What does it take to improve mental health? Some insights from three voices of experience
At the recent national TheMHS conference in Cairns, the director of the Hunter Institute of Mental Health, Trevor Hazell, received the “Award for Exceptional Contribution to Mental Health Services in Australia or New Zealand”.
Hazell, who initially trained in social work, has worked at the Institute for 15 years, and shares some of the lessons of experience in the Q and A session below.
He also reflects upon his own experiences with anxiety and depression, and the role of personal experience in advocacy, as well as sharing some advice on how to build a mentally healthy workplace.
And at the bottom of the post are links to:
• Broaden the focus beyond healthcare: a stirring speech from the Chair of our first National Mental Health Commission, Professor Allan Fels (delivered to the National Press Club last month).
• Focus on the Internet to improve mental health: A short profile of the new chief at SANE Australia, Jack Heath.
Q and A with Trevor Hazell
A. Definitely it is the Commonwealth Government getting involved in directly changing the service delivery system. It has helped enormously to provide better access to services, particularly for those with the high-prevalence types of mental illness. This target group was really missing out under the old system. By having national policy approaches we have more equitable access now than ever before.
Q. What have been the biggest disappointments in mental health over that time?
A. The tertiary level of mental health service provision remains relatively underfunded. One of the consequences of this is that the services have little capacity to be innovative and to try more flexible models of treatment. Consequently we are seeing little reform in these services.
Q. There is often a tension between whether we should focus more on promotion/prevention or more on treatment services or more on the broader needs of people with mental illness (eg employment, housing, social inclusion etc). Do you think we have the balance right? If not, how do we need to rebalance?
A. Not at all. We have done well in primary and secondary care but to some extent this has been at the expense of promotion and prevention. The current mental health plan was written “for those who have a mental illness and those who care for them”. There is no vision that we might one day prevent cases of mental illness. There is scant and limited attention to the promotion of mental health.
If we want to promote mental health and prevent mental illness, we truly need cross-portfolio leadership from the Prime Minister and from Premiers because the determinants of good mental health are influenced by all aspects of society and community life. The activity for promotion and prevention is mostly outside of the health portfolio.
It would be good to start with a Vision in the National Mental Health Plan. It would be good to broaden the mandate of the Mental Health Commission. It would be good to have a National Plan for Good Mental Health for all Australians.
Q. Which of your many professional achievements do you think has made the most impact – and why?
A. The Hunter Institute has gone from a small band to a large orchestra. As a whole, the Institute is now making a significant contribution in a range of innovative areas. I think I am good at leading a team of people, to getting them working in the same direction and caring about the outcomes of what they do, and then building their capacity to do their work well. But of course I have been fortunate to be able to recruit people with great skill, integrity and professionalism.
Q. What difference do you think social media and other online tools are making to mental health – both positive and negative?
A. I think social media is fantastic for many people who have a mental illness. Take someone who has a severe anxiety disorder. Their biggest risk is that they will become cut off from family, friends etc. Social media presents a very safe way for such people to keep up to date with what is happening to family and friends. Even if their only interaction is to press ‘Like’ on a Facebook page, they are maintaining connection which may be very useful for them as they recover from their illness.
Negatively, I think there is a lot of scope for the spreading of socially negative and unhelpful material (untruthful, misogynistic, racial etc) which would not formerly have had much currency.
Q. If there was one thing you would like to see change/happen in mental health, what would it be?
A. We know that mental ill-health is really common. Yet when people experience mental illness they feel isolated, and to some extent they tend to isolate themselves. While it might be good to for people to withdraw somewhat and to attend to their healing and recovery, they should feel that they are understood and supported while they do this.
Instead, we hide our periods of mental illness and in doing so we deprive ourselves of the support of others.
Our current goal is to stop people from discriminating against those who experience mental illness. One day I’d hope that we can mobilise the community more positively to provide mutual support during our episodes of mental ill-health.
Q. The mental health sector gives the impression of being quite fractured and divided. What might help to create a more unified sector? Or do you think the sector works well as it is?
A. No it definitely does not. There are many divisions and competitions. One part of the problem is the term ‘mental illness’. We lump together all forms of diagnosable disorders under a single term. We don’t do this with physical illness. We don’t send people to’ physical health services’.
If we lumped all the physical illnesses together and expected to see all the stakeholders united and harmonious I doubt the picture would look much better.
The scarcity of money is another problem this increases the competition between advocates of different disorders, or between youth services and adult services.
Q. You have been open in talking about your own experience with anxiety and depression, and about not recognising the signs when they developed five years ago. What did you learn out of this experience, and what role do you think personal experience has in advocacy? What reaction have you had from colleagues and others?
A. In retrospect, despite many positive aspects to my family and school life, I can see many early signs that I was an over-anxious child and adolescent. I came to accept certain ways of thinking and feeling as ‘just the way I am’. I often felt miserable, and was frequently in a bad mood.
Now of course, as a young person I would not have been able to have access to modern medications and psychological therapies. So what I have learned is that now that we have effective ways of treating these types of symptoms, we need to really encourage young people to recognise them and to know that they don’t have to put up with them. They don’t just have to accept them.
I don’t advocate because I have personal experience but I do think that my personal experience probably makes me a more authentic advocate.
I have had only positive reactions when I have disclosed my illness and treatment.
Q. Your staff say that you are known for your personal commitment to building a mentally healthy workplace. What have you learnt along the way – what worked and what didn’t? Any concrete advice for other organisations/employers about how to build and sustain a mentally healthy workplace?
A. I think the main thing is mutual respect. Now we used to think about respect in a hierarchical way. The boss was supposed to ‘command’ respect whereas new employees had to ‘earn’ it. This doesn’t really work if you want to build a team. In mental health we want to build self-esteem and self-respect. The best way to do this is for each individual to give respect to each other.
We define respect as ‘treating each other with care and consideration as another human being’. This is a behavioural definition and it is a lot easier to achieve than other definitions of respect such as “positive esteem”.
Q. A Senate Inquiry into the social determinants of health has been announced. What is the main message you would like to give that inquiry?
A. In the long view, we have to create the conditions for a greater proportion of the population to have a safe, healthy childhood, free from abuse, growing up in family environments and having access to child care and educational services that build the foundations of mature emotional and social development.
If we can get a greater proportion of children through to their adolescence with greater strengths and fewer risk factors, we can hope for a more mentally healthy adult population in the future.
Q. What is the question I haven’t asked that you wished I had?
A. “What is the biggest influence on my mental health?”
To this there are three answers.
The first is obvious – the people close to and around me (and my dogs).
The second is work. If I hadn’t faced up to my mental illness I would have had to leave work and that would have been disastrous for me. No matter how hard, work is so good for me.
The third answer is the Newcastle Knights. They give me reason to hope for better days ahead.
Broaden the focus beyond healthcare
For those who missed it, here is a transcript of the recent National Press Club address by Professor Allan Fels, Chair, National Mental Health Commission, as published by The Conversation.
It is worth reading the full version, but a potted summary is that:
• Mental health needs to be a higher priority for governments and the community at all levels, and the focus needs to be much broader than simply the healthcare sector. Employment should be be judged as a prime outcome of our investment in mental health. Other countries achieve higher employment rates for people with mental illness than we do. According to the OECD, Switzerland achieves a 66% employment rate for people with serious mental illness, whereas we’re down at 48%.
• The physical health of people with mental illness is a scandal that receives almost no attention. According to research from the University of Western Australia and other evidence, the life expectancy gap is around 15 years at least. That is, people with mental illness live 15 years less – maybe 20 years less – than the rest of us. We die in our 80s, they die in their 60s. Suicide is only one cause, not the main one. People are dying young of heart disease, cancer and diabetes.
• The move to Activity Based Funding of hospitals under national health reform has the potential to have adverse consequences for mental healthcare, if it encourages more care to take place in hospitals rather than the community.
• Fels is determined the Commission will achieve change. He said: “The National Mental Health Commission is going to make a difference and if it doesn’t, I’ll be the first to call for it to be shut down… We are also not the usual group of bureaucrats that make up a Commission. There are two family members, one person with lived experience, a welfare provider from an NGO, an Indigenous psychologist and academic, a business woman with mental health interests especially concerning Indigenous people, and two excellent professors and a former Health Minister.”
It certainly sounds like the Commission’s first report card, due later this year, will be an important document.
Focus on the Internet to improve mental health
In 1996 he founded the Inspire Foundation, which runs the ReachOut.com youth mental health service. Later he went to Ireland and the US to establish the service there.
Heath says technology should be core business for healthcare organisations, and that the Internet is a vector to provide useful tools, support and information for people with mental illness. He said: “It’s a revolution in how we deal with mental health in Australia, and globally.”
An idea for harnessing the expertise of departing journalists – and providing a powerful health service to local communities