians [3].

Smoking, stroke, head injury and no formal education are the main contributors to the high rate, with the good news that most of these factors can be changed.

Other risk factors are unemployment, underemployment and low status jobs, high rates of drug and alcohol use; brain trauma and increased rates of diabetes, hypertension, renovascular and metabolic disease [3].

Mental health is worst among Aboriginal prisoners where up to 93% of Aboriginal detainees have some form of mental illness.

Another factor is less obvious. The colonisation of Australia has caused much trauma among Aboriginal people. Because they couldn't cope with what was happening many developed mental illnesses [4].

The dispossession, loss of identity, loss of land, this has all led to a whole lot of lost people.-Liz Hayden, Aboriginal Health Unit, Graylands Hospital, WA [4]

Discriminatory behaviour also contributes to bad mental health, eroding Aboriginal people's self-esteem and value within their community [5].

Health professionals found that just treating the psychiatric illness is not enough [4], but a holistic approach is required that takes in the historical perspective. Many Aboriginal children who were stolen from their families and grew up on missions came back as "fragmented people" [4] with mental health problems.

Video: Discussing Dementia: Losing the Dreaming

Learn about people living with dementia in the Aboriginal community. The short film features Birpai Elder Uncle Bill O'Brien discussing his experience of caring for his mother, who had dementia.

Schizophrenia

Schizophrenia is characterised by abnormal social behaviour and failure to recognize what is real. Sufferers have confused thinking, hallucinations, delusions, are socially withdrawn and lack emotional depth.

In Aboriginal communities, mental disorder is still frequently identified as spiritual disorder, hence it is treated by traditional healers, often alongside Western medical practitioners [7].

Schizophrenia is said to be at least as common in Aboriginal people as in white Australians, attributed to the post-colonial epidemic of substance abuse to cope with the trauma. Traumatic stress presents as depressive psychosis in both its unipolar and bipolar forms.

Research has found that Aboriginal people express their distress differently than non-Aboriginal people [7].

Other stressors reported most frequently by Aboriginal people were death of a family member or close friend (46%), serious illness or disability (31%), and inability to get a job (27%) [7].

Mental health study resource

Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice outlines the historical, social, cultural, and policy contexts that have shaped Aboriginal mental health and wellbeing, highlights issues that are particularly relevant to Aboriginal people, contains a section that focuses on practice within the field, and presents examples of models and programs for practitioners.

The second edition contains a number of new chapters, providing more information on children and young people; the significant impacts of mental health in the justice system; the cultural determinants of social and emotional wellbeing and intellectual and development disabilities.

Chapters include: History and Contexts, Issues and Influences, Standards, Principles and Practice, Assessment and Management, Working with Children, Families and Communities, and Healing Models and Programs.

The Telethon Kids Institute offers free copies of Working Together (PDF, e-book and hardcopy), but you will need to pay for delivery.

Support services

Proppa Deadly

Proppa Deadly, an initiative of Beyond Blue, is a project encouraging Aboriginal people to take action against depression and anxiety through the telling of their own stories across the First Nations community radio sector.

The project inspires others because those who share their story also talk about the actions they undertook to combat depression and/or anxiety.

Healing Foundation

The Healing Foundation is a national Aboriginal organisation that works with communities to address the ongoing trauma caused by actions like the Stolen Generations. It aims to create a place of safety where Stolen Generations members and their families can speak for themselves, tell their own stories and be in charge of their own healing.

The Healing Foundation is also conducting research in Aboriginal healing, and supporting locally-run projects, training and education, research and commemorations.

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A report in 2014 found "dramatic" increases in Aboriginal rates of youth suicide, anxiety and depression, as well as cognitive disability and mental health among offenders, and perinatal mental health [6]. Government programs need to take a long-term view rather than employ quick "start and stop" programmes or provide too narrowly focused and inadequate mental health services.

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Health

More than four in 10 (46%) people had at least one chronic condition that posed a significant health problem in 2018-19, up from 40% in 2012-13.

The proportion of people with asthma in remote areas (9%) was around half the proportion for people living in non-remote areas (17%).

More than one in 10 people aged two years and over reported having anxiety (17%) or depression (13%).

More than four in 10 (45%) people aged 15 years and over rated their own health as excellent or very good in 2018-19, up from 39% in 2012-13.

Risk factors

The proportion of people aged 15 years and over who smoked every day decreased from 41% in 2012-13 to 37% in 2018-19.

The proportion of children aged 2-14 years who were overweight or obese increased from 30% in 2012-13 to 37% in 2018-19.

The proportion of people aged 15 years and over who had consumed the recommended number of serves of fruit per day declined for those living in remote areas from 49% in 2012-13 to 42% in 2018-19.

Sugar sweetened drinks were usually consumed every day by around one-quarter (24%) of people aged 15 years and over.

Use of health services

More than half (57%) of children aged 2-17 years had seen a dentist or dental professional in the last 12 months.

The proportion of people who did not see a GP when needed in the last 12 months was higher for those living in non-remote areas (14%) than remote areas (8%).

The National Aboriginal and Torres Strait Islander Health Survey collected data on a broad range of health-related topics, language, cultural identification, education, labour force status, income and discrimination - for full details see Appendix - survey topics.

​​​​​​​Asthma

Asthma is a chronic condition that can usually be managed through treatment, such as medication use and managing lifestyle behaviours, which can assist in avoiding and reducing asthma symptoms [1].

More than one in 10 (16%) people reported having asthma, about the same as in 2012-13 (18%).

The proportion of people with asthma was:

higher for females (18%) than males (13%)

around double for people living in non-remote areas (17%) when compared with those living in remote areas (9%).

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is a chronic condition associated primarily with smoking and environmental factors such as working or living in areas where there is dust, gas, chemical fumes, smoke or air pollution [2].

More than three in 100 (3.4%) people reported having chronic obstructive pulmonary disease, about the same as in 2012-13 (4.1%).

The proportion of people with chronic obstructive pulmonary disease was:

higher for females (4.3%) than males (2.5%)

more than twice as high for people living in non-remote areas (3.8%) when compared with those living in remote areas (1.4%)

higher for people aged 55 years and over (13%) than for any other age group.

Heart disease encompasses a number of chronic conditions associated with lifestyle risk factors such as smoking, high cholesterol, high blood pressure, diabetes, being inactive, being overweight and an unhealthy diet [1]. Heart disease was the leading cause of death for Aboriginal and Torres Strait Islander people in 2018 [2].

The proportion of people who reported having heart disease increased from 4% in 2012-13 to 5% in 2018-19.

The proportion of people with heart disease was:

about the same for males (6%) and females (5%)

the same for people living in non-remote areas and remote areas (both 5%).

The proportion of people with heart disease generally increased with age, from 1% for people aged 25-34 years to 26% for people aged 55 years and over.

​​​​​​​Mental and behavioural conditions

Mental and behavioural conditions encompass a number of chronic conditions resulting from a complex interplay of biological, social, psychological, environmental and economic factors, and can significantly affect how a person feels, thinks, behaves and interacts with other people [1].

Around one-quarter (24%) of people aged two years and over reported having a mental or behavioural condition [2].

The proportion of people with a mental or behavioural condition was:

about the same for males (23%) and females (25%)

around three times higher for people living in non-remote areas (28%) than remote areas (10%)

around three in 10 for most age groups, except those aged 2-14 years (15%) and 15-24 years (24%) [3].

Anxiety was the most common mental or behavioural condition reported (17%) by people aged two years and over. The proportion with anxiety was higher for females (21%) than males (12%).

Depression (including feelings of depression) was the second most common condition reported (13%). The proportion of females who reported depression (16%) was higher than for males (10%).

Anxiety and depression were the most common conditions reported for most age groups. The only exception was for children aged 2-14 years, where behavioural or emotional problems (11%) was the most common condition.

Psychological distress

A person's level of psychological distress [4] provides an indication of their mental health and wellbeing.

Around three in 10 (31%) people aged 18 years and over experienced high or very high levels of psychological distress.

The proportion of people who experienced high or very high levels of psychological distress was:

about the same as 2012-13 (30%)

higher for females (35%) than males (26%)

about the same for people living in non-remote areas (31%) and remote areas (28%)

about the same for all age groups.

Ear disease or hearing problems (self-reported)

The proportion of people who reported having ear disease or hearing problems remained about the same between 2012-13 (12%) and 2018-19 (14%).

The proportion of people with ear disease or hearing problems was:

the same for males and females (both 14%)

about the same for people living in non-remote areas (14%) and remote areas (13%).

The proportion of people with ear disease or hearing problems generally increased with age. It increased from more than one in 10 for people aged 25-34 years (12%) or 35-44 years (15%) to more than three in 10 (34%) for people aged 55 years and over.

One in 10 (10%) people reported having partial or complete deafness in one or both ears.

The proportion of children aged 0-14 years who were deaf in one or both ears (4%) was about the same as in 2012-13 (3%) [2]. The proportion of children aged 0-14 years with long-term otitis media also did not change between 2012-13 and 2018-19 (both 3%) [2].

Measured levels of hearing

A voluntary hearing test was also offered at the time of interview for people aged seven years and over without a cochlear implant. See Hearing data (appendix) for more information.

The hearing test indicated more than four in 10 (43%) people aged seven years and over had a hearing impairment in one or both ears at the time of interview. The proportion of people with a measured hearing impairment:

was about the same for males (43%) and females (42%)

was higher for people living in remote areas (59%) than non-remote areas (39%)

increased with age from 35 years and over, doubling from 41% of people aged 35-44 years to 82% of people aged 55 years and over.

More than two in 10 (23%) people had a measured hearing impairment in both ears.

Hearing impairment measured at the time of interview does not necessarily indicate a long-term hearing impairment. For example, a hearing impairment on the day of the test may have been due to a temporary cause (like a cold) or limitations with the hearing test (such as being undertaken with background noise present rather than in a soundproof room). However, the difference between reported and measured hearing impairment suggests a person may require further medical review for undiagnosed or untreated hearing impairment.

Overall, almost eight in 10 (79%) people who had a measured hearing impairment in at least one ear did not report having a long-term hearing impairment. The proportion of people with measured hearing impairment was:

more than three times higher thanreported long-term hearing impairment (43% compared with 12%)

higher than reported long-term hearing impairment across all age groups

more than six times higher than reported long-term hearing impairment for children aged 7-14 years (29% compared with 4.3%).

Experiences of both physical and threatened physical harm have an impact on the levels of wellbeing experienced by individuals and communities.

More than one in 10 (16%) people aged 15 years and over had experienced physical harm or threatened physical harm at least once in the 12 months prior to interview [1]. There was no significant difference between males (17%) and females (14%).

Experiences of physical harm

Six per cent of people aged 15 years and over had experienced physical harm at least once in the last 12 months. The proportion was the same for males and females (both 6%).

For all experiences of physical harm in the last 12 months, a higher proportion of females (74%) than males (56%) identified an intimate partner/family member as at least one of the offenders [2].

More than seven in 10 (72%) people were physically injured in their most recent experience of physical harm. The proportion of people who were injured was about the same for males (75%) and females (72%).

More than four in 10 (44%) people reported their most recent experience of physical harm to the police. The proportion of females who reported it (59%) was more than double the proportion for males (28%).

Experiences of threatened physical harm

More than one in 10 (13%) people aged 15 years and over had experienced threatened physical harm at least once in the last 12 months. There was no significant difference between males (13%) and females (11%).

A higher proportion of people had experienced at least one threat face-to-face (9%) than non-face-to-face (6%). Face-to-face threats were more common than non-face-to-face for both males (9% compared with 6%) and females (8% compared with 5%).

Of those who had experienced at least one face-to-face threat:

a higher proportion of females (96%) than males (84%) had experienced at least one of those threats from someone they knew [3]

almost two in ten (18%) people had experienced at least one of those threats from a stranger.

Around six in 10 (61%) people who had received at least one non-face-to-face threat had received at least one of those threats via text message, phone, email or writing.

Self-assessed health status is a useful measure of a person's current health status and also provides a broad picture of a population's overall health.

The proportion of people aged 15 years and over who rated their own health as excellent or very good improved, up from 39% in 2012-13 to 45% in 2018-19.

More than three in 10 (32%) people rated their own health as good, down from 36% in 2012-13.

There was no significant difference between the proportion of males and females who rated their own health as:

excellent or very good (47% compared with 42%)

good (31% compared with 32%), or

fair or poor (22% compared with 26%).

There was no difference in the proportion of people living in non-remote and remote areas who rated their own health as excellent or very good (both 45%). However, the proportion of people who rated their health as fair or poor was higher for people living in non-remote areas (25%) than remote areas (20%).

Regular monitoring of health may help prevent illness or injury. Consultations with health professionals can assist in many ways, including the treatment and management of short-term illnesses and injuries and long-term health conditions, monitoring lifestyle risk factors, and general maintenance of good health.

Consultations with general practitioners or specialists

A majority of people (86%) had seen a general practitioner (GP) or specialist in the last 12 months.

The proportion of people who had seen a GP or specialist was higher for:

people living in non-remote areas (87%) than remote areas (79%)

people with one or more selected chronic conditions (93%) [1] than for people with none (79%)

people with a disability or restrictive long-term health condition (94%) than for people with no disability (83%)

The proportion of people who did not see a GP when needed was higher for those living in non-remote areas (14%) than remote areas (8%).

The most common reasons for not going were too busy (33%) and decided to not seek care (28%).

people aged 15 years and over with a non-school qualification (90%) than for those with no non-school qualification (82%).

There was no significant difference between children and adults - 84% for those aged 0-17 years and 87% for those aged 18 years and over.

More than one in 10 (13%) people said they had needed to see a GP in the last 12 months but had not gone to one on at least one occasion.

Almost seven in 10 (68%) people living in remote areas usually saw a GP who was part of an Aboriginal Medical Service or community clinic, compared with almost three in 10 (29%) in non-remote areas.

Consultations with dentists or dental professionals

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National Aboriginal and Torres Strait Islander Health Survey, 2018-19 financial year

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More than four in 10 (46%) people had at least one chronic condition that posed a significant health problem in 2018-19, up from 40% in 2012-13. The proportion of people with asthma in remote areas (9%) was around half the proportion for people living in non-remote areas (17%).

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The homeless and young people both deal with mental health issues such as anxiety, depression and addictive behaviours. Homeless people are prone to mental health issues because of the constant worrying of basic needs such as water, food, a place to sleep and they're overall health. Homeless people have to deal with all these problems with very limited help from outside parties, such as basic healthcare ( hospitals and dentists). 35% of people who have experienced homelessness have a mental health issue. While the youth get mental health issues from other young people or family, such as bullying and neglect from parents and more. These actions can have serious effects on the youth like depression, anxiety, eating disorders and other addictions. Fortunately the youth have more options for help, such as therapy. 14.4% of 12-17 year olds have a mental disorder in 2013-2014. That percentage has only gone up since the introduction of social media, allowing for cyber bullying. In conclusion the homeless and the youth both have their share of mental health issues, like stress, depression and anxiety. The homeless get their mental health issues from worrying about their health, while the youth mainly get it from other people but the the youth have more access to support.

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Mental health are the emotional, psychological, and social wellbeing of ones mental state. Having a negative mental mindset can effect someone's thoughts and can lead to feeling unmotivated of simple tasks.

The LGBTQIA+ is a community with those who are lesbian, gay, queer, transgender or questioning. To put it to simpler terms, they are people who don't identify themselves with their sex assigned at birth. According to Women's Agenda, "non-binary Australians are experiencing mental health issues at more than double the rate of men and women, new data from the Australian Bureau of Statistics shows." Due to Australia having laws based on Christianity and religious beliefs, they receive much critisism. This results in mental illnesses rising. It's said that "as Sydney’s Gay and Lesbian Mardi Gras takes place this week, the latest ABS statistics paint a grim picture of the higher rates of mental illness and self-harm across the nation’s LGBTQI+ community," this is also caused by the constant harrassment from those who aren't open about the idea.

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mental health is defined as the state of your well-being which can include your emotional, psychological and social well-being, it's important to keep our well-being healthy as it promotes a healthy lifestyle which allows us to communicate and regulate our emotions. Varying groups such as the elderly and young children today both experience impacts surrounding our mental health. Mental health conditions surrounding people ages 65 and over have reached 7.9% and 11.1% for men and women, which can overall decline one's health. This is evident when it was recorded that men aged 85 and over hold the highest age-specific suicide rate (which was provided by the Australian Institute of Health and Welfare 2024). This decline may be caused because as people grow older, some may be put into nursery homes. Helen, a lady aged 90 who recently moved into residence care last year states that "There's nothing wrong with the institution or the people there but it's not home." this feeling caused her to have a terrible aching sense of abandonment having left behind her personhood and independence. Aged care is a common factor that the elderly can experience high levels of depression, it's like when you leave home or something you were attached to which can even be seen in youth or any age group as if it's a universal feeling. However, youths' mental well-being may have different causes and experiences as well as severity. The stage of adolescence is an extremely important transition in one's life as it can change how likely one is to seek better opportunities and education as well as transitioning into healthy adult lifestyles. Commonly these days young people's mental well-being may be affected by the burden of disease as well as the loss of a loved one, this was seen mainly in people aged 15-24 which caused suicide and self-inflicted amongst males and anxiety disorders among women, both youth and elderly have their highest suicide rates surrounding men. A decline in young people's mental health overall reduces their ablity to socialise with peers, regulate their emotions or find the motivation to live anymore. yay this is why you #needtotakecareofwellbeingothercheckinwithothers #stayhealthy #yougothis

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Mental Health is the emotional, psychological and social wellbeing of the certain individual. depending on their positivity and negativity is what determines the persons inner. "Census night in 2021, more than 122,000 people were estimated to be experiencing homelessness in Australia" conveys the devastating statistic on how many people were estimated to be homeless highlighting their exposure to violence and victimisation, which leads to not having a job which then leads to a developing chronic ILL health meanwhile "people in the LGBTQ+ communities often experience stigma, discrimination, bullying, violence and exclusion" illustrating the heavy discrimination towards LGBTQ+ people, which contributes in a higher rate of suffering depression 47.8 per cent of LGBTQ+ people had “seriously thought about taking their own life” at some point in their lifetime illuminates their high level of psychological stress, Therefore it highly encouraged gay people to seek health from professionals about their mental wellbeing, overall highlighting the comparison between homeless peoples sufferings and LGBTQ+ health problems

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Mental health is about the well-being of an individual, depending on the state of the individuals mental well-being, their perspective on coping with stress can be very different. for instance the difference between elderly and youth. Youth is a key transition in an individuals life it can influence on how they see life , their habits, and how they deal with challenges.

it is important to understand well-being at an early stage to support other people that are experiencing mental issues, for example the first leading case of mental issues for young females is anxiety disorders (17.1%), and for males Sucide and self inflicted injuries (12.7%). For an elderly individual who passed the transition from youth to adult mental distress and mental health conditions are common in late life The 2020–2022 National Study of Mental Health and Wellbeing identified that 7.9% and 11.1% of men and women, respectively, aged 65 years and older have experienced a mental health condition in the past 12 months (not including dementias).

Well-being is an important aspect without a mental fortitude coping with stress can be very difficult so it is very important that we understand wellbeing.

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"Mental health" pertains to an individual's psychological and emotional well-being, encompassing their thoughts, feelings and behaviours. Its impact extends to various demographic groups, including older and younger individuals. In 2023, mental health conditions, substance use disorders and injuries placed significant burdens on young people aged 15–24. The specific causes of this burden varied between males and females with suicide and self-inflicted injuries being the predominant cause among males, and anxiety disorders among females. Additionally, rapid global aging could lead to a surge in individuals with mental disorders, potentially overwhelming mental health systems worldwide. Research indicates that over 20% of individuals aged 55 or older may experience some form of mental health issues. Biological and social changes, along with somatic diseases, can impact brain function, leading to isolation and worsened symptoms of medical illnesses. Mental disorders can exacerbate these effects, increasing healthcare costs and hospital stay length. Thus, mental health issues are the leading cause of addiction, depression, anxiety, eating disorders and other health issues among the youth while it causes isolation, depression, and loss of autonomy and independence to the elderly. Several of these causes are identical and it is crucial to identify and address the symptoms to prevent significant harm to individuals.

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Mental health is significant part of our health and wellbeing. It highlights our individual and collective abilities to make decisions, build relationships and shapes  world we live in. Whether it's the LGBTQ+ community or people with disabilities, they both face a significant amount of mental health problems. Disability and health have a complex relationship, long - term mental health problems can cause disability and disability can can cause a mental health problem. LGBTQ+ people often face stigma, discrimination, bullying, violence and exclusion because they are seen as abnormal and weird. Due to this, LGBTQ+ people experience a more unhealthy social, emotional, psychological wellbeing and mental health. Disabled people have been reported to have poorer general health and higher levels or physiological distress than the people without a disability as they would often get discriminated and bullied for their disability. Out of all the LGB+ people there, 74.5% of the population has experienced a mental health disorder at sometime in their life, while only 41% of disabled people have experienced a mental health disorder.

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Mental health is a state of mental well-being that causes people to cope with the stresses of life, which includes emotional, psychological, and social well-being. For example, the LGBTQ+ community and the people who have disabilities. Half of the people who are included in the LGBTQ+ community experience very high levels of psychological distress, while 47.8 per cent of the community experienced thoughts of suicide. Most people in the LGBTQ+ community were often discriminated against, bullied, and experienced violence and exclusion. People with disabilities experience discrimination which makes people with disabilities have higher levels of psychological distress. Disabled people were often bullied including LGBTQ+ people with disability. In conclusion, 32% of disabled people experience discrimination while 72% of people who are included in the LGBTQ+ community were discriminated.