Premier Steve Bracks honoured the promise he made during last years election campaign by appointing Lisa Neville as Victoria’s first Minister for Mental Health. During the campaign the premier also pledged $129 million to create 168 additional beds for people with an acute mental illness. This followed the federal government’s announcement last year of an additional $1.8 billion over five years to mental health.
Although the provision of additional resources to treat people with a mental illness is welcomed and long overdue, the emphasis on acute care suggests that the government’s focus is on treating mental illness, not promoting mental health.
It may sound crazy, but the best mental health care service in my community is my local park. With the warmer weather, people of all ages are out in the park kicking and hitting balls, laughing, reading books, cuddling, doing tai chi, picnicking, pushing prams and walking dogs. These activities help us all to stay well, including those of us with a mental illness.
Many of us may not regard local parks as a community mental health service. Instead, what normally comes to mind are psychiatrists, psychologists and Prozac. We have come to associate mental health services with professionals who treat mental illness.
Community mental health care services provide treatment for people who have a mental illness or a ‘mental health issue’. For the most part, the focus of community mental health care services is on providing ‘sick care’, not ‘health care’.
The distinction between ‘sick care’ and ‘health care’ is an important one. In many respects, the distinction determines the way health resources are allocated.
Historically, our health care budget has been spent mostly on sick care. Yet the decline in mortality over the past century has been due to improvements in diet, employment, education, living conditions, sanitation and medical treatments. Medical treatments are only one part of the equation in improving our mortality.
Similarly, medical treatments are only one part of the equation in improving our mental health. Although people with a mental illness often benefit from medical treatments, social, economic, cultural and environmental factors also play an important role in helping people with a mental illness to get well, and stay well. A home, family, friends, and meaningful employment are just some of the things that help to keep us all sane.
Here lies a contemporary quandary: both “mental illness” and “mental health” are now treated as “medical issues”. This ‘medicalisation’ of mental health is utter madness. Although evidence supports mental illness being treated medically, mental health is often a social, not medical, issue.
Take housing as an example. We all know that living in a safe environment does wonders for mental health. Yet, according to the Office of Housing website, there are over 30,000 people on waiting lists for public housing in Victoria. This lack of access to safe and affordable housing is indeed depressing.
Housing is merely one of many social issues that can upset our mental health. Many of us experience problems due to relationship difficulties, grief, loneliness, sadness, unemployment, bullying, poverty, domestic violence, and traumatic childhoods. When these problems are treated medically, people are treated with medication, counselling or perhaps cognitive behavioural therapy. Although these treatments may be helpful for some individuals, they do not change the underlying social conditions that cause the distress.
As a community, we need to decide whether the promotion of mental health is primarily a medical issue. Or is it also a social, economic and environmental issue? Do we need more parks, or more Prozac?
We are often told that “one in five Australians” will experience some form of mental illness. According to this statistic, the majority of Australians (four out of five) will not experience any form of mental illness. However, five out of five Australians are likely to experience some form of relationship difficulty, grief, or sadness. These problems will probably cause some form of mental or emotional distress. But will medical treatment be necessary? Or will a walk in the park with friends suffice?
Clearly, resources should be allocated to both treating mental illness and promoting mental health. Who knows? Providing additional resources for the promotion of mental health may be a cost effective way of preventing episodes of mental illness
First published on ABC Radio National, Perspective on 20 April 2007