More Queues than Ays: reflections on Q&A’s mental health episode

The ABC’s Q&A program for Mental Health Week last night focussed on mental health in rural and remote Australia. The program covered a broad range of issues, including historical trends for mental illness in Australia, the role of prevention and early intervention and whether mental illnesses are determined by genetics or environment (or a mix of both).

Gordon Gregory, Executive Director of the National Rural Health Alliance, provided the following analysis of the episode. He writes:

What were the take-home messages from last night’s Q&A?

The term ‘mental illness’ is regarded by some as being inadequate. It connotes a singular, uniform set of conditions whereas the reality is that poor mental health is complex, multifaceted, undiscriminating and of various levels of acuity.

It was agreed by everyone that the single thing most needed is open communication and discussion of matters related to mental health. The language is important, so as not to pigeonhole people as having particular conditions (given the complexity referred to above) or as being ‘victims’.

There also seemed to be general agreement that the most important people for relating openly and honestly about mental health conditions are the family and friends of the person experiencing the condition. Mental health experts have their place later on in the patient’s journey, but then it may be that those clinicians with lived experience of poor mental health are much to be preferred.

In terms of programs to protect against poor mental health or to manage it where it exists, a strong preference was expressed for local people to take the lead in creating, managing and evaluating a program for local friends and family members. Cultural safety and security is clearly a part of what makes this a preferable approach. Where it has been implemented, such an approach has succeeded in reducing the very worst consequences of poor mental health.

The program had a welcome focus on rural, regional and remote areas but was dominated, as is so often the case, by considerations of those in agriculture and the minerals sector.

Various views were expressed by the panel and in tweets about the notion of communities or individuals having ‘resilience’ and the possibility that such a quality is more common or stronger in rural and remote communities than in major cities. There was a strong preference for ‘strength-based approaches’ – whatever that means. No doubt it includes use of appropriate language, focusing on the likelihood of recovery (a positive rather than gloomy approach), and building on strengths of the patient or community that already exist.

Just a little attention was given to stigma, and the more damaging place it has in rural and remote areas relating to sexuality, visibility, shame/pride etc. The discussion about homophobia was instructive.

There was explicit recognition not just of the failure of the states to invest appropriately in community mental health but of the fact that several jurisdictions, including Queensland, have gone backwards in relation to required services. The inability of hospitals to provide appropriate services, and the lack of respite care (“places for quiet retreat”) led to some particularly poignant reports.

Overall there was agreement that mental health can be normalised by more open and more frequent discussions, which should help lead to a groundswell of support for governments to do more. The prognosis for the prevalence of mental health problems in rural and remote areas varied from the absolutely negative, premised on the complete failure of agriculture, through to a quite positive view that we are on the cusp of greater understanding and thus, hopefully, of increased action.

Many thanks to Aunty. If nothing else, the program reminded us that finding a solution for poor mental health is not as simple as ABC.