Falling+Through+the+Cracks-+The+Australian+Mental+Health+System

Name: Megan Massey Student No.: n8311170 Tutor: Sophie Miller

// “Australia has a reputation and demonstrated capacity for innovation and reform in mental health. We have now entered a period of genuine climate change in mental health awareness and reform” (Patrick McGorry, Headspace, 2007). // CULTURAL ARTEFACT

The ‘Vortex of Mental Illness’ is an excellent depiction of the way in which a health care system can fail a person and consequently thrust them into the downward spiral of mental illness. Created by MacroVU Analytics, a ‘visual learning’ company aimed at addressing and creating awareness of society’s most pressing health challenges, the vortex effectively portrays the current challenges Australia is facing in reforming the mental health care system. The artefact highlights the prejudice and stigma of mental health, as well as how the complexity and bureaucracies of the health system is failing a society in need.

 PUBLIC HEALTH ISSUE

 This cultural artefact depicts the way in which a health care system can be inefficient and thus destabilise the mental health care of a population. The mental health of Australia has long been a topic of discussion and with this, a continued revision of the mental health care system has become quite prevalent. Since 1992 the programs, policies and initiatives of Australia’s mental health care have been revised, scrutinised and reformed (Department of Health and Ageing, 1992). This constant battle of reform is the Australian Government’s struggle to achieve the correct balance of services offered, where and how they are delivered, as well as an adequate way of measuring the success of these services. The question to be asked though, can this balance be achieved, or will there always be sufferers of mental illness ‘falling through the cracks’?

LITERATURE REVIEW

The World Health Organisation (WHO) defines mental health as the ‘state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community’ (World Health Organisation, 2011) and furthermore, constitutes a positive outlook on mental health as ‘foundation for individual well-being and the effective functioning of a community’ (World Health Organisation, 2011). In 2007, 45% of the Australian population aged 16 to 85 had experienced some form of mental health disorder, which in turn has led to an annual economic burden of $20 billion (Australian Bureau of Statistics, 2009). These alarming statistics, along with the rising economic burden emphasize the need for Australia’s mental health policies, programs and initiatives to be revised and properly implemented to achieve an overall better outlook and health care system to properly manage and treat the burden of mental health disorders. The scrutiny of the Australian mental health system has become apparent in recent years and is often the topic of discussion between economic, political and social debates. In a 2006 research report into the stakeholder concerns of the Australian mental health care system it was highlighted that mental health services were not easily accessible, the care offered was of poor quality, coordination of services were not adequate and accountability between governments was insufficient (Townsend, Pirkis, Harris, Whiteford, 2006). Between the 1960s and 1970s efforts were doubled and initiatives were implemented and reviewed in an attempt to curb the growing trend of mental illness in Australia. These efforts included the improvement of trained professionals in the area of mental health care and the reduction of the institutionlisation of sufferers of mental illness (Martins, 2006). The preliminary Australian mental health report, delivered in the 1992-1993 period, was used to establish the situation of mental health in Australia and provide a working foundation towards the effective reform of mental illness across the nation (Commonwealth of Australia, 2010). The initial report recognized the following main focus areas of improvement:

- Commitment from all states and territories to expand their community based services; - Improve government accountability, management and administration; - Create and establish effective programs that meet the criteria and needs of sufferers of mental illness; and - Change the way in which state and territories currently run and control mental health services to mirror the same administrative structure as general health services (Department of Health and Ageing, 1992). Access to mental health services has often been a topic of discussion and debate. Many factors can contribute to a person being unable or unwilling to access mental health services. These include people living in rural and remote areas of Australia where mental health services have yet to reach, while also communication barriers can limit a person’s awareness and overall comfort in accessing these services. The availability of services also plays an integral role in the Australian population. As mentioned above sufferers of a mental illness are often unaware of how to access these services or unsure if they meet the right criteria set by bureaucracies and health professionals. The Australian government has often measured the use of mental health services and in 2007 it was revealed that only a third of the Australian population suffering from mental illness had utilised services for mental health problems (Australian Institute of Health and Welfare, 2009). GPs were the highest used form of service at 15% while psychiatrists were second at 10% (Australian Bureau of Statistics, 2007). This gap and reduced used of mental health services highlights the issue of a lack of mental health awareness as well as an inefficient system that often has service users waiting for aid or are refused service due to a lack of compliance with criteria set by organisations alongside policies of governments. Although significant advances have been made in Australia to provide adequate primary health care, a staggering 54% of the population is still not receiving proper care and treatment (Commonwealth of Australia, 2011a). This results in a direct reflection on the Australian mental health care system and their inability to provide proper intervention, promotion and preventative initiatives among the Australian population suffering from a mental disorder. One of the main disparities concerning not only the mental health care sector, but also Australia’s health care system as a whole, is the issue of accountability among governments. The responsibility of health funding is often skewed and divided between governments (Martins, 2006). Due to these disparities among governments cost shifting and blame is often brought up in parliament and the media. A reflection of this divergence is in the Australian society’s perceived view of the health care system of Australia as inadequate and inefficient. In taking action against the rising incidence of mental illness as well as the Australian society’s negative perceptions of the mental health system the ministers for health and ageing announced the National Mental Health Reform as part of the 2011-2012 Australian Health Budget. The report emphasises the altering and improvement of the mental health system with a ten-year plan focusing on: - Better care for people suffering from debilitating mental illness; - Strengthened primary mental health care services; - Prevention and early intervention, specifically among adolescents; - Increased economic and social participation of those suffering from mental illness; and - Improved quality, accountability and innovation in mental health services (Commonwealth of Australia, 2011b). By implementing these 5 main action areas, all focused on over the ten-year action plan, the Australian government will endeavor to achieve what has been elusive to them for the past 20 years of policy; reaching an effective and balanced mental health system that effectively provides long-term services and initiatives through properly implemented and run programs and policies among government and non-government agencies.

SOCIAL AND CULTURAL ANALYSIS

The exhausted question that will continue to be raised in the Australian government and society is what is the solution and will this solution be adequate for generations to come? This question is unmistakably on the minds of all governmental and health care sectors in Australia. There is no definite answer to improving the mental health care system of Australia. Until this balance can be identified and properly implemented, the complex prevalence and stigma of mental disorders in the Australian community need to be applicably understood and articulated. Since the announcement of the 2010-2011 Australian Budget (Commonwealth of Australia, 2011b) an influx of expert opinions and analysis of the effect on the mental health system has become a forefront of the Australian political agenda. Professor John Mendoza, the former chairman of the national advisory council on mental health has spoken out recently and lent his expert opinion on the Australian Government’s contribution to mental health.

media type="youtube" key="fU1OXu3GEdE" height="315" width="560" Mendoza raises the important aspect of the mental health reform ‘falling short of a clear direction’, articulating the vital need for a well-defined, faultless system of mental health care. The current reform lacks effective long term services, such as housing and employment initiatives, while still focusing heavily on short-term solutions such as medication and psychiatric services. The latest reform plan, referred to as ‘the Fourth Plan’, highlights five priority areas; social inclusion and recovery, prevention and early intervention, service access, coordination and continuity of care, quality improvement and innovation and accountability (Commonwealth of Australia, 2009). The reform, a five-year action plan, concentrates on changing the stigma of mental disorders in Australia, focusing on promotion and early intervention, while also emphasizing the need for accountability among governments. In an interview assessing the mental health system, Bronte O’Brien, a sufferer of bipolar disorder described her experience with the public health system as “wildly inconsistent” and the care she has received has been “…delayed and so consequently, fallen short of adequate” (NewsOnABC, 2011).

media type="youtube" key="e9Q_NpIEiuc" height="315" width="560" Another point raised in the video above was made by Professor Ian Hickie of the Brain and Mind Institute, stating that the bureaucracies and ‘shambolic system’ of Australia’s health care have failed to develop, improve or coordinate the long-term reformation of community-based services, early intervention practices and awareness programs (Commonwealth of Australia, 2009). It is clear that in order to tackle mental disorders affecting one in every 5 Australians, the stigma surrounding mental illness needs to be reversed and a focus on early intervention, promotion and prevention needs to take a forefront position in Australia’s ongoing reform of mental health. A focus on the youth of Australia has also been recognized as a top priority for Australian mental health services and initiatives. Although remarkable advancements have been made in the understanding and treatment of mental illness the stigma surrounding the burden still remains and can often be seen as a barrier to the overall effect of Australia’s mental health reform. However, in recent decades the stigma has slowly changed, as the movement of deinstitutionalization has been made possible by the advancements of treatment, prevention and promotional initiatives. The issue of a lack of access to mental health services can also be put down to the stigma still surrounding mental health. Many people with mental health do not seek services simply out of shame and feared discrimination from society. This in return develops two forms of stigma; public stigma, the way in which society reacts to a group based on the prejudice surrounding the group, and self-stigma, the way in which an individual reacts and turn against themselves because they are perceived as members of a stigmatized group (Waston & Corrigan, 2009). It can be concluded then, that self-stigma is the most debilitating of the two as it is leading to a declined rate of sufferers not seeking help as they do not wish to be labeled under the stigmatized group. The mental health of Australia will be forever on the minds of many generations to come. A clear balance and direction may never be achieved, but with adequate funding, programs and initiatives Australia can work towards achieving a better mental health system and an overall reduction in the presence of mental health can be achieved.

ANALYSIS AND REFLECTION

The above artefact is an excellent depiction of not only society’s view of the mental health care system, but also the Australian government’s failed attempts at reversing the effects and prevalence of mental illness. The pathways down the vortex effectively portray the complexity of the mental health system and how easily a sufferer of mental illness can be failed and not receive adequate treatment. The vortex also effectively outlines the most at-risk groups and factors that contribute to mental illness. By portraying a pathway of education the need for early intervention among youth groups is highlighted while another factor underlined is the need for employment and an adequate income for a person and their family. These factors, along with countless others, all contribute to the vortex of mental health and if these factors aren’t met or people experiencing trouble aren’t able to reach proper aid and assistance they will continue to spiral down the vortex of mental health. In the description of the ‘system’ the creator describes how difficult it is for health professionals to focus on the job at hand. The vortex reads ‘the system is coping continually with crisis, long hours, too many meetings, having to justify everything, cutting of budgets, high caseloads…and requirements for more programs, without more funding’, this comment highlights the need for a less fragmented system of health care and a better system to emphasise the accountability of governments and taking the workload off of health professionals to enable a clear focus on the treatment of their patients.



Sufferers of mental illness seeking help are also often turned away because of their lack of compliance with programs and initiatives. ‘You don’t meet the criteria’, ‘I have to drop you from the program’ and ‘your benefits have expired’ all depict the level of fragmented and inaccessible mental health services in Australia. This fragmentation can be seen as one of the main reasons people leave the ‘vortex’ early by committing suicide as they contribute this ‘lack of compliance’ to an unhelpful and prejudice society. Upon reflection this assignment has enabled me to thoroughly research and gain a deep understanding of the mental health system of Australia. Through research I have encountered a country that has thrived for over two decades to achieve an effective and long-term reform in mental health care. Furthermore, through the analysis of past reforms and annual reports of Australia I have come to realise how important the aspects of prevention, promotion and early intervention is for the future of the mental health of Australia and believe Australia is finally getting on the right track to overcome the burden of mental illness.

LINKS [|Fourth National Mental Health Plan] [|National Mental Health Report 2010]

M  REFERENCE LIST

World Health Organisation. (2011). //Mental health: strengthening our response//. Retrieved October 18th from []

Australian Bureau of Statistics. (2009). //Australian social trends: mental health//. Retrieved October 18th from [|http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features30March%2 02009]

Headspace. (2010). //Annual Report 2010//. Retrieved October 18th from []

Townsend, P.E., Pirkis, J.E., Harris, M.G., Whiteford, H.A. (2006) Stakeholder concerns about Australia’s mental health care system. Australian Health Review, 30(2), 158-163. Retrieved from []

Commonwealth of Australia. (2011a). //Australian government 2011- 12 health and ageing portfolio budget statements: outcome 11 mental health//. Canberra, ACT: Australian Government Publishing Service

Martins, J.M. (2006). Health challenges in Australia. //Asia Pacific Journal of Mental Health, 1//(1), 17-23. Retrieved from []

Commonwealth of Australia. (2010). //National mental health report 2010//. Canberra, ACT: Australian Government Publishing Service

Commonwealth of Australia. (1992). //National mental health plan//. Canberra, ACT: Australian Government Publishing Service

Commonwealth of Australia. (2011b). Budget: National mental health reform. Canberra, ACT: CanPrint Communications Pty Ltd

Commonwealth of Australia. (2009). Fourth national mental health plan. Canberra, ACT: Australian Government Publishing Service

NewsOnABC. (April 12, 2011). Mental Health System Crisis – NewsOnABC [Video File]. Retrieved from [] Australian Bureau of Statistics. (2007). Mental health service use. Retrieved November 1st from [] =

Australian Institute of Health and Welfare. (2009). Mental health services in Australia 2006-2007. Canberra, ACT: Australian Government Publishing Service Watson, A.C., Corrigan, P.W. (2009). The Impact of Stigma on Service Access and Participation. Retrieved from http://www.bhrm.org/guidelines/stigma.pdf Y DISCUSSION (REFLECTION TASK)

PAGE: Mental Health in Australia – Issues Divisions Perceptions Link: http://healthculturesociety.wikispaces.com/Mental+Health+in+Australia+-+Issues+Divisions+Perceptions Comment: Great WIKI. Very interesting read.

I found your wiki really interesting. Youth mental health services have become quite prevalent since the early 2000s and I really believe that they should sit on the forefront of Australia’s bid to tackle the prevalence of mental illness in the population. In the most recent mental health reforms an enormous emphasis has been put on early intervention practices and initiatives. These initiatives start with youth mental health as you highlighted the fact that they are the most vulnerable at-risk group, surrounded by peer pressure and outside influences. I truly believe if an emphasis is more heavily focused on youth mental health Australia will be more able to tackle the rising prevalence becoming a primary agenda for the Australian government.

PAGE: An equal playing field for women and girls Link: http://healthculturesociety.wikispaces.com/An+Equal+Playing+Field+For+Women+%26+Girls Comment: Excellent Wiki

I found your wiki very informative and interesting. Since the feminist movement the world has made enormous advancements towards gender equality. However we are still so backwards in some of the simplest areas. You articulated the fact that there are limited initiatives and programs aimed at increasing the participation of females in sport and physical activity. I think this is appalling considering the current health crisis of obesity affecting most of the western society. The participation of women in sport needs to become a greater focus of sporting organisations and government agencies to not only reverse this discrimination of women’s rights, but to also curb the exponential growth of obesity in today’s 21st century western society.