Abandoning the mentally ill

Australia’s psychologists are an under-utilised resource in our attempts to treat or prevent mental illness and this results in unnecessary suffering and a waste of health resources. The fact they are under-utilised is largely because of short-sighted, ill-informed government and non-government policies.

It is important - from the point of view of the Australian Psychological Society, the peak professional body of psychologists with over 14,500 members - to emphasise that by no means do all psychologists work in the mental health area. Those who do are usually clinical psychologists and are probably the largest and best known sector of our profession.

This perception is a source of frustration to those who work in the areas of health psychology, forensic psychology, industrial and organisational psychology, educational psychology, counselling psychology, sports psychology, or psychological research and teaching. Because mental health issues arise in all areas of life, psychologists in all of these other areas can find themselves drawn into clinical work, but it is not their main focus. For the purposes of this article, the psychologists I refer to will usually be clinical psychologists.

Historically, as in other areas of health, the emphasis has been on the treatment of mental illness after it has developed. Only recently has health research recognised the advantages of preventing illness and health promotion but it is an area which still receives comparatively little funding and consequently less application.

The sad fact is more than a half the Australians with a psychological disorder will receive no treatment - not just bad or inadequate or out-of-date treatment, although there is plenty of that around - but no treatment at all. They will just endure their mental illness, with the attendant adverse effects on those around them and loss of productivity to the community.

Mental illness continues to suffer from its traditional stigma. Those with little direct experience of it often cling to a belief that it represents a lack of willpower, determination or courage and that mentally ill people should just “pull up their socks” and “get on with life”.

It’s definitely easier to raise funds for research into, or treatment of, a physical illness such as cancer, than it is for schizophrenia or depression. Governments know this and it shows in their funding decisions. Simply, there are not adequate resources in the Australian community to effectively meet the needs of people who are mentally ill.

This situation has been worsened by government policies. First was the policy of deinstitutionalisation. This recognised correctly that the grand old psychiatric hospitals were little more than waste bins for mentally ill people, and should be replaced by practices that keep them within the community, as much as possible, and helping them to integrate with normal life. But this can only work if the old institutions are replaced by adequate community support to help mentally ill people adhere to their illness management plans and enjoy good quality of life.

Governments have happily pocketed the savings made by closing the old institutions but failed to spend anything like enough to deliver adequate community support. As a result, many mentally ill people wind up in doss houses, prisons or homeless.

Despite persistent misrepresentations by the media, mentally ill people are no more dangerous than anyone else, except when their illness is active, meaning they have stopped adhering to their treatment plan, often because the necessary support wasn’t available. The Hollywood stereotype of the mentally ill bogeyman does not help.

Second, state governments, the major providers of mental health services, and hence often employers of psychologists, have embarked on a penny-pinching program of converting psychologists’ positions to generic mental health worker positions. Their apparent belief is that anyone with any vaguely relevant training can deliver effective psychological services. The underlying motive is more likely that the cost of employing a two-year TAFE-trained welfare worker is much less than the cost of employing a four or six-year university trained psychologist. There is little, if any, real evaluation of the effectiveness of cheap mental health services, just claims of provision.

The mental illness of depression illustrates many of these points. The WHO has predicted by 2020 depression will be second only to cardiovascular disease as a source of excess mortality, morbity and disease burden to the community. There goes the myth that mental illness isn’t really important.