April 29, 2010

A fragmented system

Since the closure of Australia's psychiatric asylums over the last three decades, the hospital emergency room has become the first port of call for both physically and mentally ill patients. However, over the last 40 years (during which time the population has doubled), psychiatric bed numbers have decreased by 80 percent.

In Australia, 4 million people have mental health problems in any given year, but only one third of them get access to treatment. That's 500,000 Australians turned away or discharged because hospital emergency departments are so desperately overburdened.

The few remaining psychiatric inpatient units are so overcrowded and overwhelmed they lack the resources to provide any therapeutic benefits (or real care) for patients. In fact, when I visited a dear friend in a Melbourne based psychiatric unit a few years ago, I was so horrified by the desperately bleak environment that I cried myself to sleep.  

The consequences of Australia's failing mental health system are extensive. Acute mental illness spills over into the homeless and prison population and this in turn affects the wider community. 

A 2005 health survey of a NSW prison found that the prevalence of psychiatric disorders in prison was much higher than in the general community (76 percent compared to 22 percent). 

In fact, according to The Bureau of Statistics, Australia's prison population has doubled in the past twenty years. Or in other words, our prisons have gradually taken the place of our psychiatric asylums. 

Executive director of Sane Australia told The Australian Newspaper that under the current system, sufferers of severe psychiatric disorders such as schizophrenia and bipolar disorder are more likely to fall through the cracks because they did not receive follow up care or support. 

In the absence of support networks, it is not difficult to see how the mentally ill get pulled into a cycle of addiction, homelessness and crime, and why so many innocents wind up trapped in the revolving door of the prison system. 

Australian of the Year, Professor Patrick Mcgorry, a renowned expert in mental health, believes that better mental health care would cut homelessness by 25 percent. This estimate alone should be enough to urge the government to take mental health issues more seriously. 

Despite Prime Minister Kevin Rudd's recent triumph over health care reform, mental health received less than 2 percent of the new funding initiatives ($174 million of $5.4 billion over the next four years), a drop in the ocean compared to what is needed.

To put these figures into perspective, an investment of $436 million has been allocated to sufferers of diabetes. 
To make matters worse, most of the $174 million allocated to mental health will be thrown at common disorders such as depression and anxiety as opposed to severe psychiatric disorders. 
Professor Patrick McGorry has repeatedly called for early intervention in the field of mental healthHe suggests a complete overhaul in the way we tackle mental health and the implementation of federally funded community based care. 

This type of system would take the pressure of state funded public hospitals and psychiatric units and provide the opportunity for therapeutic care at different junctions across the board.  

The current one size fits all approach to mental illness is collapsing. 
Urgent funding is needed to build community based care facilities that are linked to supported accommodation. Rehabilitation and recovery programs, early psychosis treatment centres, clinical services and mentorship programs are all examples of a well-functioning system aimed at long term planning and early intervention. 

One in five Australians will suffer from a mental illness at some point in their lives. With statistics like these, we need to get behind people like Patrick McGorry and ensure that mental health is taken seriously in this country. 

  • Psychology Professor Mark Freeman examines the link between memory and identity in this essay about his mother's battle with dementia. Its a scholarly article for those who like that kind of thing.
  • Siri Hustvedt journeys into the land of nod in this opinion piece from the NY Times and asks What Is Sleep?


Anonymous said...

Excellent article. With regards to mental health, I recently read that more Americans kill themselves than they do each other! As in suicide is more common than murder. Levin.

Mandy Lee said...

Ugh. The state of mental health services in Australia is appalling. It's not only funding that's the issue - it's the mismanagement of existing services that make it so hard for people to WANT to seek help. Dedicated mental health workers are being frustrated again and again in their attempts to provide consistent community care by a micromanaging government system that has little interest in anything but a fiscal bottom line. Most mental health workers I know will burn out, and will seek refuge in academia/research/the private sector at some point in their careers, often permanently.

Great article.

mishaloula said...

Levin, I agree. Mental illness permeates so many facets of society and suicide prevention is just another reason this country needs to tear down the current system and start from scratch. Mandy, you are 100% right and in regards to mismanagement, a new approach is desperately needed. Mental health workers are burning out fast under the current system, and this leads to inexperience on the front line. The closure of Australia's mental institutions was a cost saving measure by govt, however those savings were not redirected into alternative services for mental health. We have it backward in this country when we pay our nurses, health workers etc peanuts and our footballers make so much money that they end up shoving it up their noses... Anyway thats another post entirely.

johnR said...

Good post Misha interesting and heartfelt..

Anonymous said...

Wow, interesting post. Thanks for shedding light on this issue. I also have a pet peeve that, in the States too, athletes and entertainers are paid so much while teachers, health care workers, and others in the trenches are paid so little.