There have been dozens of inquiries into mental health in Australia.

Between 2006 and 2012, there were 32 independent statutory inquires; more recently we’ve seen the Productivity Commission Inquiry Report into Mental Health, the Report of the National Suicide Prevention Officer, the Victorian Royal Commission, the National Mental Health Workforce Strategy and five National Mental Health Plans.

Despite myriad recommendations for reorganising and transforming the way we support and manage mental health care, the system remains grounded in hospital- related services, medication and the rigid biomedical framework.

Australia’s mental health care system is failing to provide the holistic care consumers need.

The ‘missing middle’ is a term used to describe the gaps between the GP and hospital emergency department.

Almost every inquiry recognises this critical failure, calling for some type of ‘unifying vision’ and holistic model that supports team-based mental and physical healthcare.

Physiotherapists, and indeed all health providers, have an important role to play in mental health.

Those with mental health issues should have access to appropriate and professional mental healthcare based on their individual circumstances and needs. This includes access to allied health services that support people across the whole continuum of care.

The role of physiotherapists in managing and treating pain, improving mobility and function, and enhancing quality of life has not been properly recognised and incorporated in mental health and suicide prevention strategies.

Physiotherapists will often see components of mental health in every patient’s story, and yet they are unable to provide any assistance or advice other than to recommend that their patient ‘seeks help’.

When patients reach out for help, every door is the wrong door for them.

To transform the mental health system to one where people are supported, treated and managed mentally and physically, governments and providers must work towards an ‘every door is the right door’ healthcare system.

Mental illness and chronic pain places significant burdens on individuals and the healthcare system.

Untreated, or inappropriately treated, pain is a factor in mental ill health.

Any person with reduced or poor physical mobility, loss of function or experiencing chronic pain is less able to participate in aspects of life, including work, social activities, exercise and travel.

Physiotherapists are qualified and trained to work with people who have mental illness across all health settings, including hospitals, aged care facilities, disability services and private practice.

They are trained in multidisciplinary and interdisciplinary care, but Australia’s mental health system limits this care by not properly investing in, and promoting, team-based care.

Australian Health Practitioner Regulation Agency (Ahpra) accredited physiotherapists know that exercise is incredibly valuable in the treatment of some forms of depression, post-traumatic stress disorder and other disorders.

Improving mobility and addressing health issues that are barriers to exercise should be recognised as part of the assessment and treatment for people experiencing mental illness.

Addressing mental illness and suicide prevention, however, remains predominantly within the GP mental health specialist domain. Transformational change to the health system is required.

Governments and providers of mental health treatments and prevention services need to shift their thinking towards a wellness approach to help individuals manage and get the best out of life.

We need a health system that is personalised, coordinated and enabling.

There is clear evidence from these many inquiries that current treatment models do not adequately support the complex challenges of mental health. Yet the system funds and supports few alternatives to hospital treatment and medication.

In a recent submission to the Select Committee on Mental Health and Suicide Prevention, the APA called for investment in expanding multidisciplinary mental health teams, which offer diverse skills and expertise.

We said that the best outcome for those needing mental health care is from coordinated multidisciplinary and multisector teams that include GPs, psychiatrists, paediatricians and mental health nurses working alongside physiotherapists, psychologists, social workers, counsellors, peer workers, and drug, alcohol and gambling counsellors.

These types of multidisciplinary models are accepted internationally as delivering higher quality healthcare and better outcome measures.

The APA stresses the importance of promoting multidisciplinary team approaches, such as physiotherapy within general health settings.

Many people experiencing mental ill health also experience difficulties in accessing appropriate healthcare treatment. They can also be reluctant to engage with different service providers.

Multidisciplinary team approaches, which is used in the UK and other countries, improves access to much needed supports and services.

Multidisciplinary models or care enable the sharing and transfer of skills.

Even within Australia’s existing system, it is possible to modify the structures to reform how responsibility of patient care is understood and managed.

This may require investments in education and training; however, that would be a small consideration given that $10.6 billion was spent on mental health in 2018–19.

Adopting this type of approach better addresses the high rates of mental illness among the cohort of people with long-term physical health problems.

As noted, people experiencing more severe types of mental illness have a reduced life expectancy and commonly report poor physical health and lack of appropriate exercise and activity.

According to a 2020 Australian Institute of Health and Welfare report, ‘Physical health of people with mental illness’, people experiencing mental illnesses are more likely to develop physical illness and tend to die earlier than the general population.

From available data, such as the National Health Survey, we know that Australians experiencing mental illness are much more likely to report having a chronic medical condition such as chronic back problems, arthritis, and pain.

It is, to use a colloquialism, a ‘no brainer’ to support people with psychological conditions, along with their physical health.

We see this as not only cost-effective, but it is far better for the patient/consumer to have holistic, team-based care rather than navigate between the mental and physical arms of the health system.

Multidisciplinary and interdisciplinary teams working together to understand, diagnose and treat individuals can only be achieved if primary care and Medicare Benefits Schedule reform includes allied health practitioners, such as physiotherapists.

We also want Primary Health Networks to be more engaged in this reform.

The physiotherapy workforce is well positioned to deliver this care. In enabling service shifts, we can help build a resilient, educated community.

A highly pain-literate community will produce more effective health outcomes and reduce the demand on already stretched services.

We know that by enhancing physical health, we also promote mental wellbeing.

It’s time to unlock these benefits by formalising physiotherapy as part of the multidisciplinary team through Medicare access to private physiotherapy.