The recent announcement of a new partnership between state and federal governments to provide mental health care across Australia (“PM to act on mental health” - The Australian, 2/1/06) comes as no surprise. The government has little choice to do otherwise as some of Australia’s most vulnerable people make on through another day. Also pressing will be the findings of the Senate Select Committee Inquiry into Mental Health due in March.
But I fear that no amount of policy shift will fix a fundamental failure of the mental health system: the failure of the Federal Government to value mental health care and the people who need it. For our “national shame” to end, there must be a government breaking the bonds of its own thinking when it does not fully serve the community it represents.
If state and federal governments are to provide culturally relevant, integrated and sustained mental health services, they should be properly funded and not imposed by a predetermined set of monologic or monocultural beliefs and values designed with only cost in mind. They should be applied in partnership with the needs of local and regional communities.
For those who do experience mental health problems emphasis must be given to the provision of recovery and relapse prevention services; cultural competence should guide partnerships in service delivery. Also important will be family supports through regional infrastructure, meaningful employment, child support and affordable long-term housing. Such factors go a long way to promote positive mental health and reduce emotional suffering.
Like improved nutrition and physical activity, these factors also provide substantial insight into the role of risk and protective factors in the developmental pathways to mental health problems and mental illness. High co-morbidity of mental ill health and its interrelatedness with physical illness and social struggle stress the need for integrated public health activity which will target groups of related problems and issues, common determinants, early stages of multi-problem trajectories, and people at multiple risk of injury.
At the core of an integrated response driven by the Federal Government will be the need to engage with and understand the significance of the NGO sector, the family unit and a willingness to understand (value, really) the lived experience of carers and consumers of mental health services. This will go a long way in forming a trusting and therapeutic partnership - a relationship of sorts - that promotes trust as a fundamental requirement for growth and mental stability. This will be particularly helpful when working with carers and consumers of mental health services who may feel on occasion that they have no will or reason to continue advocating for the needs of family members.
It will also be helpful in trying to ensure that community service providers, such as the online 24-hour not-for-profit service depressioNet.com.au serving 200,000 people annually, receive continued funding. If there is ever a need for a paradigm shift by government, consider the following exchange between Sydney talkback radio host Alan Jones and Tony Abbott, Federal Minister for Health, on Friday, October 14, 2005 (listen to the audio file here):
JONES: But it’s a half a million bucks. Tony, this is saving lives!
ABBOTT: But even people who are doing very good things can’t deliver ultimatums to government and say: you’ve just got to give us this …
JONES: But if the thing’s going to close. I mean, people have written to me and said: If it weren’t for this site - I put this in my letter to you - I wouldn’t be here writing an email asking for your assistance. This is some poor coot about to take their life, Tony. "I suffered from depression and came across this website when I was looking for a way to end my life". Are we going to allow this thing to close?
ABBOTT: I don’t think it is necessary to do the service that they are doing that the Federal Government give them $400,000 a year. We want them to stay open but we owe it to the taxpayers to say: What does the Federal Government legitimately need to spend to help these people? And that’s the discussion that we’re having with them.
JONES: So we send billions of dollars overseas and our own people are committing suicide and dying of a mental illness, and an instrument which actually saves people’s lives, you’re fiddling and arguing over a couple of hundred thousand dollars?
ABBOTT: Alan, I know it sounds …
JONES: It sounds dreadful, it sounds dreadful. It sounds completely un-Tony Abbott. It sounds appalling, Tony. Don’t say you know, it sounds woeful to the people listening to you.
ABBOTT: I’m sorry, Alan, but I owe it to taxpayers not to …
JONES: Owe it to taxpayers? Can you think of the amount of money that’s wasted in Canberra on every imaginable thing - bloated bureaucracies, extraordinary payments to politicians, public servants, and these people are threatening to close the show down because they haven’t got money, and that’s saving people’s lives.
ABBOTT: And look Alan, moral blackmail is moral blackmail.
JONES: It’s not blackmail. These people are desperate.
depressioNet.com.au did eventually receive funding - albeit slightly less than what was needed.
However, the practical implications of the Jones-Abbott exchange reveal a much deeper problem: the alienation and humiliation of not-for-profit mental health organisations as functionless and valueless.
People value and connect with organisations they trust and need and this is critical in a system known to push people back in to the community without adequate support.
The need for valuing such organisations and the people who provide support is consistent with a recent extensive review of literature about treating possible suicide and life-threatening behaviour. The reviewers concluded that it is the trust inherent in the therapeutic relationship that allows the person to take the necessary risks, do things differently, reach out during periods of acute and excruciating vulnerability, and experiment with new skills, all essential for progress and recovery.
From this perspective a new paradigm is needed to emphasise the importance of meaningful engagement and connectedness between people with mental illness, governments and health professionals.
This means examination of the way in which symptoms of mental distress are understood and presented, the way help is sought, and the way care is evaluated by those who receive it. This process links the mental health experiences of people in our community as they are held by them and other concerned individuals with governments’ interpretation of them.
Such a paradigm shift will also help bring about more informed and compassionate awareness and respect for the deeper meaning structures and alternative points of view held by some of the most vulnerable people in our society.