Inequity and inequality in Australian mental health and care systems: an investigation into the economics of wellbeing

Inequity and inequality in Australian mental health and care systems: an investigation into the economics of wellbeing

In Australia, significant mental health inequalities still exist, and the population has lost 572,775 years of healthy life owing to mental illness. This results in a total direct and indirect cost to the Australian economy of $271 billion each year. As a result, mental health is critical for the Australian economy, and no one should be deprived the opportunity to achieve a good mental state. Thus, mental health equity is a critical component of Australia's health care system. Nevertheless, equity is a normative term, and applying equity to any process demands the application of positive economics principles. However, a review of the health disparity literature reveals a dearth of studies on mental health equity and the extent to which mental health inequity is understood in Australia is unclear.

The primary goal of this thesis is to analyse significant concerns in the pursuit of mental health equity in Australia and potential ways to address these issues. This thesis includes five essays that examine equity challenges in the context of mental health: i) to determine the prevalence of mental disorders in socioeconomic groups ii) to investigate the origin of mental health inequality in early life (relationship between family endowments and youth mental health disparities) iii) to investigate the origin of mental health inequality in adult life (influence of life shocks and mental health inequality) iv) to establish a methodological framework to assess mental health mobility using longitudinal data and lastly, v) to assess inequity in mental health service use. In summary, the determinants of mental wellbeing (i.e. socioeconomic inequalities) in the health system context are the subject of three essays. The remaining two essays address mental health service provision and accessibility issues, and mental health system outcomes.

The essays employ data from two nationally representative Australian surveys, namely the Household, Income and Labour Dynamics in Australia (HILDA) and National Health Survey (NHS), for its investigations. This thesis applied distributional analysis and health econometric modelling methods to explore the topic. This thesis contributes to the literature by creating methodological and empirical knowledge and offers policy prescriptions on designing equitable and cost-efficient mental health interventions.

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