It is no secret that the Australian mental health system is in an unworkable and unmanageable mess. In 2021 the report from a Victorian Royal Commission into mental health delivered its scathing findings. Chair Penny Armytage said she was personally shocked by what she had seen and heard. The system, she said, had catastrophically failed to live up to expectations and was woefully unprepared for current and future challenges. She called for a completely new system built on compassion but this call has gone unheeded. Nearly two years later, despite a lot of hype and promises it is business as usual and that business is often dark, ugly and hideous.
At the moment there are about 5 million Australians experiencing mental health problems. About half a million of us suffer from what is regarded as serious problems. In the past, psychiatric hospitals catered for us in a way that was far from ideal but all the large state owned hospitals closed down years ago. This was meant to have made things better for us. In fact the situation seems to have gotten worse.
The savings from the closing of these hospitals was supposed to be have been diverted into community based support facilities. If this had happened it could have resulted in significant improvements to our mental health support system but it didn’t. The response instead has been to rely almost completely on powerful, anti-psychotic drugs. These do help some of us control symptoms but they don’t do anything to heal the underlying problems in fact they make things much worse for most people.
Long term use of these drugs often causes major problems. They are addictive, significantly shorten life expectancy and can result in a zombie like existence when overprescribed which is far too often the case. The effects of being over medicated in this way have been described as a hell worse than death or torture . If people are well informed and chose to use these drugs of their own free will then that is their business but forcing people to use them against their will and often better judgment is simply evil.
Despite all the significant problems and limitations, these types of drugs have become the default mental health treatment in developed countries around the world. Australia is one of the worst offenders for overuse and abuse of prescribed psychiatric drugs. Based on government information, it appears that in 2022, about 70,000 Australians were subjected to involuntary forced or coerced treatment of these drugs.
These drugs are often administered by force in a form known as Long Term Injectables (LTI’s) Their effect typically lasts about 3 months. If you complain, the dosage is likely to be increased. If you refuse treatment, government mental health workers accompanied by police come to your place of residence, hold you down, pull down your pants and inject you. Apart from the humiliation and trauma of being treated this way, many people suffer horrifically from the side effects. It is hard for any reasonable person to believe that 70,000 Australians or even a small fraction of that number are mad enough or dangerous enough to warrant that sort of degrading treatment. 70,000 is nearly double the number of people in Australian prisons.
The United Nations and World Health Organization have laid down international rules banning these practices. Australia is a signatory to these agreements but has failed to implement them. As a consequence, those of us with mental health problems have less rights than criminals and often get treated abysmally. Even the few limited rights we have are often ignored or blatantly violated. Any complaints to authorities are typically ignored or fobbed off.
You don’t need to be an expert to figure out that if someone has a mental health issue and you subject them to these sorts of frustrations, abuses, threats and maltreatment it is not going to help their condition. Dr Niall McLaren, one of the many Australian psychiatrists, opposed to involuntary drug treatment has said. “If you treat people like animals, that is how they will behave”. Unfortunately many Australians are being treated worse than animals by many of our state mental health authorities.
It should be noted that any move to abolish these practices doesn’t mean that thousands of people will suddenly be deprived of their required medication. What it means is that people will have a choice of the treatment they want. The claim that those of us subjected to this involuntary treatment are too stupid or sick to know what is good for us is itself pretty “sick”. In order to make good decisions, people do of course need to be properly informed. Unfortunately this is also often not the case.
There are many complex issues in mental health that need to be recognised, talked about and resolved one way or another. These include the way that mental health is impacted by things like loneliness, joblessness, housing, relationships, physical health and more. While common sense would suggest that these are all important issues, there seem to be a number of experts around who control our mental health systems and advise governments who think otherwise. Their solution, which all to often is the only option being offered, is to “just take a pill” and shut up. If that doesn’t work they can always revert to ECT electro-shock treatment.
One of the complexities of mental health support and treatment in Australia is the severely limited availability of alternative choices. The standard scheduled fee for a nominal fifty minute consultation with a clinical psychologist is currently $280 while the Medicare rebate is $131.65 or less than half.
If you are reasonably well off financially a private psychologist may be a viable option but for many it is just not affordable Not all psychologists charge the scheduled fee but there is normally a substantial gap.
At the moment there is talk from the psychologists lobby urging politicians to spend more money training more psychologists and to a higher academic standard. More highly educated psychologists provides no help whatsoever for the many who cannot afford these services at all. If you are looking for free or low cost services be prepared to wait at the back of a very long queue. The same applies to psychiatrists except the queue is usually even longer.
Does more formal education for mental health professionals result in a higher level of competency? Many of us have found through our own bitter experiences that this is not the case. This seems to be another reason why many professionals resort to either medication or cardboard cutout psychological methods.
A common “solution” suggested for solving these problems is for the government to spend more money. To be sure, money does or will need to be spent but the existing system is in such a mess that spending more money on it “as is” will just create a bigger more expensive mess. Since money is seen by both government and others to be such a problem, the first and obvious thing to do is to stop wasting it. Some of the serious underlying problems in the mental health system would cost little or nothing to fix. These changes have the potential to set in motion a process or providing a more effective user friendly mental health services offering better value for public money than the existing worn out, inefficient and hopelessly outdated one.
The problem with this approach is that it will require a big shift in both public and government thinking. The government would need to acknowledge and face up to the fact that there are some very large elephants in the room which could perhaps be politely called the Collection of Conservative Self Interests.
At the moment both state and federal governments appear to be doing little more than kicking the can down the road but there appears to be growing public awareness of the problem and intense resentment from many who are affected by it.
We certainly need to look at doing something different to just throwing more money down the drain.
Hearing you Tim. Throwing money at it is unlikely to help. The waste is horrific, but seems to suit vested interests. There are less expensive approaches than clinical, although insurance seems to be an issue, which most clinicians have sorted.