How Australia’s Mental Health System Is Broken

When Sam* was taken to hospital via ambulance after a deliberate overdose a few years ago, the last thing she expected was to be sent away without any kind of treatment.

The now 29-year-old had been dealing with depression and anxiety for months, and it had come to a head. But when she arrived, she was more or less turned away.

“I was left in a public waiting room for hours,” she told PEDESTRIAN.TV. “I spoke to a doctor who told me that the CAT [Crisis Assessment and Treatment] team would call me later that week to refer me to outpatient treatment. They never did, so I went to my GP who told me I was ‘not sick enough’ for the public system, and told me to ‘Google therapy to find a counsellor near you’.”

This kind of thing is happening all too often to Australians seeking help for mental illness.

Dr. Sebastian Rosenberg, a senior lecturer in mental health policy at the Brain and Mind centre at the University of Sydney, says our mental health system is “broken”.

He says that since most of Australia’s psychiatric institutions were closed in the 1980s, due to widespread abuse and human rights violations, only two institutions have replaced them: the psychiatric wards of general public hospitals, and prison.

“I think it’s reasonable to suggest that Australia’s mental health system is broken,” he told P.TV. “We have failed to fill the initial promise that was made when the psychiatric institutions closed: to establish a vibrant and sustainable system of community mental health services that would permit people to have a good chance of living with dignity in the community.”

People living with serious mental illness have one of the lowest life expectancy rates in the country, typically living between 10 and 32 years less than the general population. Despite endless ‘awareness’ campaigns, funding measures, and (generally good) efforts to ‘fight the stigma’, this life expectancy gap hasn’t closed in 30 years.

They’re also shockingly overrepresented in the homeless and prison populations. Three quarters (75 percent) of homeless people are living with a mental illness (with about a third of those affected by severe disorders) and just under half (40 percent) of prisoners have a mental illness (with about 10 to 20 percent of those having a severe disorder).

Right now, Australia is spending $15 million per week on access to psychologists, via the Better Access scheme that provides rebates for up to ten appointments per year.

But ten therapy sessions is hardly going to cut it for people dealing with serious mental disorders, like schizophrenia, bipolar disorders, major depressive disorders and borderline personality disorder. So where are they supposed to go?

“Your options are really limited to attending the emergency department,” says Dr. Rosenberg.“Things are as piecemeal and segmented and siloed in mental health as they’ve ever been.”

Mentally ill people are being turned away.

The awful reality is that countless people are, like Sam, turned away from being admitted to hospital on the grounds that they are ‘not ill enough’. Dr. Rosenberg likens this to having a cancerous tumour, only to be told it’s not big enough for treatment.

“In mental health, you only qualify for care once your lump is large,” he says. “It doesn’t make sense from a personal point of view, from a health point of view, from an economic point of view, from an efficiency point of view. It’s quite the wrong way round.”

And then still other hospitals are simply ill-equipped to deal with emergency visits related to mental health.

Jackson Langford, a 22-year-old from Newcastle, told P.TV that the first time he tried to admit himself to hospital after a mental health scare, he was essentially turned away because they had no idea how to treat him.

“My depression and anxiety was super, super severe,” he said. “I started to self harm and have suicidal thoughts on the regular. It was really devastating time for me, obviously, but also my friends and family. No one really knew what to do. No one was aware of any services that existed to help out.”

At one point, feeling “petrified” he would self-harm again, he tried to admit himself to hospital. He waited an hour to be triaged and another hour to be seen, before being told by a nurse that they were “not apt to cover this stuff” and that he should visit another hospital instead.

But that hospital couldn’t help him, either. Langford says he’s visited it every time he’s had a mental health scare since, and each time was told he’s not “depressed enough” to be admitted.

“Other times I’ve literally been told I’m not ‘crazy’ enough – which is fucking gross – to be admitted,” he said. “I was speaking coherently and clearly and therefore I felt like these people at the hospital just assumed that I was fine and didn’t need overnight stay.”

How did we get here?

Like most things, it comes down to money and stigma. Mental health sees just 5 percent of the total health spend, but accounts for about 12 percent of the burden of disease.

Stop-gap measures, awareness campaigns, funding for research and support lines… the various measures implemented by successive governments are usually a mix of genuinely helpful stuff and a health minister wanting some nice coverage, but none of it is working. Mentally ill people are still dying. They’re still being turned away.

“We don’t provide good clinical care in the community, we have not built the psychosocial rehabilitation services that we need,” says Dr. Rosenberg. “You reap what you sow. And it’s leaving young people in particular vulnerable to a costly, life-long disability.”

He points to the 32 separate statuary inquiries into mental health between 2006 and 2012 alone, all of which came to roughly the same conclusion: that our mental health system is “in crisis”.

One of them, the 2006 ‘From Crisis to Community‘ inquiry, even recommended that we establish a network of 200 community mental health services, which would provide short-term stay outside of a hospital. That hasn’t happened.

Then there’s the money part of it. At its most basic level, the brain is still the most mysterious of all the human organs, and we don’t have nearly the research to truly understand why some of us own ones that are a wee bit cooked. But that knowledge comes at a very literal price tag.

“Research has been poorly supported in mental health,” says Dr. Rosenberg. “The range of things that we know work for mental health is growing, but growing slowly.”

And of course, you have the stigma. Is it even possible to write about mental health without mentioning the stigma? We all know the old comparison between mental illness and a broken leg. One gets you sympathy, the other unhelpful comments about “keeping your chin up” and suggestions to mediate.

On the one hand, we’ve never been more open and supportive of people’s mental health stories; on this website alone, we’ve written about countless celebrities and public figures opening up about their mental health struggles (Cara Delevingne, Osher Günsberg, Scott Ludlam, Buddy Franklin, Triple J‘s Ben and Liam, Chrissy Teigen), and each time they were met with support.

Swans star Buddy Franklin. Photo: Michael Dodge / Getty.

But we’re comfortable when someone we admire opens up about mental struggles. It’s comforting. It shows us we’re not alone, and it’s often followed by a ‘success’ story: Ludlam went back to work, Franklin returned to the oval.

When you start talking about severe, life-long mental illness (and this isn’t to say anxiety or mild depression isn’t awful or debilitating, simply that severe disorders like schizophrenia require a different level of treatment), there’s this idea that recovery is impossible.

“People still view recovery in mental health as somehow surprising, or maybe unlikely, when in fact, it is normal,” says Dr. Rosenberg. “Even people with schizophrenia or bipolar disorder often have long periods of wellness. Our system is not set up to deal with them.”

He says that kind of stigma translates into funding, with governments exercising caution in investing in mental health services. (FWIW, he thinks the ‘one-stop-shop’ service launched by the Federal Government over the weekend might be useful, but mostly serves to make it look like they’re doing something.)

“What can we do to prolong those periods of wellness [for people with severe mental disorders]?” he asks.

Whatever is is we’re doing currently, it’s not working. We’ve come a long way from locking people up in asylums, but all the mental health awareness days in the world aren’t going to affect real change unless they’re followed by a big fat cheque. We need to fix our mental health system – and we need to fix it fast.

*Name has been changed to protect the person’s privacy.

If you or someone you know is dealing with mental illness, there’s a bunch of resources you can turn to, including: BeyondBlue (1300 22 4636), Kids Helpline (1800 55 1800), Suicide Call Back Service (1300 659 467) and Lifeline (13 11 14).