Gillard comes from a long line of Labor mental health failures
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On Tuesday Julia Gillard made her first policy announcement on mental health. She’s said on several occasions she understands the issues in mental health and has reminded us of her significant cultural capital in this regard. I, like many in the sector, expected her to take a very different policy stance to her predecessor and to dig minister Nicola Roxon out of the hole she continues to dig for herself on mental health. In her speech to the Committee for Economic Development in Brisbane, Gillard made much of Labor’s credentials in health reform, citing reform going back to Chifley and the PBS, Whitlam and Medibank and Hawke and Medicare. Fair enough. She said “a nation’s health system is a measure of the nation itself … a test of a nation’s prosperity … and accessibility … a test of its fairness”. She set out the case that health reform is part of the Labor Party’s DNA. Seems reasonable. Someone clearly didn’t point out to the PM that Ben Chifley actually signed a deal with the states to reduce funding for mental health in 1949 (‘Mental Disease Benefits’) that significantly reduced services and beds for mental health care. Following a wave of national concern about over-crowed and “sub-human conditions” in mental health institutions, PM Menzies commissioned a national inquiry. State Labor governments (in every state except South Australia) resisted meeting then federal Health Minister Earle Page to address the problems, which forced Menzies to set up the Stoller Inquiry in 1954. It was the Menzies government who led the first national response to mental health, which led to a large increase in funding to the states, the updating of state mental health laws and the scrapping of such archaic institutions as the Lunacy Court in NSW despite resistance from the then Labor Premier John Cahill. Of course there have been a dozen or more major inquiries or Royal Commissions into the state of mental health since the 1960s and all have had much the same to say about the sector — underfunded, overcrowded, poor quality of care, inaccessible services, human rights abuses, etc, etc. The 1961 Royal Commission in NSW, headed by Justice McClements, even set out some fundamental human rights for the mentally ill: “the right to have his right to liberty balanced against community concerns; the right for the hospital to care and teat him and if possible rehabilitate him; and the right to work”. Regrettably nearly 50 years later, people with serious mental health problems still have these basic rights ignored or abused. Quite correctly, as a nation we moved to reduce the number of beds in standalone psychiatric institutions from the 1960s but not until Burdekin’s report in 1992, and under Health Minister Brian Howe’s leadership, did we even attempt to have a planned approach to this extraordinary social change. Only one state government, Victoria, under a so-called Thatcherite Jeff Kennett, fully implemented the agreement to close all standalone psychiatric institutions. As of today, we continue to see these institutions in every state that happens to have had a Labor government over most of the past decade. Since Burdekin, for nearly 20 years, Australians have been told that mental health is a national health priority. To show this commitment, every five years since 1992, all Australian governments have signed five-year National Mental Health Plans. Minister Roxon signed off, against the advice of the National Advisory Council on Mental Health, on the Fourth Plan in August last year. This is a plan that commits no one to anything; a plan that simply contains a range of suggestions for action; a plan that like the one before, contains no specific spending commitments. What I would call the “Fourth National Mental Health Deception”. Deceptions because the percentage of healthcare spending in mental health has remained largely unchanged since the First Plan in 1993. The only exception to this was in 2006 under the CoAG National Action Pan on Mental Health led by John Howard and Morris Iemma when $4 billion over five years (ultimately $5 billion) was injected in the sector. Howard and Iemma acted in the face of denial of any problems from the health bureaucrats, advisers and the ministers of the day, but fortunately Iemma and Howard listened to the voices of mentally ill and their families. The national health priority on mental health for the past 18 years has been one long deception on the Australian community. While there has been change, there has not been reform nor a response to the changing mental health needs of the community. Just the same old rear-view mirror perspective of the state mental health directors and co. Gillard knows that there is deep trouble in mental health. In 2005 at the time of the release of the Not for Service report, she stood outside the Brain and Mind Research Institute and called for national leadership and promised to “hold the feet of her Labor (state/territory) colleagues to the fire on reform”. She strongly endorsed the recommendations in that report that called for national leadership, national accountability, national infrastructure akin to that established by Neal Blewett in the drug research, and new investment in new innovative services. Tuesday’s latest policy announcement on mental health is not about mental health reform. I’m not even sure there is a lot of suicide prevention in it when one sees almost all the funds directed to crisis intervention and the largest single investment for support services for those with severe mental illness. Aside from the one investment of a woeful $9 million in building safety infrastructure at suicide hotpots, there was not one innovation in the announcement. Gillard knows a lot about mental health but the policy announced on Tuesday is straight out of the top draw of Roxon and the bureaucrats at DOHA (Health and Ageing) responsible for this shambles and mirrors the same old scatter-gun, incoherent strategy we have seen for too long in mental health and suicide prevention. Knowing Gillard and knowing what she knows of mental health and suicide prevention, this is not her work. The history of mental health reform would suggest that as a test of political party values, as a test of fairness, the conservative side of politics in Australia has a greater number of reform DNA polymer chains than the ALP. I find this hard to explain when the Gillard government knows that it is people on pensions, on lower incomes and in minority groups that have higher rates of suicide, higher rates of mental illness and have even less access to care. If, as Gillard purports, “health reform is in Labor’s DNA”, then she had better find the genetic links to the likes of Morris Iemma, Neal Blewett and Brian Howe — and not the chain linked to Nicola Roxon and Ben Chifley. *John Mendoza resigned last month as chair of the National Advisory Council on Mental Health |
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33 Comments
so mr mendoza, the opposition has a far superior mental health policy than labor ?
did you ask tony abbott how many mental health problems he was responsible for when he was a minister in the howard government and they were locking up people including children behind razor wire in camps both in australia and overseas.
it is well documented that there policies drove people mad
i hope you mention this when you talk to mr abbott again and tell him how well your campaign is going to get people to vote liberal ahead of labor because of your concerns about this issue
Speaking about the opposition’s superiority on mental health - does Dr Mendoz not remenber the Howard era’s welfare reform and it impact on those with mental illness? What does he say about the damage caused by placing people with significant mental illness under extreme pressure - not to get work (employment outcomes for that group are not very good) but merely to satisfy mean and rigid activity tests and job seeker participation requirements through the then disability employment and job network? What does he say about the impact of removing income support for eight weeks at a time for every breach, often brought on by the episodic nature of the illnesses? That was the Coalition way, Dr Mendoza.
Mr Mendozza you are suffering from the biggest dose of sour grapes. If you regard Abbotts phoney promises as cosha you are a bigger fool than I realised. He has pulled your chain and you have jumped. For goodness sake man, look agt his record. Look at the lack of accountability in his promises. You are becoming a joke.
Given the very large sums proposed for expenditure — would it not make sense to examine the cost-benefits of proposed programs. mental health is, perforce, extremely labour-intensive and most of that work is undertaken by highly trained professionals, making it extrmely expensive. Unlike orthopaedic surgery which is also very expensive but which is easier to measure, mental health outcomes are far more nebulous.
It’s a very complex field of disease and moreover, intersects other areas of need — housing, early childhoodintervention, drug policy, human services. While I agrere both that the total health budget and the proportion of it earmarked to address mental health needs to increase, agreeing in the middle of an election to arbitrarily dump a large bucket of money into this bolthole seems a poor way to get good outcomes.
What would be far better would be a review of existing programs assisting those with mental illness to see if a change in the range of services could deliver better outcomes and on that basis, funding these things.
John Mendoza forgot to put at the bottom of his media release “authorised by the Liberal Party”.
I guess it is easy to fix mental health, and that is why it is being done with such fantastic success in most of the western world (and on the moon and elsewhere). However, if it is accepted that many mental illnesses are at least a bit intractable to whatever treatments or other arsenal is thrown at them (at least for some of the people for some of the time) then we might want to stop talking about beds and drugs and funding and start talking about people and what can actually be done to support them rather than policies to make them (us) ‘well’ again.
Bit of a rant I know but I’m hyper-manic at the moment and need to take my pills and see the shrink before voting starts for the election or I will spoil my ballot paper or something more sinister damn damn damn and that government I don’t like might get in again.
Anyway, perhaps we should start sending the mentally ill to Afghanistan instead of just expecting well soldiers to come back dead or with PTSD and cluttering up our mental health system.
I am sick of this sort of bullshit. The mental “health” lobby pretend they can prevent mental illness if only more suckers can go to shrinks and make them richer.
We do not have a massive mental illness problem in this country.
Mailyn what Mendozza conveniently doesn’t mention is, he has a personal grudge he carries towards Labor and Nicola Roxon in particular.
I agree mental health, like everycountry has its problems, but it is not the massive problem Mendozza would have us believe. Of course more money can always be thrown around, but to the detriment of other areas in health? Each and every sector would be grateful for more money, the way Mendozza is carrying on, you would think our streets are alive with mental health patients, wandering from door to door with begging bowls. The man is on the Coalition bandwagon and as a payback to Abbott for his change of heart after 12 years of doing nothing, he will write and present anti Govt, pro Coalition scenarios and give favourable exposure to Coalition health policies.
Mental health deserves better than shonky political posturing Mr Mendozza.
Over the last 17 years, I have been admitted as a public mental-health patient seven times - in two different mental-health wards and a clinic - for a total of about 9 months. So I have some experience of the ACT and NSW mental-health “systems”.
On all of these occasions and at all locations there were insufficient nursing and support staff, and patients were inadequately supervised and cared for. Doctors were few and far between, and very rarely had time to spend more than a few minutes (each week) with each patient. There was time only for a superficial assessment of symptoms and the prescription of “quick-fix” drug/s (used mainly to keep patients quiet and non-troublesome) rather than any serious investigation into causes. In my experience, the patients helped each other more than the staff did.
And despite all the talk from the ACT, NSW and Federal governments, the situations in the hospitals of which I have experience has become significantly worse over those 17 years. One hospital, servicing a population of about 50,000, had only 4 mental-health beds. It was replaced a couple of years ago with a shiny new one that cost $40 million. It has 4 mental-health beds - and no mental-health nurses (70% of the other beds are permanently out of use because of a shortage of nurses).
In the meantime, the stress of modern life (work, or lack of it; housing or lack of it; and the threat - REAL in the eyes of most young people - of global warming & climate change), alcohol and other drugs, etc., etc. is driving more and more people, especially young people, into mental illness and - all too awfully often - to suicide.
Mental health is a serious matter and a huge drain on our national human and financial resources. Yet our governments fiddle; our politicians prattle and promise (very little); and our political parties preach (to the converted). A genuine and serious commitment is needed.
(By the way, what planet does SHEPHERDMARYLYN come from?)
I have Crohn’s disease that has been resistant to everything except massive doses of immuno suppression medication.
In 1992 I was in acute pain all of the time and nothing eased it. Because I was in tears in the doctors surgery the doctor claimed I was depressed and put me onto anti-depression medication with the lie that it would stop the pain as the pain was imaginary.
After a couple of months I threw them in the bin because by then I was depressed and still in pain.
Then I was put onto a pain management plan and have not been “depressed” ever since.
The mental “health” industry would have us believe that schizophrenia can be prevented, or bi-polar and we know they can’t.
They treat all drunks as if they are really mis understood depressives instead of just drunks. My brother is a drunk, he is not depressive, he is just a drunk like my father and his brothers.
Those stupid ads with kids walking backwards drive me nuts, they claim that every kid feeling confused or sad is “mentally ill” when they are just confused or sad.
Now get back to me about what planet I live on.
My grand-daughter just had a brief psychotic break due to violence by a former boyfriend. She spent a week in excellent hospital care and is being counselled because she has a real problem.
The problem today is we call everything an illness when it is just behaviour.
No rational person pretends they can prevent mental illness, or cure the seriously mentally ill (SMI), people who have schizophrenia, bipolar 1 disorder and/or severe clinical depression. People suffering these incurable biological diseases constitute 3% of the world’s population and 600,000 are Australian.
The huge problem of the SMI here is the result of decades of underfunding from all governments of both major parties, state and federal. Indeed, research was published 10/1/2010, which looked at mental health-related deaths, natural, accidental, suicidal, from 1916-2004. The report’s abstract states that, for the mentally ill, “THERE ARE NO GAINS.”. (emphasis added) The past century, one of amazing medical advances in all fields, has been a blessing from which we have all gained. For our SMI, it has been one of standing still, or moving backward. Nearly a century of underfunding by our leaders: surely the greatest stigma and discrimination ever shown to millions of SMI, whose lives are always endured surrounded by a miasma of public stigma?
Our most vulnerable and neglected citizens are a majority of indigenous Australians and all of our seriously mentally ill (except the few treated privately). Both groups have life expectancies which are 25 years less than other Australians. Some advances have been made in helping the indigenous people in need. Now mental health reform must begin.
I’m with you Douglas. When are you running for parliament mate?
To start to fix these problems (with our mental health system) it may need someone to actually listen to mental health patients and families of patients and the few other intelligent life forms left. Not just copy what others are doing….
So, I’m considering running on a ‘What Planet?’ ticket, as long as there isn’t anyone called *** on it.
Not that I’m an intelligent life form, just I’m from another planet (I think).
David said:
As the saying goes … need is infinite but budgets finite.
I’m all for doing more in research, running programs that can be developed in concert with other health and community programs and evaluating them, but simply saying — here’s $2-3 billion and ripping it out of some other set of programs is not the way to go.
Fran suddenly Abbott is big on promises where he and his 12 year Govt under Howard failed and failed badly. He has not at this stage, accounted for 1 cent of the promised spending and suddenly at election time he becomes father bloody xmas, here you are, some for you and some for you and some for you, hohoho and humbug. He is picking on schemes where he thinks electors will have short memories, more so areas where he as a minister was derilict.
This man is a serial promise maker. But he has form doing nothing. His promises of billions to mental health is just that a non commital promise. Politicians toss them around like confetti, remember Howards pork barrelling leading up to the 07 election? but do they come back to earth or just float away in the wind, never to be seen again. On Abbotts past form, I’ll back the wind.
I sympathise with you, Marilyn: my father had Crohn’s disease (two operations, continuous pain, almost useless digestive tract). The doctor who prescribed antidepressants for you was plainly wrong (doctors are far from infallible) and probably irresponsible or even negligent. I agree with you up to a point about mental illness being over-diagnosed (it isn’t always clinical depression), but the fact remains that there are many hundreds of thousands of people with serious mental illness who need help.
Schizophrenia is a really hard one, and I don’t know much about it. I don’t know if bipolar disorder can be prevented, but as far as I know, bipolar disorder types 1 and 2 can both be treated with things like Epilim, which is pretty benign and safe.
Depression is what I do know a bit about: it is a biochemical disorder of the brain - reduced and/or delayed production of serotonin. It is NOT simply a behavioural problem. Depression can be induced or aggravated by the use - especially prolonged, excessive use - of alcohol. So “drunks” (many of whom are alcoholics) are commonly depressed (clinically) to some degree. However depression, unless it’s very severe, CAN be managed to a degree by conscious effort (sometimes ‘sold’ under the label ‘cognitive behaviour therapy’).
There are many drugs that, at least allegedly, help to correct brain serotonin imbalance. Most sufferers need at least some initial help from anti-depressant drugs. But things like exercise, social interaction (especially talking over your problems with someone who has the patience to listen and the wisdom to understand and help/counsel) and having a good laugh are the best medicine of all, and are what should gradually take over from the drugs altogether. This is the part of the treatment that takes time and people: and it is what our governments are not providing.
I am a clinical nurse and I have been working in mental health for 25 years in south australian mental health service. The people who are making all the noises in mental health today are those who particular therapeutic barrows to push and who want their particular organisations to get most of the new funding e.g. Headspace. We also have the NGO sector, who stand to profit greatly from the move to ‘de-institutionalise’ mental health (by providing a lower standard of care). I can tell you, mental health is awash with money. The result is large numbers of staff -nurses, doctors, occupational therapists, social workers etc- taken off the coalface to do half baked, sometimes useless ‘projects’ because their is all this money around and they have to spend it.
It is unfortunate that passionate people have little or no sense of perspective. To support Abbott is a disgrace. This money (????) will come from canning the Electronic Health Records initiative. This program has the result of saving 1500 lives a year, not government estimate but medical experts. So Mendoza is happy to allow 1500 a year die so he can have his money. Abbott is also slashing many hundreds of millions from other medical funding, including new nurses, doctors, upgrading skills, developing best practice to fund this. These cuts will also result in major hardship, trauma and death for many more thousands of people. These trade offs are not acceptable and Mendoza’s endorsement of them is an affront to many thousands of people.
He does not acknowledge the billions that Labor has poured into health to fix the disgrace of the Howard, Abbott years and one can only wonder at his amazing narrow view of health or his political aspirations. His ignoring of the 12 years of neglect is quite staggering.
This article is worthy only to be on the front page of the Australian. It says more about Mendoza than Labor.
OK, here we go - there are those who have been sexually and otherwise abused and traumatised as kids - through no fault of their own - who will suffer mental health issues throughout their lives.
And soldiers and others who have experienced horrific events… who will also suffer from the effects, many because they signed up without reading the small print that comes with this thing called ‘Life’.
And then there are those who have psychotic illnesses like bi-polar disorder and schizophrenia.
And those with depression and whatever other DSM IV diagnosis you want to throw at them. About 1 in 5 if we believe some diagnostic surveys.
And then there are politicians, many of whom DO suffer from delusional thinking and other signs of mental illness. However, not all are mad, and not all require treatment, but some should be locked up at election time.
So, having established the quantum of the ‘mental health’ problem, please give ME several billion dollars to describe it, while we are all a bit delusional.
My main point - should I have one - is that mental health is not an election issue, or even a political one - it is an issue that is every day, and for some people, every hour and every minute. It is personal, and it is for families and communities (and government) to try to deal with using a bit of understanding and support and suitable facilities (as well as alcohol and drugs and all that too).
Most of you people, just listen to yourselves, insulting the author and making up an on-the-spot opinion for yourselves on mental health (in Marilyn’s case, deciding it’s mainly a political beat-up) just because the author favours the Liberal approach to mental health. Fran Barlow, I really like your stuff on energy, but on this subject I would have hoped for either something better thought out from you, or nothing at all.
There is a fundamental difference between mental health and most other types of health problem, and that is the potential for impairment ability of the patient to take responsibility for his or her own care and treatment.
Most of the rest of us are able to work, earn a wage, buy health insurance, ask for help getting to hospital … even if the system isn’t always perfect or the $10 million dollar experimental procedure you need isn’t covered. It’s nice to have Medicare, however all but the poorest of us could really get by without it if we tried.
But that’s not the same as not even knowing anything’s wrong with you, or being terrified something’s going very wrong with you, and not knowing if the people you go to for help are going to help you or kill you. That’s really a whole nother thing.
There seems to be a lot of shrieking about whether or not Dr Mendoza has an axe to grind, or whether he’s pro-Liberal or -ALP. I think he’s making the point that all governments have neglected Mental Health as an issue, and Gillard is being slightly hypocritical by claiming that any and all progress in the area has been as a result of only ALP governments. He’s angry about it, and so am I.
Talk to any police officer or paramedic about what happens all night every night with mentally ill people: taken to hospital under (in Victoria, for example) Section 10 of the Mental Health Act because they’re a danger to themselves or others, then turned out within hours and either picked straight back up again by the coppers, or dead.
Former boxer Lester Ellis was going through severe suicidal psychosis a couple of years back - police were called over and over again, took him to hospital, only to be called back an hour later after he’d been released and was jumping in front of traffic again. The ONLY way they could get the help the poor bastard was crying for was to arrest and remand him in custody; once in prison there was finally a Duty Of Care that could not be abrogated.
The justice system, police and prisons are absolutely the wrong place to be dealing with the mentally ill, but they are the only department that can’t say “Not our problem, not enough funding”, so prisons and courts are becoming more and more just filing cabinets for the mentally and psychiatrically damaged.
Mental Health services in Australia are a disgrace, and I’m yet to see any government, state or federal, commit to actually doing anything about it.
Mendoza may be bitter, and he may be slightly partisan, but at least he’s trying to tell it something like it is.
Whilst readers spend time assuming Mr Mendoza’s political preferences or dismiss mental illness and its prevalence, we are missing the point.
Critisizing Gillard is not necessarily a sparkling endorsement of Abbot, the liberal party or their policy and “promises” to mental health should they be elected. Instead it could be viewed as highlighting those who have the power and are in the position to do something, anything in this space that they need to listen and take guidance from those in the sector, to heed the cries and the pleas of those of us who live, love and work with far too many people whose lives are devastated by these very real health conditions, who can’t ACCESS the HELP they need WHEN they need in 2010.
Gillard is in power now - okay as a caretaker only, however should she get elected she needs to know that this is a most emotive complex issue that requires thought and a strategic approach that is sustainable. We want her party, and those who have the health portfolio to actually ” get this” issue and not pay lip service to it. Mental Health reform requires real leadership not tokenism or a mish mash of let’s pick a few good programs and throw some money to them, whether they need it or not ( Lifeline and suicide prevention absolutely do). Of course there is limited money and that’s why care needs to given to how it is used and for it to be spent wisely not in an ad hoc band aid approach.
By highlighting what doesn’t and isn’t going to work re Gillard’s plan - the other hope is that the opposition will also take heed from these voices, frustration, ideas for a better system and way forward and perhaps respond appropriately.
Mendoza has never stated that Abbot or the Coalition have come up with a perfect solution or one that is the gold standard - what has been said is that the dollars are in the better range. Until that cheque is in the bank and cleared from them - as we all know that is never said or done until that moment occurs, we know political promises are fickle and change with the weather. Discussion around where the money would come from to fund their ideas is also something that isn’t in concrete. We have forgotten how often it is that whenever a promise is made that when a new government get’s in and how things change, promises unmade because the real picture of what was left behind was different than expected.
So please let’s not shoot the messengers, the campaigners and our lobbyists who are working damn hard to make a real difference to people’s lives, they are giving there hearts and souls - not because it is popular or because they enjoy receiving stinging criticism as I have ashamedly noted here in some of these responses. Mendoza could be doing so many other things with his time, but he has chosen this.
I suspect that Mendoza is motivated by this cause perhaps because it is a issue close to home
( as it is for most of us if we are really really honest) rather than bitterness from having to walk away from his role as the Chair of the National Advisory Council for Mental Health. This would also be totally understandable on his behalf when he was supposedly appointed to lead a group of experts that as it turns out where never going to be given a voice or opportunity to do anything of substance - no one likes to waste time or energy.
At the end of the day it is people power and courage to stand up to all our governments and politicians that we need, being just “yes ” people gets’ us no where, especially with the unsexy complex issue of mental health.
Both sides of politics need to take heed - this is going to be an election issue - one day - whether this one or the next one.
For too long all our polllies cook up crook pots of mish mash and think they can serve us up a masterchef signature dish that gullible voters will judge as a ten. So far neither comes close to that score for me.
Smell the roses, folks.
Mendoza and the dozen or more writers who have tried to understand this topic. Yes, I have been medicated and counselled over a decade by professionals. I might say that this assistance was both real and welcome. For what it may mean to you, this is ongoing and may never cease; I am happy to take it as it comes. I am, and always have been, a rational human. Ditto emotional, short tempered, unforgiving, generous, whatever you wish. My point is that I was functioning normally within a complex professional environment, but I was far from well. I am very much different now and work at it every day.
However, there is a place for institutional care and the facilities available for this have been very much reduced since the residential facilities started to close in the 1970’s. This is not only very sad - it is beyond comprehension. Ask any ambulance officer; check with police officers who deal with violence and homelessness. Review the reports which I have found regarding the percentage of the prison population which is challenged by mental illness. Mental illnesses, whatever the root causes, are immensely damaging to those involved and to our communities.
There is a seriously broad opportunity to improve our cities and towns by providing better assistance to those who are ill but who have no external symptoms.
I have never put my own history to print before. Please understand that I very much agree with that which Dr Mendoza is saying, no matter how much I may hold reservations about his recommendations for the future. Mental health is something which affects every family and every classroom, every hotel, every club and every sports team. We must value healthy communities and communities more than we value money… or is money our best friend?
So, please put aside individual assessments and personal needs. Our communities need and deserve far better support for those who need it especially in the area of mental health.
OK, OK, I’ll stop arsing around….
To summarise the issues from a very partisan point-of-view:
1.Mental health is an issue.
Mental illness affects a lot of people, directly and indirectly.
Mental illness is an issue for individuals, families, communities, and society more generally.
Mental health is a political issue.
As a political issue, it affects a lot of people, especially when public policy fails, as with ‘deinstitutionalisation’.
Any policy that is such a mouthful probably deserves to fail but, at its core, where some worthwhile aims - to change how society viewed psychiatric illness, and to return people who had mental health issues to the community. However, the policy went much further, because politicians saw that it could save public money (if viewed in isolation from the issues wholescale release of the crazy into the community would cause). As a policy, partly noble and partly a bloody mess that we continue to live with.
As yet I haven’t seen any actually mental health policy, except for throwing funding at the ‘problem’, what ever the problem is.
Good public policy is not created this way, nor is public debate helped when it is about who did or didn’t do stuff to fix the problem.
I just want to know how either Loabor or the Coalition (or anyone else) should they be elected actually propose to ‘fix’ mental health. And, before that, I want to know just how Gillard and Abbott and anyone else who can be bothered actually think the ‘problem’ is, because that will tell me a lot about what they are likely to try and do to fix it.
And, if the problem is money and the solution is money, then I just want my share.
Sorry, that last reply got away on me for some reason before I could edit it, so apologies fgor (ha ha) typos and other mistakes.
I think I hit the ‘Tab’ key or something and there all sorts of unintended consequences. I hope that is the reason (and other bits of magical thinking).
I appreciate some may think I have an axe to grid - that’s understandable in an election context. I am deeply dissppointed with the response of the Rudd Government and now Julia seems to be following the same flawed script. And I know she does know this issue well and is capable of so much better than what was delivered on Tuesday.
A point some commentors seem to have missed is that no political party has a good track record in this area. What we have seen from both sides of politics is largely platitudes, promises and missed opportunities for real action and real reform over the past 60 years. There have been from both the major parties people (leaders) who have acted and made a difference - I think I referred to three from each side.
As for Tony Abbott, those who look at the record, will see what I said about his lack of engagement and leadership when he was health minister. It was left to Howard to address the issue when his backbenchers were saying to him “we need to address mental health”.
Abbott’s announcment to date is both better policy and smarter politic. I will continue to pursue justice fr people with mental illness until they and their families have the same right to care as those Australians who develop other illnesses or injuries.
John Mendoza
John, you are forgetting that unions have tried over the years to address many of the mental health service provision issues as well as the demands of their members for job security and wages and conditions improvements, and been pilloried for it. in 1985 as General Secretary of the NSW Nurses Association, I, and the mental health nurses of the system fought off the worst rationalising aspects of the Richmond Report. We didn’t win all our demands, but we tried, and I remember well, the families of mental health consumers being extremely grateful for our efforts. Now unfortunately, the unions are not as active on policy and service provision issues. Even if they were, governments would not listen to them. So old fashioned to have to listen to a union official talking about the provision of services to meet people’s needs, when it is all about budgetary stringency and efficiency
Mr Mendoza you have toned down your rhetoric following your first contribution, however you seem to be still of a mind to take Abbott at his word, in that he has promised you millions of dollars, and you yourself describe his ’ promise ’ as smarter politic, I presume you mean politics. It may very well be smarter than Gillards politics, because she has not promised something she can’t deliver. Abbott, a self confessed teller of porkies, fires out promises of policy and money with no costing, no scrutiny yet you accept him at his word and have made your support of him and the Coalition well known in the public arena. Perhaps the glisten of gold is causing you problems in the world of reality. Should the Coalition win this election I will watch with interest the timing and substance of that which you were promised. Mr Abbott’s history suggests holding your breath could be fatal.
PS : You fail to mention the Opposition spokesperson on Health directly or indirectly. Do you share the same confidence in Mr Dutton as you do Abbott?
We should lok at some more figures…and so should our leaders. Professor Mendoza is correct in seeing Kennett as the instigator of deinstitutionalization in Victoria. It was, and is a worthy cause, but his government, and all Labor governments since then, have chosen to do it backwards…so much more money that way, which may, or may not, have been returned to mental wellbeing. Probably not.
Deinstitutionalization; first step, the building of community, shared and individual housing for the seriously mentally ill (SMI) sent from hospitals, acute, short term and rehabilitation.
Second step; the destruction of stand-alone hospitals (though God knows we need them despeately for rehab. now) and the acquisition of their often beautiful treed gardens for luxury developments (perhaps seen as wasted on the SMI). Any person can understand the confusion, chaos and deaths which ensued from doing the 2nd step first, the unhousing of thousands of SMI to substandard houses, caravans, streets, prisons, graves and urns. The ABS statistics show a spike of suicide deaths in the later 1990s, as the exodus took place and the re-housing was, and still is, only barely begun.
Another disabling of mental wellbeing came when the same Kennett (of beyondblue fame) stopped psychotherapy for the SMI, an essential part of their treatment.
The Mental health Council of Australia, 2009, and the ABS, 2008, say that only 45% of our
SMI receive anyspecialist treatment and/or hospital admission when presenting in a critical condition. This, of course, leads to more suicides. Professor Mendoza, (2009) said that “suicide rates are 20-30% under-reported” in allstates.
To move back to the most tragic statistic; for the mentally ill, in nearly 100 years,
“There are no gains.”.
A belated response to CAROL93 and the other very good recent contributions to this discussion.
I have been a SMI patient (with severe agitated depression) in a certain NSW country psychiatric unit on five occasions over the last 11 years. This unit has only 22 beds, but services a population of about 100,000. As I mentioned in a previous contribution, conditions at that unit - staff numbers, staff time devoted to each patient, amenities, and the condition of the building - all deteriorated progressively over that time. It had begun to resemble all too closely that awful place in “One Flew over the Cuckoo’s Nest”.
During most of my last (voluntary) stay of 6 weeks, early one winter, patients were locked inside the unit for almost their entire stay because of the shortage of staff. There was very little to do except watch TV (generally someone else’s choice) or read a book (if you had one). The activities that used to be run by staff had ceased (staff shortage, I was told). To say it was like a prison is no exaggeration: in fact, as far as I am aware prisons commonly offer much better amenities, better medical attention, and (much) better food. The food at this centre was, frankly, appalling: most of the time most of the food served up was overcooked, tasteless mush almost entirely devoid of nutritional value. It was all brought in from a huge central catering factory about 80 km away. And there was no heating - just a cold draught coming from two huge holes in the ceiling in the patients’ lounge and dining area.
I saw the psychiatrist once a week for about 5-10 minutes; otherwise I was ignored. On the day before I was discharged, I finally managed to corner the doctor and talk with him for about 40 minutes(!). Finally, after 11 years, a doctor and I both understood clearly the root causes of my condition: it helped me immensely - it was as though I’d at last crawled out of a deep, dark pit. I like to think that perhaps that young doctor learned something too. The irony of that last stay was that I then qualified for, and could afford, private treatment; but the only local private psychiatric clinic would not accept any more patients because of, allegedly, a shortage of doctors! So I ended up back in the same old place, 100 km away from home, as a burden on the public purse.
I don’t know about you people, but I don’t think this is good enough. And no government or political party seems genuinely willing to tackle the problems in a reasoned, practical fashion - or even to understand them.
I can absolutely recognise and empathise with Douglas’s description of his experience with the mental health system, even though my own experience of mental illness has been quite different, and a lot more mundane. Fortunately or otherwise I have never been an inpatient, although I can see the damage that my condition has done to others, and there have been times when I should probably have been locked up.
Nevertheless, I keep wanting to make the same point – there is no quick fix for mental health – for example, most GPs do not suddenly become competent in mental health, nor do psychiatrists grown on the same trees all the money that politicians throw around does, nor does turning loonies out into the street.
Often help and insight into one’s own issues come from the most unexpected places – and the unusual and unexpected (which does seem to a part of mental illness) is very difficult to plan for.
What system can recognise the individuality of mental health issues – condition, severity, its frequently episodic nature, and all of the interconnects with other aspects of health and welfare, and safety, and everything else?
It takes time, and strategy, and some brute political force to even make a start – all with the solid backing of appropriate public policy and adequate funding. And, in the meantime, there is a need to continue to do and develop and expand those things that do make a difference.
I would like to see, as part of the public debate during this election campaign (and after), much more discussion of the current problems with publicly funded mental health services – their failure to meet the needs of many people (but not all) – and how this interrelates with all of those other aspects of society – like welfare and living standards and abuse (including substance abuse) and war (sorry, defence) and space travel and everything else (just joking about the space travel) that is part of public policy.
I don’t believe that we need to keep arguing about the causes of the current set of problems, or even what those problems actually are, because there already is plenty to quantify them.
It is very different to experience someone’s suicide, for example, than it is to count it as part of a statistical collection, or debate the historical level of under-reporting of suicides. WE KNOW WE HAVE A PROBLEM.
So, can someone please ask Julia and Tony to discuss the present, pertinent and (for many people) painful aspects of publicly funded mental health, instead of just pointing the finger. Anyone can do that. Point the finger that is.
Hi, Douglas Mackenzie, your recent comment about the revelation of you and the young doctor who spoke to you for 40 minutes shows absolutely the necessity of frequent (3 times a week) and lengthy (40-50 minutes) for all our seriously mentally ill (SMI). The three essentials for the SMI to become all they can be are (usually) medication, psychotherapy and safe, adequate, low cost, long-term housing. Very best wishes, Douglas.
Speaking of mental health, Julia Gillard’s freudian slip today again exposed her tin ear for language. Defending Rudd against Downer’s accusation of duplicity, she ponderously observed that “Kevin Rudd is lying in a hospital bed”.
Quite possibly true. They should take his mobile off him.
Dear Professor Mendoza, your preference for Howard as some sort of leading light in mental health is hard to comprehend. On a macro level he was a war monger, and child and human rights abuser ( think detention camps). He also presided over policies that lowered equity ( dental health, education, industrial relations etc). Plus he had a profound disrespect for the enviroment unless there was a dollar in it. How can you stand up and make partisan claims that the coalition is better on mental health?