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. Carlene Colahan

    Could this be the first time the majority of comments on a HR piece were made a) by people who read the piece first; b) thought about what they read & then commented & c) value added with their comments? Take a bow Ms Razer for another great thought-provoking piece & Crikey readers for doing some great thinking

  2. anne morphis

    I work as a clinical psychologist and see clients under Better Access ( Bulk billed with a centrelink healthcare card) and ATAPS ( the current PHN scheme) and am paid approximately the same for each type of session.
    I am a general clin psych but also have expertise with working with particular groups including LGBT and have undertaken considerable extra training in my these areas.
    My experience is that Better Access is by far the better system.
    Its flexibility allows GP’s to match clients with the appropriate therapist in terms of expertise but also personality. The referrals I get under Better Access are generally a better fit than under ATAPS as referrals under ATAPS tend to be based on geography rather than fit and under ATAPS I cannot see clients who live out of my local PHN but who would be happy to travel to access my particular expertise .
    This also means that under ATAPS there is no incentive to do extra training in a particular area as this is not taken into account during the referral process.

    To date the admin burden of working under ATAPS is extraordinary and for a sole practitioner this is difficult to accommodate.

    Not all doctors refer under ATAPS so when a client seen under ATAPS moves or changes doctors they can find it very difficult to get a referral for further sessions ( this year 2 people seen under ATAPS have dropped out due to this problem).

    I am also interested in your comment that Better Access is less suitable for clients with MDE or bipolar . This has not been my experience , in particular I see a large number of clients with bipolar disorder who also see psychiatrists and have access to other services in including PHAMS and find that there is good communication between different service providers. Of course more sessions are needed but this could be given under Better Access rather than adding all the complexity of a PHN system.
    In my view there is a need for PHN’s to identify areas that are not currently serviced and develop innovative programs for these rather than taking funding from Better Access a program that is working well.
    Finally in the long term we need a system that attracts excellent experienced clinicians to treat people who cannot afford to pay , in my view Better Access does this better

  3. Kate Sommerville

    Dear Helen –

    I came late to this article but think it is one of the best pieces you’ve written.
    Been down the MS road, and your story about this is spot on. I had two difficult decades but the last two have been OK. My MS seems to have gone into remission. It can happen, and I hope your friend has a similar journey. Some people are seriously affected. Others are better off.

    My concern about organisations like Beyond Blue is that they medicalize what is often a natural response to social conditions. Thereby, they also locate the problem with the individual. At the risk of sounding like a conspiracy theorist, Big Pharma helps with this illusion because it sells anti-depressants by the truckload to busy and sometimes careless GP’s. There is plenty of evidence that over-prescription of anti-depressants is a real issue in Australia. Depression and anxiety seem to be inter-linked.

    I think there is a place for psychotherapy because many people are just so trapped in negative ways of thinking. Therapists can help especially given the fact that people are often so lonely and lack contact with ordinary people who can simply listen and be kind. The trouble is that psychotherapy is just out of reach for many.

    1. Kate Sommerville

      I didn’t mean to imply that kindness and acceptance can be the only cure for depression and anxiety, but they certainly help.
      Access to meaningful employment, housing, a liveable income, and counselling help if you need it are also important.

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