Apr 21, 2016

No, Beyondblue, we do not need more awareness about mental health

If you don't have a mental illness, you don't need more "awareness" of a condition you don't have.

Helen Razer — Writer and broadcaster

Helen Razer

Writer and broadcaster


Eight years ago this winter, my then partner and I sat in a waiting room so comically depressing, we might have laughed but for fear of the Carry On Matron administrator. Management of a public MS clinic is not easy work, and this honourable health worker made that clear in an unspoken instant. There was to be no laughter, no lateness and no threat at all to the smooth operation of a barely funded, enormously useful service. You arrive on time. You submit to tests. You try to help the doctor place you on a disability status scale. The other thing you do is try to understand a peculiar illness that, as the neurologist herself might tell you, is itself only barely understood by medical science. You try to understand how to live with daily injections, the side-effects of those immune-modulating drugs and the legitimate fear that one day, you might go blind or choke or piss yourself in public. As any Australian diagnosed with a fairly serious disorder can attest, those early weeks of treatment are a cruel crash course in awareness. There’s so much to learn and so many decisions to make and just as you’re learning and making those decisions about your course of treatment, it occurs to you to make some provisional plans for the course of your illness. What if I die in 10 years? What if I can’t walk next year? This awareness, although crucial, is hard-won and exhausting. Matron Carry On, whom I came to know as an inveterate softie, knew the toll this awareness took on her patients. One day at the clinic, we saw her dump a box of “Raising Public Awareness of MS” brochures in the recycling tub.  My partner, who was by then truly tired of awareness, offered thanks. “All I want is not to be so aware of this disease for a few hours a week,” she said. “And I don’t see why anyone else would want to be aware of it, either.” People who have this particular disease become so painfully aware of its ravages, they hardly need reminding. People who don’t have it really require no awareness of it at all. So long as the unaware don’t revolt in the streets against funding to our nation’s neurology departments, it’s all OK. Of course, it’s irritating when some of these happily unaware persons say dumb stuff about juice cleanses or they fail to understand why the MS patient might avoid outdoor events on a very warm day. Otherwise, the need for public awareness about this disease, which will eventually make itself loudly known to you and your doctor in any case, is really an optional extra. Awareness of disorders is the good work of medical science and the unfortunate obligation of the ill. But Public Awareness seems, in many cases, to be a peculiar sop. There are, of course, those prevalent disorders of whose symptoms and screening procedures we should all be made aware in the interests of public health. But none of us needs to be made aware about the particular nature of a particular illness unless we are affected by it very directly. But try telling that to Beyondblue. Another month and another public awareness campaign emerges from an organisation that has, since its inception 16 years ago, committed itself to the project of just making people understand. While the information that the prominent organisation provides to people suffering from mental illness is in many cases fairly practical, the moral prescription it continues to deliver to everyone else has become, in my view, absurd. The “Get to Know Anxiety” campaign might have some value if it were directed at those many Australians estimated to suffer from anxiety disorders. But, like many of the influential organisation’s campaigns, it’s not. What is provided here is an injunction to the rest of us to understand anxiety because, apparently, 17% of us refuse to do so. So 17% of Australians think that anxiety disorders are imaginary. Beyondblue and its many slavish fans in press report this as a terrible injustice. In my view, this is an excellent statistic. Given that so many Australians can find a reason to vote for the Coalition, grumble about non-existent terrorist threats and buy Paleo recipe books by Pete Evans, I am delighted that the figure is so low. I’d say that Beyondblue can now shut up shop, congratulate itself on a job well done and leave broad discussion of public health to those less ideological. And Beyondblue is a very ideological organisation. There is little that is more ideological than routinely shifting the blame for the prevalence of a health disorder on bad personal attitudes. It’s the 17% who are getting in the way of good mental health! It’s not, say, an absence of bulk-billed psychology or psychiatry services. In the ideological world of Beyondblue, it’s recalcitrant individuals. From the outset, chairman Jeff Kennett has advanced the ideological nonsense that “mental illness can affect anyone, anytime”. Which is, strictly speaking, true. But, like any disorder, mental illness tends to affect particular groups of people: socially disadvantaged ones. To its partial credit, Beyondblue has acknowledged in recent years that LGBTI and Aboriginal and Torres Strait Islander peoples are significantly more likely to encounter problems with mental health. What the organisation will never acknowledge is that homelessness and poverty are not only great risk factors in mental health -- this is not to say that the well-to-do don’t suffer; they do, but not in such spectacular numbers -- but are themselves great hurdles to getting treatment. Still. The real problem is that 17% of insensitive bastards. The choice of a famous and successful actor to convince that stubborn 17% fits the Kennett ideological project well. See. It can even happen to the fabulous Guy Pearce! I feel for Guy Pearce. But, as a person who once had a diagnosis of PTSD that led, as such things overwhelmingly do, to complete professional meltdown, I know that seeing a handsome dude who makes about five feature films a year talk about his struggles with anxiety would just have made me feel more unproductive and worse. Of course, when you suffer anxiety, just about everything has the potential to make you feel worse. My PTSD was provoked by birds, supermarkets, traffic and, of course, people who just didn’t understand. People who just didn’t understand were in very ample supply and, unfortunately, among their number was my boss, who gave me the arse, not just because he was a prick, but because he could. This unpleasant man, who may or may not be part of the 17%, was not the problem. The problem was disregard for my rights at work. The problem was an institutional failure. Not that of private individuals. I truly, genuinely and actively understand how the insensitivity of others to one’s condition can send one even pottier. It would be very nice if they could understand. But it might be nicer if some of the nation’s most prominent commentators would make the effort to understand, which the author of Tuesday’s editorial in The Age, in my view, did not. Like so many influential pieces written around mental health, this one takes many of its cues from Beyondblue’s ideological program of understanding. Sure, the paper says, after much to-do about “ending the stigma”, that more funds are needed. And, of course, they really are. But it goes on to recommend funding to a particular program, Better Access to Mental Health Care, which  has already -- and it pains me to say this about a Liberal politician -- had some of its monies responsibly reallocated by Sussan Ley, a politician doing her best to work within a very strict budget envelope. Thank heavens Ley is actually listening not to Beyondblue but to some of the best advice she can on how to use her limited mental health funding. Even our most prominent newspapers don’t really seem to be taking the time to listen to mental health advocates about how to make the best of a bad budget. Championing the effectiveness of this particular program itself shows a great lack of “awareness” about the good, if under-funded, policy changes recently made around mental health. Most everyone is listening to Beyondblue’s ideological and moral injunction to be nicer to the mentally unwell. When, really, the nicest thing we could do is to put them in a waiting room, even a slightly depressing one, and give them bulk-billed treatment. Awareness is an optional, user-paid extra. It’s not any kind of cure.

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44 thoughts on “No, Beyondblue, we do not need more awareness about mental health

  1. joyjan

    The patronising tone of those who believe that ‘right thinking’ will solve all problems whether they be a better understanding of anxiety or such other issues as gender equality or disability does nothing to provide practical and meaningful help to those experiencing these horrors. As Helen says, ‘… the nicest thing we could do is to put them in a waiting room, even a slightly depressing one, and give them bulk-billed treatment’. Awareness is an optional, user pays extra’. Attitudinal change would be a lovely outcome but also rather haphazard, unpredictable and a dreadful drain on resources.

    1. Ben Mullings

      The problem is that bulk-billed care is only accessible via Medicare. You can only get access to bulk-billed psychological care in the Better Access scheme. The article above seems to say we should redirect funding away from that, which is at odds with arguing for more bulk billing. The reasoning makes even less sense when we examine how much more expensive it is to provide psychological care via Medicare Locals (or PHN’s or whatever re-branded label we want to call these places). If we don’t have much funding for psychological care, how can we justify redirecting funding away from those places where the funding is being invested to reach the maximum number of people who have a diagnosed mental disorder?

      Wouldn’t it be better for us to look at ways to increase the rate of bulk billing in the system, rather than cutting the funding from such a well-established and widely accessed public system?

  2. shea mcduff

    Good article, I admit I thought it was a strange attitude when I first started reading but the writer made such good points so clearly that halfway through I had switched to understanding and agreeing with the viewpoint expressed.
    Of particular importance was the emphasis on structural changes and not adopting the individualistic approach as joyjan above noted.
    Thanks for that article Helen, it educated me.

  3. old greybearded one

    I had a mum in law who was an MS martyr and I have a wife who has had dangerous depressive episodes who was also a clinical psychologist. I live in regional Australia in a small town. I see the struggles of parents to find advice, I see the indigenous suicides and I worked with some of them, I knew the young farmer who just shot himself one morning while his family was at breakfast. Beyond Blue is windbagging. Just try and find the mental health services in a town like mine. Even the city of 35 000 up the road has almost no one there on a weekly basis. Where is this in the media blather?? Often dislike Ms Helen’s views, but if you are actually close to the sharp end, whe is right today!

  4. Lingo

    Thanks, Helen, for putting beyond blue and Kennett in their place, and distilling aspects of my experience of anxiety and depression, and breast cancer. Re the latter, I wouldn’t be alone in wanting to be free of PINK everything – a trigger for public awareness of breast cancer, and God I came to hate it, particularly the candy version of it appropriated by whatever PR firm was employed to get the first awareness campaigns under way. Would you believe, oh I’m sure you would, that when I saw the wonderful breast care nurse allocated to me before surgery and she gave me a ‘show bag’ of goodies including a soft post-surgery bra and a book about my journey (binned along with the word ‘journey’ on the way out of the hospital), it was BRIGHT CANDY PINK! Leaving the building and walking to the carpark with it in my hand, I knew that this announced BREAST CANCER SUFFERER to the world. Helen, I was treated like shit by a boss during the six weeks of radiation therapy following surgery, through which I worked every day, and was ‘let go’ from my job at the end. And over the years, having depression and anxiety has provided the odd HR section with a stick to beat me with. No amount of pink- or beyondblue-generated awareness would have made a difference to those experiences. I’m with you on the need for better funded and effective health services; but I’d add that we need strong mechanisms for dealing with the kind of bullying that arises when individuals become only too cruelly aware that someone is dealing with a condition, and goes in for the kill.

    1. Helen Razer

      Thanks, Lingo. The workplace anti-bullying legislation goes a little way toward reclaiming conditions workers have lost over the years. But the fact is, so many of us have lost our rights at work and are forced into arrangements or scheduling when our employers can get-out-of-jail-free. I agree.
      And, the breast cancer thing. I could go on but shall not and advise you only to remember that (a) some studies find that all this pink is bad for our health http://www.crikey.com.au/2013/11/28/razer%E2%80%99s-class-warfare-a-weekly-diary-of-dissent/?wpmp_switcher=mobile and (b) I can’t imagine a better book on the impatience with lovey-lovey pinkwash than Barbara Ehrenreich’s. If you haven’t read the book, you must. It’s kinda perfect http://www.theguardian.com/books/2010/jan/10/smile-or-die-barbara-ehrenreich

  5. Jason Murphy

    I feel like Razer is becoming a warrior for opportunity costs of directing our attention. Just because something is worthy, she argues, doesn’t make it the most worthy thing to focus on. I saw her do the same thing the other day with Safe Schools.

    She’s basically arguing the current zeitgeist for placing the cultural aspects of every issue above the material is not optimal. I dig it.

    1. Helen Razer

      The secret of my materialism is out. omfg

  6. Norman Hanscombe

    If ever anyone tells me we don’t need more [worthwhile] research about depression and similar problems I refer them to Crikey as a cornucopia of materials which illustrate that at least among the Crikey Commissariat and its faithful camp followers the need is there.

  7. Justin

    Good article. Another piece of your writing where I began reading it disagreeing with your premise, but by the end of the article my opinion had been swayed.

    1. Helen Razer

      Are you saying that I raised your awareness?!

  8. Steven

    Another good yarn HR.
    Like Lingo I have several mental illnesses which I am managing reasonably well and have suffered at the hands of a bullying CEO and a useless HR department. The bully CEO and her 2IC actively worked to get me to leave and knew the continual performance meetings and letters hand delivered to my office late on a Friday would push me over the edge. It did … just and I fought the demons including alcohol and looked over the precipice and won. I moved on and out of the area and now live in the country away from their bullying and vindictiveness.
    Mental illness resources even in the big cities like Sydney and Melbourne are way overstreched with months on waiting lists to see the right specialists. Rural and regional services are barely able to cope. It is a national disgrace. More resources not platitudes as Helen so eloquently puts it are needed. NOW.

  9. Ben Mullings

    Helen, you make some good points, however, the situation around access to psychological care is not quite as simple as is being suggested.

    First, they only way for people to access bulk-billed psychological care is via the Better Access scheme. This is in fact, the only program where Medicare provides direct support for psychological care. The reallocation of funding you have referred to will see a large chunk of that funding go to PHNs (primary healthcare networks), where we know from decades of analysis, the cost of services will blow-out considerably. For instance, a report by the Australian National Audit Office shows that it is routine for up to 25% of allocated funding to go directly to administrative costs – not on the actual care of people seeking help (https://www.anao.gov.au/work/performance-audit/administration-access-allied-psychological-services-program). In terms of real human beings, that means one in four people will go without access to psychological care as a result of sending that funding to PHNs.

    Second, the structure of the changes being proposed under the banner of “stepped care” has some serious problems which have not yet been examined. For instance, if we cash out a person’s access to Medicare support as is being proposed by Sussan Ley, then unfortunately that funding is not retrievable. What that means is that the money is then captured and quarantined by a corporate agency, with no opportunity for them to step up or step down, despite the rhetoric. In short, that funding is gone.

    For those interested in finding out more about the coming “shake up” of mental health policy, you might want to take a look at some of the fine print. I have assembled some of the information at http://drben.com.au/?p=758 and would appreciate reading what others may have to say (including yourself Helen).

    1. h_j_m

      Hi Ben, this is really interesting to me and I’ll be checking out your blog… My initial thought on this is that I don’t know if it’s logical to assume that just because 25% of funding might end up on administrative costs, then 25% of patients don’t get seen – surely it is assumed some of the funding is to be spent on administrative costs (those appts don’t just book themselves), and it’s more a reflection of insufficient funding all around. Although I do think it’s important to keep an eye on administrative costs I’m always wary of this line of complaint because it reeks of corporate style business management which can have a corrosive effect in areas like health.

      1. Ben Mullings

        My attempt to quantify the figures in real human terms was intended as an illustration. In the present climate of extreme under-funding (in the order of billions more needed annually) people are already refused care right now. If we add administrative costs on top of that then it stands to reason that even more people will be unable to access the support they need. It’s a problem of scarcity and figuring out how we can adequately help the most in need.

        Having said that, we do have data from the Department of Health. Unfortunately if those figures are anything to go by, the situation is far worse than I described (http://www.health.gov.au/internet/main/publishing.nsf/Content/annual-report2012-13). That is, with a $31 million funding boost across the 2013 financial year we were supposed to reach an additional 27,900 people via PHNs (at the time ‘Medicare Locals’). The data shows we barely reached 13,200 more people. If we look at that as a cost per service, that amounts to the taxpayer footing an average bill of $470 for every visit of psychological care.

        I don’t think that’s a wise use of the few funds we have currently dedicated to mental health care. In my humble opinion, it would be far better to encourage (or require) more bulk billing via Medicare. In the Better Access program, those costs you mention of booking appointments (and so on) is simply absorbed by the practitioner.

    2. Ben Mullings

      *a decades analysis (re: ATAPS)

    3. Helen Razer

      Warm thanks, B.
      I am grateful for your analysis. I can’t claim to have read the terms of the “shake up” with as much scrutiny or professional knowledge as you. But my reading and conversations with advocates and clinicians have led me to suppose that Better Access is not, despite the good claims you make about its costed efficiency, always the best thing. First, have you seen some of the shrinks that get funding from that thing? 😉 I have. I reckon that not all registered psychologists (Ben is going to know this difference, but for those eavesdropping, that is opposed to clinical psychologists) are much chop. And you will be aware that I derived this view from speaking with psychiatric professionals and advocates. The other thing is that this stepped approach is intended for those, as I understand it, who have more complex problems. It may be more expensive but, as we know those who tend to more complex or serious conditions have been those the least likely to get care. Better Health is great for people such as myself who has a condition like PTSD or those with generalised anxiety disorders. Not awesome for people, as I understand it, with major depressive illness, bipolar and the like.

      1. Helen Razer

        I apologise for the grammar casserole of the above message.

      2. Ben Mullings

        Thanks for your reply Helen. Like yourself I have been watching this space for some time now and hoping for better reforms.

        The stepped care model that we here in Australia are being offered is full of the good intentions you mention, but actually doesn’t allow room for people to step up and down as would be implied by the name “stepped care”. As I hinted at above, if we cash out a person’s right to Medicare support then they can’t go back to accessing that funding, whether they want to or not. Once cashed out, the money is gone, into the hands of those private businesses called Primary Healthcare Networks (PHNs).

        The cost expense issue is a significant here because of the lack of funding. We already know that people miss out in the current system, both in terms of being refused access to therapy in the first place and then also having their support for therapy cut short prematurely after ten or so visits (depending on the program). The main problem with sending people to PHNs is that the cost blowout is so large that even more people are turned away from care.

        I absolutely agree with you that it is worth the expense to reach as many disadvantaged people as we possibly can (I was myself homeless for a time as a young man). Once again though, the statistics have repeatedly shown that Medicare reaches a lot more disadvantaged people than ATAPS (i.e., PHN-delivered psychological care). Depending on the way we do the calculations, the Better Access program reaches between 3 to 5 times as many disadvantaged people in real human terms (http://drben.com.au/?p=371). There’s a simple reason for that: the massive scope of Medicare services.

      3. Ben Mullings

        Oh the other thing I wanted to mention (important!)…

        We need to move away from this dichotomy of ‘clinical psychologists’ versus ‘the others’. I would recommend the open letter by Dr Bill Saunders (Clinical Psychologist) to help explain why: http://counsellingpsychologists.org/archives/1400

        This issue has also been debated and challenged within the profession of psychology. It’s a lot more complex than a two-tiered classification may suggest 🙂

        1. Helen Razer

          Thanks again, Ben. Some top-drawer Crikey commenting there which serves to (a) remind me why this publication, which serves such cranky and informed readers, is mighty and (b) gives me hard evidence that not everyone who disagrees with me is an idiot. As a narcissist, I need this reminder.

          1. Ben Mullings

            Ha! You are a gem Helen! And I do love to read your work, even when we see different sides of the same issue 🙂

  10. Lingo

    Thank you Helen, I will follow up those readings. My experience with Comments sections to date has been of the order, “Ye gods, have these people READ the article carefully? Are they using the comments section for wheeling out their hobby horses solely to get a public airing?” But I see that while this kind of commenter does leap on to Helen’s articles, they don’t suck all the air out of the commentary. It’s pleasing to see generous responses from Helen, informed and friendly exchanges of information and views, and comments that take the discussion some steps further. I’ve read much of the preceding material with interest and pleasure. Big ups to Helen and to correspondents like Ben for setting and maintaining a fine tone (with wry humour here and there), reminding me rather of New Society in its heyday.

    1. Helen Razer

      This *may* be anomalous, Lingo. Although, one hopes not. Perhaps the internet has suddenly become a site for considered exchange?!

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