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Outlining some priorities for mental health reform

Thanks to The Conversation for allowing republication of this article.

Jon Jureidini, professor of psychiatry at the University of Adelaide, writes:

As the Commonwealth Government’s community consultation period for mental health reform comes to an end this week, health bureaucrats will begin finalising Australia’s Ten year roadmap for national mental health reform to “guide future action and investment”.

The consultation period was deliberately short – just two weeks – because it’s the tail end of a long reform process, leaving little room for the community to provide feedback to the Department of Health and Ageing.

The roadmap correctly identifies two fundamental priorities in mental health reform: addressing the social determinants of health and injecting greater resources and energy into supporting those with serious mental illness.

But the 42-page document is based on some problematic assumptions about the causes and prevention of mental illness, and conflates illness with other forms of distress.

Road to a healthy society

The draft roadmap acknowledges that the future wellbeing of our society is contingent on significant investment in parenting, childcare, schooling and vocational opportunity. The problem is, the document classifies these ambitions as “longer-term actions”, which is too often a euphemism for merely aspirational.

It’s true that the benefits of such interventions will only become apparent in the long term, but that shouldn’t detract from the urgency of initiating action. Community-based programs that enhance parenting capacity (especially for younger mums and dads) and school-based schemes that build students’ emotional strength are just two examples of potential short- to medium-term actions.

The draft ten-year mental health plan conflates illness with other forms of distress.

Unfortunately, as many of us have come to expect from the government’s pronouncements on mental-health reform, the roadmap’s rhetoric is driven by sloppy thinking and populist notions.

The first sentence, for example, says “Mental health is fundamental to a person’s ability to lead a fulfilling and rewarding life”. But this ignores the context of the individual’s circumstances. There’s no doubt that we make judgements about our mental health based on how fulfilling and rewarding our life is.

Fifty years ago, many disenfranchised people were primarily identified by the fact they were unemployed and were regarded as miserable because of their lack of vocational opportunity. Now many of these same people are categorised as primarily depressed and unable to work because they are sick.

It’s also important that we don’t make overly optimistic assumptions about the benefits of the early interventions outlined in the roadmap and overly pessimistic assumptions about people’s capacity to recover without intervention.

The roadmap tells us that “two-thirds of those with mental illness will have experienced their first symptoms by the age of 21, and without support some may experience life long disadvantage”. But with or without support, some people will experience lifelong disadvantage. We can hope that intervention improves the chances of having a good outcome but there is little evidence to show it makes a dramatic difference.

Similarly, the roadmap overplays the link between depression and suicide. A critical reading of the literature shows that suicide is only partly about mental illness; intoxication with alcohol and other substances and the desire to escape pain at any cost are just as pertinent.

In each of these cases, the roadmap recommends providing immediate treatment for “sick” citizens rather than facilitating social reform.

The roadmap’s repeated use of the term “mental health problems and/or mental illness” highlights the inability to really define the boundaries of mental illness. We conflate socially determined dysfunction with bio-psychological disability and too readily apply mental illness labels as “unexplanations” of people’s predicaments.

Success in reforming the mental health system might be measured, in part, by our ability to be clearer about just what constitutes mental illness.

In the meantime, Australia’s ten-year reform plan needs to focus on the hard slog of setting up the building blocks that will allow Australians to lead happy, healthy lives.

Perhaps we require two separate roadmaps – the first to guide us in the management of serious mental illness and the second to lead us towards a fairer and healthier society.

By seeking both destinations at once, there’s a risk that this roadmap will take us to neither.

• This article was first published at:
http://theconversation.edu.au/time-to-go-back-to-the-drawing-board-on-mental-health-reform-5041

***

Previous Croakey posts on the draft roadmap

Beyond a mental health framework driven by healthcare suppliers

Improving mental health: beyond a framework driven by health care suppliers


Matt Fisher

Mental health reform roadmap needs work

Mental health reform roadmap needs work


Alan Rosen

 

Related Posts

Comments 1

  1. jillian Horton says:

    I fully agree with Professor Jureidinis two main comments. Firstly, that there is confusion about the limits and boundaries around what constitutes “mental illness”. This term should not be applied to all forms of psychological distress. It is more applicable to people who suffer from psychotic based disorders (eg schizophrenia, bipolar), who may then require medical, housing, employment, welfare and psychological interventions. However, when this term is applied to those with non-psychotic disorders such as depression and the anxieties, then it confuses what interventions are needed and helpful. For example, the vast majority of people I see in my practice do not need housing or employment or welfare support, but do definitely need specialist psychological therapy and sometimes medication.
    The second point regarding the need to look at the wider issues is highly relevant, especially for people with depression and anxiety (ie the non-psychotic disorders). The social fabric which drives high levels of family stress such as poor work/family ratios, consumerism pushes, high costs of living – which very often require both parents having to work full-time leaving children from very early ages in child care and later in stressed situations of various sorts, are significant factors contributing towards psychological distress. These wider factors drive the psychological problems as much as anything, which then leads to the need for therapy intervention. It is perhaps important to add that good psychological therapy actually includes an examination of these factors and support for people to make healthy changes in their lives. However the therapy room has limited scope and wider issues need wider social change, driven by governments, and fair and thoughtful employment conditions, whether they be in the private or public sectors.

    Dr. Jillian Horton
    President of the Australian College of Specialist Psychologists

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2013 conferences
Australian Centre for Health Services Innovation Forum 2013
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Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
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