Odd socks stamp out mental health stigma

mental-health
Odd socks for mental health, photo supplied by www.grow.org.au

My choice to wear a matchless pair of socks today was a deliberate tribute to Mental Health Week. Odd Socks Day is just one of the many events sponsored through October to remind us that one in five Australians suffer a mental health disorder in any 12-month period.

I’d never heard of Odd Socks Day, but spotted a flyer in a café somewhere and tucked it away for future reference. It’s a national anti-stigma mental health campaign now in its fourth year, using odd socks as a metaphor that anyone can have an off day.

Despite the fact that the majority of people visiting GPs are consulting them about mental health or psychological issues, those with physical ailments are not confronted with the same level of discrimination, stigma and social shame.

Young people are particularly vulnerable to stigma. Research in 2016 uncovered some alarming facts about stigma and what an obstacle it is to people trying to recover from a mental illness. Headspace found that 26% of young people aged 12-25 would not tell anyone if they had a mental health problem and 22% would be unlikely/very unlikely to discuss it with their family doctor.

Fifty-two percent of young people (12-25) identified with having a mental health problem would be embarrassed to discuss the problem with anyone and 49% would be afraid of what others think.

The Royal Australian College of General Practitioners recently found that 62% of people (via the traditional 10-minute consultation), were seeking support for mental health disorders.

The most common mental health ailments likely to afflict people are depression, anxiety and substance abuse. Sadly, many people struggling with depression use drugs and/or alcohol to self-medicate, often with negative results.

In my former work life, the notion of taking a ‘mental health day’ was anathema to your average hard-bitten journalist, for whom the deadline reigns supreme. But in recent years the previously taboo subjects of depression and suicide are now being freely publicised and debated. The hidden cost of not properly dealing with workplace mental health problems is now an $11 billion problem for Australian commerce. There is now an argument that $1 spent on mental health services equates to a ROI (return on investment) of $2.30. So why aren’t we spending?

If there is one indicator to show how stigma and mental health ratio is shifting, it is the NRL ‘casualty ward’, which lists rugby league players and their injuries. Through the season I recall at least six players said to be having counselling for ‘psychological’ or ‘personal’ issues, the latter covering a range of non-physical traumas. Dragons half Ben Hunt spoke candidly to the media this year about seeing someone to help overcome a slump in confidence. Armchair critics (virtual bullies) did not help Ben’s situation, with a steady stream of vitriol posted on social media.

Suicide is often the end-game for people fighting ongoing battles with mental health disorders. Australia’s standardised statistics on suicide are not as high as some (11.7 per 100,000 people). Lithuania (28.6) and South Korea (26.3) head the World Health Organisation list, but Australia is nonetheless in the list of 10 countries with a suicide rate in double figures and has been for a decade.

In Australia, men are three times more likely to commit suicide (17.8 deaths per 100,000 people) than women (5.8 deaths per 100,000 people). More than 75% of all severe mental illnesses occur prior to the age of 25, and youth suicide is at its highest level in a decade.

The telling statistics revealed by the Royal Australian College of General Practitioners clearly show that the system is under untenable strain.

Author Jill Stark wrote about it in a Sydney Morning Herald opinion piece – ‘What happens when the answer to R.U.O.K is no and there’s nowhere to go?’

Stark wrote from a first person perspective, after  fronting up to a GP with what she suspected was an acute recurrence of anxiety and depression. She was handed a form to fill in – a routine step in such a consultation, so the GP can make a more objective assessment of the patient’s mental health state. As Stark related, she scored 25 ‘mild to moderately depressed’ and was prescribed medication (after first being asked if she was suicidal).

The answer was no, but on the way home Stark reflected that should she indeed want to kill herself, she’d been prescribed with something well-equipped for the job.

As Stark bluntly pointed out, the time for wristbands and hashtags has passed. Doctors need the financial support Medicare can bring by allowing longer consultations for patients with complex psychological problems.

“As a matter of urgency we must stop rationing psychological services to 10 subsidised sessions per year,” she wrote.

So that was Jill Stark, wearing her odd socks in public. Bravo.

People like Jill who are having an acute mental health crisis need expert support at least once a week for as long as the crisis lasts.

The Black Dog Institute reminds us that 45% of Australians will experience a mental illness in their lifetime. One in five mothers with children younger than two will be diagnosed with depression. At 13%, depression has the third highest burden of all diseases in Australia (burden of diseases refers to financial cost, mortality, morbidity etc).

The World Health Organisation (WHO) estimates that depression will be the number one health concerned in both developed and developing nations by 2030.

That gloomy prediction was no doubt behind the WHO’s decision in 2013 to introduce an eight-year plan to change the direction of mental health in its 194 member states. The plan’s main objectives are to:

  • strengthen effective leadership and governance for mental health;
  • provide comprehensive, integrated and responsive mental health and social care services in community-based settings;
  • implement strategies for promotion and prevention;
  • strengthen information systems, evidence and research.

Global targets and indicators were agreed upon as a way to monitor implementation, progress, and impact. The targets include a 20% increase in service coverage for severe mental disorders and a 10% reduction of the suicide rate in member countries by 2020.

These are noble aims, but as the WHO observes, it requires effective leadership and governance to implement meaningful change.

Odd Socks Day is one of the rare light-hearted efforts to raise awareness of mental health. Grow, the organisation behind the campaign, runs an in-school peer program that helps young people support each other through their issues.

The overall cost of unmanaged or mismanaged mental health in the Australian workplace is approximately $11 billion a year, according to Dr Samuel Harvey. Dr Harvey, a Black Dog Institute consultant, leads the workplace mental health research program at the school of psychiatry for the University of New South Wales. He was the lead author for research published in The Lancet which found that workplaces that reduce job strain could prevent up to 14% of new cases of common mental illness from occurring.

Quite clearly, we all need to pull up our socks, odd or not, and change our attitude. If only 35% of Australians in need are actively using mental health services, we need to do more than ask R.U.O.K.

Resources: Lifeline 13 11 14, beyondblue.org.au

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Mental Health Week – a psychiatrist walks into a bar

mental-health-week
A mural by Giudo van Helten on 30m grain silos in Coonalpyn, South Australia. https://flic.kr/p/XUsAK9 Steve Swayne

You wouldn’t always associate grain silos with the national funding crisis facing Australia’s mental health sector. Mental Health Australia chief executive Frank Quinlan did just that, using the silo analogy to lament the distribution of funds that so often see alcohol and drug problems and mental health problems dealt with separately.

He cited the 2016 Australian Institute of Health and Welfare report on alcohol and drug use which states that one in four people who abuse substances had also been diagnosed or treated for a mental illness.

Mental illness was the subject of a short film shown at Gympie’s Heart of Gold Festival last weekend. A psychiatrist is late for his 11am appointment with a new patient – a man who suffers from delusions that he is…a psychiatrist. It sounds like a man walks into a bar joke, but in this case, the clever premise for a 13-minute film by Josh Lawson (actor/writer) and Derin Steele (director).Lawson and Steele control the farcical plot and sharp dialogue with the panache of John Cleese and Connie Booth.

The film won the best Australian short film award at the Heart of Gold Festival, the 10th year of this splendidly curated short film festival held in Gympie.  I’m happy for the writer/director that they won best Australian short for a film by using humour to have something to say about psychiatry and mental illness.

Seeing is believing – maybe

Unlike physical disabilities (cerebral palsy, MS,  spina bifida, brain or spinal cord injury, epilepsy, muscular dystrophy or the long-term effects of a serious stroke), mental illnesses are hardly ever that obvious. Once the mentally ill person’s latest acute episode has settled, they can present in society, well, as normal as you and me.

The point is well made in “The Eleven O’Clock” where the secretary (a temp), accepts what she sees as “normal”.

There is, alas, nothing funny about mental health, its proven links to alcohol and drug abuse and a lack of co-ordinated national funding that leaves so many mentally ill people in a cyclical holding pattern.

As Mental Health Australia chief executive Frank Quinlan wrote in a recent MHA newsletter, separate plans and strategies to deal with mental health perpetuate the silo model of funding.

Quinlan writes that Primary Health Networks, set up in 2015, offer an opportunity to genuinely integrate and co-ordinate programmes and services.

“But this is only going to happen if we can break down the boundaries that see separate streams of funding for drug and alcohol issues, mental health issues and various psychosocial supports.”

The 2016 AIHW report, which canvassed 23,772 people, noted that 27% of illicit drug users have a mental health issue, compared with 21% in 2013. Mental illness occurred in one in four users of ecstasy and cocaine and in 42% of methamphetamine users (29% in 2013).

The abuse of amphetamines and derivatives doesn’t let righteous boozers off the hook. One in five people who drink alcohol at risky levels have also been diagnosed or treated for a mental illness. That was a 25% increase over three years.

Patrick McGorry, professor of psychiatry at the University of Melbourne, says the overlap between mental ill health and substance abuse is enormous, yet treatment for drug abuse and mental health has been “progressively de-funded, de-medicalised and split off from mental health care.”

He told ABC News: “Mental ill health drives self-medication with drugs and alcohol and yet virtually no services are equipped to respond to this toxic blend.”

Meanwhile, many community mental health programs, be they government-funded units or NGOs, have been ring-fenced within the National Disability Insurance Service. This means that the mentally ill who do not qualify under the NDIS may be without support outside of acute hospital wards. The Federal Government set aside $80 million in the May budget with the intention of plugging the gap.

Sebastian Rosenberg, Senior Lecturer, Brain and Mind Centre at the University of Sydney, said the federal budget’s promise of $115 million in new funding over four years was one of the smallest investments in the sector in recent years. The Council of Australian Governments (CoAG) added more than $5.5 billion to mental health spending in 2006, while the 2011-12 federal budget provided $2.2 billion in new funding.

“In 2014-15, mental health received around 5.25% of the overall health budget while representing 12% of the total burden of disease,” Rosenberg wrote in The Conversation.

“(These figures) speak to the fact mental health remains chronically underfunded. Mental health’s share of overall health spending was 4.9% in 2004-05. Despite rhetoric to the contrary, funding has changed very little over the past decade.”

Rosenberg says Australia lacks a coherent national strategy to tackle mental health.

“New services have been established this year, but access to them may well depend on where you live or who is looking after you. This is chance, not good planning.”

This is where the silo analogy reappears: those with the gold key to the silo door will get a quick fix. Treasurer Scott Morrison said the $80 million allocated over four years for ‘psychosocial services’ was for Australians with a mental illness such as severe depression, eating disorders, schizophrenia and post-natal depression. The funding, which seeks matching contributions from the States, includes those who had been at risk of losing their services during the transition to the NDIS.

Some 230,000 Australians with severe mental illness have chronic, persisting illness and most have a need for some form of social support. This can range from low intensity or group-based activities to extensive and individualised support. The latest data available on this subject suggests that 22% of people with psychosocial disabilities have been unable to meet access requirements for the NDIS. (NDIS/COaG Quarterly report).

So $20 million a year won’t go very far, although as much as $160 million a year could be available if all States chip in. But each State and Territory will have to retain responsibility for what was previously known as community mental health services.

Still, you’d agree it’s a better application of taxpayer funds than the $20 million spent in 2015 on charter flights to and from detention centres on Nauru and Manus Island.

From the archives