Yesterday, both Bernard Keane and former Crikey staffer Matthew Knott did good diagnostic work on the slow death of the same-sex marriage plebiscite. This demise, they said, could sure tell us a lot about Coalition politics. Our government is decrepit, worn down by the quaint afflictions of the cultural right. It’s true. Turnbull, today’s champion of innovation, is eaten alive by the Bernardi appetite for yesterday’s cold virtue.
We’ll leave the autopsy of a prime minister’s hope to Coroner Keane. Let’s focus here on another passing. And, no, not the end of the plebiscite itself — although someone should probably say something about what such a forceful rubbishing of a democratic process might mean for our future. It’s about the waning hope for useful conversation on mental health, the reason almost uniformly given for abandoning the plebiscite.
Opponents of the plebiscite have not equivocated; this, they said, would be a disastrous mental health event. Taking their cue from Australian Marriage Equality and other traditionalist LGBTI groups, politicians have said that thing long uttered by a particular kind of lobbyist: this decision is very bad for mental health.
Bill Shorten has written that the proposed vote would cause LGBTI people, already at increased risk of poor mental health, further distress. Later, he mentioned the Orlando shooting. Last Friday, Richard di Natale said that the vote could lead to suicides.
Okay, this nightmare scenario is possible. It’s also possible that a plebiscite could lead not to suicide, but to an extraordinary national conversation on marriage and intimacy. Certainly, the constitutional recognition talk among Aboriginal and Torres Strait Islander intellectuals has been pretty darn good. In fact, it’s offered fearless proof that the subjects of that proposed referendum have both great solidarity and great disagreement. And this, undertaken by a class of people confronted with the problem of suicide prevention more than any other. No one is claiming that this referendum should not take place for fear of poor mental health outcomes.
But let’s forget that. Let’s say that a plebiscite, even if it does provide the fastest route to the same-sex marriage that conservative gay lobbyists have long insisted will somehow prevent suicide, will provoke suicide. Let’s ignore the absence of data — the claims made about mental ill health during the Irish referendum are anecdotal — and let’s even overlook the ethics of Di Natale publicly predicting a tragic outcome. Let’s just agree and say that we are glad that we have, perhaps, avoided a catastrophe. Let’s say we are so committed to good mental health outcomes for an at-risk group we are prepared to forego the possibility of future plebiscites, which we are now all agreed are just a costly sham, to preserve them.
We are committed to the idea of good mental health outcomes, and we speak about the need for more tolerance, understanding and sensitive speech around the matter non-stop. We’ll “call out” incorrect language, enjoy the ABC’s awareness-gasm every year and agree with the latest Beyondblue campaign that compassion is what is needed most. We bear particular concern for LGBTI youth and we believe quite utterly that learning to recite this year’s accepted sexual identity categories in schools will prevent suicide. We believe that same-sex marriage will prevent suicide. We believe that any bumpy democratic route to that suicide prevention strategy will likely provoke suicide. We are absolutely committed to good mental health outcomes for this and other groups, so long as their address demands nothing more from us than kindness.
Kindness is great. Safe Schools is OK. Marriage equality will bring some people happiness. But these are not proven suicide prevention strategies. To be effective, suicide prevention strategies must be evidence-based.
Researching those strategies is the work, inter alia, of the Black Dog Institute. Director Helen Christensen has recently undertaken a NSW study of the most effective means of suicide prevention. While she is, she says, relieved to learn that the plebiscite is unlikely to take place, she is eager to see implemented those methods that work to prevent suicide in both the LGBTI and general populations.
“What are known interventions that work for suicide prevention? Making sure that people are screened properly and identified. That GPs are equipped and supported to do this. Ensuring that there is follow-up care. Developing school programs around reducing suicide ideation,” says Christensen, for starters. “Implement strategies simultaneously in a local area and take into account the target groups for this local area.”
Professor Patrick McGorry, a well-known advocate for mental health services, is a complex man with a simple answer to the question of what works: “Providing proper care for people with mental illness or mental ill health.”
Like Christensen, McGorry is pleased that the potentially divisive plebiscite will not take place. But he is displeased, as he has been for some time, that moments of public understanding serve to mask the problem of inadequate services.
“Mental health care. No one focuses on that. The emphasis is on awareness-raising and community cohesion, which is difficult to deliver and to measure.”
Mental health care in general and suicide prevention strategies in particular are not impossible to measure; the Black Dog Institute is just one research body that assesses their effectiveness. These services are not difficult to deliver if they are well-funded. But, as McGorry and other advocates keep on saying, the budget envelope for mental health services in Australia is a crappy joke. Which is to say, less as a proportion of GDP relative to the spend of other OECD nations and, jeez, just not nearly enough.
Mental ill health and suicidality are real problems. They are real problems that really afflict real categories of real people disproportionately, including the LGBTI community. If we really care about all those afflicted, we must care beyond the point of saying, in this case, “no” to a vote or, more generally “yes” to the many entreaties by awareness-focused groups like Beyondblue to be more understanding and tolerant.
These are good qualities. These are not evidence-based strategies that will produce good mental health outcomes. Nor, for that matter, is the suspension of a plebiscite. I mean, I’m thankful that for the sake of my own mental health I will not hear more than the usual volume of idiocy from cold virtue politicians and tepid equality lobbyists who will go on and on about how the possibility of marriage is, somehow, good for my mental health. But this is a relief from a trifle, not relief from the institutional and domestic homophobia that cause mental ill health in LGBTI populations and nothing like the relief that an adequately funded mental health service would provide.
We do not have an adequately funded mental health service. Instead, we have the slow death of interest in addressing mental health with anything but conspicuously considerate gestures.
*Lifeline: 13 11 14