A problem worth solving #1: Mental health care is complex, fragmented and overwhelmed.


Inspired by Victoria's Royal Commission into Victoria’s Mental Health System, and my lived experience of mental illness and of the system, these research papers provide the short and (not so) sweet low down on the remaining problems worth solving. Often invisible, but oh so real, mental illness remains a neglected health issue. The system is overloaded and we must find alternative, workable solutions for 'consumers' as they meet one of life's greatest challenges.

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So, you are having a mental health crisis.

Where do you go? Who do you turn to?

Well, it depends on many factors; your age; where you live; how much money you have; your history of mental illness; whether you say you are a threat to yourself or others; what medication you are on; whether your GP has sufficient experience diagnosing mental illness; whether you have a treating psychiatrist; whether a hospital has beds for you; whether community care facilities have enough room for you; which organisations have enough funding at the moment; whether you have other family members you can rely on; whether you are you seeing things that are not real; whether you have self awareness; whether you can control your behaviour….

Have I overwhelmed you yet? If not, imagine how frightened, confused or overwhelmed someone would feel during a crisis.

Let’s define what mental illness is.

Well first, let’s rule out what it’s not. Mental illness is not a normal emotional response to an event or circumstantial environment.

So for example, sadness is genuine emotion, anxiety is a normal response. They serve a purpose and are supposed to exist for functional and evolutionary reasons. For example, you could be sad or grieving for a very long time due to a tragic event. You might not be coping with this. It may be terrible. But this is not a mental illness in of itself.

Then there is emotional trauma which does not necessarily equate to mental illness, but it is a fine line. Emotional trauma can most definitely lead to mental illness, especially if exposure to trauma is prolonged and if the associated emotions are inadequately dealt with.

Mental illness and mental disorders

Mental illness (and disorders) are different. Disorders are when a part of the body is not working in the way it was designed. They present abnormalities and irrationalities that interfere with a person’s ability to function.

Mental illness is like a bathroom tap with a broken valve — the entire point of the tap is defeated because you can no longer control the flow of water. If not fixed, the sink will eventually overflow onto the floor and into the carpet. It has the potential to destroy your house and all notions of comfort and stability.

Mental illness is remarkably similar to any kind of soft tissue physical injury (for example a strained ligament in your knee). If you continue to move or attempt to perform, your impairment is likely to get worse. It takes time and patience to recover.

Sometimes, we may even fracture our bones. Depending on the seriousness of the fracture, and if this injury is not supported and treated effectively, you risk having an impairment for life.

Welcome to Australia’s lack of an overarching mental health ‘architecture’.

Mental illness rarely manifests overnight. A person could have received help sooner but a lack of education in being able to pinpoint emotional pain coupled with a combination of stigma and not knowing who to turn to for affordable and appropriate care can prevent that person from getting help.

No one is disputing that many mental health services exist (see below). But, do people in crises know how to reach out to them? Are they efficient? Do they speak to one other? These are critical questions that lack an affirmative answer.

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Demand far outweighs supply when it comes to specialist mental health services

The graph below shows the difference between the actual number of people receiving specialist mental health services vs the estimated demand for specialist services mental health services. It shows a very large gap in consumers not receiving the specialist care they need.

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Let’s speak with the punters and see what they say…

A parent recently testified in the recent Royal Commission into Victoria’s Mental Health System:

“I have a son who has had leukemia, and now a daughter with a mental health challenge. When my son was diagnosed with leukemia, we were immediately connected into an incredible amount of support and services, including those outside the hospital. Our experience when my daughter’s mental illness was diagnosed was completely the opposite.”

Similarly, a health care worker within the system stated:

“I am a nurse and my husband is in the medical profession, and yet we didn’t know where to get help and had to shout and scream to get help…I don’t know what people not in the field do.”

“One of the main problems I encountered with the mental health system was that when I asked for help, it felt like there was nothing there. The narrative around mental health seems to repeat the same message — ’don’t be afraid to ask for help’. The problem comes when you ask, there doesn’t appear to be any answer. It’s so heartbreaking when you finally work up the courage to voice the horrible things that you’re experiencing, but there’s nothing there to help you.” — Anonymous consumer

To be fair, complexity and fragmentation in mental health care is nothing new…

The complexity and fragmentation of the mental health system is nothing new and has become increasingly apparent since the last major reform in the 1990s. A major contributor is the fact that no one entity has oversight or control of the mental health system.

Services have different target groups — often defined by age, location or severity of illness — and are provided by many different organisations, under different administrative, governance and funding arrangements.

While there may be a method to some of this madness, this patchwork usually leads to confusion among consumers, especially in the midst of a crisis.

But can I access affordable mental health care?

Mental health services can be more or less accessible depending on a person’s income, private insurance status, distance from the service and other factors.

Accessing a GP is a privileged assumption. A disproportionate number of people living with mental illness have low incomes and no private health insurance. For many, access to a GP is becoming harder to afford, especially a GP’s willing to take on new patients on a bulk billing basis.

With the help of a GP, the government subsidises visits to the psychologist. But there is always a significant gap of between $50 to $100, and good therapy takes at least six sessions. This is a lot of money for someone who has been left in the perils of despair due to mental illness and often has little to no disposable income.

But what about community health services?

Over recent decades, the focus on free community-based services has increased, but have lacked in their accessibility and effectiveness. They are often provided through different locations and different organisations with limited integration between service elements.

As noted by the Commission people living with mental illness are waiting longer and becoming sicker before they can gain access to community services; increasingly, a person must exhibit signs of major distress or crisis before treatment, care and support become available.

I feel like I am losing control, where do I go?

Probably the hospital. But it should never have got to this stage.

The lack of appropriate community-based mental health services, or at least you or your GP not knowing they existed in the first place, has led to disproportionate growth in mental health presentations to emergency departments. People in crisis often get an emergency service response instead of a therapeutic, holistic, community-based one.

In Victoria, the hospital and inpatient operating environment is one of sustained demand pressure. Client growth of over 7 per cent per annum over the last five years has led to services operating overcapacity, as evidenced by high community caseloads and chronic acute bed blockages.

So, if a person desperately needs a safe and secure bed, they may have to play a game with the emergency triage nurse to convince them that their symptoms are more severe than the person standing next to them, who is also probably in crisis.

The revolving door of crisis management

Our mental health care system currently offers a crisis-driven services response, difficulties with service and bed access, and a large cohort of ‘revolving door’ clients. We see more medication and risk management, with a loss of support to the primary health care sector such as GP’s and social workers.

Due to financial pressures, community health centres are being sold off, and mobile crisis services are being dismantled or retracted into emergency departments.

Ultimately, people living with mental illness, their families and carers, are not receiving the right type of support, where and when they need or want it.

We, as a society, can no longer turn a blind eye to Australia’s alarming mental health crisis and must start building a system that reflects the standard of care we would expect from any other health care setting. Particularly when so much remains unknown about the crushing toll the pandemic has had on the acute and long-term impacts of our mental health.

Change is on the way following the Royal Commission

Following the findings of the Royal Commission into Victoria's Mental Health System, the Victorian Government has committed to building a new mental health system from the ground up, with those with lived experience at the heart this change.

The government with establishing Victoria’s very first residential mental health service designed and delivered by people with lived experience. This service will provide short?term treatment, care and support in a community setting, providing an alternative to acute hospital?based care. Importantly, it will be designed and delivered by a workforce of people with lived experience.

The government has already established a new entity, the Victorian Collaborative Centre for Mental Health and Wellbeing. The Centre will bring together people with lived experience, researchers and clinicians to establish best practice in adult mental health services, including conducting research, sharing knowledge and ensuring the real, lived experience of Victorians is at the heart of our response.

A new independent statutory Mental Health and Wellbeing Commission will also be established, with dedicated positions for Commissioners with lived experience. The Commission will hold the Government to account for the performance of the mental health and wellbeing system, ensuring our reform remains on?track.

Furthermore, eight Regional Mental Health and Wellbeing Boards will be established which each board including at least one person with lived experience of mental illness and one person with lived experience as a family member or carer.

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About the author:?Heath works as a personal injury lawyer (including psychiatric injury) and as a volunteer peer worker in the mental health industry. With lived experienced of mental illness, he is devoted to progressing mental health care and advocating for consumers.

?'I once lived in a dark house with Bi-Polar disorder. I have since fixed the lights, and they have moved out. I now carry a torch at all times. If we cohabitate again, I will not be alone, and they will know the house rules. I am in control.'

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Are you experiencing psychological distress?

?Support is available!?I am not a doctor or clinician. I write from my own experiences and research only. If you are experiencing psychological distress please reach out to your treating practitioner or one of the resources below. You have more options than you think.

Lifeline Australia — Call 13 11 14 — Lifeline is staffed by volunteer telephone crisis supporters who are ready to take calls 24/7.

Carers Australia — Call 1800 242 63 — Counselling, emotional and psychological support services for carers and their families.

Relationships Australia — Call 1300 364 277 — Relationship support services for individuals, families and communities.

NACCHO — Call 02 6246 9300 — National Aboriginal Community Controlled Health Organisation.

Suicide Callback Service — Call 1300 659 467 — Free, professional 24/7 telephone and online counselling to people who are affected by suicide.

Mensline Australia — Call 1300 789 978 — Supports Australian men and boys dealing with family and relationship difficulties. 24/7 telephone and online support.

Beyond Blue —Call 1300 22 4636 — Telephone and online support for those experiencing depression or anxiety.

Butterfly Foundation — Call 1800 33 4673 — Information, counselling and treatment referral for people with eating disorders.

Kids Helpline — Call 1800 551 800 — Free, private and confidential 24/7 phone and online counselling service for young people aged 5 to 25.

1800 RESPECT — Call 1800 737 732 — Counselling and support service for people impacted by sexual assault, domestic or family violence and abuse.

Open Arms — Call 1800 011 046 — Veterans & Families 24/7 Counselling and support services.

QLife — Call 1800 184 527 — Australia-wide anonymous, LGBTI peer support and referral services.

Siobhan Boyd-Squires

Board Director (GAICD), Panel/Tribunal Member, Executive Director

2 年

Valuable insights Heath. Well done on presenting a consumer perspective to help inform change.

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Nicole Davidson

2022 Mediator of the Year | I save businesses time, energy and money by resolving disputes without costly trials. And I train and coach clients' to build skills and confidence in negotiation and conflict management

2 年

Congratulations Heath Mitchell for writing this informative article and for your ongoing advocacy for increased awareness of and support for mental illness.

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