by Alex Wilson, accredited mental health social worker
Mental health care is once again featuring predominantly in Australian media at the moment, following acts of aggression allegedly perpetrated by people with mental illness. There is extensive research which shows people with mental illness are not more likely to engage in violence or aggression towards others. However, people with mental illness are at increase risk of harm towards themselves. Increased scrutiny of mental health services is warranted however. Australia’s ever–rising suicide rates show our current mental health system is failing. The following are some key challenges in mental health care, with practical examples.
challenges
Lack of early intervention
Most serious mental illnesses start in adolescence. Psychotic illnesses, such as schizophrenia and schizo affective disorder get harder to treat the longer they persist. Teenage years are the optimal time for screening and early interventions that can significantly improve long–term outcomes.
Schools are the logical place to have early screening and psycho–education services, however school counsellors are overwhelmed in their roles dealing with a huge range of behavioural issues and early symptoms of serious issues can easily be missed.
Parents are also lacking in education about early–warning signs in teens, and when to seek specialist advice.
Example
Kyle (16) has been acting differently lately. His friends are confused about why he has become more withdrawn. Kyle’s parents have noticed he has become preoccupied with the number 23, and talks about how this number has deeper, magical meaning. Nobody does much though, they just figure Kyle is going through a phase.
By the time Kyle is 23 he is floridly psychotic. He won’t agree to any mental health treatment and eventually he is admitted to a psychiatric unit against his will. He requires long–term, intensive monitoring in the community and when he stops taking his meds he becomes erratic and unpredictable.
What is needed?
If Kyle’s parents and friends had education about early warning signs for psychosis, they would notice the warning signs of a mental health issue. Kyle’s parents could book him an assessment with their local Young People and Psychosis team, who could provide expert advice. If early psychosis symptoms were detected, Kyle could be started on treatment to quickly stabilise him and prevent worsening of symptoms.
Lack of collaboration between public and private mental health services
Public mental health services can only respond to high risk presentations. However, public services often cite policies and procedures preventing them from referring to the private sector. These policies need to be challenged at a local, state and federal level, and patient care needs to be prioritised.
Example
Rory (15) has been struggling with his mental health for some time. Rory has been in the local emergency department for self harm and seeing the public child and adolescent mental health team for over six months, but things continue to get worse. Rory’s parents are beside themselves with worry and frustration. They feel that Rory needs more in depth psychological therapy to figure out why he is so distressed, but the contact with the public service just feels like
a band–aid.
What is needed?
Rory’s parents and Rory would all benefit from advice on what kind of therapy might be most helpful at addressing the underlying issues. The public team should refer Rory to a private service for long–term therapeutic care, since they can’t provide that. The recommended treatment model for Rory would be dialectical behavioural therapy (DBT).
Lack of matching right patient to right treatment
We have extensive research showing what kinds of treatments are more effective for certain mental health conditions. Therefore, we need health professionals to get better at matching the right patient to the right treatment.
Example
Mariah (30) has been experiencing poor mental health since she was a teenager. Mariah has been taking antidepressants for years and has done previous talking therapies without improvement. Her GP is unsure what will help, as usual treatments have not been effective.
What is needed?
Mariah’s GP should educate themselves on other treatment options, especially those effective for chronic or resistant symptoms. Treatments that fit this category include dialectical behavioural therapy (DBT) and transcranial magnetic stimulation (TMS). Mariah’s GP should explore the pros and cons of trying a new type of treatment, and convey hope to Mariah they she can get better.
take aways
Increased attention and scrutiny of mental health services in Australia is long overdue, and hopefully upcoming community investigations will highlight the need to fix some of the challenges discussed above.
Most importantly, mental health care should be viewed as just as valid and worthy of treatment as physical health conditions. By addressing what is not working, we can move towards a society where mental health care is sought quickly and effectively whenever needed.
Mental Health Access Line (Central Coast): 1800 011 511 – Lifeline: 13 11 14 – Mindful Recovery Services: (02) 4660 0100
mindfulrecovery.com.au
Alex Wilson is an Accredited Mental Health Social Worker and Director of Mindful Recovery Services and the Central Coast DBT Centre, providing psychological treatment and support for adolescents and adults. Alex is passionate about dispelling myths about mental illness, and is highly skilled in dialectical behavioural therapy. She is an experienced public speaker and provides consultation to other professionals on managing difficult behaviours in teens. Alex lives on the NSW Central Coast with her partner, 2 young boys, 2 goats, a bunch of chickens and a cheeky puppy named Axel.