One in five Australians will be affected by mental illness in some form - depression, schizophrenia, bipolar disorder, anxiety or other disorders. The symptoms and disability experienced cause profound distress for those affected and their families. Untreated, or ineffectively treated, it is a major contributor to the high suicide rate in our country.
Since 2001 there have been at least six major inquiries into mental health services in Australia at a state, territory and federal level. All of these have uncovered gross under funding and mismanagement. The Mental Health Council of Australia’s recent Not for Service report (released in October 2005) confirms this picture, and no one expects the Senate report due in 2006 to paint a different picture.
The facts are indisputable: Australia's National Mental Health Strategy is in disarray and in urgent need of reform - in leadership, additional funding and delivery of services.
Lack of direction
Health Minister Tony Abbott has shown a disappointing lack of interest and leadership in this area. There is no longer a branch dedicated solely to Mental Health in his Department. He has delegated the issue to his Parliamentary Secretary and fails to acknowledge that the crisis in mental health services requires any leadership from him. In 2004, for example, Hansard showed he spoke on over 400 occasions in Parliament and in all this time he mentioned mental health services just once in answer to a question.
Service delivery equals crisis management
Despite careful non-specific language in policy documents about "quality of care", ordinary Australians achingly endure the distress of inadequate services.
The National Mental Health Strategy was launched in 1992 to transfer services from an institutional to a community setting. After 12 years, four of the five mainland states still have standalone psychiatric hospitals. These institutions continue to soak up around $420 million a year - 14 per cent of the entire cost of mental health services of around $3 billion per annum. In several states, community-based services are being withdrawn onto hospital grounds to make short-term savings. Prisons are also becoming de facto psychiatric institutions - in NSW, for example, 46 per cent of inmates at reception have a mental disorder and the prevalence of psychosis is 30 times greater than the norm.
Stigma is the "heart of darkness" which lies behind Australia's appalling treatment of people affected by mental illness.
Stigma and discrimination are usually considered the acts of individuals, yet the extent and range of problems with Australia's mental health services reveal that stigma against people affected by mental illness is also systemic. The widespread prevalence of stigma often leads to self-stigma, leading to reluctance to seek treatment. This untreated illness, in turn, contributes to suicidal thinking and behaviour.
The needs of people affected by mental illness are disregarded at the highest political levels where policies are set and funding decisions are made within health bureaucracies. These bureaucracies regularly give such people the lowest priority.
Because mental health services are crisis-driven, the focus is on people when they are acutely ill. The remainder of the time they are largely ignored, yet this is exactly when rehabilitation and support are most needed to help prevent further episodes and promote recovery: an optimum level of dealing with symptoms and disability.
In most parts of Australia it is unlawful under anti-discrimination acts to vilify people on the grounds of race, religion, sexuality or gender identity. In NSW it is also unlawful to vilify people with HIV-AIDS. Under current Australian legislation, however (apart from Tasmania), people with a psychiatric or other disability do not enjoy this protection. It is totally unacceptable that vilifying the mentally ill remains a legal activity in mainland Australia.
While there has been some improvement in media coverage of mental illness, this is not sufficient to counter systemic stigma. Some newspapers and TV dramas also continue to portray mental illness in an inaccurate, sensationalised and disrespectful way. This can suit political leaders because it displaces blame for the consequences of poor service delivery onto the mentally ill themselves.
SANE calls for leadership by the federal, state and territory governments in reform of the National Mental Health Strategy to focus on:
- a closure of all psychiatric institutions and implement properly-funded, community-based care for all those in need;
- national strategies for early intervention, dual diagnosis and treatment of borderline personality disorder;
Medicare-funded access to psychological treatments from clinical psychologists;
- forensic mental health services to replace prison psychiatric units;
- urgent action to recruit and retrain mental health professionals;
- genuine involvement of consumers and carers in planning services;
- an increase in the proportion of the health budget allocated to mental health services, from 8 per cent to at least 12 per cent;
- the establishment of a National Mental Health Commission;
- monitoring and reporting the effectiveness of mental health services;
- the implementation of evidence-based, recovery-focused rehabilitation, supported accommodation and employment services for people affected by mental illness, as well as education, training and support for family and other carers through coherent national strategies and provided by non-government organisations; and,
- legislative change at federal and state levels to outlaw vilification and harassment of people with a psychiatric or other disability.
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