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Cracking up? The unsustainability of government mental health policy

By Xue Wang - posted Thursday, 28 November 2013

One of the key features of current Coalition government's mental health policy is to invest $440 million in funding towards 20 Early Psychosis Intervention Centres in major metropolitan and regional areas. Of $440 million, $18 million will be invested in the mental health provider Orygen over the next four years to establish the country's first National Centre for Excellence in Youth Mental Health. The government's argument is that 75 percent of those mentally ill are under 25. The most recent statistic circulating is that, according to the Department of Health and Ageing, one in every five people in Australia is suffering or has suffered from mental illness. [Mental Health Statistics Fact Sheet (2009), cited by Joe Hockey. These new investments are to get a better understanding of what is supposedly a rising tide of mentally ill youth and hopefully not only find a solution but also lift the country's economic productivity, among other things.

Apart from the government's political commitment, it seems from its policy statement of August 2013 that it has no clear idea whether these outcomes are really achievable through early intervention policies or what role intervention generally has actually played and is playing in the mental health industry - or even if there is any actual correlation between youth mental illness and economic productivity.

Mental health is a very ill-defined field. Since the birth of the mental health profession, psychological professionals have been struggling with distinguishing the mentally ill from the sane. Even now there is still no clear definition of either mental illness or mental health. Is someone who is highly superstitious mentally ill? Is someone who is a control freak mentally healthy? The Diagnostic and Statistical Manual of Mental Disorders (DSM), widely known as the bible of psychiatry and psychology, has among its unintended consequences cultural hegemony and social exclusion within society. The classifications and criteria in the DSM were created by professionals upholding Western concepts of normality. However every cultural community has its own normality.


We are after all the products of our past experience influenced by cultural values and beliefs. Within society, by labeling some behaviors as abnormal, we are trying to eliminate them or differentiate the people displaying them from us. The message is that "our" behavior is beautiful, yours alien. Rufus May, a British psychologist who was diagnosed with schizophrenia at the age of 17, is convinced that the label schizophrenic shows the intolerance of our society towards the diversity of human behavior, and mystifies problems. He advocates acceptance of this behavior and suggests treating the person as a whole by understanding individual behavior in the context of individual lives and emotional stress. If we understand a person's behavior in its social, cultural and personal context, it is certain that each behavior encompasses a meaning or meanings, thus is normal.

The role that government has played in mental health has always been controversial. The DSM was born as a result of the American government's efforts for clarification of the problem of mental illness.The DSM became almost the sole legitimate diagnostic tool for psychological professionals world wide. Apart from the achievement of standardizing medical language, the DSM has been criticized for unscientific methods, subjectivity and unreliability. Despite widespread criticism, the American government has blithely backed the dubious revelations of the DSM and licensed the American Psychiatric Association (APA) as its sole publisher. With no competition, the APA has enjoyed huge economic benefits.

In Australia over the last 30 years the government has spent multibillion dollars on mental health reform, aiming at deinstitutionalizing mental patients and increasing client access to mental health services. The visible outcome of government spending is that most people with diagnosed mental illness have managed to live in their chosen communities with the support of government, NGO and community organizations. It is common for one person to receive help from multiple organizations. Mental health clients also enjoy all kinds of subsidies--medical, rental, travel and more.

However, very few of them have joined or rejoined the workforce, as most them have been given unemployment benefits or disability support pensions and public housing. Their lives may not be rosy but are definitely not desperate. Thanks to the government's generosity, as Andrew Walker has pointed out, there has been no rise in job seekers on unemployment benefits. These people are classified by government as "non-jobseekers"! Given the current policy, the mentally ill population is ever growing and ever more liable to seek and gain government protection.

Behind the government's claims on the benefits and urgency of investing in the mental health provider, Orygen, its complications need screening. The founder, Professor Patrick McGorry, Australian of the Year in 2010, has been a long term advocate and orchestrator of the early psychosis prevention intervention centre (EPPIC), which became the core production of Orygen, and headspace, born with government funding in 2006, the institution that implements the EPPIC model. The Coalition government is committed to invest another $225 new millions to set up additional 60 headspace sites.

Professor McGorry has argued that there is a lack of specialized service for youth in the existing mental health system and attributes youth's reluctance to seek help to the fact that many mental health professionals do not have appropriate skills. In addition, he argues, existing mental health services are too scattered and thus inconvenient for youth looking for help. By contrast, headspace is a one stop center where youth can receive all the help they need without looking around. The services that headspace provides range from community support, counseling and psychiatric diagnosis to medical treatment for psychosis. It also provides professional training.


McGorry's model has been widely questioned by other mental health professionals. One argument is that headspace services overlap with existing services: many mental health organizations already cover youth services. Despite McGorry's claims there is not much objective material to demonstrate Headspace's superiority over other organizations. Psychiatry professor Jon Jureidini of Adelaide University asserts that evaluation of EPPIC has shown the advantage of early intervention is short lived. As soon as the intervention stops the advantage disappears. Professor Allen Frances, who chaired the committee that produced DSM IV, has been highly critical of EPPIC. He argues that the program has ignored the volatile mental state of youth and in fact most youth who have experienced psychotic episodes do not end up mentally ill in their later age. ('US expert slams Patrick McGorry's psychosis model'. He is concerned that the EPPIC does not have reliable diagnostic tools and could lead youth to be wrongly medicated.

It seems that the professionals from headspace have not yet proved that their skills are more suitable for youth than those of other professionals. There are, for instance, hundreds of modalities in counseling, and specialist counselers have focused on youth for a long time. The danger for a one stop centre is that it might deprive youth of seeking other help that is more suitable for them because the skills that headspace professionals can offer are limited, while youth needs are multifarious.

Both sides of politics in Australia agree with McGorry that there is an increase in mental illness in youth. However all have failed to identify the source of it. An obvious candidate would be the DSM itself. In fact the DSM has single handedly expanded the types of mental illness from 106 in DSM I to more than 300 in DSM IV and V. For instance, DSM V included "substance use" as a part of mental disorder, which of course captures many youth. In fact the increasing incidence of supposed mental illness in youth is obviously man made. More and more behaviors are getting labeled. Many that used to be seen as normal are now abnormal.

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About the Author

Dr Xue Wang is a mental health professional. She obtained her doctoral degree in politics from the University of Sydney.

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Creative Commons LicenseThis work is licensed under a Creative Commons License.

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