Viktor Burcevski
5725402
Tutor: Sophie Miller

"Father protects him from any occasion which might upset him as he continually threatens violence ... Martin tells me he would like to go around shooting people. It would be unsafe to allow Martin out of his parents' control"





Professor Paul Mullen - Forensic Psychiatrist



Cultural Artefact
Born or Bred? Martin Bryant: the making of a mass murderer

Born or Bred?
Born or Bred?

Born or Bred? Martin Bryant: the making of mass murderer is a book by Herald journalists Robert Wainwright and Paola Totaro. It follows the life of one of Australia's most notorious serial killers and compiles hours of taped conversations with Martin's lawyer, his family and traces back five generations of the Bryant family in search for answers to this tragedy. The most crucial part of the book is a call for action from the authors, for the government to invest more resources and research into reducing stigma associated with mental illness and violence, especially at adolescence. If adopted, these measures may help prevent future loss of life arising from similar circumstances such as the Port Arthur massacre.





The Public Health Issue Mental Health Stigma and Discrimination

Within Australia mental health is an issue of great priority (Australian Bureau of Statistics, 2007) with over $5.32 billion being spent in 2008 alone. This year's mental health budget is a 10% increase on previous years and a 137% increase in total funding since the Mental Health Strategy was first implemented within 1993 (Mental Health Council of Australia, 2010a). However, only one third (or 34%) of those diagnosed with a mental illness ever seek treatment (Australian Bureau of Statics, 2007) within Australia. Stigma and discrimination are the largest contributing factors as to why treatment is not utilized in larger numbers (Corrigan, 2004). The largest proportion of the afflicted that never take up any form of treatment are also those that have some of the most disabling mental conditions and could benefit from therapy the most, such as schizophrenia and psychosis (Australian Bureau of Statistics, 2007). While increased funding by government agencies will provide the facilities and opportunities for those that suffer from a mental illness to receive quality and timely health care (Australian Institute of Health and Welfare, 2011) only education and campaigning against stigma will see increased utilization rates of these services (Mental Health Coordinating Council, 2010).

"...not only to understand the dimensions of mental health and its detriment, but to develop a socially, economically and culturally attuned response" (Quentin Bryce - Governor General of Australia).

(Mental Health Coordination Council, 2010 pg.2).







Reviewing the Literature


Mental illness itself is often considered a two edged sword (Corrigan, 2000). On one side the symptoms that arise from having a particular psychiatric disease provide a barrier to becoming a fully functional member of society, with the disease interfering with many “…social roles, work and independent living opportunities” (Corrigan, 2000 pg. 48). The quality of life of the sufferer is reduced becoming one of the leading causes of healthy years of life lost due to disability in 2003 (accounting for an estimated 24% of the total years lost due to disability) (Australian Bureau of Statistics, 2009). On the other side of the sword, society’s reaction to severe psychiatric illnesses has resulted in stigma and discrimination. Undoubtedly the sufferer has difficulty obtaining work; functioning in social situations and over time becomes economically disadvantaged, leading to a host of other problems (Corrigan, 2004). Several studies have shown that public stereotypes and prejudice about mental illness have a deleterious impact on obtaining and keeping good jobs (Coorigan, 2004; Wahl, 1999). Within Australia and around the world (World Health Organisation, 2007) the greatest population of mentally ill belongs within the lower socioeconomic status, which brings its very own stereotypes and discriminatory behavior without the symptoms of a psychiatric illness exasperating the situation (Wrigley, Jackson, Judd and Komiti, 2005). The Australian government is active on the mental health front in attempting to create an accessible environment for those that require treatment, without stigmatization and discrimination.

Mental health was a critical issue of discussion at the latest Coalition of Australian Government’s summit, concerning the health system reforms, in Canberra (Mental Health Council of Australia, 2010c). In conjunction with annual funding from the government’s Mental Health Strategy a further $538 million was provided as part of the mental health reform package in July 2006, over a period of five years, as a result of the most recent COAG summit (Mental Health Council of Australia, 2010c). This further funding is targeted at providing “…better access to Psychiatrists, Psychologists, GP’s and other allied health professionals through the Medicare Benefits Scheme (MBS)” (Mental Health Council of Australia, 2010c pg. 1). Nevertheless, the rates of those that suffer from mental health have remained consistent over the years to the point where the World Health Organisation (2007) now views depression as the largest global health problem by 2020. Within Australia alone people aged between 25-49 years accounted for over 55% of all suicides (Hickie, Groom, McGorry, Davenport and Luscombe, 2005) while less than 40% of them will ever receive any therapy.

Most of our current progress within Australia concerning mental health has been in primary health care and in the treatment of mental illness from the scientific perspective (Mental Health Coordination Council, 2010). Currently over 70% of mental health care provided is within the primary health care sector, with the focus being on clinical treatment through the use of psycho-pharmacology to treat symptoms and therapy administered by a registered psychotherapist (Hickie et al., 2005). Corrigan (2004) adds to research compiled by Wrigley (2005) and associates that many of the patients feel dis-empowered by primary health care therapies and therefore do not choose to fully participate, leading to the worsening of symptoms. The Australian government had made attempts to move away from institutionalized health care, into a community based care setting with a focus on social support (Australian Institute of Health and Welfare, 2011). The presence of others in whom one can confide in and from whom one can expect help and support are scientifically proven to not only reduce the burden associated with mental illness, but also decrease the chances of cancer, herpes, hypertension and heat disease (Burton, Westen and Kowalski, 2006).
Mental health policy is based on research and the gathering of scrutinised epidemiological data from the population under which the specific intervention will be targeted upon (Australian Institute of Health and Welfare, 2011). However, the Mental Health Coordination Council (2010) states there is still evidence of mental health public policies not being implemented at the community level and many of the services funded by the current Mental Health Strategy remain underutilized by the greater population (Australian Institute of Health and Welfare, 2011). While strides are being made in moving away from primary to community care, there are still hurdles in both service access and the stigma associated with mental illness.

Wrigley et al. (2005) mention that discrimination and stigma are substantial hurdles that lead to many mental health services being unused. Stigma also influences the interface between mental illness and the criminal justice system. Criminalizing mental illness occurs when police, rather than the mental health system, respond to mental health crises, thereby contributing to the increasing prevalence of people with serious mental illness in jail (Corrigan, 2004). Recent surveys within a Victorian prison also found the mental health population over represented, with 74% of prisoners having a mental disorder at some point within the last year (Mental Health Council of Australia, 2010b). Rudd (2007) also mentions the inadequate training of nurses in dealing with the mentally ill.

Stigma is something that cannot be changed over a short period of time. Within many societies, the stigma and discrimination faced by those that suffer from a mental illness has been created over many years and represents more then just individual prejudices. Larger social constructs based around stereotyping those that suffer from a mental illness create further obstacles in obtaining employment and leading fulfilling lives. The negative impact of public stigma is also observed in the general health care system; people labeled mentally ill are less likely to benefit from the depth and breadth of available physical health care services than people without these illnesses (Corrigan, 2004). Self-stigma also acts as a further barrier to seeking treatment and prevents those that do suffer with a mental illness from ever reaching their full potential (Gary, 2005). "Living in a culture steeped in stigmatizing images, persons with mental illness may accept these notions and suffer diminished self-esteem, self-efficacy, and confidence in one’s future" (Corrigan, 2004 pg. 618). Corrigan and Penn (1999) state that, in order for there to be a decrease in stigma there must be an emphasis on contact, of not just between patient and doctor, but contact between those suffering from a mental illness and other community social support networks. There must also be education of the public, the health care staff and the media about the dangers of holding negative and stereotypical views of those that suffer from a mental illness. Finally promotion of the issue in the media and the establishment of national mental health organisations that will act on the behalf of those that suffer from a mental illness in fighting for their rights.

Australia has progressed in promoting the issues that are associated with mental health, including the stigma and discrimination that comes with suffering from a mental illness. SANE Australia (2006) reports that greater then 50% of those currently suffering from a mental illness are witnessing an improvement in how they are being treated within by the general public. Professor Anthony Jorm, of Melbourne University, praises the non-government agencies in advocating for mental health rights within Australia (Street, 2011) and says "It’s not just a matter of increasing services, we’ve got to have greater acceptance of those services, greater acceptance of people in general, willingness to support people in their employment and support them in their education if they have mental illnesses" (Street, 2011 pg. 1). Non-government organisations like Lifeline also encourage people, that fear they may have symptoms of a psychiatric illness, to seek help as soon as possible, since there is a greater chance of reducing or even eliminating symptoms if the illness is treated at an earlier stage (Australian Bureau of Statistics, 2007). Australia is moving in the right direction for the implementation of a holistic mental health policy that will treat those that suffer from a mental illness with the respect and care they so rightfully deserve.




CULTURAL AND SOCIAL ANALYSIS

THE "ILLUSION OF FREEDOM" IN THE FACE OF OUR SOCIETY'S INSISTENCE ON "CONFORMITY OF BEHAVIOR" IS 1 PROBLEM THAT CAN BE CONSIDERED WITHIN THE FRAMEWORK OF ATTRIBUTION THEORY (Kelley, 1967)

In attempting to describe what drives stigma within today's modern society we really must take into account what drives individual prejudices and how they apply to a larger population setting. The first instinct may be to refer to Durkheim and his theory on suicide as a tool for explaining how individuals cope with social changes (Burton et al., 2006). This would be a convenient theory to implement within this instance since it does account for the feelings that are accompanied by depression such as helplessness, loneliness and many other debilitating symptoms that associate with this mental illness. However, Corrigan (2000) recommends Social Attribution Theory as a more useful tool for understanding the reasons behind stigma within society.

Attribution Theory itself is a concept developed within social psychology and it is considered more of a field of study rather than a specific scientific conception (Weiner, 2010). In addition, there also is concern with the consequences of causal beliefs, including their emotional and motivational significance (Weiner, 2010). "Attribution theory is an especially appealing model for understanding and changing stigma because path model developed from this theory have mapped the relationship among signaling events, mediating knowledge structures (attributions), emotional reactions, and behavioral responses" (Corrigan, 2000 pg. 48). What this theory allows for is organisation of several social cognitive approaches to stigma in terms of knowledge structures and what these structures allow for is the efficient means of categorizing information about social groups (Weiner, 2010). The below is an example from Corrigan (2000) of how these social phenomena can be classified into measurable knowledge structures.

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There are two major types of attributions which attempt to explain as to the reasons behind the prevalence of stigma within society. They are Explanatory attributions and predictive attributions. Explanatory attributions are created by people to aid in understanding the world around them and make sense of situations by labeling them with a particular per-existing event from experience (Burton et al. 2006). For instance a person might have seen a media report about a mentally ill individual that has committed heinous crimes and thus will attribute this, sometimes sub-consciously, to other mentally ill persons. Explanatory attributions are used as a defense mechanism by the brain to compartmentalize information about the environment and group it for easy access at a later time (Weiner, 2010). Predictive attributions are created in order to predict future events or actions by a particular person based upon previous experiences. An example of predictive attributions is the contact between a mentally ill person applying for employment and the employers making judgements about that person's ability, or lack of, at some future instance (Weiner, 2010). For example, mentally ill people have lower I.Q. therefore why would I want someone like this in my company if I only have to fire them later for not performing up to standard? As untrue as any of this sounds, this is a natural human reaction to many situations and it is only counteracted through education and sometimes lifelong efforts in changing ones on stereotypes and prejudices (Burton et al., 2006).

It is also accepted that many people will have their own attribution style (Burton et al., 2006). For example, some people will have a positive outlook on all events and people within their environment and thus form explanatory and predictive attributions based on this overall positive view. Others may adapt a more negative and judgmental stance as to their surroundings and thus their attributions will tend to be based more upon stereotyping and over generalising for particular societal subgroups (Burton et al., 2006). However, the largest impact about how we create attributions comes from our culture. People from collectivist cultures make more external attributions for others' behavior than do people from individualistic cultures. Research from Choi, Dalai, Kim and Park (2003 pg. 47 ), has suggested that "people within collectivist cultures take more time before assigning cues to people or events". This means that these cultures are more ready to take into account all relevant factors, including situational ones, that may have influenced behavior. People within westernized societies are more ready to judge others and in turn are more inclined to make fundamental attribution errors, such as the mentally ill commit crime because they chose to, and do not take into account any situational attributions that may have contributed to an event (Choi et al., 2003). This stigma created by both culture and personal beliefs leads many of those that do suffer from mental illness feeling helpless. Learned helplessness is a phenomenon in all animals, not just humans, which leads the individual into a spiral of feeling useless and powerless to change their own situations (Burton et al., 2006). Through the constant negative attribution of others within society, the individual already suffering from a mental illness usually has a worsening of symptoms and this leads to further decline.

In conclusion, the promotion of stigma and how it affects those that suffer from a mental illness needs to be made a priority. If no one challenges the way we think and how we stereotype and judge those that need the greatest help, than we are doomed to repeat our mistakes over and over again. Funding and establishing services for easier access and greater care of those that suffer from a mental illness are a step in the right direction. However, these services will go unused if those that need them the most have a distrust in society and will never receive the full benefit. The government has acknowledged the serious health problem that mental health is and now needs to implement programs that will treat stigma like any other public health issue.

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ARTEFACT ANALYSIS AND MY LEARNING REFLECTIONS

What Wainwright and Totaro do best with this book, in investigating the events that led to that tragic day, is that they present over ten different opportunities that Martin Bryant had as a child and an adult to receive the psychiatric help he so desperately needed. His chronic depression and psychosis were met with criticism, ignorance and a general uncaring nature from not just his parents, but from psychiatric staff as well that treated Martin as a child. In one portion of his life, after inheriting a great deal of money, Bryant traveled constantly all over the world just for the opportunity to have a discussion with someone in the seat next to him. Leading up to the final hour before the murders, Bryant was documented to have stopped over eleven times striking up conversations with random shopkeepers and buying items that he would never use. He would later attribute this behavior to trying to find at least one reason as to why he should turn back and not go through with the murders, but obviously this did not happen. A picture of a lonely, depressed and very sick young man is formed whom had never in his life received any real therapy. He was labelled, discriminated against and finally pushed to the point where the only way out was taking another 35 souls with him.

What I have learned from this tragic story is that mental illness cannot be treated by pretending it is not there. With so many hundreds of thousands within this country alone suffering in silence and never receiving the help they so desperately require. As an employee of the Prince Charles Hospital I have first hand experience with aged care and have seen some of the effects of mental illness upon these patients. Never have I really attempted so see how they view the world and the challenges that they may face on a daily basis from not just their illness, but from those around them. I feel guilty, to a point, in that I would have at one point in time been a part of the crowd that discriminated against this group. However, if I can change my beliefs and stereotypes about mental illness, than the opportunities are out there for everyone. Let our generation be the first to truly make Australia a land of equality.



Out of the Blue (New Zealand - Aramoana)
I also recommend you all watch this movie. Out of the Blue is a true story about a mass murder that had taken place within a small New Zealand town and is very similar to the events that took place at Port Arthur. It just goes to show that ignorance of mental illness will cause history to repeat itself.











Reflections

Reflection 1: A Review of Issues impacting on the Mental Health of Indigenous Australians

Link: http://healthculturesociety.wikispaces.com/message/view/A+Review+of+Issues+impacting+on+the+Mental+Health+of+Indigenous+Australians/45700738

Well done on focusing upon a very difficult and sensitive subject to most Australians. You have attempted to cover two very complex issues within the Australian system, which are Indigenous health and mental health, while staying very objective, which at times is very hard to do especially when looking at Indigenous history.

I applaud your use of the Dance of Life painting, depicting the holistic view of mental health that is held within many Indigenous communities not just within Australia, but around the world. I am not certain if you are aware of a TV program called America's Hardest Prisons and their recent cover on Indigenous alcohol abuse, suicide and incarceration rates of American Indians. Their findings were disturbingly close to what is seen within Australian indigenous communities, indicating that maybe our individualistic western culture contributes to the worsening of their situation. The video you have at the ending of your piece only goes to show that the mental patients that were being treated within that community were in large social groups and had the bush implemented within their treatment programs.

I believe that the only way mental illness can be treated in the future is in a holistic way. You cannot separate the disease from he person like it can be done with other diseases. With mental health it is often very difficult to identify where the person ends and the illness begins.

Well done

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Reflection 2: An arm and a leg for what? - A discussion and analysis of the challenges facing diverse nations with regards to mental health and its attached issues of human rights.

Link: http://healthculturesociety.wikispaces.com/message/view/AN+ARM+AND+A+LEG%2C+FOR+WHAT%3F+%E2%80%93+A+discussion+and+analysis+of+the+challenges+facing+diverse+nations+with+regards+to+mental+health+and+its+attached+issues+of+human+rights/45700420
First of all, I would like to commend you upon highlighting the important issue that mental health is not just within Australia, but around the world. The obvious trampling of human rights of those in developing countries reflects years of stigmatisation of mental health and an ignorance rarely seen towards any other sub-group within a population. The survey that had been conducted in South Africa on the citizens attitudes towards mental health is an eye opener, however it was not that long ago that Australia had the same beliefs concerning the mentally ill.

I commend you on mentioning the strong effect the media has in not just negatively reporting mental illness, but also the benefit it can provide by educating the public against stigmatizing and stereotyping the mentally ill. Only education and information will change the way society thinks about mental health, but this approach must be treated like a public health issue and attacked head on, like how anti smoking campaigns were.

Overall, a great look at mental health and a a great focus on the lack of human rights that most of these people face. Only through de-institutionalization and shifting mental health care to a community setting will we truly witness a full utilisation of mental health care.


Well Done!!





References

Australian Bureau of Statistics. (2007) National Survey of Mental Health and Wellbeing: Summary of Results. Retrieved from Australian Bureau of Statistics website http://www.ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/6AE6DA447F985FC2CA2574EA00122BD6/$File/43260_2007.pdf

Australian Bureau of Statistics. (2009). Australian social trends, March 2009: Mental health. Retrieved from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features30March%202009

Australian Government, Australian Institute of Health and Welfare. (2010). Australia’s Health 2010. Retrieved from Australian Government website http://www.aihw.gov.au/publication-detail/?id=6442468376&libID=6442468374
Australian Institute of Health and Welfare. (2010). Mental Health FAQ. Retrieved October 20, 2011 from http://www.aihw.gov.au/mental-health-faqs
Australian Government, Department of Health of Ageing. (2011). National mental health report, 2010. Retrieved from the Australian Government Department of Health and Ageing Website http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-report10
Burton, L., Westen, D., & Kowalski, R. (2009). Psychology: Australian and New Zealand edition (2nd ed.). Brisbane, Australia: John Wiley & Sons. Chapter 11.
Choi, I., Dalal, R., Kim, P., & Park, H. (2003). Culture and judgement of causal relevance. Journal of Personality and Social Psychology, 84, 46-59. doi 10.1037/0022-3514.84.1.46
Corrigan, P. (2000). Mental Health Stigma as Social Attribution: Implications for Research Methods and Attitude Change. Clinical Psychology: Science and Practise, 7, 48-67. doi: 10.1093/clipsy.7.1.48
Corrigan, P. (2004). How Stigma Interferes With Mental Health Care. American Psychologist, 59, 614-625. doi: 10.1037/0003-066X.59.7.614
Corrigan, P. W., & Penn, D. L. (1999). Lessons from social psychology on discrediting psychiatric stigma. American Psychologist, 54, 765–776. doi: 10.1037/0003-066X.54.9.765
Gary, A.F. (2005). Stigma: barrier to mental health care among ethnic minorities. Issues in Mental Health Nursing, 26, 979-999. doi: 10.1080/01612840500280638
Hickie, B.I., Groom, L.G., McGorry, D.P., Davenport, A.T., & Luscombe, M.G. (2005). Australian mental health reform: time for real outcomes. The Medical Journal of Australia, 182, 401-406. Retrieved from http://www.mja.com.au/public/issues/182_08_180405/hic10810_fm.pdf
Kelley, H.H. (1967). Attribution theory in Social Psychology. Nebraska Symposium on Motivation, 15, 192-238. Retrieved from http://psycnet.apa.org/index.cfm?fa=search.displayRecord&uid=1968-13540-001
Mental Health Council of Australia. (2010c). Mental Health Fact Sheet – Analysis of the Better Access Scheme. Retrieved from http://www.mhca.org.au/documents/FactSheets/MBS%20Fact%20Sheet.pdf

Mental Health Council of Australia. (2010b). Media Backgrounder – Fact Sheet #5: Mental Health, Victimisation and Crime. Retrieved from http://www.mhca.org.au/documents/AboutMentalHealth/CrimeVictimisationandMentalHealth.pdf

Mental Health Council of Australia. (2010a). Mental Health Fact Sheet – Statistics on Mental Health in Australia. Retrieved from http://www.mhca.org.au/documents/AboutMentalHealth/FactsonMentalHealth.pdf

Mental Health Coordinating Council. (2010). From Discrimination to Social Inclusion: A review of the literature on anti-stigma initiatives in mental health. Retrieved from Queensland Alliance website http://www.qldalliance.org.au/sites/www.qldalliance.org.au/files/news/2010/07/341689-upload-00001.pdf

SANE Australia. (2006). Stigma and mental illness. Retrieved from http://www.sane.org/images/stories/information/research/0701_info_rb4.pdf

Street, Z. (2011, October 10). Summit addresses mental health stigma. QUT News. Retrieved from http://www.qutnews.com/2011/10/10/summit-adresses-mental-health-stigma/

Wahl, O. (1999). Mental Health Consumers’ Experience of Stigma. Schizophrenia Bulletin, 25, 467-478. Retrieved from http://schizophreniabulletin.oxfordjournals.org/content/25/3/467.full.pdf+html

Weiner, B. (2010). Attribution Theory. Corsini Encyclopedia of Psychology. 1–2. doi: 10.1002/9780470479216.corpsy0098

Wrigley, S., Jackson, H., Judd, F. & Komiti, A. (2005). Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town. Australian and New Zealand Journal of Psychiatry, 39, 514-521. doi: 10.1111/j.1440-1614.2005.01612.x

World Health Organisation. (2007). Expert Opinion on Barriers and Facilitating Factors for the Implementation of Existing Mental Health Knowledge in Mental Health Services. Retrieved from Department Mental Health and Substance Abuse website: http://www.who.int/mental_health/emergencies/expert_opinion_on_service_development_msd_2007.pdf



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