Scott Morrison’s suicide prevention adviser, Christine Morgan, is pondering the risk factors that lead people to the point of despair where they take their own lives. As the chief executive of the National Mental Health Commission begins to work through the specifics of the advisory role the prime minister handed her last month, the deliberations lead her, inexorably, to questions about Australia’s mental health system, and whether it is fit for purpose.

Morgan tells Guardian Australia’s politics podcast the mental health system was “birthed” from general healthcare, and its medicalised models. Medicalised models can deal brilliantly with lumps and bumps but don’t necessarily respond effectively to the complexities of illnesses of behaviour, thoughts and feelings. When people become very ill, they also lose the language to communicate their illness.

Two challenging questions then suggest themselves. The first is linked directly to Morgan’s current commission about suicide prevention. Does Australia’s mental health system, despite the best of intentions, perversely increase the risks that an ill person will engage in self-harm, or try to end their own life, because the system doesn’t respond to their needs, and sometimes will only respond swiftly if a medical emergency forces the issue? The second question is broader: are the deficiencies of a sufficient order of magnitude to warrant redesigning the system from scratch?

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On the first question, Morgan says the mental health system “runs the risk” of elevating the risk factors for suicide and self-harm. On the second question – do we have to go back to the drawing board and redesign the system entirely – Morgan is candid. “That’s a very live question,” she says, “one I’m asking myself as I work through this project”.

She says the answer to the current problems isn’t more programs. The lens to look through is policy – “what do we need to consider at a policy level … as distinct from further programs, which are activity-based?”.

“I kind of hope we don’t have to go right back to the rebirthing point, but I certainly do think we need to broaden the scope of what the system is so the entry point is not when you have a clinical, medicalised illness”.

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When he appointed Morgan (who came from the Butterfly Foundation – an organisation dealing with eating disorders – to the National Mental Health Commission, to the suicide advisory role), Morrison noted suicide is now the leading cause of death for young Australians, accounting for over one-third of deaths among younger people aged between 15 and 24. The prevalence of suicide among Aboriginal and Torres Strait Islander people is around twice that of non-Indigenous Australians.

The prime minister noted that around 80% of people who die by suicide have a mental health issue, but there are a range of factors and circumstances which may contribute to suicide. Morgan says we have to be careful not to consider suicide as indistinguishable from mental health, because many people who end their own lives have had no contact with that system at all.

In order to think through steps that can be taken to lower the risks of a person reaching the critical point of despair, there is a need to consider the social determinants. “To do that, we need to look at unemployment and what that might mean for somebody, you need to look at housing security … and believe it or not, food security,” she says. Morgan says the justice system is another factor, as is trauma, which she says is “a clear area of risk”.

We talk on the podcast about one cohort known to have elevated risks – trans young people. The ABC’s Media Watch program this week criticised the Australian for renewing its focus on transgender issues, including the creation of a “gender” page on its website, containing almost completely negative coverage of trans issues.

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Morgan says she is concerned about the trend, and she’s also concerned about the impact of social media discussion on people who are either battling illness, or at risk of becoming unwell.

She says there is no prospect of turning the tap off, so intervention is needed to help kids at risk to be resilient in the face of insensitive public debate. She says media companies need to mind “the manner” in which material is communicated. “It’s about respectful dialogue,” Morgan says.

More broadly, she says also that the stigma associated with mental illness remains a significant problem in Australia. People who are unwell worry about the consequences of disclosing their illnesses – how it might impact their job prospects, or the capacity to get life insurance. Women in custody battles can also find their medical history used against them.

Morgan says while Australians are much more aware of mental health than they used to be, “we use two words, mental health, to describe a broad range of what it is to be mentally unhealthy, unwell, having psychotic incidents – and I fear we still have a long way to go to properly unpack that whole concept of mental health, and fully attribute different concepts of unwellness”.