Bernard Keane’s recent Crikey piece questioning the current political and policy focus on prevention has provoked some interesting discussions on a University of Sydney email list.

Dr Brian O’Toole, an epidemiologist specialising in mental health issues and the director of the Vietnam Veterans Study, has entered into the fray, arguing that the public health community doesn’t pay enough attention to mental health. He writes:

“This is a plea to extend the focus of public health and prevention beyond the  causes of death and their risk factors – heart disease, cancer, diabetes, etc – that seem to dominate public health in these days of chronic  disease epidemiology and the push to extend survival and postpone and compress the inevitable morbidity into a much shorter time. But public health seems uninterested in what actually happens to people as they move through towards the inevitable ending – many people’s lives are a  constant misery on this journey because of mental illness. Do we all “live lives of quiet desperation”?

There is hardly a family in this country that is unaffected by some  kind of mental illness, and mental illness (particularly depression and the schizophrenia spectrum disorders) make a mighty contribution  to the burden of disease. Yet research and funding for clarification and discovery of brain-based disorders and primary and secondary  prevention efforts are very poor. Enquiry after government enquiry has demonstrated the need for attention to understanding and preventing  the deterioration that accompanies mental illness, yet nothing has changed.

Ten years ago, with colleague Stan Catts, we mounted the First  Australian Schizophrenia Prevention Conference in Sydney (see Catts S, O’Toole BI, Dragen D (Invited Editors) First Australian Schizophrenia  Prevention Conference, Aust NZ J Psychiat 2000; 34 Supplement S1-S212). Since then, nothing has changed. Mentally ill people still  get shot by police and populate the jails. Thousand are still homeless. Even getting a differential diagnosis in early onset (usually teens and early twenties) disorders is a herculean task, reflecting the lack of knowledge about mechanisms of disease and  prevention in mental health. Three psychiatrists can give five opinions, and all that.

Sadly, there is almost no attention given to mental health in schools  of population/public health in Australia; a few epidemiologists can be found in a couple of enlightened schools of psychiatry, but there are far too few.

Wouldn’t it be a great idea to prevent schizophrenia? Bipolar disorder? Recurrent severe depression? Antisocial personality disorder? The madness that underpins extremist terrorism?

Sorry, I’ll stop the rant now, and go back to my ward…”

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Peter Fray
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