A broken mental health system, but some light in the dark

Many people face an uphill battle in obtaining help for their mental health – not just overcoming the stigma attached to seeking help, but also in terms of the quality of care available from an underfunded and understaffed health service. Thankfully, grassroots projects provide support to those in need. (Image source: Presidencia de la República Mexicana (CC BY 2.0.)).

By Stephen Galvin

In 2018, 3,046 lives were lost to suicide in Australia. This equates to an average of 8.3 deaths a day. While $9.9 billion was spent on mental health in 2017-2018, suicide remains the leading cause of death for all Australians aged 15-34, according to the Australian Institute of Health and Welfare (AIHW).

Adelaide man *Thomas, 25, was almost one of those 3,046 Australians lost to suicide. After being involved in a motor vehicle accident stemming from a medical episode, and his licence was suspended as a precautionary measure pending a medical diagnosis, Thomas found his thoughts going to a dark place. He ended up in a hospital one night. Told to rest, he waited all night, and into the next morning for his promised visit from the mental health team.

“[It was] like they didn’t care; I didn’t know what to do, who to talk to,” Thomas said.

Although it was only hours after a suicide attempt, he was sent home. Thomas said he felt ignored because there simply weren’t enough beds available for him to begin an in-patient program.

A spokesperson from the Central Adelaide Local Health Network said, “Our dedicated staff work tirelessly to care for mental health patients who often present at our emergency departments with complex and difficult needs”.

“There are a number of considerations when deciding treatment options, however we may implement alternative pathways of care to ensure our mental health consumers access the right care in the right place.”

When you look at the funding for psychiatric wards and hospitals, it becomes clear why beds are hard to come by. According to the AIHW, 2017/18 saw a marked decrease in the number of hospital beds available in public psychiatric hospitals – with just 157 beds – compared to 225 in 2016/17.

Per capita spending on public psychiatric hospitals also hit its lowest point in 25 years – with just $40.30 spent per capita in 2017/18, compared to $48.70 in 2016/17; a decrease of almost 20 per cent (AIHW).

Thomas received a few visits from the Community Mental Health Care Team in the coming weeks.

“I was told ‘getting fit will make you feel better, you should buy a fitbit’,” he said.

“This is after telling them we’re close to losing the house and having to choose between a bunch of bananas or a big bag of rice.”

Once again, when you take a look at the spending on community mental health care services, it becomes clear why they may be missing the mark; per capita spending here in SA hit a five year low in 2017/18, according to the AIHW.

Community mental health care encompasses many different outpatient services, including the Community Mental Health Care Team, which provides support and help for people who are not at an inpatient facility.

Thomas is not an outlier when it comes to being disappointed with the level of care provided to mentally ill members of our community.

*Nicole, 32, who has been diagnosed with Major Depressive Disorder, Borderline Personality Disorder, and Generalised Anxiety Disorder, has had several inpatient stays in both public psychiatric hospitals, and psychiatric wards.

She spent six weeks at a specialised mental health clinic, and felt it wasn’t a positive experience for her.

“The nursing staff didn’t seem particularly interested in working through my issues with me, and I only got to see the psychiatrist once or twice a week,” she said.

“I was released after six weeks, when I was told they ‘needed the bed’,” she said.

Being made to feel, or outright told, that their stays in psychiatric hospitals and wards are being cut short due to a shortage of beds is a common complaint from patients.

Here in South Australia, if you are struggling mentally, you can request a Mental Health Care Plan from your General Practitioner (GP). This enables you to access psychiatrists/psychologists either for free, or paying a gap – albeit for a limited number of up to 10 sessions.

After receiving a Mental Health Care Plan, Nicole saw two psychologists.

Nicole felt the first seemed to deem her mentally fit because she had a university degree, and a job, and no more sessions were offered.

She said the second psychologist she saw minimised her concerns about the unfair division of household labour, and she felt like her issues were being swept aside.

Nicole described mental health care services here in SA as “woeful”.

“[Services are] difficult to access, with long waiting times and usually prohibitively expensive for someone on Centrelink benefits – even with a Mental Health Care Plan

“One thing I have found that poses a real problem for me is that most providers don’t seem to know how to deal with someone who has had persistent mental health problems long-term; I have been dealing with these issues for more than half my life and I still get treated like I have no idea what I am talking about. They offer band aid solutions without ever really getting to the root of the issue or providing any long-term strategies on how to live a decent life,” she said.

Sadly, a lack of support of the mentally ill in our community can lead to higher numbers of incarcerated people with mental health issues. This is even more concerning due to the challenges the prison system faces in providing the help these individuals need.

An expert in clinical psychology, Dr Ken O’Brien was the former Clinical Director of the Forensic Mental Health Service here in South Australia from 1982-2015, and oversaw the treatment of prisoners in Yatala Labour Prison as part of his role, as well as testifying in numerous court cases.

“To deliver equivalent health services, compared to the community outside the prison is challenging – and that’s the challenge; to provide the same level of care that’s available in the general community,” he said.

Dr O’Brien spoke about the differing opinions of those in the upper echelons of SA Health in regards to funding.

“There is an argument in the literature regarding the number of inpatient beds in a community,” he said.

“Some people think too much money has been spent on inpatient beds, while others think more should be spent on community services.

“There’s a lot of philosophical and political debate and difference of opinion.

“So, it’s not just funding, funding is important, clearly, but it’s driven by other factors too.”

Dr O’Brien further said how “until relatively recently, mental health was kind of the ‘orphan’ of health services; it was down the pecking order”.

It is only recently, that mental health has been in the public eye through the work or organisations such as BeyondBlue, Headspace, and LifeLine, as well as high profile celebrities; particularly former AFL stars such as Tom Boyd and Dayne Beams, whose careers were cut short due to battles with mental illness.

Dr O’Brien described how while the number of beds in public psychiatric hospitals and wards have been cut, beds at James Nash House (South Australia’s high-security psychiatric ward that holds people such as Cy Walsh, who killed his father, Adelaide Crows coach Phil Walsh, in 2015) have remained the same. He put this down to them being seen as a “danger to society”.

But with the proportion of emergency department presentations relating to mental health increasing from 3 per cent in 2011–12 to 4 per cent in 2017–18 nationwide, according to The National Mental Health Commission, this points to a growing issue of people not being able to find help and support until they are in a crisis or at a breaking point, or become a ‘danger to society’.

Dr O’Brien described how, “some areas of mental health have been reasonably funded, because they’ve been very successful in advocating and publicising the need, while other areas have been neglected”.

“I would anticipate that more money will be moved to cover mental health issues regarding Covid, and particularly services for the elderly… so I think monies will start pouring in those directions,” he said.

“Now, there is only a finite amount of money available, so it stands to reason that if monies are being directed into specialist areas, monies from general mental health might be affected by that.”

However, it is not all doom and gloom. There are numerous grassroots projects popping up across both Australia, and South Australia, that provide support to those suffering from mental illness, and information for families whose members suffer from mental illness.

Men’s Shed is one such project. An organisation that aims to provide men with camaraderie and an outlet to keep busy, it began in 2007, with ‘Men don’t talk face to face, they talk shoulder to shoulder’ becoming the motto.

Barry Heffernan started a Men’s Shed in Adelaide’s beachside suburb of Glenelg for veterans in 2011, after initially just meeting up with former service personnel in his lounge room and cafés.

While the national suicide rate for men in Australia is 5.7 per 100,000 people, ex-servicemen commit suicide at almost five times that number – 27 per 100,000 – and ex-servicewomen commit suicide at a rate of 12 per 100,000 people.

With no government funding, Barry and his colleagues raise money through barbecues, restoring old toys, and building furniture. Barry said woodworking has become a great outlet for himself and his fellow members to bond and take their minds off things and tune out.

“It gives people a place to meet, talk, and to be with like minds – we don’t speak about what we have done and seen if we don’t want to, but being around people who have been through the same experiences as you is a great help,” Barry said.

With around 80 members, and around 20 people coming to the Shed each week, Barry’s Men Shed offers support to a wide range of people; from Vietnam veterans, to East Timor veterans, to Iraq and Afghanistan veterans – as well as the partners of those who served.

Barry stressed that people aren’t put on the spot about what their problems are – they sometimes sit down as a group and discuss trauma, while sometimes sit one-on-one with each other.

“Sometimes they don’t talk at all about their service – they’re just there to be with people who have experienced the same sorts of things as they have,” he said.

“We have a lot of wives and husbands coming in to see how best support their partner, whether it be from Post-Traumatic Stress Disorder (PTSD) to depression and anxiety,” Barry said.

Barry has even visited former service personnel in prison, whose trauma has caused them to turn to a life of crime.

While lamenting the lack of support from both local councils, state governments, and the federal government, Barry is fully committed to helping out former service personnel.

“Police often call us about former servicemen who have gotten themselves into trouble due to mental health issues, and I try to help as best I can – whether that be visiting the people or by writing to members of parliament, which I do quite often,” he said.

Barry now has plans to increase the size of the Shed to accommodate 25 people at one time.

Now with his mental health vastly improved, Thomas is recovering with the support of his family.

Although he felt neglected in his dealings with the mental health system, he praises the work of non-profit aid agencies such as Beyond Blue and Lifeline in looking after those in crisis.

“That’s where the money should be going, they have a lot of my respect; they do a lot of good work and always have been there for me,” he said.

If you or anyone you know are experiencing mental hardship please call:

Lifeline: 131 114

Beyond Blue: 1300 224 636

To get into contact with a Men’s Shed near you, visit https://mensshed.org/

*Names and ages have been changed to protect individuals’ privacy.

Story originally published in The Junction.

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