Awareness is not enough by Honor Eastly
Today is World Mental Health Day. A day to bring to the fore one of the most pervasive human blights and most under-recognised conditions. A day for frank conversations and acknowledgement. A day for openness.
It is also a day for young people, with mental illness the ailment of the young. In Australia, suicide is the leading cause of death for people under the age of 25 (AIHW, 2012) with mental ill-health contributing 60-70% to the burden of disease for this age-bracket (Orygen, 2014). Despite the ferocity of its afflictions, it is largely a quiet ailment, an unspoken one, and unfortunately, this serves to exacerbate symptoms, disconnect sufferers and leads to poorer outcomes overall.
One of the biggest barriers facing the achievement of good mental health for all is shame. That insidious, hard to kill emotion that thrives off things unsaid and prevents people seeking help. This is especially true for young people, who seek medical help at the lowest rate of any age-strata. For mental illness, only one in four young people will access medical care.
This is why, seemingly, much of our public efforts around mental health care focus on awareness, on opening up, on personal stories and on de-stigmatisation. Of course, with such low access rates to services for young people, awareness is important, but we need to make sure that when people are brave enough, or desperate enough (or both), to finally access care, that there is adequate help for them.
Currently, for a wealthy nation like Australia, the funding for mental health services is disappointingly low. Whilst we have an innovative service for young people in the headspace model, our overall budget for mental health is only 7% of the entire health budget. This is well below the average of other OECD countries of 12-16%, and well below the burden of disease for mental illness in Australia at 14% (Mental Illness Fellowship of Australia).
This results in stigmatisation against mental illness within the health care system itself. Unlike physical illness, mental illness receives little funding for preventative care, combined with strict limitations on clinical care. At present, the system caps individuals at 10 subsidised sessions per year with a psychologist or other registered practitioner. For many people this is not enough, and particularly for young people, who are unlikely to be able to afford to pay for care outright, this is a dangerous limitation.
On televised debates this week we will hear talk of people who are “falling through the cracks”, as if we didn’t know what they were. The problems are obvious and two-fold, stigma and access. As aforementioned, stigma is a giant cultural and structural problem. It can be battled through conversations, campaigns and by educating health professionals, and we are doing this. But access is a problem that is given so little airtime and yet the solution is relatively simple – make mental health services affordable and accessible for all Australians, especially those in regional areas. There is no point raising awareness if the services aren’t there for people to use.
In a bid to avoid the real problem, mental illness is still carted out as a mysterious condition; the brain an unknowable depth. But we forget that we largely have the answers to solve many of our ailments, we just won’t grant people access to them. We put wellness on a leash where even if services are available, they are provided on a drip feeder with unrealistic limitations and often insurmountable financial barriers.
Every day, at least six Australians die from suicide. We forget sometimes, that there are people behind the numbers, but last year, I was nearly one of them. A year ago today I was spectating Mental Health Week from my bed in a psychiatric hospital in Melbourne. Ultimately, I shouldn’t have been there, but I was put there by a failed system that has, and continues, to palm me off, service to service, year to year. I have been falling through those cracks for over a decade now. Last year, when I was admitted to hospital, I crossed what the National Mental Health Review has deemed the “missing middle” in mental health services and entered acute hospital care, finding in it the riches and resources such a place brings. I’ve now been in a private hospital-based therapy program for over a year. It’s a steal at $137 for private health insurance per month, but at the end of the year, my time is up. I’ll be pushed back out into the public sector. I tell my psychologist my concerns, how I am scared that next year through the public system I will receive eight times less care, at significant cost. Frustratingly, she has no answers for me, just condolences.
This situation is cruel, inhumane and ultimately, serves to make wellness harder to achieve. But what’s worse is, I’m so very far from alone. In 2009, the Australian Government called for a mental health system that “ensures that all Australian’s with a mental illness can access effective and appropriate treatment and community support to enable them to participate fully in the community.” What we have currently is so embarrassingly far from that that we should be ashamed.
So yes, today let’s start a conversation about stigma and awareness, but please, let’s also start a conversation about how to fix this problem. Now more than ever, we are the media, so you can choose to contribute to this cause, I assure you, it’s a worthy one. Talk about your experiences with mental health on social media – Australians for Mental Health is a good forum – but please, also share your solutions. I know it may sound unglamorous, but write a letter to your local member. Write to your Mental Health Complaints Commissioner (if you have one). Tell them that you deserve better, that we deserve better. This type of grass roots community-focused advocacy is one of the most powerful things you as an individual can do for this issue. Half of all Australians will experience mental ill-health throughout their lives, if we all spoke up about it we’d see real change, let’s use this day to do just that.
Honor Eastly contributes to the Youth Participation and Engagement Program at Orygen, The National Centre of Excellence in Youth Mental Health.