This article is for you the Kind Taxpayer.
You are being required to support mental health even more this financial year than you have been in the past. You must be asking if there is a limit to it especially when every survey finds that more and more people are expected to experience mental illness sometime in their life. The estimate from the 2007 National Survey of Mental Health and Wellbeing is now that one in two people will experience some kind of mental health problem in their lifetime.
You must also be questioning the expenditure of all this money when basically the life expectancy of people who attend mental health services is still only marginally above that of Indigenous Australians and we all know that is a national tragedy. Why isn’t the expenditure of all this money making any difference to key indicators like life expectancy?
Another statistic which should give you cause to ponder is that two-thirds of people with mental health problems don’t use mental health services at all.
First I say thank you for your financial support and then I will propose a rather radical adjustment to the present system which does attempt to deal with some of these problem statistics. The first thing I propose to do is to remove most of the NGOs operating in the mental health area.
This is not because of any ill feeling or that these groups are not well meaning but because they have inherent problems in that they are basically underfunded, are ideologically driven and also because they are not socially inclusive.
When I say that these groups are ideologically driven I don’t mean by your usual religious beliefs but rather by an increasingly vague body of ideas which are often put before the clients of these groups as ideas that they too have to accept.
These ideas, an example of which is the Recovery Model, are sometimes accepted by clients and sometimes not. The trouble is that if the clients don’t accept the proselytizing that is current in many mental health services then they won’t use the service. While I am sure that many persons with mental health issues get a lot from the Recovery Model, I am quite sure an equal amount will be put off by it.
Another reason why the NGO sector should probably make way is because they are essentially social welfare driven and the extent to which social welfare modalities are effective in the mental health area is arguable. The problem is that the social welfare approach starts from the assumption that people with mental health issues have various entrenched problems which is not necessarily the case. These assumptions generally circle around “dependency” and “autonomy” issues.
Because of these underlying assumptions there is a tendency in the social welfare sector to regard direct assistance or “help” as somewhat of a Bad Thing. The reasoning for this is apparently that “help” of a direct kind impinges on independence. While I mention the social welfare sector as being the source of these beliefs, high profile consumers also contribute to these ideas.
What is happening in practice is that people in the mental health sector are not getting the kind of full, enthusiastic help from the social welfare sector that they need in order to achieve favourable health outcomes. The kind of help that I think you the Kind Taxpayer would like to think that you were funding.
I am sure that people working in the area are absolutely certain that they are acting in the best interests of their clients however the word to describe what is actually happening is that the help or offered within the mental health sector is very often “grudging”. This kind of assistance can only lead to diminished self esteem on the part of a group that is already seriously lacking in feelings of entitlement and self worth. It also diminishes the ability of people in this situation to access support when they need it because no one wants to receive help that is ringed around with negative assumptions and judgemental attitudes.
Another problem is the general underfunded nature of NGOs. There are many of these organisations and they are all trying to do a bit of everything with the result that programmes often don’t have the level of sophistication that is required for adults. For example if you cut costs on an art programme you will generally get something that isn’t challenging or exciting for the people attending. In addition the proliferation of different agencies often leads to confusion rather than choice.
To this end I would suggest a moving away from the social welfare approach to mental health altogether and instead propose that all mental health services be mainstreamed and conducted by already existing health and education facilities.
First we could move a significant part of services currently offered by NGOs into the mainstream by moving all educational type courses or programmes currently run for people with mental health issues into established TAFES, Colleges and Universities.
I have attended one of these integrated courses at a TAFE and it was really quite astonishing. There was no proselytizing by the staff. The people with disabilities in the class were treated like everyone else. Students received an additional DSP payment for attending; they received a qualification at the end of the programme; people had access to the considerable campus resources; there was a stronger duty of care and there was much better procedural support for people with disabilities. While there were some hiccups with the programme I attended it would only take the appointment of perhaps a peer support worker (a trained person with lived experience of mental health) to each facility iron out any problems with this proposal.
The counselling type services offered by NGOs could very easily be moved to Neighbourhood Houses, where people could access many other community programmes as well as the counselling. Community Houses also often have access to community buses so people could overcome the transport problem which is a major constraint on people with mental illness participating in community life. This would also serve the needs of the two-thirds of people with mental health issues who don’t access mental health services at all at present.
There is one other aspect that NGOs do and this is what is called psychosocial rehabilitation. This is really support to help people live independently in their homes and in the community through a service called Personal Helpers and Mentors. Basically there is no reason why this sort of activity can’t be carried out under the aegis of Home and Community Care as this is just an extension of what they do. The beauty of Personal Helpers and Mentors is that they could be attached to any mainstream facility.
I think we will find that there is no need for a huge bureaucracy to oversee the mental health sector now that it has been mainstreamed. Mental health could be just one aspect of population health and this I am predicting is where considerable savings can be made.
Seeing that we have trimmed the inflated mental health industry what do we keep? Which aspects of the mental health system actually keep people from becoming a statistic?
We keep drop-in centres because that is what people with mental health issues want, only we will mainstream them. Centrally sited these facilities will be the “Third Space” promoted by social inclusionists. They will be large, comfortable, well-furnished centres which anyone can use to eat their lunch, read the newspaper, have coffee or drop in to use the photocopier and computers. Such drop in centres would actually be another form of a Neighbourhood House and could be managed by the same bureaucracy that manages those facilities. They could even be run by local councils.
The Third Space could have showers and a Laundromat attached for use by the homeless and others and also have a visiting GP or mental health nurse. You understand that this can be a very salubrious place as we have made a veritable bucket load of money available.
We will also keep self-help groups because this is what people with mental health issues want. They could be sited at the Neighbourhood Houses. They cost nothing to run and are extremely successful in treating mental illness. The Recreation Programmes which are so essential to people with mental health problems could also be run from the Neighbourhood House system.
Another institution we should keep is the Time Out House for people who fear self-harm. We have one in Launceston which is staffed by volunteers and there is a professionally run one in Queensland. These facilities keep people out of emergency departments and out of hospitals.
With the considerable savings arising from the integration described above we could provide more case management for those who need it, extend the Medicare free psychologists scheme, provide more mental health nurses who are trained to deal with people with mental illness who have other health problems, extend programmes to rural and remote areas and perhaps provide more support for GPs. The GP is arguably the most important person in the entire mental health system and there needs to be more support provided, probably by means of subsidising longer visits. Many of the two thirds of people with mental health issues who don’t use mental health services at all could really benefit from being correctly diagnosed by a GP and that takes time.
As for all those workers potentially displaced by this re-arrangement, they need to be attached to mainstream programmes in order to support people with mental illness in situ rather than in isolation. For example the addition of Personal Helpers and Mentors would really help people with serious mental health problems to access such programmes as New Enterprise Incentive Schemes or TAFE programmes to develop business skills.
This is necessary because those people with serious mental health problems are not sitting at home doing nothing, many of them have advanced skills and talents in many areas and they just need a bit of help and mentoring to develop them to the stage where they could actually earn money.
Therefore Kind Taxpayer, let’s not keep people with mental illness in isolated programmes where they are constantly told they have to “recover” – lets treat them as though they have already recovered, place them in the mainstream with support and see what they can do.
