Along with climate change and ecological damage, Australians face an equally important challenge of exposure to stressful social conditions leading to declining psychological health for millions.

Our governments hitherto have largely failed to address known social causes of stress and confined their policies to politically safe but untenable medical “solutions”. This isn’t necessary.

Effective and affordable policy responses are possible to prevent mental ill-health and promote psychological well-being, but require two changes in policy direction. One is for governments to revise their conception of “mental health” as a policy problem.

The other is to shift the orientation of public policy toward universal access to the essential conditions needed for psychological well-being. Without such changes, we will see a continuing deterioration in people’s psychological health, higher levels of harmful social behaviours, and healthcare services struggling with demand.

Redefining the problem: Fundamentally, more so than a “mental health” problem as such, Australia has a problem with exposing people to social conditions causing chronic stress and concomitantly limiting access to supportive conditions for psychological well-being. Focusing on the former issue firstly, human stress arousal responds to perceived threats to a person’s sense of coping or social standing. Chronic (longer-lasting) stress occurs when a person faces stress-inducing life conditions over an extended period and has no way to readily resolve that situation.

Common social causes of adult chronic stress include financial hardship, housing insecurity, excessive work demands and low autonomy at work, insecure employment, exposure to discrimination, violence or coercive control, social isolation and lack of safety. Youth mental health in Australia is adversely impacted by determinants such as socioeconomic disadvantage, social media use, low social support and poor family relationships. Children are especially vulnerable to stressors occurring in dysfunctional family environments. Exposure to stressors in childhood increases the risk of mental ill-health in adulthood and undermines abilities to self-regulate positive social behaviours.

Socially induced chronic stress has harmful effects in the brain and body and is a primary cause of the more common forms of psychological distress and mental ill-health. The widespread harms of stressful social conditions in Australia are indicated in the evidence on the prevalence of these conditions. In any 12-month period, about 22% of adults and 39% of young adults are subject to a mood, anxiety or substance abuse “disorder”, with higher rates among groups subject to disadvantage. Chronic stress is also implicated in high rates of employee burnout in Australia, and in the unacceptable levels of domestic violence. Chronic stress also contributes to physical illnesses such as heart disease, obesity and autoimmune conditions. All these harms come with significant costs to individuals and the wider society. In 2020 the Productivity Commission estimated that “mental illness … is costing Australia about $200-220 billion per year".

Australian Governments’ predominant response to this unfolding crisis is to expend increasing amounts of public money on mental healthcare services in various forms. Such services may have value for those who need them, and recent steps to improve access are useful. However, this biomedical approach has also led to high and escalating levels of drug prescription and, despite increased spending on services, the scale of the problem is not decreasing. Without action on social causes, no amount of money poured into mental health services will ever be enough.

Redefining the solutions: The real solutions to our mental health crisis begin with policies to reduce population exposures to known sources of psychosocial stress. There are some small signs of positive change in this direction such as social media age restrictions and requirements on employers to manage psychosocial hazards in the workplace. Much more is required on all the other social stressors listed earlier.

However, as I argue in my recent book on How to Create Societies for Human Wellbeing, the long-term solutions to the problem of chronic stress demands more than piecemeal, remedial changes. Contemporary social conditions not only cause harm through chronic stress, but also, in effect, create deficits in access to the essential conditions needed for psychological well-being. Subtracting from the harms is not enough, we must also build capabilities for positive well-being.

In my work, I argue that well-being is about the development and exercise of abilities to self-regulate social behaviour in ways that cope with minor stressors, avoid chronic stress and cultivate experiences of meaning, social connection, creativity and self-awareness. (Interestingly, the federal Department of Health defines "mental health" is quite similar terms.) Well-being is a basic resource for functional societies. Certain social conditions are needed for people to reliably develop and exercise wellbeing abilities, which are neither foreign to current knowledge nor inherently difficult to implement. We just fail to give them priority.

I propose 10 areas of social practice needed to create and sustain essential conditions for psychological well-being: supportive environments for child development, meaningful work and strong local economies, positive social connections, connection with and care for nature, healthy sustainable food, housing access and healthy neighbourhoods, comprehensive primary health care, education for lifelong learning, creative practice and availability of time.

To deliver their benefits for well-being, these conditions must be created and sustained within, and with, the real families, communities, schools and workplaces where people are born, grow, live, work and age. Governments have a crucial role but if they overlook this necessity for community-engaged change, any commitments to well-being will miss the mark. The well-being community is the basic building block of a well-being society.

As a public health researcher, I see many communities already working in diverse ways to create such conditions for well-being in local spaces, often with few financial resources. I also see a growing body of leaders and organisations in Australia committed to a well-being agenda. These seeds of change need public support to grow to their potential.

Australians’ mental health is going backwards. A better way is possible. Do any of our political leaders have the courage to face these facts?

The views expressed in this article may or may not reflect those of Pearls and Irritations.