Australia is facing a significant backlog of untreated mental health problems as a result of women's mental illness being overlooked and under-resourced.
That's according to psychiatry professor and director of the Monash Alfred Psychiatry Research Centre Jayashri Kulkarni, who has spent decades researching and treating mental health disorders in women.
"Even before the pandemic, women experienced about twice as much depression [as men], about four times as much anxiety and about eight times the rate of eating disorders," Professor Kulkarni said.
"Doing the 'same old same old' in mental health ... is just not hitting the target."
Australia's mental health services and treatments are largely "gender blind", Professor Kulkarni said, despite men and women experiencing unique mental health challenges due to different biological, psychological and social factors.
"When I was a medical student, all of medicine was taught pretty much with the archetypal patient being the 70 kilogram Caucasian male. I think a lot of that has continued."
With the exception of perinatal mental health programs, Professor Kulkarni said there were few services dedicated to the treatment of mental health disorders in women.
"There's nothing specifically for women with trauma, and women experience the biggest amount of violence and trauma — interpersonal, domestic, and in early life — with consequent mental ill-health."
She added depression at menopause was often unrecognised or inadequately treated.
Last year, Professor Kulkarni and her colleagues at Monash University established Health Education Research (HER) Centre Australia to expand research and develop gender-specific treatments.
On Thursday, at a Parliament House forum in Canberra, they called on political leaders to invest more in women's mental health research, treatment and education.
Earlier this year, the federal government announced a National Women's Health Advisory Council to address differences in the health outcomes for women and girls.
"Women's mental health is different and it needs better resourcing, understanding and approaches," Professor Kulkarni told the ABC.
"There is a considerable need, we believe, to look at mental health differently."
Establishing specialist women's mental health clinics
One of the most urgent changes needed to the provision of mental health services, according to Professor Kulkarni, is the establishment of specialist women's mental health clinics.
At HER Centre Australia, Professor Kulkarni and her colleagues run a multi-disciplinary, second-opinion clinic for women experiencing a range of mental illnesses, including schizophrenia, psychosis, complex post-traumatic stress disorder, eating disorders and menopause and menstrual-related mood disorders.
"We have the model, we know how to do it, but we need it to be replicated."
In addition to more outpatient clinics, she said more inpatient mental health facilities for women were also needed.
Generally, inpatient mental health units manage men and women together, and women are sometimes subjected to violence or sexual assault during their treatment, Professor Kulkarni said.
"When the acuity has gone up, which it has — because anyone who can be managed in the community is managed in the community — assaults happen, and usually it's male-to-female assaults."
In 2021, Australia's first private, female-only mental health clinic was established at Cabrini Hospital in Melbourne.
Elizabeth Moore, president-elect of the Royal Australian and New Zealand College of Psychiatrists, said gender was an important consideration in any psychiatric assessment, but agreed that more could be done to ensure "gender-sensitive" mental health treatment.
"I have worked with a lot of people from culturally and linguistically diverse backgrounds who find it very difficult if they're admitted to a mixed-gender ward," said Dr Moore, coordinator-general of the office of mental health and wellbeing in the ACT.
"[Gender-specific wards or treatment areas] is something the college has been looking at so people are more comfortable receiving their inpatient treatment."
Dr Moore added that more needed to be done to improve mental health services for transgender and LGBTIQ+ women who have higher rates of psychological distress and self harm.
"The same goes for Aboriginal and Torres Strait Island women who find it much more difficult to access services," she said.
"We need good access across the whole continuum of care — from mental health promotion … to early intervention services, as well as having comfortable treatment services and recovery."
Clinical trials to investigate hormone treatments
To improve women's mental health, clinical trials investigating the link between reproductive hormones and mental health problems were also needed, Professor Kulkarni said.
While reproductive events like menarche, pregnancy, childbirth and menopause are normal physiological processes, they cause significant hormonal shifts which can contribute to poor mental health in some people.
"What we've done for decades is draw a line in the middle of the body and say the hormones affect below the waist and not above the waist — and that's wrong," Professor Kulkarni said.
"The neuroscience is very clear that these hormones have considerable effects in the brain, and so in women who are vulnerable — and we don't quite know what that means yet — that's when they get mental ill-health."
Professor Kulkarni said hormone treatments were being under-utilised in women experiencing depression at menopause because not enough research had been undertaken to evaluate their use.
"At the moment, everyone just goes straight to antidepressants, and our clinic's experience is that this isn't hitting the mark," she said.
"One of the simple things that really needs to be done very quickly is a head-to-head trial [to establish] what is a better treatment: a hormone strategy or an antidepressant?"
Karen Magraith, president of the Australasian Menopause Society, agreed that hormone treatments were potentially being under-utilised, but that more research was needed.
"There's a distinction to be made between symptoms such as anxiety and low mood associated with menopause, and a condition such as major depression," said Dr Magraith, a Hobart-based GP.
"Major depression itself is not necessarily a symptom of menopause … and not everyone who feels depressed around the time of menopause feels that way due to menopause.
"Often women [during menopause] are managing adolescent children, ageing parents and challenges in the workplace, so we need to think about addressing those stresses too."
Professor Kulkarni agreed that taking an integrated approach — assessing biological, psychological and social factors — was critical.
"This is not an attempt to try and pathologise menopause … but many times we find that what is happening is that brain hormones are not talked about."
She added that more studies were needed to better understand the effects of hormonal contraception after research found a link between the pill and depression.
"In many cases … young women are not aware of that, and doctors are not aware of that either. That's a study we've done that needs replicating."
