Clinical tips: mental health

woman with dog looking pensive at beach

Mental health is a significant issue for many Australians, writes Louis Roller

Some statistics on mental illness in Australia

  • In each year, approximately one in every five Australians will experience a mental illness.   
  • Mental illnesses are the third leading cause of disability burden in Australia, accounting for an estimated 27% of the total years lost due to disability.
  • About 4% of people will experience a major depressive episode  in a 12-month period, with 5% of women and 3% of men affected.
  • Prevalence of mental illness decreases with age, with prevalence greatest among 18-24 year-olds.
  • Women are more likely than men to seek help for anxiety disorders (18% compared with 11%) and mood disorders (7.1% compared with 5.3%).
  • A national survey showed that 35% of people with a mental disorder had used a health service and 29% consulted a GP within the 12 months before the survey.
  • Women are more likely than men to use services for mental health problems.

Around one in five people in Australia will experience a mental illness at some stage of their life, including alcohol or other substance abuse disorders. The term, ‘mental illness’ is poorly understood and is often used in a derogatory manner.

Only a small proportion of people exhibiting disturbed or aggressive behaviour do so because of mental illness. Medical or psychiatric intervention is indicated only where the disturbed behaviour is based on an underlying abnormal mental state.

The cause may be a simple one or the combination of several abnormal mental states. 

In extreme cases, mental illness can be debilitating, affecting all areas of a person’s life from employment, to relationships, to everyday functioning.

There are two major categories of mental illness:

  1. Depression and anxiety disorders.

Depression affects about 16% of adults and anxiety disorders affect about 10% of adults at some point in their life.

The conditions of depression, sadness, tension or fear, phobias, obsessive compulsive disorder are so disturbing they affect the person’s ability to cope with day-to-day activities.

Conditions that can cause these feelings include anxiety disorders eg phobias, obsessive compulsive disorder, eating disorders and depression.

  1. Psychotic illness.

The more serious psychotic illnesses include schizophrenia, which affects about 1% of Australian adults and bipolar disorder (previously called manic depressive illness) which can affect up to 2% of the population.

Psychosis causes changes in a person’s thinking, emotions and behaviour. People who experience an acute psychotic episode lose contact with reality and may develop delusions or hallucinations.

Other forms of psychosis include drug-induced psychosis and some chronic forms of depression. The causes are still not fully understood but may be triggered by stressful life events, drug abuse and hormonal changes.

Up to 10% of people affected by mental illness commit suicide—compared to an average of 1% for the whole population.

With treatment and support, the majority of people with mental illness will recover well. Organisations such as SANE Australia Tel. 1800 18 SANE (7263) ( can offer support as well as local doctors and community mental health services.

Women are more likely than men to report anxiety and affective disorders; on the other hand, men are more than twice as likely as women to have substance use disorders, with alcohol disorders being three times more common than drug use disorders.

Older persons with mental illnesses such as delirium or mania may present in confused states with poor contact with reality, marked overactivity and disorganised behaviour. Consequently they may become acutely disturbed and place themselves at risk or react aggressively.

Others, with idiopathic disorders such as paranoid illnesses or schizophrenia can have periods of organised activities but can become acutely disturbed and aggressive on the basis of their delusions. 

Pharmacists, please note that common adverse reactions of a number of medications can mimic various symptoms of mental illness, or they can exacerbate existing symptoms.

In the Australian population, the prevalence of mental or behavioural problems among people born overseas is similar to those born in Australia. Similarly, the rates among people who speak a language other than English at home are about the same as for those who speak English at home; however, people from culturally and linguistically diverse backgrounds do not access mental health services as often as the mainstream populations.

It should be noted that the perception of mental illness differs from culture to culture, as the level of stigma attached to mental disorder and mental health problems.

There is some evidence that people with mental illness may be more stigmatised and marginalised in some cultural groups.

Loss, physical illness or disability, or the onset of disorders such as dementia, which often result in a loss of competency in English, can increase the risk of depressive disorders and suicide in older people from culturally and linguistically diverse backgrounds.

The role of the pharmacist is to be up to date with the various conditions, appropriate medications and to be able to pick out clues of mental illness, particularly in young people, where referral may be indicated; and be on the alert for suicidal ideation.

Associate Professor Louis Roller, from the Faculty of Pharmacy and Pharmaceutical Sciences Monash University, was the 2014 recipient of the PSA Lifetime Achievement Award.

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