Mental Health Week – a psychiatrist walks into a bar

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 10^th 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