The pendulum may have swung too far in mental illness

The pendulum may have swung too far in mental illness

Jill Margo
December 3, 2014

It’s time to stop saying almost half of all Australians suffer from a mental illness at some time in their lives. Although this is the official view, it depends on floppy definitions and figures.

Drawing on figures from 2007, the Australian Bureau of Statistics tells us “almost half (45 per cent) of Australians aged 16 to 85 reported they would have met the criteria for a diagnosis of a mental disorder at some point in their life”.

This is quite different to glibly saying, as many mental health campaigners do, that half of us suffer a mental illness at some time.

On the numbers, Jon Jureidini, professor of psychiatry at the University of Adelaide, believes the touted 50 per cent results from the conflation of two populations.

He says 1 to 2 per cent of the population suffers from severe mental illness that requires psychiatric help.

Community surveys show that in a given year, 15 to 20 per cent suffer a level of distress that meets the criteria for a mental disorder. However, there is little evidence they need more psychiatric help than seeing their GP or a counsellor, or doing nothing.

“The problem is that people translate the 15 to 20 per cent in any given year as 15 to 20 per cent at any given time. But a lot of these episodes are self-limiting and resolve within the year, so the number of people suffering at any given time is significantly lower.

“The assumption is also made that the 15 to 20 per cent have the same sorts of needs and will benefit from the same sorts of interventions as the 1 to 2 per cent.”

Jureidini says the 50 per cent is absurd, and can easily slide to 100 per cent.

“If you want to define every episode of significant distress that someone experiences as an illness, then we all suffer from self-limiting mental illness at some time in our lives.

“Taking distress seriously doesn’t amount to giving it a medical label and giving medication for it,” he says.

The number of Australians who may be mentally ill has grown as the definitions of mental illness have expanded.

The ABS describes mental illness as “a number of diagnosable disorders that can significantly interfere with a person’s cognitive, emotional or social abilities”.
Naming or shaming?

The definitions of mental illness are global, but their floppiness is evidenced by the fact that in Britain, officially only 25 per cent of people suffer a mental illness in their lifetime.

Or is it that we have double the trouble?

But there is a positive side to broad definitions. They help destigmatise the illness and the suffering.

The fact that mental illness is so common makes it easier for people to volunteer that they have an issue and easier to seek help.

Some are greatly relieved to receive a diagnosis. “Thank goodness you’ve got a name for this, and a treatment,” is a sentiment that is often heard.

This helps people understand their condition and perhaps find some community support. But then, on receiving a diagnosis, some feel they have a label that will dog them for life.

For others, a label can be a useful excuse. Jureidini says when a boy is labelled with ADHD, the parents feel less blamed and the boy feels he has an explanation. “But then you hear him saying ‘Oh, I couldn’t control that. That was my ADHD’. ”

Labelling often brings a loss of autonomy. A key word in mental health, autonomy is about a person’s ability to be self-governing and make decisions that are informed, rational and in accordance with their values.

“The difference between good psychiatry and bad psychiatry is whether I increase or decrease my patients’ autonomy,” Jureidini says.

“Feeling worse but being more autonomous is a superior state to feeling better and being less autonomous.”
Medication paradox

Jureidini also points to a paradox in the push to medicate more people.

“Take a man in his 50s who becomes depressed out of the blue. He’s invited to think of it as biological and adds antidepressants to the booze he is already drinking to excess, which everyone, including his doctor, is turning a blind eye to.

“The alternative is to reflect and think back regretfully about how he gave so much priority to work, and look at the effect on his relationship with his kids and say ‘I am really disappointed at how my life turned out’.

“It could be good for him to live with this distress for a few months and maybe begin to build meaningful relationships with his grandchildren rather than taking a few pills and getting on with being a dead-shit father.”

The paradox lies in the stigma. Jureidini says people take a dimmer view of mental illness caused by brain chemistry than by social and environmental factors.
Trivialising problems

The broadening definitions bring negatives, particularly for those with milder forms of mental illness.

Paul Biegler, winner of the Eureka prize for his book The Ethical Treatment of Depression: Autonomy through Psychotherapy, says many people are unnecessarily put on medication when they are going through variations of normal experience, such as loss in the form of grief, relationship breakdown or financial failure.

“We trivialise these experiences and treat them as a derangement in brain chemistry that can be normalised with a pill. Perhaps a better approach might be to look for the meaning in what has happened and address it more functionally,” he says.

When people are given anti-depressants for such conditions, they are encouraged to take a biological view of their illness, which can rob them of autonomy. Rather than working out a way to resolve or accept the circumstances, they take a pill.

Biegler, a physician and an adjunct research fellow at the Centre for Human Bioethics at Monash University, says people treated with psychological therapy, such as cognitive behavioural therapy, are less likely to accept a biological model of their illness.

Rather, they tend to see their condition as a response to stressors in their environment and are more motivated to target them. “They are more autonomous in getting through their current and their future episodes of depression,” he says.
A primitive science

Despite questions about their efficacy for mild to moderate depression, antidepressants are often the first line of treatment for these conditions.

And Australia is a very high user. Last year, an Organisation for Economic Co-operation and Development survey showed that out of 33 countries, Australia was the second-biggest user per head of antidepressants. Iceland was first.

The survey showed almost 9 per cent of Australians were prescribed some form of daily antidepressant. A decade earlier it was half that.

“I think 9 per cent is an excessive amount of prescribing,” scientia professor and head of the school of psychiatry at the University of NSW, Philip Mitchell, says.

“In any 12 months, some 5 per cent of Australians experience depression and some of it is mild and does not require medication.”

Much prescribing is done in the general practitioner setting, often under pressure from patients. Mitchell points to the structural difficulty of remuneration and time in general practice.

“The system is antithetical to coming to grips with the patients’ experience and distinguishing clinical depression from a difficulty adjusting to difficult circumstances.”

Mitchell, also a professorial fellow at the Black Dog Institute, is concerned about the 50 per cent.

“Any condition where you start to talk about that level of prevalence in the community starts to worry me.”

It has not been well communicated that the figures include mild, moderate and severe disease. Formal diagnostic criteria are used because a degree of impairment or dysfunction exists, but some of it is mild illness, which requires watching and waiting without active intervention.

So what does the 50 per cent mean? “It means that a trained interviewer in the community would say at some stage in their life, these people have had some symptoms that fulfil the diagnostic criteria.”

It does not mean that half of all Australians have needed to go through the mental health system.

Our definitions and criteria are largely drawn from The Diagnostic and Statistical Manual of Mental Disorders. Known as the DSM, it is American and serves as an almost universal authority for psychiatric diagnosis. With each new edition, new diagnostic categories emerge.

The benefit is that it allows people to know what they are talking about in different countries. In this regard, Mitchell says it has improved the reliability of diagnosis. But he says the big issue is about its validity – its ability to validate reality to the diagnosis.

“I see these things as evolutionary. Today, for most of the disorders we don’t have a biological test. We are dependent on pattern recognition in dealing with these complex and subtle disorders and this can be a problem.

“We look for signs and symptoms that cohere, that make a syndrome. This is where medicine was in the mid-19th century. It had syndromes but few biological tests.

“Psychiatry will evolve. I believe we will look back in 50 years and say this was very primitive. But we can only do the best we can with existing knowledge.”
Too much goodwill

At the moment, however, our prescription rate is rising fast. Last year a study in the Australian and New Zealand Journal of Psychiatry showed that in the decade to 2011, there was a 58 per cent rise in dispensing psychotropic drugs.

Ray Moynihan, senior research fellow at Bond University’s Centre for Research in Evidence-Based Practice, believes the pendulum has swung too far in mental illness.

“There have been extremely valuable campaigns in Australia to destigmatise mental illness, but some zealous advocates have created the appearance of a giant epidemic.

“When you label every second person as having had a mental illness, you run the risk of undermining the debilitating and severe nature of genuine psychiatric illness.”

In our attempt to help, we are pushing the boundaries too wide and labelling too often. Rather than a conspiracy, Moynihan says it’s an accident of too much goodwill – a road paved with the best of intentions!

This page reproduces an article on the Australian Financial Review’s website.

Australian researcher discovers promising treatment for depression

Australian researcher discovers promising treatment for depression

Nicky Phillips
The Sydney Morning Herald
January 25, 2015

David* has lived with depression on and off since he was 19. At times over the past 15 years it has arrived without warning, whereas other episodes have been triggered by a stressful event.

Having tried various treatments, including counselling and medication, all with some degree of success, he enrolled in the trial of a promising new therapy that combines gentle brain stimulation using weak electric current and thinking exercises.

During his 15 sessions over three weeks last year David found his mood unchanged, but about a month later noticed he was feeling good.

“Then in June and July I had quite a few stressful situations and in the past I probably would’ve fallen into a heap. However, I found I had this new resilience to get through them, which was really surprising,” he says.

David wasn’t the only one who was surprised. Dr Rebecca Segrave, the neuropsycologist and researcher who came up with the idea to combine gentle brain stimulation with brain training, was so shocked by the trial’s results she re-checked her figures several times.

But the results were real, and she could see improvements in her patients.

“It’s really thrilling to sit with someone, one on one, and hear how their life has improved,” she says.

In a pilot study of about 30 participants, almost half who received the combined therapy – rather than a single treatment or a placebo -improved, and about a third were in remission by their three-week follow-up.

“That means their symptoms of depression had gone completely,” Segrave says.

About one in six people will experience depression at some point in their lifetime, and of those almost 30 per cent will not respond to standard treatment such as medication, counselling and cognitive behaviour therapy.

Psychiatry professor Paul Fitzgerald says life for these patients can be very disabled. And they have high rates of suicide.

“For many years we have been hopeful that the pharmaceutical industry would come up with solutions, that there would be new drugs that would be better than the ones we already have,” Fitzgerald, who works with Segrave at the Monash Alfred Psychiatry Research Centre, says.

“But many drug companies are choosing not to invest in new drug treatments for depression, so we really need other approaches,” he says.

The brain training part of Segrave’s encouraging new treatment works by exercising a specific brain region known as the dorsolateral prefrontal cortex. This smallish area at the front of the head is a critical control-centre for thoughts and emotions. In people with depression it is often under-active.

This explains why people with the condition have trouble controlling their emotions and disengaging the negative thoughts swirling through their mind, Segrave says.

“The area that would normally regulate that and put the brakes on is the dorsolateral prefrontal cortex, but it’s under-active, so not able to control and regulate their thoughts, particularly their negative thinking.”

Much like exercising muscles makes them stronger, research has found brain training based on computer-generated thinking activities can re-activate neurons in this region, reducing the severity of depression symptoms.

To maximise its effect, Segrave combines it with a gentle form of brain stimulation, known as transcranial direct current stimulation (TDCS).

“People have gotten particularly excited about it because it’s very safe, it’s inexpensive and it’s portable,” she says.

TDCS is  milder than the more familiar electroconvulsive therapy (ECT), also used to treat severe depression.

While researchers have been exploring brain stimulation using electric currents as a treatment for several mental illnesses for decades, what began as rather crude experiments have evolved into a sophisticated field.

Another technique to stimulate the brain applies magnetic coils that create electrical pulses to a small region of the brain. It has become a well-established treatment for depression.

A recent experiment at Melbourne’s Alfred Hospital found transcranial magnetic stimulation could offer relief to severely depressed patients after three-days of intensive treatment.

Segrave was drawn to TDCS however because, while it has been shown to improve depression symptoms, there is also evidence it can enhance a recipient’s thinking skills. Repeated sessions have other downstream effects on the brain, strengthening connections between neurons, she says.

“We apply stimulation to the same region during the training to gently pre-activate that area of the brain while the training is going on.”

The study found the two techniques combined had a much greater impact on reducing patients’ depression severity, with lasting effects.

Fitzgerald says the combined therapy has a lot of potential. “We’re very pleased with the results,” he says.

Segrave applied for money from the National Health and Medical Research Council, the country’s main medical research funding agency, to run a larger trial this year. While the project received positive reviews, it was not funded.

“It was considered good science, rigorous and worthy of funding, but there’s not enough money to cover all the science that’s worthy of funding,” she says.

She is looking for other donors, and will spend months applying for government funding again this year, because she believes in the treatment.

“I’m committed to trying to get more funding because the initial results suggest this could be an exciting new treatment for depression.

“It’s expensive to test new treatments, and the NHMRC is one of the only funding bodies that can give you enough money to ask the hard questions about whether it really works.”

* name withheld

This page reproduces an article on The Sydney Morning Herald website.

Mental health funding crisis: doctors planning to quit over lack of resources

Mental health funding crisis: doctors planning to quit over lack of resources

Amy Corderoy
The Age
March 9, 2015

  • Survey of psychiatrists reveals emerging crisis
  • Lack of transparency around budgets, lack of services in some areas
  • Authorities aware of the problem, and trying to fix it

Mental health care is heading towards a crisis in NSW with one quarter of the state’s psychiatrists considering leaving the public system this year because of “grossly inadequate” resources and low morale. Mental Health Minister Jai Rowell says the government is committed to meeting community needs.

The exodus comes amid allegations that some local health authorities are systematically siphoning off mental health resources and refusing to fill key clinical positions so money can be diverted to other areas.

Sources have told Fairfax Media that immense pressure being exerted on resources, particularly in some rural areas and parts of western Sydney where needs are greatest, with people suffering acute psychiatric crises often left without help until the problem escalates and police are called.

However, the government said it takes the problem extremely seriously and has introduced ongoing auditing to prevent the diversion of funds.

Paul Fanning, who worked as a director of mental health services in NSW for 23 years, said local health districts had been forced to find efficiency savings at the same time as improving treatment times.

“To me there is a straight-line relationship between the financial state of the districts … and the degree to which mental health is impacted,” he said. “Where we mostly see that is in community mental health services … where an enormous amount of work is needed in following up on people when they are discharged from hospital and doing early intervention work so things don’t escalate into a crisis.”

In its inaugural report last December, the Mental Health Commission said if the siphoning of funds away from mental health services was not addressed within two years it would consider asking the government for independent auditing powers. The commission, which started in 2012, was set up by the NSW government to advise on how it should improve mental health care across the state. No-one knows exactly how much money is being lost, although one 2009 report seen by Fairfax Media estimated so called budget “leakage” could be as high as $20 million annually.

Survey of psychiatrists paints ‘grim picture’

Doctors’ groups were so concerned they surveyed the state’s psychiatrists, with the interim results showing more than half believe resources have decreased over the past year and a third say they are “grossly inadequate”. One quarter are likely to leave the public sector this year if nothing changes.

AMA councillor and psychiatrist Choong-Siew Yong said it painted a grim picture, and more needed to be done to ensure psychiatrists were included in the health district decision-making so they could protect resources.

“Psychiatrists look after some of the most vulnerable groups in the state … but historically mental health has had less funding in relation to need and there is still a huge catch-up to do”.

The exclusive survey of more than half the psychiatrists in the public system – 250 doctors – undertaken by the NSW branches of the AMA, the Australian and New Zealand College of Psychiatrists and the Australian Salaried Medical Officers’ Federation, also found 44 per cent of doctors believe positions are deliberately left unfilled and one third believe the number of doctors employed in their area has declined.

Dr Yong said the scale of the problems varied from district to district, but more resources were needed everywhere to improve morale.

Lack of transparency around budgets, lack of services in some areas

Alan Rosen, a professorial fellow at the University of Wollongong and a clinical associate professor at the University of Sydney’s Brain & Mind Research Institute, said he believed tens of millions of dollars that could be spent on community workers and other treatments was being siphoned out each year, often through excessive corporate fees and charges, with the problem increasing in some areas after greater control was given to local areas over budgets.

“If we don’t do something we are going to end up with an inquiry into the disasters,” he said. “It’s time for the government to act”.

The differences in approaches between local health districts also meant a person’s ability to access services could depend simply on where they lived and what time of day they became sick.

“In NSW we do very little consistently and on an equitable basis around the state, and based on the building blocks of evidence,” he said. “We don’t even have out-of-hours crisis teams in every catchment … Crises occur maybe a third of the time in weekday periods, a third at night and a third on the weekend, so you need your crisis teams to work 7 days a week, 24 hours a day.”

Last month Fairfax Media revealed the number of people with mental illness dealt with by police had grown massively over the past decade, with a lack of mental health services in the community partly to blame.

However, the director of mental health and drug and alcohol for NSW Health, Peter Carter, said major costing reviews were undertaken twice yearly to examine corporate charges.

He said that over the past three years corporate and other related costs have ranged from around five to six per cent, although he acknowledged there was “volatility” between districts the ministry was trying to abolish.

However, Professor Rosen disputes the figures, saying it does not accord with what he has heard from clinicians working in the area.

Ministry aware of the problem, and trying to fix it

The Ministry of Health says it is working hard to fix the problems, including recruiting more staff in areas where it has been hard to attract qualified people.

The chief psychiatrist of NSW, Murray Wright, said the ministry took the staff survey very seriously, and he intended to discuss the issue further with the staff professional bodies and follow up with individual districts about any concerns.

“Local health districts have assured me that they are implementing recruitment strategies to deal with what are, in many instances, long-term challenges in recruiting and retaining skilled psychiatrists.”

Minister for Mental Health Jai Rowell said since its election the government had ensured mental health budgets were listed separately in service agreements with the local health districts.

“The NSW Government is committed to meeting community need for mental health care services,” he said.

“This financial year alone the NSW Government invested $1.62 billion in mental health – a record spend on our state’s mental health system.”

This page reproduces an article on The Age website.

Monash university finds rural Australians under serviced for mental health issues

Monash university finds rural Australians under serviced for mental health issues

Minto Felix
The Age
March 9, 2015

Last week’s Monash University findings from the largest ever study into Australian mental health services paint a bleak picture for individuals living in rural and remote areas. This examination of 25 million mental health items, taken between 2007 and 2011 from Medicare data, highlights that those living in metropolitan areas have about three times better access to psychological services than those living in rural and remote locations. Unfortunate as this is, these findings should not at all be surprising given the high levels of mental illness in rural and remote areas. However, what is alarming is the significant number of young people experiencing mental illness within this demographic. Given that 75 per cent of mental illness occurs before a person turns the age 26, it places an already vulnerable population group at an increased risk.

But unequal access isn’t the only challenge in youth mental health. The McClure report on welfare also shone a light on the proportion of people who receive disability support pensions, a significant 30 per cent of whom are diagnosed with psychiatric or psychological conditions, and again, who develop these illnesses young in life. Despite the overwhelming majority of young people wanting to complete education and work, life chances are often damaged due to a lack of early intervention and a mismatch in care delivery for them and their families. This pattern of young people as most at-risk extends to drug and alcohol abuse, suicides, and so many other mental ill-health scenarios. Costing the world about $16 trillion to address, mental illness profoundly impacts families and communities, but no doubt, bears a particular burden on the one in four young people who live with serious mental ill-health.

“Youth participation is not only essential for an individual’s own healing process, but it can be an instrument of enormous change.”

Despite the massive reforms in youth mental health over the past decade, enormous obstacles still stand. And in order to conquer these new and emerging challenges, the most important actors need to be front and centre of forming the solutions – young people.

Termed by mental health professionals as youth participation, this concept is nothing other than young people having ownership over their mental health, and being empowered to shape mental healthcare in all respects. Youth participation is not only essential for an individual’s own healing process, but it can be an instrument of enormous change. We are beginning to see examples of this engagement in action – the Youth Reference Groups affiliated with headspace Centres around the country, and ReachOut, the online youth-led mental health network. But deeper investment in this area is urgently needed.

For young people to make a meaningful difference on the mental health landscape, they need to work alongside researchers in shaping future priorities. Together with policy makers, they need to design the systems of care that will best match their needs. To the fullest extent possible, young people should be involved in every aspect of health services.

Among both young people experiencing mental ill-health as well as mental health professionals, there can at times be a patronising tone in the way we are addressed. But  the lived experiences of young people need to be part of the diagnosis, prevention, and cure of mental illness. Such an approach can also work to reduce the stigma experienced by so many young people that live with mental illness, and builds trust in health care services.

Taking stock of the bigger picture – within local communities and across the nation, we are indeed in need of a revolution that is driven by young people to tackle these complex health challenges. Young people who are prepared to demand appropriate health services, equipped to influence others, excited to innovate with technology and other tools in therapy and committed to driving positive reform on mental health.

Minto Felix is a mental healthcare advocate.

This page reproduces an article on the website of The Age newspaper. Comments can be made on the page linked.

Melbourne psychiatrist wants end to ‘fingers crossed’ approach to antenatal mental health

Melbourne psychiatrist wants end to ‘fingers crossed’ approach to antenatal mental health

Rachel Kleinman
The Age
March 14, 2015

As Samantha* cradled her newborn in the first days of his life, she began to sense her mental health deteriorating.

Within two days, she was experiencing familiar manic symptoms such as racing and confused thoughts. Samantha, a public servant from Melbourne’s north, was transferred to a mother and baby unit where she remained for more than three weeks until she stabilised enough to take her baby son home. It took a couple of months to fully recover from the postnatal episode.

In consultation with her mental health clinicians, Samantha had stopped taking her anti-psychotic medication quetiapine prior to her son’s birth because of concerns about its safety in breast milk. “If I had my time again, I don’t think I would come off the medication. Knowing what I went through after the birth, I would just stay on it,” Samantha, 31, said.

A Melbourne psychiatrist and researcher said clinical research into safe use of anti-psychotic medication during pregnancy is extremely sparse. “What we actually want is clinical practice guidelines based on evidence … At the moment, everyone is just crossing their fingers and hoping for the best,” said Jayashri Kulkarni, from the Monash Alfred Psychiatric Research Centre.

In 2005, Professor Kulkarni and her colleagues established a world-first database, known as the National Register of Antipsychotic Medication in Pregnancy. The project tracks the impacts of taking anti-psychotic medication on pregnant women, their foetus and the newborn baby up to 12 months of age.

The gap between prescribing and clinical evidence is enormous. According to Pharmaceutical Benefits Scheme figures, use of quetiapine (the most common anti-psychotic) has increased from 1500 annual filled prescriptions in 2000 to more than 1 million in 2014.

“And nobody in the world has any data about outcomes for babies whose mothers took anti-psychotics during pregnancy,” Professor Kulkarni said.

“Anti-psychotics are prescribed for serious mental disorders such as schizophrenia, bipolar disorder and major depression,” she said. “But they are also now used [at lower doses] to treat anxiety, eating disorders and insomnia.”

Mental illness, to varying degrees, can affect up to 10 per cent of pregnant women. And women with a pre-existing psychiatric condition are more likely to experience a relapse of symptoms during pregnancy. But Professor Kulkarni said antenatal mental health is heavily neglected.

So far the study has tracked 240 women and their babies. Findings included higher rates of gestational diabetes and pregnancy weight gain beyond 15 kilograms in mums. Weight gain is a common side effect of anti-psychotics and the impact of gestational diabetes on maternal and neo-natal health is widespread. Study participants had higher rates of babies admitted to intensive or special care, often for respiratory distress. And there was a pattern of withdrawal symptoms among some newborns, who were jittery, had goose flesh and were colder than usual. “On the plus side, most of our babies were healthy, [with] no limb or organ malformation or serious abnormalities,” Professor Kulkarni said.

The centre needs more pregnant women on anti-psychotic medication to join the study. Contact Heather Gilbert on 03 9076 6591 for more information.


This page reproduces an article on The Age website.

Victoria’s mental health sector struggling with demand

Victoria’s mental health sector struggling with demand

Richard Willingham
The Age
March 22, 2015

Mental health services, including those for prisoners and the state’s most acutely unwell, are stretched to the limit, the sector and unions say.

The industry says community treatment teams have been hurt by a lack of investment in the sector while the Thomas Embling Hospital at Fairfield is facing rising demand on the back of an “unique” explosion in the prison population. Thomas Embling Hospital is described as ‘bursting at the seams’.

Last year the Health and Human Services Department prepared a master plan mapping out the next 10 years of forensic mental health services in Victoria. It is yet to be released.

The high-security Thomas Embling psychiatric hospital serves patients from the justice system as well as highly acute patients from the public. It has been described by the Health and Community Services Union as “bursting at the seams”.

Chairman of the Victorian Institute of Forensic Mental Health Bill Healy said last year that the hospital was only designed to service a prison population that was 40 per cent of what it is now. Writing in Forensicare’s annual report Mr Healy said there had been as “extraordinary increase” in the prison population in the past three-four years, many of whom needed specialist mental health services

“The human impact on prisoners with a mental illness, correctional staff and clinical staff where mentally ill prisoners are waiting more than 30 days for involuntary treatment is concerning to myself and the board,” Mr Healy said.

The former government was briefed on some of the options in the master plan just before last November’s election, including expanding services at Fairfield or building a new acute forensic service at another site.

Labor promised to create a 10-year mental health plan including services for those in the justice system and that plan is currently being developed.

Extra mental health capacity in prisons will be created by the Ravenhall prison, which was signed off by the Napthine government – it includes 75 mental health beds as well as services for another 100 patients.

The health union’s state secretary, Lloyd Williams, said there were continuing concerns about the lack of investment in mental health in the state.

He blamed the previous Napthine government, saying Victoria had dropped to the state with the lowest investment in mental health than any other state.

“You end up with a crisis driven, squeaky wheel situation, where people in the most difficulties get the most focus,” Mr Williams said.

“The demand on staff is so high because they are so stretched. People are burned out and new graduates aren’t joining the system as it is overworked.”

With a more reactive system it was easier for people to fall through the cracks, he said.

The former government said it had increased funding to community mental health services by 30 per cent.

Other issues dogging the sector include an ageing workforce and the ability to attract and retain staff.

The peak body representing community managed mental health services Vicserv’s chief executive, Kim Koop, said the expectation on mental health services were high but “resources don’t allow these expectations to be met”.

Minister for Mental Health Martin Foley said the government was working on its promised 10-year plan, which would include planning for forensic mental health services and services for patients from the criminal justice system.

“The former Liberal government’s preoccupation with funding prison beds instead of forensic treatment beds and facilities has created the situation where a significant number of prisoners with mental health conditions and illnesses have not been getting the treatment they need,” Mr Foley said.

This page reproduces an article published on The Age website.

Facebook steps up suicide prevention

Facebook steps up suicide prevention

Kristian Silver
The Age,
March 27, 2015

A Facebook suicide prevention initiative has been welcomed by mental health groups.

Facebook will roll out suicide prevention and support tools for vulnerable Australian users in the next few months, according to the social network’s local head of policy.

The initiative was welcomed by mental health groups when it was unveiled in the United States earlier this year.

It allows users to report concerning online posts, which are then reviewed by Facebook who can then send the original poster a message of support or advice on where to seek professional help.

Mia Garlick, Facebook’s Australia and New Zealand policy head, said the company was working with the Young and Well Cooperative Research Centre on a localised version of the suicide prevention initiative.

“All the feedback has been strong and powerful from a lot of the clinical experts and we’re looking forward to rolling that out in Australia in the coming months,” she told Fairfax Media.

Facebook has also ramped up its campaign to tackle bullying, taking its approach off screen for the first time in Queensland during a workshop with students and teachers last week.

Ms Garlick said initial reports of abuse or bullying online were handled by teams working round-the-clock in the United States, Ireland and India. There were also Australian staff who could work with police if required.

However Ms Garlick said the social network does not keep statistics on the bullying complaints it receives, or data on who the culprits and victims are.

“We don’t have those statistics and sometimes I’m not sure that statistics help us tell the story. For every person who does get bullied, it’s such a strong and bad situation that almost looking at the numbers doesn’t help,” she said.

“What we want to do is solve [problems] every single time it happens and make sure those people feel supported.”

Ms Garlick welcomed the announcement of Australia’s first children’s e-safety commissioner, who has the power to fine Facebook $17,000 a day if it does not comply with takedown orders for offensive material.

It still remains unclear what would happen if the social media site did not agree with an order made by the commissioner.

“We’ll have to cross that bridge when we come to it. We’ve been engaged with the Australian government for many years when it comes to what constitutes harassing bullying and content,” Ms Garlick said.

“For bullying and harassing content, we try and action it within a 24-hour timeframe. Sometimes there’s a lot of context in a bullying situation, and that’s where people on the ground can let us know what that is so we can see it in a proper light … So sometimes it can take longer than 24 hours.”

This page reproduces an article on The Age website where comments may be made.


Mental Health funding confirmed

Mental Health funding confirmed

The Hon Sussan Ley MP
Media Release
April 2, 2015

Mental health services will have their funding renewed in a move to give them certainty, Minister for Health Sussan Ley has announced.

PDF printable version of Mental Health funding confirmed

Mental health services will have their funding renewed in a move to give them certainty, Minister for Health Sussan Ley announced today.

Ms Ley said the 12 month extension – worth almost $300 million – would allow frontline services to continue to be delivered while work progressed on the current Mental Health Review.

Ms Ley thanked the sector for their patience and said negotiations would commence immediately, with priority placed on frontline services.

“The Abbott Government is committed to working with the mental health sector to deliver effective, efficient and high-quality services,” Ms Ley said.

“We are also committed to building a world-class mental health system, which is why we commissioned the Mental Health Review.

“This review will allow Government to form long term plans to ensure our high-quality mental health services continue to provide the right care, at the right time in the right setting.

“However, most people also recognise that to achieve this, improvements need to be made in the way mental health is organised and funded in Australia and it’s important this opportunity for positive reform isn’t rushed.

“Therefore extending funding for another 12 months will provide frontline mental health services with clarity and certainty while we work through the complex issues raised in the review.”

Ms Ley said the Abbott Government had tasked the Mental Health Commission to complete a review into the mental health sector following an election commitment.

Ms Ley said the Government was currently working through the findings of the review and it would be released soon.

This page reproduces the announcement on the Department Of Health’s website.

‘Horror stories’: Think twice before telling your boss

‘Horror stories’: Think twice before telling your boss you have mental health issues

Larissa Nicholson
Sydney Morning Herald
April 15, 2015

Mental illness still carries significant stigma in many workplaces, BeyondBlue has warned.

Workers who tell bosses about their mental health issues are risking their careers, the head of national charity BeyondBlue has warned.

BeyondBlue chief executive Georgie Harman said that openness about mental health issues could potentially help managers create the best environment to aid recovery.

But workers should speak openly only where they were confident they would be supported, she said at an event in Melbourne to promote improved mental health outcomes in businesses.

The tragic actions of Germanwings pilot Andreas Lubitz brought workplace mental health issues into sharp focus.

BeyondBlue still heard “horror stories” about people finding themselves stigmatised and victims of outdated attitudes to mental illness at work.

Debate over the disclosure of mental health issues has intensified in the wake of the Germanwings plane crash, after co-pilot Andreas Lubitz was later revealed to have suffered from depression.

But Ms Harman said workers considering revealing mental illness should think about what support networks employers had in place, the culture of their workplace and how their immediate manager was likely to react to the discussion.

For employees considering whether to reveal their condition in workplaces where there was little awareness of mental health issues, Ms Harman had simple advice:

“Don’t, because you might not get that promotion, you might get the sack, there might be repercussions.”

Ms Harman said she would like to see every workplace have an open disclosure policy and the end of discrimination.

“But where we want to be is a workplace culture where everyone feels they are confident and safe to disclose. That’s nirvana,” she said.

Ms Harman said the construction and banking industries had been particularly proactive in building healthy workplaces, but businesses in other sectors needed to change to treat mentally ill employees more fairly.

But there was still a long way to go, she said.

“We’re not encouraging full and open disclosure in every circumstance.”

“But where we want to be is a workplace culture where everyone feels they are confident and safe to disclose. That’s nirvana,” she said.

Ms Harman said the construction and banking industries had been particularly proactive in building healthy workplaces, but businesses in other sectors needed to change to treat mentally ill employees more fairly.

Starts at the top

It was a good idea to start at the top of a business – with the chief executive announcing that creating a safe environment for employees to disclose their mental illness was a priority, Ms Harman said.

Monitoring workloads and stamping out bullying providing would help, she said, as would providing flexible work arrangements and return-to-work plans for people experiencing a mental illness.

The Mentally Healthy Workplace Alliance had created an online tool to help workers weight up the pros and cons of telling their manager about their mental ill health, as part of their “Heads Up” initiative.

BeyondBlue co-hosted a workshop with Diversity Council Australia and the Business Council of Australia in Melbourne on Tuesday morning to teach employers how to build mentally healthy environments for workers.

Business Council chief executive Jennifer Westacott said creating a mentally healthy workplace was important on both ethical and economic grounds. She said PwC had found mental health issues cost the Australian economy $10.9 billion dollars a year.

But for every $1 businesses spent on mental health initiatives, they got $2.30 in return, due to lower absenteeism and higher productivity among other factors.

“Work should be a dignifying experience, it’s not just about the money you take home,” she said.

ANZ Bank, Wesfarmers and Bupa are providing adult colouring books to employees to help them handle workplace stress, a Fairfax Media report revealed last week.

Ms Harman said she was aware of only a little evidence behind the approach, but encouraged businesses to do whatever worked.

“Create a fun environment, create an environment where people know it’s OK to say I need a mental health day, if that means colouring books … if it works, great.”

Technological revolution in mental health care

Technological revolution in mental health care means care can be provided for $9.70 per patient

Sue Dunlevy
May 6, 2015

AN extra $9 billion will need to be spent on mental health and 9,000 new psychologists trained as the population grows and more people seek help in the next 15 years a new report shows.

However, the care could be delivered at a fraction of the cost, just $9.70 per person annually, if early mental health intervention was delivered through online services the Ernst and Young report says.

It costs $845 to treat each person per year face to face with a psychologist but just $9.70 through an online mental health service says the report titled A Way Forward: Equipping Australia’s Mental Health System for the Next Generation.

The report also finds people prefer seeking help online because it is anonymous, there is no stigma attached and research shows online care is just as effective as face to face care in early stages of mental illness.

And online services can fill the gaps in rural and regional areas where access to psychologists and doctors can be extremely difficult for those with a mental health problem.

“In the time that it takes to train additional health professionals, existing online services could be helping literally thousands of people every year who are currently struggling and alone,” the authors say.

Online mental health services can involve cognitive behaviour courses that help people identify unhelpful thoughts and behaviours and learn healthier skills and habits. They provide fact sheets on common mental health problems, online forums where people with mental problems can speak to others with difficulties, and videos showing how other people with common mental health problems coped with their situation.

The report was prepared for online mental health service which provides mental health help for around 140,000 young Australians a month.

The report says e-mental health could provide an excellent “first line of defence” in a system of mental health stepped care.

Online services can deal with people suffering from early stages of anxiety and depression while those with more severe mental illness should be treated by GPs and the most severe cases by psychologists and psychiatrists.

“No it (online services) can’t treat all people, but it can be a first line of defence that helps people find a solution that is better for them,” says ReachOut chief Jono Nicholas.

One in two Australians will experience a mental health problem during their lifetime but up to 70 per cent of young women and 80 per cent of young men will receive no help at all.

“We’re not realising the potential of these online services,” says Mr Nicholas.

Australian research has found it takes an average 6.9 years for those experiencing depression and anxiety to recognise they have a disorder and a further 1.3 years to seek help.

In this time their mental illness will likely have progressed to become more severe and may have led to family breakdown, employment problems, crime, suicide and other problems, the report says.

Under the existing government funded Better Access initiative it costs $507 per person to provide 6 face to face sessions of care and $845 per person for ten sessions of care.

By contrast, the report finds it costs $97,000 to build a high end online mental health service but the cost of the service is just $9.70 per patient once 10,000 patients use it.

It costs $290,000 to train 4.7 new psychologists who could treat a maximum of 1,416 people but you could build a high end online service that could treat 100,000 people for the same money.

The report concedes that it is impossible to treat all new cases of anxiety or depression as many people never present for help.

Research shows only half the burden of all mental health disorders can be averted with treatment.

However it estimates screening adolescents for early signs of depression and providing brief cognitive behaviour therapy could reduce incidence depression by 35 per cent.

An online program targeting 13-25 year olds mild depression and anxiety could help 78,500 people recover and avoid $346.4 million in costs per annum, the report says.

Reachout says if all the 371,915 young people with a mental illness who currently are not seeking help accessed an online service it would cost just 26 cents a head to provide them with early help.

If you need help you can call Lifeline on 131114 or contact ReachOut.

The material on this page has been transcribed from an article on the website