A National Summit on Mental Health and Physical Health will be held in Sydney tomorrow with the aim of identifying actions that could be taken in the “immediate, short and long term” to address these longstanding health concerns.

In the article below, public health writer and publisher Dr Mark Ragg urges summit participants to come up with a ‘Closing the Gap’ style campaign to reduce the 20-25 year difference in life expectancy suffered by people with serious mental illness.

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Will there be money on the table to address this critical issue?

Mark Ragg writes:

Tomorrow in Sydney a whole bunch of people in important positions get together with the opportunity to make a real difference for one of the most disadvantaged groups of people in this flat brown land.

They’re gathering at Parliament House for the national summit of health and mental health ministers who will discuss the physical health of people with mental illness, and expectations are high.

For it won’t just be the ministers present, who have to reconcile stakeholders’ wishes, ideology and budgetary reality. They’ll be surrounded by consumers, mental health commissioners, advocates and others who all want to see something solid happen. Spectacular isn’t necessary. Real is enough.

And this is why.

People with a serious mental illness die young, probably 25 years earlier on average than they should. And they don’t die necessarily of suicide, as significant a problem as that is. They die of all those run-of-the-mill conditions that get everybody else – heart attacks, diabetes, kidney failure, lung cancer. All things that are preventable to some extent, but not yet in that group of marginalised people.

The lifespan of people with serious mental illness is similar to that of an average person in the times of Parkes and Barton. On any given day, a person with serious mental illness is roughly twice as likely to die as a person with serious mental illness, even after adjusting for socioeconomic status.

Why?

At one level it’s complex – people with serious mental illness may find it hard to get help, to follow advice, to eat well, to keep appointments, to navigate a complex system. And some of the drugs used to treat psychotic illnesses pack the kilos on very quickly.

But at another level, it’s straightforward. Those who look after people with mental illness have not bothered to take good care of their physical health. Partly that’s a systemic and structural issue – mental health care and physical health care and divided at many levels.

But it’s also a matter of personal responsibility – many health professionals stigmatise people with mental illness, feeling their lives aren’t as important, that they don’t need all the investigations offered other people for their illnesses, and sometimes even that their cancers don’t need treating.

There’s been a real shift in thinking in the past five years or so. Nurses, psychiatrists and policy-makers have begun recognised that if everybody else is encouraged to eat well, get some exercise and quit smoking, then, well, people with mental illness should be offered the same advice.

That shift is stronger in the mental health sector than the rest of the health system, and it still has a way to go before it is the norm. And there is still a long way to go before people with mental illness are routinely offered the same investigations and treatments of their symptoms of heart disease, cancer and other physical illnesses as others.

Money has started to flow as well. On the issue of smoking, South Australia led the way, with smokers demanding help and getting it. The Cancer Council NSW saw the importance of the smoking. Health departments in South Australia and New South Wales got active and put significant funding into the issue.

But the funding has not grown in the past year or two, and may well have shrunk as state health budgets come under as much pressure as that of the Commonwealth.

South Australia has disbanded a centralised service, largely due to disputes over whether it should be funded by mental health services or drug and alcohol services, and New South Wales is yet to deliver on promises made a year or more back about further work. Queensland is a basket case, and others find themselves too stretched to deal comprehensively with the issue. The spirit is willing, but the flesh is beholden to GST distributions.

What is needed now, tomorrow, is solid action. This summit is sure to come up with a ‘Closing the Gap’ type of approach to reduce the 20-25 year difference in life expectancy suffered by people with serious mental illness. It will make efforts to give people with mental illness a better chance to reach their allotted years through prevention and by improving services. Reducing the stigma faced by people with mental illness, even among health professionals, is going to be important.

But all eyes will be on the final session, when the money is doled out. Changing people’s minds takes time and effort, as does improving services. Time and effort costs money.

Tomorrow’s summit is the first national meeting on the issue, and has importance in its own right. It is a beacon that things are changing. It is likely to signal a nationally consistent approach and a commitment to collecting data and measuring change.

But without funding to keep them going, beacons fade.

• Mark Ragg is director of RaggAhmed (www.raggahmed.com) and adjunct senior lecturer in the school of public health, University of Sydney. He has worked in this area with the NSW Government, the Cancer Council NSW and the Cancer Institute NSW.

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PS from Croakey: Meanwhile, in other mental health news:

• A draft Global Mental Health Action Plan 2013-2020 is up for discussion at the Sixty-sixth session of the World Health Assembly now underway in Geneva.

• Earlier this week in Canberra, the Council of Non-Government Organisations on Mental Health met to progress work on developing national mental health indicators and targets. In a related interview with ABC Radio, psychiatrist and National Mental Health Commissioner Professor Ian Hickie noted that cardiovascular disease and smoking are major contributors to the life expectancy gap for people with mental illness.

Women admitted to psychiatry wards experience high levels of violence and sexual assaults, according to a report released this week by the Victorian Mental Illness Alliance Council.

Across the nine different psychiatry hospital wards surveyed in Victoria, 85% of female inpatients felt unsafe during hospitalisation, 67% reported experiencing sexual or other forms of harassment and 45% of respondents had experienced sexual assault during an in-patient admission.

The report further described that when the women patients reported the incidents, 82% found the nurses to be “not at all helpful”.

The report reveals two major areas of concern – first, that violence against women patients occurs commonly and second, that the incidents are not appropriately dealt with.

Mixed-gender wards

Prior to the 1960s, it was customary for men and women patients to be managed in separate psychiatry wards. Inpatient admissions were often for several months to years.

Since the 1960s, psychiatric inpatient units in many parts of the western world housed male and female patients together. The rationale for mixed gender wards was to mimic “normal” society as much as possible, since the psychiatry institutions became the patients’ world for many years.

Deinstitutionalisation occurred in the 1990s in Victoria, with the mainstreaming of psychiatry wards into general hospitals and closure of the institutions. Psychiatric patients were managed in the community, with short stay admissions to psychiatry wards if required. On average, patients had two to three weeks of hospitalisation in mixed-gender wards.

This rapid turnover of patients and preference for community treatment has meant that hospital wards now treat acutely and severely unwell people, who cannot be treated in the community.

And the level of illicit drug and alcohol use in the inpatient population, both prior to and during hospitalisation, heightens the level of behavioural disinhibiton in this population.

These combined factors lead to a greater risk of aggression and assault, predominantly against women inpatients, who often already have a history of sexual abuse and other traumas.

UK reforms

In response to escalating assaults in inpatient units, the United Kingdom government adopted a strict policy of gender segregation on psychiatric wards in 2006.

This followed a national audit of violence in inpatient settings, which found one-third (36%) of psychiatric inpatients had experienced, and almost half (46%) had witnessed, violence on their current ward/unit.

Patients and staff had similar perceptions of the most common factors triggering violent behaviour: illicit drug and alcohol issues, staff behaviour, space and overcrowding, medication and treatment, and frustration and boredom.

The UK National Patient Safety Agency, in its audit of violence in the acute psychiatry ward between 2003-2005, specifically examined sexual safety, with 122 incidents relating to sexual safety reported. These included allegations of rape, with the alleged perpetrator (another patient) in 40% of cases and a staff member in 60%; consensual sex; exposure; sexual advances; and touching.

The report does not detail how many incidents involved women, but comment is made that both men and women are vulnerable.

Australia lags behind

Australian governments over the past decade have provided funding to reduce domestic violence and sexual assault in the general community and subsequently developed the Women’s Safety Agenda in 2003.

The latest plan to combat violence against women sets out important programs in primary prevention, white ribbon campaigns, work with Indigenous communities and employment-related policies. But has no mention of action to be taken to prevent violence against women in psychiatric wards.

So why has violence against women in psychiatry wards been ignored?

For many decades, women with severe mental disorders were thought to be “too unreliable” to believe when they told their stories of harassment, assault and rape. Disempowered women patients, often with personal backgrounds of domestic violence, have been subjected to violence within a mental health system that is meant to care for them.

For a long time there was denial of this major issue by overstretched, under-resourced mental health systems, with an endemic culture of passivity about violence against women in psychiatric wards.

Over the past years, we have seen improvement in the reporting systems implemented in mental health services and better management of violence against patients, with some shift in the culture of inpatient units; but it is still not good enough.

Steps to reform

We need to take definitive actions to prevent violence occurring in our psychiatric inpatient units, not just implement mechanisms to report and manage the aftermath of assaults.

Investment in improved building designs of psychiatric wards is urgently needed, with special areas designated for women. Wards should be designed to be safe places of healing, with sensitivity for the traumatic backgrounds of many female patients. Privacy and safety measures can be designed into the structure of existing wards, and new units should be provide an individualised, safe space for each patient.

Importantly, the culture of psychiatry wards needs to change through staff gender-sensitivity training to ensure that the safety and privacy is provided and actively maintained for all patients.

Close monitoring of the situation by the general community and governments will ensure violence in psychiatry units is not tolerated.

The history of psychiatric institutions abounds with shameful stories of abuse and maltreatment of women. It’s time to end violence against women in our present day psychiatry wards and provide the therapeutic environment these women need.

** Jayashri Kulkarni is Professor of Psychiatry at Monash University. 

This article was originally published on The Conversation. A reminder to Croakey readers that TC articles are freely available for republishing under a Creative Commons licence.

Just when we thought we were heading for a more tolerant and accepting attitude toward people afflicted by mental illness, a feature and a news article in Saturday’s The Australian quoting leaders in the area of forensic psychiatry have revived the old mental-illness-equals-axe-murderer stigma.

One of the articles was based on a recent paper published in the journal Acta Psychiatrica Scandinavica showing a higher rate of conviction for all violent offences by people with psychiatric disorders in Victoria.

The second article examined the random attack of a stranger by a person with mental illness, which research has shown to be a rare event; most violence by mentally ill people is directed toward family and acquaintances.

Both of The Australian’s articles quoted Professor Paul Mullen and Professor James Ogloff of Monash University, who are co-authors of the Acta Psychiatrica Scandinavica study.

In 1984, Mullen wrote a paper that reported no increased risk of violence from people with a mental illness. And his 1997 review reported an increased risk of violent behaviour in a small proportion of patients. He is quoted as saying that new data has changed his views.

The newspaper articles include errors that are very damaging to the mentally ill. First, by using the umbrella term “mental illness”, they suggest that everyone with mental illness is more likely to be violent.

However, there is no increased risk of violence in most of the more common types of mental illness; the risk is almost entirely confined to a small proportion of those patients diagnosed with schizophrenia-related psychosis.

By suggesting that everyone who has a mental illness could possibly be violent (just as you and I), the articles isolate, highlight and stigmatise everyone with a mental illness, from depression and anxiety to most people with psychosis.

Most cases of more serious violence by these patients have occurred because of frightening persecutory beliefs arising from active symptoms of the illness.

The increased risk of violence in people with conditions such asbipolar disorder, on the other hand, is almost entirely due to the effects of substance abuse. And it goes without saying that violence is one of the many things people with anxiety and depression fear.

Rather than being perpetrators of violence, the mentally ill are far more likely to be its victim. This is mainly because of the disability and social disadvantage associated with being mentally ill, but also because these people are forced to associate with a small number of violent patients while in hospital.

Mental health laws in Australia detain patients in hospital after they have been deemed at risk of harm to others, rather than because they need treatment. Indeed, they do not even recognise the need for treatment.

This exposes patients who will never commit an act of violence to assault by the minority of patients who are, in fact, violent. For example, three patients have been killed in the Thomas Embling Hospital in Melbourne in as many years.

But the main omission in the two Australian articles was their failure to point out that most of the psychotic patients who committed acts of violence were not receiving treatment.

Indeed, the more serious the violence, the more likely the patient has never had the experience of remission from symptoms such as hallucinations of voices or false beliefs, or a medical explanation for their symptoms.

People with schizophrenia who are receiving treatment are rarely violent, a fact that is evident from the very low rate of violent offending by conditionally and unconditionally released forensic patients in New South Wales.

Only 12% of non-lethal serious violence by people diagnosed with psychotic illness that were dealt with in the NSW District Court, for instance, were committed by people receiving treatment at the time of their offences.

Rather than the blanket statement that the mentally ill are more violent than other members of the community, the correct conclusion is that while most people with mental illness will never commit an act of violence, people with untreated psychotic illness (and those involved in substance abuse) are more likely than the average person on the street to be seriously violent.

** Olav Nielssen is Senior Lecturer in Psychiatry at the University of New South Wales. He has received speaker’s fees from Astra Zeneca. 

This article was originally published on The Conversation. A reminder to Croakey readers that TC articles are freely available for republishing under a Creative Commons licence.

It seems so, suggests a review of the evidence around involuntary treatment orders, conducted by the Deeble Institute for Health Policy Research and Schizophrenia Research Institute.

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Time for a rethink around involuntary treatment for people with schizophrenia

Dr Anne-marie Boxall writes:

Under Australian mental health laws, people with schizophrenia can only be involuntarily committed to a mental health facility if they are assessed and it is determined that their illness is making them dangerous to themselves or others.

To determine whether they are to undergo involuntary treatment, mental health workers must assess people against an ‘Obligatory Dangerousness Criterion’. This criterion is an advance on methods used prior to the mid-1970s, when many countries authorised involuntary commitment to a mental health facility on medical certification alone, without court approval or any proof of an emergency situation.

An Obligatory Dangerousness Criterion is now widely used in Australia, the USA, and some areas of Canada and Europe as the means by which patients are assessed for the appropriateness of involuntary (compulsory) treatment.

There is no doubt the policy underpinning its use was well intentioned; an Obligatory Dangerousness Criterion was originally developed in an attempt to better balance the rights of the mentally ill with the need to protect the public.

However, over time some experts have begun to raise questions about the utility of this criterion, suggesting that it sometimes means patients don’t get access to necessary treatment as quickly as they should.The problem stems from the fact that in order to be classified as being dangerous to themselves or others, people generally need to have a history of violence or self-harm, and most patients in their first episode of psychosis do not have this kind of history.

Up to 80 per cent of patients in their first episode of psychosis require inpatient treatment early in their illness. In many cases, admission to hospital has to be involuntary because few people recognise that their symptoms are due to an illness.

In community-based treatment, patients sometimes do not adhere to the treatment prescribed, and this may lead to consideration of compulsory community treatment orders.

When people with schizophrenia do not adhere to or consent to treatment, their families, friends, mental health professionals and the legal system may have to wait for them to threaten, attempt, or complete acts that could, or do, result in harm, before they can be involuntarily admitted to hospital, or before compulsory community (outpatient) treatment orders are initiated.

In these circumstances, necessary treatment is delayed, and when psychosis is left untreated for lengthy periods, it adversely affects a person’s psychological state and can lead to poorer outcomes (see for example here, here and here).

While many countries continue to use an Obligatory Dangerousness Criterion to determine whether involuntary treatment is justified, some countries have also begun to use other methods: the United Kingdom (UK) and some parts of Canada and Europe, for example.

In these countries involuntary treatment is permissible even if patients have not been assessed as dangerous, but only if they have previously been deemed incapable of giving consent when it comes to matters of their own health and welfare.

As an example, to commit someone with schizophrenia to involuntary treatment in the UK, a formal application must be made by either an approved mental health professional or the patient’s nearest relative. This application is then assessed by two qualified medical practitioners, one of whom must be approved for this purpose under the Act.

With some countries moving away from relying solely on an Obligatory Dangerousness Criterion to determine if involuntary treatment is justified, Australian policymakers should re-examine current mental health laws, along with the evidence underpinning them.

The evidence in this field is not clear cut, but there are some systematic reviews showing that the use of an Obligatory Dangerousness Criterion can have a detrimental effect on patients suffering from schizophrenia because it can delay timely access to treatment (see for example here, here and here).

The criterion has been shown to particularly problematic for patients in their first-episode of psychosis, and over the short to medium term. The impact of an Obligatory Dangerousness Criterion on long-term outcomes for patients is yet to be determined. See the full version of this paper for a more detailed examination of the evidence.

Because it is likely to be some time before there is strong evidence on the long-term impact of an Obligatory Dangerousness Criterion, there needs to be a broader discussion in Australia and other countries about how we should address the challenge of committing people to involuntary treatment when they cannot or will not consent to voluntary treatment.

Australia should first examine the criteria used in other countries. If there are other policy options available that make inpatient psychiatric treatment more accessible, reduce the duration of untreated psychosis, improve treatment outcomes, and reduce dangerous behaviours in people with severe mental illness, they should be considered.

• Dr Anne-marie Boxall is Director of The Deeble Institute for Health Policy Research, and Managing Editor, Australian Health Review

It’s time for some real action, according to the commentary below, from:

• Vern Hughes of the National Campaign for Consumer Centred Health Care, and

• Dr Lesley Russell, a senior research fellow at the Australian Primary Health Care Research Institute at the Australian National University.

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What real reform would look like

Vern Hughes writes:

Every year there is a report on the state of mental health in Australia, and every year it recommends more of the same: more services, better access, a stronger focus on prevention and coordination, and more funding for the service-centred, provider-driven mental illness industry in the hope that some of the $6.3bn spent on it might begin to turn around the growing incidence of mental illness and its social and economic impact.

Every year the same faces release the reports and the same industry voices assess their inability to make a significant difference.

Enough is enough.

Let’s call a moratorium on enquiries into mental health, and a moratorium on feeding the service industries that rely on mental illness, and introduce serious reform which:

1. redirects the $6.3bn to the well-established cohort of the population who have a serious mental illness in the form of individualised packages of care and support, payable to a fund-holder chosen by the consumer and their family/significant persons;

2. requires the establishment of circles of support (a mechanism well-established in disability) around each vulnerable person, comprising family, friends, supporters, and professional workers, as a condition of receipt of funding, with the circle having authority to allocate resources for the purchase of preventative and emergency interventions; and

3. requires the development of a transparent, cost-conscious retail market amongst services and practitioners so that consumers and their support circles may select and purchase the supports of their choice.”

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What happens next is what matters

Lesley Russell writes:

The 2012 Report Card on Mental Health and Suicide Prevention has a single clear message – despite numerous reports, strategies and policies on mental health and considerable spending, Australia still has a failing grade.

This new report card is considered in tone, but reading between the lines, the frustration with the status quo is palpable.

It makes the case that mental health is literally a life-and-death issue that is everyone’s responsibility. Too many Australians with mental health needs do not get treatment and only about 50 per cent of those who do, get the services they need.

Mental health is at the root of the majority of suicides and suicide attempts, and people with serious mental illness die up to 32 years earlier than those who are not mentally ill.

The huge burden mental illness imposes on patients, their families and carers, healthcare and social welfare systems, and society as a whole makes it shameful that we have not done more sooner and imperative that we do more now.

Despite a growing volume of evidence about mental health needs in Australia and how to address them effectively, there is still a lot we don’t know and much of what we do know is not being utilised.

For people with mental illness, the spectrum, capacity and quality of services available depends on where they live and their income.

We must move beyond counting hospital beds, Medicare services and prescriptions to improving health outcomes by ensuring that mental healthcare is well-targeted, effective, accessible and affordable, that it includes the full range of services for patients and their carers such as case management, housing, employment and disability assistance, and that it is delivered in a co-ordinated fashion.

Certainly no one should be discharged from care into homelessness, and families and carers should not be left alone to cope with situations that vary from dangerous to soul destroying.

The report card makes plain what most stakeholders think about the fourth National Mental Health Plan by stating: ”Australia has no nationally agreed picture of what a good mental health framework should look like and how it should be properly resourced.”

It challenges government to be brave enough to set goals and targets and be publicly assessed against these.

The report also issues a veiled threat that if governments don’t deliver an honest picture of how Australia is performing and if the current Ten Year Roadmap for National Mental Health Reform doesn’t deliver, then ”we [the National Mental Health Commission] will work with others”.

But the reality is that there is no one else to work with. Mental health reform in Australia is totally reliant on leadership and sustained investment from the highest levels of the Commonwealth, state and territory governments.

There are many in the mental health sector who find fault with this report.

To some extent they are justified: it says much the same thing that the Richmond report said back in 1983; there is too little focus on prevention and early intervention, especially for children and youth, and the huge burden of depression and anxiety in the chronically ill and elderly; and the strong links between mental health problems and substance abuse are not being effectively addressed.

The real question is, what happens now?

What is the agenda for the next 10 or 20 years and, given the ephemeral nature of governments, how do we get long-term commitments and sustained funding so that each annual report card from the commission will show the needed progress on the agreed-upon priorities and directions?

Can all this start to happen now without resorting to yet another round of consultations and strategy development?

From the beginning of the 20th century, Australia has averaged a report or inquiry into mental health every 2½ years.

Despite these reports and inquiries and dozens of plans and policies, Australia is not succeeding at matching mental health services to need.

Since 2006 Australian governments have committed to spend $8 billion of new money on mental health, but spending between jurisdictions continues to be unco-ordinated and lacking accountability.

For the National Mental Health Commission’s Report Card to become the game changer that everyone so desperately hopes for, what is needed is a culture change that sees mental health and wellbeing as a key indicator of the nation’s commitment its citizens.

There should be no conversation or policy about healthcare reform, closing the gap on Indigenous disadvantage, tackling homelessness, addressing social inclusion, improving education, and productivity without ensuring that mental health is also on the table.

• This article was first published in the Canberra Times

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Related posts

• A detailed summary of the report card

• What’s missing from the report card, by Sebastian Rosenberg

• Are we stuck in groundhog day?

A report card on the report card is provided below by Sebastian Rosenberg, Senior Lecturer, Brain and Mind Research Institute, at the University of Sydney.

While he welcomes aspects of the Commission’s work, he also identifies some concerns and omissions, and suggests the report puts too much faith in “existing moribund processes”.

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Evaluating the National Mental Health Commission’s Report Card

Sebastian Rosenberg writes:

The Commission’s Report Card, launched today, is a funny mixture.

No one can doubt the sincerity of the Commissioners in attempting to establish a more holistic picture of what it means to have a mental illness in Australia in 2012.  They have asserted the primacy of the notion of ‘a contributing life’ built around access to decent services, housing, employment and social inclusion.

This is a refreshing change from the previous national mental health reports, which have rather depressingly focused on bed numbers or other such unhelpful metrics.

However, there are several other issues raised by the Commission that limit the utility of the Report Card.

First, there is no new data as such and indeed the Report Card goes so far as to curiously claim to have “avoided the trap of calling for new data”.

So instead it is a rehash of publicly available data from a variety of sources, including CoAG and other reports. A recommendation for more or better data is made, in particular for a regular five yearly national mental health survey starting in 2014.  Optimistically, this would mean waiting until 2015 for the first blush of survey information to be available.

In the meantime, while the Report Card stresses the importance of knowing whether people with a mental illness are unemployed, homeless and socially excluded, Australia cannot report this currently and the Commission refrains from calling for new data collection efforts to answer these questions.

The Report Card states that Australia has no nationally agreed picture of what a good mental health service framework should look like and does not offer one itself.

No reference is made to the body that preceded the Commission; the National Advisory Council on Mental Health (chaired by John Mendoza) which published its vision in November 2009 entitled A Mentally Healthy Future for all Australians.

Nor does the Commission take this opportunity to articulate its own vision, instead suggesting faith in the National Mental Health Service Framework project currently being developed by the Commonwealth and the states.

The report states the desirability of establishing a national collection of the experience of care for mental health carers and their families.  On the back of comprehensive national survey of carers, the Mental Health Council of Australia currently publish an annual collection of such experiences, reporting their views against fifteen agreed indicators as the Mental Health Carers Survey Report.

The Report Card makes the point there is little or no accountability for the $6.3bn Australia spends on mental health annually.  The Report Card does state that mental health spending has increased by 4.5% per annum between 2005-06 and 2009-10.

It fails to contextualise this increase by stating that the AIHW report that overall health expenditure has been increasing by around 8.5% per annum over the same period meaning mental health’s share of the health budget is shrinking not growing.

The Report Card does not establish or propose any indicators or system of accountability.  Instead, worryingly, it states:

“We will also not waver from our view that governments need to agree and report on a small number of meaningful national indicators and ambitious but achievable targets.”

My concluding point is that this statement really represents largely business as usual; a situation in which governments and a small number of officials determine what is reported and how.

This is wholly inadequate, disenfranchising the mental health sector, health professionals, consumers and carers from what should be their central role in determining the mental health indicators that are most relevant to them.

Instead of articulating this, the Report Card instead suggests that the responsibility for establishing Australia’s system of accountability for mental health lies with the long-mooted National Mental Health Roadmap.  This Roadmap began life in the Commonwealth Department of Ageing; its current whereabouts are unknown.  The opportunity for the mental health sector to shape this roadmap has been minimal.

The Report Card purports to be an independent eye on the mental health system.  The construct of the mental health commission, as an office within the Prime Minister’s Department, naturally means that even with highly independent commissioners and dedicated bureaucratic support, there will always be a limit to the amount of independence available for such a Report Card.

The National Mental Health Commission was established largely in response to the high level of community frustration at repeated failures by the machinery of governments to properly address mental health.

This first Report Card suggests a new beginning, but seems to offer faith in some existing moribund processes.

The Report Card is presented as a mirror.  You can only see backwards in a mirror.  Perhaps the next Report Card should focus less about the past twenty years and more about the next twenty.

• Sebastian Rosenberg is Senior Lecturer, Brain and Mind Research Institute, University of Sydney

But before we come to its findings (which are summarised below, together with the launch address of Commission chair, Professor Allan Fels), let’s take a few minutes to consider some of the wider context.

• We live in a society which tolerates the incarceration of vulnerable and traumatised people who have not committed a crime, including children. As University of NSW researcher Belinda Liddell writes at The Conversation:

“Current immigration policies continue to promote uncertainty, fear and disempowerment among asylum seekers, which are known to contribute to poor mental health. There are also concerns that allowing asylum seekers to live in the community on bridging visas without the right to work could further exacerbate these feelings of helplessness.”

• We live in a society where the wounds of racism are prevalent. According to this recent report, Mental health impacts of racial discrimination in Victorian Aboriginal communities, documenting the experiences of 755 Aboriginal people, 97% of those surveyed had experienced racism in the previous 12 months, and over 70% experienced eight or more racist incidents. Imagine the stories of those experiences and their impact upon health and wellbeing.  Meanwhile, the Australian Financial Review has reported on the sexist and homophobic jokes told at an Australian Hotels Association function.

• We live in a society where governments are unable or unwilling or too cowardly to take on the industries which have such a profound impact upon mental health at a community and an individual level – (I’m thinking alcohol and gambling, in particular).

• We live in a society which pays a great deal of lip service to the importance of children and parenting, but is prepared to sacrifice children’s health to corporate profits, and to add to the burden of single mothers. According to a report in The Australian (sub only unless you google the headline), single mothers are being advised to turn to charities when their government allowance is cut back:

“Centrelink officers are advising single mothers who say they will not be able to cope when they lose welfare money under a budget savings initiative that begins in January to contact charities for help.

The government has come under fire, including from some Labor backbenchers, after passing laws to move single parents on to Newstart payments when their youngest child turns eight.

The changes will save the government $728 million over four years and will cost single parents up to $223 a fortnight…”

• We live in a society where the virtues of employment are regularly extolled but far less attention is paid to the distress caused by insecure work. Consider the ACTU inquiry report, Lives on Hold: Unlocking the Potential of Australia’s Workforce, which documents the toll that insecure work takes on individuals and family finances, health and wellbeing.

The inquiry learnt of one manufacturing plant in western Sydney where the entire staff were employed as casuals through a labour hire firm. Employees were expected to be available for a full-working week, and were notified by text message around 4pm each day of whether and when they were required to turn up the next day – but without any information about how long their shift would be.

These are some of the wider issues that should be part of our conversations about mental health and suicide prevention, beyond the provision of services.

Now to the report.

It frames mental health as a human rights issue, a community issue, and a life and death issue, and promotes the value of a “contributing life”.

It encourages us to see the importance of the interconnections between services, the place of families and support people, health care providers, co-workers, and teachers and friends.

It stresses the importance of listening to and learning from peoples’ experiences:  “The three straightforward messages we heard from the remote Aboriginal community of Ltyentye Apurte (Santa Teresa) ring true wherever we go – “Listen to us, involve us in decisions that affect us, support us to make our recovery successful.”

It includes a focus on:

• Aboriginal and Torres Strait Islander peoples’ mental health and wellbeing.
• The physical health of people with a mental health difficulty – which is worse than the general community on just about every measure.
• Connections with family, friends, culture and community, and participation in personally rewarding work, employment and community involvement.
• Housing (It notes, for example: The Commission is deeply concerned that since 2008, despite some attempts, thereis still no reliable and robust national measure of exits into homelessness from human services or government mental health and drug and alcohol services and centres. This is an absolute priority for the Commission and should also be one for Australia),  and
• Preventing suicide.

 ***

It identifies four priority areas

1. Mental health must be a high national priority for all governments and the community

The Australian Government must ask the Productivity Commission to work in partnership with us to report on the economic and productivity impacts of mental ill health and suicide in Australia and the value of
good mental health.

2. We need to provide ‘a complete picture’ of what is happening  and closely monitor and evaluate change

There are over 75 national mental health indicators, but these focus too heavily on health services. It is currently almost impossible to get a good picture of whether support is effective. Data doesn’t always show the important work being carried out in the community or by private providers or the important role that families, support people and peer workers provide.

It doesn’t tell us if people’s lives are improving, whether they are being treated with respect, or whether we have got the balance right in where we spend money.

Data must be rationalised and the right data collected with better linkages between data sets.

All governments must independently and transparently report each year on the actual expenditure on mental health prevention, community based, rehabilitation, recovery and acute care services and compare this with the announced expenditure. This way we will know that money committed to mental health is actually used in mental health, is used in the right areas and is not used to offset funding pressures or subsidise shortfalls in hospital or related budgets.

3. We need to agree on the best ways to encourage improvement and get better results.

The Independent Hospital Pricing Authority (IHPA), which develops the ‘national efficient price’ for public hospital services must have the authority to price an annual package of support that meets all of the health needs of people with mental health difficulties. If not, COAG will have got it wrong. We hope that COAG continues to drive improvement in mental health services and not push services back into hospitals. This will be more costly and less effective all round.

The National Disability Insurance Scheme must fully cover the psychosocial disability that results from mental illness.

4. We need to analyse where the gaps and barriers are to achieving a contributing life and agree on Australia’s direction.

All governments must prioritise the development and implementation of a nationally agreed mental health service planning framework. Unlike Canada and New Zealand, Australia has no nationally agreed picture of what a good mental health service framework should look like and how it should be properly resourced, nor of the role that families and support people should play in such services.

The framework should tell us what services people should get regardless of where they live, so there is the best use of resources to support people to gain the most improvement.

It must give a clear picture of the appropriate coverage, levels and range of mental health services needed at a regional level along with the workforce mix needed to deliver it.

A national service planning framework must over time move beyond beds and clinical services and include non- government/community services across all sectors, including peer and family workers.

COAG should give the Commission the role of monitoring progress against the Ten Year Roadmap for National Mental Health Reform  to assist in driving reform between government and other service providers. The Commission must be given access to the data needed to do this properly.

***

The report’s ten recommendations

1. Nothing about us, without us – there must be a regular independent survey of people’s experiences of and access to all mental health services to drive real improvement.

Action: The National Mental Health Commission will undertake a regular national survey of people with mental health difficulties and their families and support people. The survey will consider access to services, as well as perceptions and experiences. This will build on and complement existing efforts and ensure that people always have a voice and remain at the centre of decision-making about all the services that impact on them

2.  Increase access to timely and appropriate mental health services and support from 6-8 per cent to 12 per cent of the Australian population.

Action: All governments must agree and meet the target proposed in the Fourth National Mental Health Plan Measurement Strategy that 12 per cent of the population should be able to access mental health services in a year.13 There must be agreement to this indicator with an implementation plan and investment strategy to achieve this.

3. Reduce the use of involuntary practices and work to eliminate seclusion and restraint.

Action: All jurisdictions must contribute to a national data collection to provide comparison across states and territories, with public reporting on all involuntary treatments, seclusions and restraints each year from 2013. This information should be reported at the service unit level.

Action: The National Mental Health Commission will call for evidence of best practice in reducing and eliminating seclusion and restraint and help identify good practice treatment approaches.

We will do this in partnership with the Mental Health Commission of Canada and Australian partners, including the Safety and Quality Partnerships Subcommittee, Disability Discrimination Commissioner, Australian Human Rights Commission and interested state mental health commissions.

4. All governments must set targets and work together to reduce early death and improve the physical health of people with mental illness.

The three big drivers of early death are suicide, cancer and heart disease.

Action: All jurisdictions must contribute to a national data collection to provide comparison across states and territories, with public reporting on all involuntary treatments, seclusions and restraints each year from 2013. This information should be reported at the service unit level. Enduring mental illness must be given the status of a chronic disease to give it higher national focus and support.

Action: The physical health needs of people with mental health problems need to be given a higher priority in all areas of health. The initial focus must be on rapidly reducing cardiovascular disease by reducing risk factors such as smoking, poor diet and by increasing physical activity for people living with mental health problems.

Action: All government funded mental health related programs must also be measured on how they support people to achieve better physical health and longer lives. Priority should be given to the financing of multi-disciplinary primary care (through GPs and other primary health care organisations).

Action: All relevant services must give priority to tracking both the physical and mental health needs of those with enduring mental illness.

5. Include the mental health of Aboriginal and Torres Strait Islander peoples in ‘Closing the Gap’ targets to reduce early deaths and improve wellbeing.

Action: Mental health must be includedas an additional target in the COAG ‘Closing the Gap’ program. This must be done through the development and implementation of an Aboriginal and Torres Strait Islander Mental and Social and Emotional Wellbeing Plan to commence  in 2013. This must also address the current work and future findings of the Aboriginal and Torres Strait Islander Suicide Prevention Advisory Group.

Action: Training and employment of Aboriginal and Torres Strait Islander peoples in mental health services must increase. There must also be better support for Aboriginal and Torres Strait Islander families. There must be regular reporting on progress.

6. There must be the same national commitment to safety and quality of care for mental health services as there is for general health services.

Action: All governments must agree that there is the same emphasis on improving the quality of care and reducing adverse events in mental health services as applies to other physical health services. Governments must commit to implementing nationally agreed and mandatory service standards in mental health services as they have done for other health services. The National Mental Health Commission will work with the Australian Commission on Safety and Quality in Health Care (ACSQHC) to identify what it takes to get proper uptake of national mental health service standards and make them mandatory.

7. Invest in healthy families and communities to increase resilience and reduce the longer term need for crisis services.

Action: Increase enhanced and personalised support for parenting through culturally relevant forms of home-based visiting (ante-natal and in the first few years of life). These must be provided at a local or regional level. There must also be active follow-up where a family is under stress or experiencing tough financial or social difficulties.

8. Increase the levels of participation of people with mental health difficulties in employment in Australia to match best international levels.

Action: The National Mental Health Commission will pull together a Taskforce, including industry, government and community leaders to actively promote effective employment support programs and workplace based programs that increase the participation in employment of people with mental health difficulties.

The Commission will partner with the Business Council of Australia (BCA), Council of Small Business of Australia (COSBOA), the Mental Health Council of Australia (MHCA), Comcare and other key industry and community groups (including beyondblue and SANE Australia) to call for evidence and work together to advance the adoption of good workplace practices in Australia. This should support workforce leaders to change the way mental health is dealt with so that workplaces are more capable of dealing with mental health matters in a manner that leads to the betterment of the workforce and the workplace. The Commission will report progress.

Action: Employment support programs, initiatives and benefits must be more flexible. They must recognise that mental illness comes and goes and what that means for people and their families. Programs must provide long-term support for the employee, families and support people and the employer, with appropriate incentives and milestones.

9. No one should be discharged from hospitals, custodial care, mental health or drug and alcohol related treatment services into homelessness. Access to stable and safe places to live must increase.

Action: All governments must implement and report regularly on the existing COAG commitment of ‘no exits into homelessness’18 from statutory, custodial care and hospital, mental health and drug and alcohol services for those at risk of homelessness.

Action: Discharge planning must consider whether someone has a safe and stable place to live. Data must also be collected on housing status at point of discharge and reported on three months later, linked to the person’s discharge plan.

Action: Governments must commit to removing any structural discrimination barriers to people with mental health difficulties accessing social housing. Just as important is providing support to help vulnerable residents to settle in, adjust and remain in their homes.

10. Prevent and reduce suicides, and support those who attempt suicide through timely local responses and reporting.

Action: Programs with a proven track record (which are evidence-based) must be supported and implemented as a priority in regions and communities with the highest suicide or attempted suicide rates – action needs commitment and a humane approach.

Action: Develop local, integrated and more timely suicide and at-risk reporting and responses. These should be co- ordinated, community based, culturally appropriate, early response systems and suicide prevention programs. They should promote community safety, reach the most vulnerable, and use up-to-date information from the ‘first responders’ such as Police officers, occupational health workers, ambulance officers and mental health workers.

 ***

The report also highlights a lack of accountability 

It says:

“It is not good enough when we know that as a nation we spent over $6.3 billion or $287 per Australian on mental health- related services in 2009-2010.

This expenditure has seen an average annual increase of 4.5 per cent of spending per Australian between 2005-06 and 2009-10.30 But there is little or no accountability as to what improvements we are getting for such a significant investment, whether it improves the health and wellbeing of people with a mental illness and provides them with the services.”

The report also says that increased access to psychological services under the Better Access and other initiatives have not addressed inequities, and that there are also unanswered questions about the effectiveness of services. It says:

“…increased access to services under these programs was not evenly shared across all communities. Under the Better Access program, people living in rural and remote areas had lower rates of access than those in cities. Young people also had lower rates of access… we start to see that services are growing, but not necessarily connecting with the people who need them most.

In short, we are currently unable to track if services are providing the right type of quality care and interventions – be it from a lived experience, family or government perspective – and whether these are making a difference.”

***

The Commission’s agenda for the future

Its forward work program includes:

• Undertaking a regular qualitative, whole-of-life survey that will capture the experiences of people with mental health difficulties and their families and supporters.

• Looking to governments to develop a set of national mental health performance indicators and targets that will tell an honest picture of how Australia is performing. If the Ten Year Roadmap for National Mental Health Reform doesn’t deliver, we will work with others to develop these

• Examining how Australians really think and feel about mental health, mental illness and suicide, including stigma and discrimination.

• With business leaders and other partners, calling for evidence on and working to advance good workplace practices. We will also take a broader look at the full impact of mental illness in Australia, on our work and the economy.

• Calling for evidence on the best international practice in reducing and eliminating the use of seclusion and restraint, in partnership with the Mental Health Commission of Canada and key Australian bodies

• Releasing a snapshot on how to engage young people in our work to ensure that they have a voice in our future Reports and the drive for improvement.

• Working with the Australian Commission on Safety and Quality in Health Care to look at what it takes to get the proper uptake of national mental health service standards and make them mandatory.

• Progressing mental health workforce issues commencing with a collaboration with Health Workforce Australia on the peer workforce.

• Providing policy input to the National Disability Insurance Scheme and Activity Based Funding

• Supporting the establishment of an International Knowledge Exchange to help in identifying and promoting evidence-based practice.

****

 Speech Notes for Professor Allan Fels, Chair of the National Mental Health Commission

Australians are comfortable talking about a lot of things, but mental illness isn’t one of them.

However, learning from personal stories and experiences is essential to developing a new narrative, a new view of mental health in Australia.

I thank everyone who has given their time to speak with us this year about their lived experiences of mental health difficulties or their experiences supporting others.

Sharing personal stories takes immense courage.
I’d particularly like to acknowledge:

… Chris, Julie, Maddison, Kathleen, John, Kylie, Emma Leigh and Madeline, Greg, Elaine, Men, Carol, Carmel, Pat and Keith, Jasmine and Cindy

… whose stories are featured in our videos and this Report Card.

At the same time we can’t do enough justice to the overwhelming good work of people in support services and elsewhere, and the very positive initiatives that are happening across Australia every day.

We commissioners all felt a strong sense of responsibility while we developed the first of our Annual Report Cards, in our first year of operation.

Today over 7 million Australian adults have experienced a mental illness.
One in five Australians will experience a mental health difficulty in any given year.

Virtually every family has their own story but these personal stories are too often never heard.

For this reason, the Commission has placed people with a lived experience of mental health difficulties, as well as their families and supporters, at the core of all we do.

So when you read our report you’ll see that it’s different to the kind of report you might normally see because it goes far beyond the clinical and the medical.  It looks at the whole life of those with mental health difficulties.

And the theme of our report card reflects a theme that came up again and again during our conversations with members of the community and our many stakeholders this year – A Contributing Life.

When we talk about a contributing life we mean a fulfilling life.

We mean a recognition that people living with mental health difficulties want and need the same things as everyone else, including a stable home, something meaningful to do, something to look forward to, strong connections to family, community and culture, and access to effective care, treatment and to services. To not be discriminated against. To have their rights acknowledged and acted on.

We have therefore written this report card for all Australians and we say:

We don’t care about political divides, and state divides.

We aren’t interested in buck passing, excuses, or even what’s been deemed to be acceptable.

We care about giving all in our Australian community a fair go.

We care about services, but more importantly, we care about people.

We especially care that right now, even when excellent services are being provided, they often are not wrapped in an approach that looks at the whole life of a person with mental health difficulties. Therefore they don’t necessarily offer people who experience a mental illness the best chance of recovery and a contributing life. And that includes their families.

I hope that we will all will look back on today as a special day

… when all Australian governments and communities recognised that mental health and suicide prevention are and must remain a high, national priority and found the courage to address some difficult truths.

In particular, here are some of the things that worried us that we believe must, and can be fixed:

We are shocked and saddened by the long-term high rates of physical illness and early death among people with mental health difficulties.

The statistics related to the physical health of these Australians are appalling.
Their health is worse than those in the general community on just about every measure.

Looking at people living with severe mental illnesses such as bi-polar disorder, schizophrenia or psychosis

… their life expectancy is reduced by 25 years on average because they face an increased likelihood of heart related conditions, diabetes and obesity.

We know that there are several reasons for the poor physical health of those with severe mental illness.

First, some antipsychotic medications prescribed to manage mental illnesses such as schizophrenia also contribute to the likelihood of developing chronic physical disorders.

…This is a difficult issue.  But it is something that people living with mental health issues, families, supporters and community members raised with us again and again during the year.

Second, smoking, poor nutrition and physical diseases have a major bearing on physical health – and their incidence is high amongst people living with severe mental illness.

…Mental health difficulties too often overshadow chronic physical problems.

And health carers in either hospital or the community can underemphasise physical health problems when they see a person with a mental illness.

Third, suicide contributes to the worse death rate of those with severe mental illness.

Physical health and mental wellbeing are weaved intricately together and they need to be treated as such.

It highlights that mental health practitioners and GPs must work very closely together, and as part of a team with the person, and their family.

In relation to Aboriginal and Torres Strait Islander peoples, the Commission is also concerned that dealing with mental health problems is not currently included in national policy targets even though cardiovascular disease and mental illness are the two leading drivers for the burden of disease.

Another concern relates to the rates of involuntary commitment and treatments, which have remained stubbornly around 30 per cent, and the lack of public data around seclusion and restraint of people in care situations.

In 2005, all Australian governments agreed to reduce and where possible eliminate seclusion practices and treat people in care in the least restrictive way, but only four jurisdictions report seclusion rates publicly.

This is a very difficult and complex area and we don’t have all the answers
…but in the very least, the community must have the opportunity to see the data and contribute to the discussions on this issue.  All governments must meet their legal obligations and existing commitment to ensure that involuntary treatments, seclusion and restraint of people in distress are minimised or eliminated.

And they must report publicly across all states and territories from 2013.

Other urgent actions include:

• stopping people from being discharged from mental health services into homelessness or unstable homes
• providing effective, local interventions to prevent suicide
• increasing access to mental health services from 6-8 to 12 % of Australia’s population
• and increasing access to home based visiting to support families and children.

The Australian community, service providers and all employers, have an important role to play too because Australia is not realising people’s potential.

We foresee real potential for improving the productivity of workplaces by supporting employers and employees alike to proactively increase participation rates of people living with a mental health condition.

This is an area where, with the willing support of business, we will do much more work next year.

These are just some of the issues we have raised in our report.

However, we had to make some very tough decisions on what we could cover in our first report this year.

We know that there are issues, problems and system gaps, and that many different groups of people, such as those from culturally and linguistically diverse backgrounds, veterans, refugees, people with intellectual disability and those living with borderline personality disorders and others face very real challenges.
Throughout the years ahead we will work on additional areas requiring a special focus such as these, as separate pieces of work.

This year we have also had to rely on existing data and statistics – much of which is incomplete or not particularly helpful.

For example, in 2009-10, we know that 1.7 million Australians (8% of our population) accessed public and private specialised mental health services.

Also, Australian taxpayers contributed $6.3 billion towards mental health service provision.

This is a significant investment. Yet there is little or no accountability as to whether these services improved the health and wellbeing of people with a mental illness, or provided them with the services they need.

In other words, we don’t know if they assisted people to move towards a contributing life.

Australia leads the world in progressive mental health policy, but it still falls down in delivery.

When the Commission was established this year attached to the Prime Minister’s portfolio, it kept mental health’s place at the top table, and the commitment to drive reform across all parts of government and the service system.

It also moved mental health out of the health sector and across each and every sector of a government’s portfolio and in every part of the community.

We believe that Australia can improve the lives of millions of Australians if the Prime Minister and State and Territory leaders find the courage to act tenaciously in their interests.  We look to them to reaffirm their commitment to improve services and supports to that people have the opportunities to live contributing lives.

This will require continuing, strong bi-partisan support, and COAG’s leadership and commit to working collaboratively and swiftly to address the issues this world’s-first report has raised.

This means:

• reaffirming that mental health is a high national priority for all governments and the community
• agreeing on the right incentives to drive good services
• providing ‘a complete picture’ of what is happening and closely monitoring and evaluating change
• analysing  the gaps and barriers to achieving a contributing life and putting a framework in place that sets Australia’s direction

This evidence and experience needs to demonstrate what represents good value for the taxes we pay.

And the real measure of success is whether services and support are being provided in ways that make a positive difference to vulnerable people’s lives.

This includes promoting inclusive approaches to supporting people with mental health difficulties

… which will include their families and support people as part of the one team, offers the best recovery pathways.
The Commission takes its role in holding Australian governments accountable extremely seriously.

We will be back with our second Report Card in 12 months’ time, reporting on what’s happened, whether people’s stories have changed and where things have improved.

 ***

Reaction and further reading

• Statement from headspace

• Statement from National Congress 

***

 • Next at Croakey: Sebastian Rosenberg’s report card on the report card – could do better next year…

Paul Fitzgerald, Professor of Psychiatry at Alfred Health and Monash University, kicked off the series with an explainer on what the DSM is and how mental disorders are diagnosed:

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a publication of the American Psychiatric Association. It was originally published in 1952 to provide a standardised means for making and coding psychiatric diagnoses.

The DSM is currently undergoing its fifth revision, planning for which has been underway since 1999. This process has generated world-wide debate which has escalated as we approach its publication date. The DSM-5 is due to hit psychiatrists’ shelves in May 2013.

Read the full story here

**

Hans Pols, Associate Professor, History and Philosophy of Science at the University of Sydney, charted psychiatry’s move away from talking therapies to pharmacotherapy:

You’re feeling down. But do you have a low mood because you’re dealing with the loss of a loved one, a break-up or divorce, or abusive co-workers? Or are you suffering from a depressive disorder: a recognised mental illness caused by an imbalance in the neurotransmitters in the brain, for which a variety of effective medical treatments are available?

Modern psychiatry no longer views our low moods as misguided reactions to life’s challenges. Instead, negative emotions are seen as biomedical problems which often require a prescription. This fundamental change in psychiatry occurred in the 1980s, when we shifted from the second to the third edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (the DSM).

Read the full story here

**

Dominic Murphy, Director for the Unit of History and Philosophy of Science at the University of Sydney, looked at cultural variations in mental illness and the need to take cultural differences into account:

There’s an old saying that psychology has two model organisms: the rat and the American college student. As research subjects rats are fine, the problem is that that Americans are, as evolutionary psychologist Joe Henrich and his colleagues recently pointed out, WEIRD. That is, they’re Western, Educated, Industrialised, Rich and Democratic. In fact, most westerners are WEIRD, but Americans are the WEIRDest of all.

People in western countries have values and minds that are not like those of the rest of humanity. These differences should not be overstated, but they are real, and they have implications for the cognitive sciences that we are only just beginning to explore.

Read the full story here

**

Imogen Rehm, PhD Candidate and Richard Mouldling, Lecturer, Clinical Psychologist from Swinburne University of Technology, discussed the difficulty in classifying compulsive hair pulling into a clinical category:

Trichotillomania is a psychological disorder where individuals feel the urge to remove their bodily hair, to the point of obvious hair loss.

While the general community remains largely unaware of the condition, psychiatric cases date back to 1889, when the French physician Francois Hallopeau described a male patient who “manically” pulled out his scalp hair, resulting in bald patches.

Read the full story here

**

Michael Kyrios, Professor of Clinical Psychology & Director, Brain & Psychological Sciences Research Centre at Swinburne University of Technology, examined why the DSM-5 will categorise hoarding as a separate diagnosis:

We’ve all got boxes of old letters, clothes and other keepsakes we’ve collected over our lifetime. Sometimes these boxes or shelves seem to take over spare rooms and garages. But while we might joke that we’re “a bit of a hoarder”, there’s a big difference between holding onto important mementos and compulsive hoarding.

Hoarding is the persistent difficulty discarding or parting with possessions and their ultimate stockpiling – regardless of their value. Possessions may include objects or animals, with the resulting clutter rendering living spaces unusable, unsafe or unhygienic.

Read the full story here

**

Peter Parry, Child and Adolescent Psychiatrist and Senior Lecturer at the University of Queensland, looked at the confusion around labeling mental disorders in children and teenagers:

As a child and adolescent psychiatrist my daily work involves diagnosing children and young people with various mental disorders. There are diagnostic manuals to guide me: the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the mental disorders section of the the International Classification of Diseases of the World Health Organisation, 10th Edition (ICD-10).

These manuals give algorithms and criteria by which diagnoses can be made. Since its third edition in 1980, the DSM has mostly followed the “medical model” of diagnosing by checking off lists of symptoms with little reference to past or present life stressors or the person’s coping or personality style. And ICD-10 followed the same post-DSM-III model.

Read the full story here

**

Jon Brock, ARC Research Fellow in Cognitive Science at Macquarie University, discussed the controversy surrounding the DSM-5’s redefinition of autism:

For autistic people and their families, getting an autism diagnosis is just the first step in a long struggle to access much-needed intervention, support, and appropriate education.

In Australia, as in many countries, autism diagnoses are made according to criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The latest update to the manual, the DSM-5, is due for publication in May 2013 and will bring significant changes to the definition and diagnosis of autism.

These changes reflect a continually evolving understanding of autism, as well as a desire to make autism diagnosis simpler and more reliable.

Read the full story here

**

Andrew Kemp, NHRC Career Development Fellow at the University of Sydney and Andre Brunoni, Psychiatrist and researcher at the University of Sao Paulo, outlined the controversies around pharmaceutical companies, depression and prescribing:

In Australia, antidepressant medications account for 61% (13.7 million) of all mental health-related subsidised prescriptions, followed by anxiety-reducing medicines. One in five Australians aged 16 to 85 are afflicted by either a mood, anxiety or substance-use disorder.

We now know that depression is not just a disorder of the mind; it also increases risk for a host of conditions and diseases, and mortality. Hence the need for effective treatments.

Read the full story here

**

Richard Bryant, Professor and Director of Traumatic Stress Clinic at the University of New South Wales, looked at the inclusion of prolonged grief as a mental disorder in the DMS-5:

Grief is one of the most universal and distressing experiences that humans suffer.

For most people, the emotional pain of losing someone close to them lasts for a relatively brief period. Many studies indicate that by six months after bereavement, most people begin to experience remission of the severe grief response. Waves of grief may come and go for months or years afterwards but these reactions don’t impair or limit a person’s capacity to engage in life’s activities.

In contrast, a proportion of bereaved people (approximately 10% to 15%) suffer persistent grief that can last for many years. Many studies from different countries and cultural settings have documented that severe yearning for the deceased that persists beyond six months is associated with marked impairment and difficulty in engaging with people and in activities.

Read the full story here

**

Gemma Lucy Smart, MSc Candidate and Dominic Murphy, Director of the Unit for History and Philosophy of Science at the University of Sydney, explained why the DSM-5 will reintroduced the term ‘addiction’ after its absence from the current edition:

The term “addiction” is conspicuously absent from the pages of the current Diagnostic and Statistical Manual of Mental Disorders, the DSM-IV. That’s because in the 1980s, the committee working on the DSM-III-R were keen to avoid the cultural baggage and stigma associated with the word addiction. They hoped to provide more neutral and clinically useful terms by using “dependence” and “abuse” in the current category substance-related disorders.

Experience proved this to be a mistake – the terms were confusing and misleading.

Read the full story here

**

A reminder to Croakey readers that TC articles are freely available for republishing under a Creative Commons license.

In the article below, he responds to a recent 4 Corners program investigating a series of youth suicides, and suggests that future media reports should also explore the “unwitting conspiracy that serves to maintain a social status quo increasingly hostile to young people and their wellbeing”.

And below his article are links to related recent research publications, with some suggestions for improving the mental health of Indigenous children, and a study showing an association between the use of online cognitive behaviour therapy and a reduction in suicidal thoughts amongst people with depression.

***

Investigating the wider factors affecting  the health and wellbeing of young people

Richard Eckersley writes:

The recent 4 Corners program on ABC TV once again drew our attention to youth suicide. As is often the case with the media, it focused on the latest cluster of deaths, this time in Melbourne’s south-east, and dwelt heavily on the ‘human interest’ of intensely personal tragedies and their impacts on families, friends and communities.

And so, as is also usually the case, the program missed the opportunity to explore the deeper dimensions of what is happening to young people’s health and wellbeing. The failure is understandable. You won’t get this perspective from psychiatrists and psychologists, for whom suicidal behaviour is an individual illness requiring treatment. You won’t get it from governments, who take their cue from medical professionals.

To the extent that social explanations are offered, they tend to focus on structural changes in the family, education and labour market: conflict and breakdown, exclusion, disadvantage, joblessness. Too much blame is directed at parents, too much is expected of teachers, and too much emphasis is placed on medical interventions (although all have an important role to play).

It’s more from the arts that a different understanding comes. As French Nobel Prize-winning writer Albert Camus commented: ‘There is but one truly serious philosophical problem, and that is suicide. Judging whether life is, or is not, worth living amounts to answering the fundamental question of philosophy.’

Theo Padnos, an American prison teacher with a doctorate in comparative literature said of youth violence:  ‘In a world stripped of meaning and self-identity, adolescents can come to understand violence itself as a morally grounded gesture, a kind of purifying attempt to intervene against the nothingness’.

This also applied to violence against the self. Intentional self-harm (which can become suicidal) reflects a deeply human need to turn intangible suffering into tangible pain, to transform the passive experience of suffering into something we can actively control.

As one young woman, whose body was criss-crossed with scars from self-inflicted cuts, revealed: ‘When I saw the blood, I stopped thinking about what was happening inside. And I just focused on that, and that was really powerful: that something external could grab all of my attention and I could think about that, rather than what was going on inside my head’.

Australian novelist Ruth Park, in describing in her autobiography growing up in New Zealand during the Depression, wrote: ‘Whatever hardship came our way was all on the outside. Inside we knew, without doubt, that Life was aware of us and somehow had us in its care’.

She does not elaborate, but she is not talking specifically of God or religion; she appears to be describing a sense of intrinsic worth, spiritual comfort and existential confidence instilled by a web of influences: church, yes, but also family, community, school and nation.

These are all ties that modern Western culture, with its emphasis on materialism and individualism, tends to loosen (my own research showed strong associations between national youth suicide rates and measures of individualism). It can leave young people dangerously adrift, at the mercy of relentless (and ruthless) consumer pressures and the superficial, distorted and transient connections of the mass and social media.

It leaves too many young people stuck ‘inside their heads’, mixed up, struggling to make sense of their lives and to deal with a welter of emotions that becomes too confusing, too painful. The self is being hollowed out. Loneliness, isolation and self-absorption co-exist with constant, even obsessive, connection and social activity.

American literary scholar William Deresiewicz observes in a 2009 essay, ‘The end of solitude’, that the contemporary self wants to be recognized, connected, visible. ‘This is how we become real to ourselves – by being seen by others. The great contemporary terror is anonymity.’ His students have little time for intimacy, and no time for solitude, he says. There is no mental space that is not social.

Our cultural focus on the external trappings of ‘the good life’ increases the pressures to meet high, even unrealistic and inappropriate, expectations, and so heightens the risks of failure and disappointment. It leads to a constant need to make the most of our lives, to fashion identity and meaning increasingly from personal attributes, achievements, possessions and lifestyles, and less from shared cultural traditions and beliefs. It distracts us from what is most important to wellbeing: the quality of our relationships with each other and the world, which contribute to a deep and enduring sense of self-worth and existential certainty.

We struggle to understand the intangibility and subjectivity of what lies behind youth suicide – and young people’s wellbeing more generally. Added to this are the multiplicity of other factors implicated in youth health problems, and the complexity of their interactions. At a personal level these include changes in diet, sleep, physical and outdoor activity, experience of nature, drugs, sex and relationships. At a societal level are the broader changes in the worlds of family, education, work, religion, leisure and entertainment, the natural environment – and an increasingly uncertain global future.

Modern Western culture – our collective worldview, values, beliefs and priorities – is a fundamental determinant of all or most of these things.

One specific influence raised by the 4 Corners program was that of the social media on individual suicides and suicide clusters. Researchers have warned that sensational or detailed media coverage can contribute to suicide clusters, especially among adolescents.

American psychologist Madelyn Gould, who has studied suicide clusters, was quoted by the BBC in 2008 as saying: ‘It’s like the first person who commits suicide becomes a sort of role model for those who come afterwards. And if you are vulnerable and depressed then the fact that someone has gone ahead and done it might be enough to tip the balance inside your mind. Suddenly, suicide becomes a realistic option.’

It seems plausible that social media like Facebook could have an even more potent role because of the more personal connection between people. Gould says that victims of cluster suicides are usually not best friends, but they know each other, or have heard of each other. Social media would greatly enlarge that pool. Certainly the suicide on which the program focused – that of a teenage girl who disclosed her growing distress to her 600 Facebook ‘friends’ – suggests this hazard. There was a sense that Facebook provided not so much a source of support as an audience before which her despair was played out.

Maybe it did both. New technologies often amplify both the good and bad in human behaviour. With the intended benefits also often come unintended harms. This goes for social media.

The program showed local young people responding to the spate of deaths by setting up a Facebook page to assist their peers, with links to online sources of help. But it also hinted at Facebook’s darker role in effectively ‘turning up the heat’.

Can the social media romanticise or glamorise suicide, especially for teenagers? Can they crowd out more intimate and supportive relationships? Have suicide clusters become more common in the last decade or two because of the growing importance of social media in young people’s lives?

Youth suicide rates have fallen significantly in Australia since 1997 (although data quality is an issue with the trend). But suicidal behaviour and self-harm remain a concern, a part of a widely perceived crisis in mental health. While youth suicide is rare (284 deaths among 15-24-year-olds in 2007, a rate of 10 per 100,000), it remains the second biggest killer of young people, and it represents the extreme end of a spectrum of distress that affects many, many more. This distress contributes to more suicides in later years (the suicide rate is highest among those in their thirties).

Youth suicide has been on the political, health and scientific agenda for over 20 years. Yet, as a society, we still fail to understand and deal with it appropriately because neither governments, nor the health and education professions, nor the media will face up to what this existential predicament means and what is causing it.

It is an unwitting conspiracy that serves to maintain a social status quo increasingly hostile to young people and their wellbeing. Awareness of these matters needs to become part of parenting, teaching, public health – and of media reporting and political debate.

• This article has also been published by Crikey. Richard Eckersley is a director of Australia21, a not-for-profit research company (www.australia21.org.au). He has been researching and writing about youth suicide as part of an analysis of youth health and, more broadly, of social progress and wellbeing, for over 20 years.

See also his previous article at Croakey: Challenging accepted wisdoms about young people’s health

***

PS from Croakey: some recent related publications that may also be of interest

• A Western Australian study, published by BMC Public Health, has investigated the role of socioeconomic factors in the mental health problems of Aboriginal and Torres Strait Islander children.  The researchers say their findings generally indicate that higher socioeconomic status is associated with a reduced risk of mental health problems in Indigenous children. They conclude that improving the social, economic and psychological conditions of families with Indigenous children may help close the substantial racial gap in mental health. They say: “Interventions that target housing quality, home ownership and neighbourhood-level disadvantage are likely to be particularly beneficial.”

• A NSW study suggests that patients who have suicidal thoughts can be included in clinical trials of  internet cognitive behaviour therapy (iCBT) for depression.

The study, published in BMJ Open, was based on a clinical audit of 299 patients prescribed an iCBT course for depression by primary care clinicians. They had six lessons of a fully automated cognitive behaviour therapy course delivered over the internet.

Suicidal ideation was common (54%) among these patients, but dropped to 30% post-treatment despite minimal clinician contact and the absence of an intervention focused on suicidal ideation. This reduction in suicidal ideation was evident regardless of sex and age.

The researchers said: “To our knowledge, this is the first study to document an association between iCBT for depression and reductions in suicidal ideation.”

The researchers, from St Vincent’s Hospital in Sydney, have previously done two randomised controlled trials of their iCBT programme for depression but these had excluded patients with suicidal ideation. “On the basis of the current results it is now difficult to justify excluding patients from clinical trials on the basis of their high suicidal ideation scores when iCBT can reduce them quickly and effectively,” they reported.

This UNSW press release has more information.

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If you or someone you know needs help, contact Lifeline’s 24-hour helpline on 13 11 14, SANE Australia on 1800 18 7263 or the Beyondblue Info Line 1300 22 4636. See here for more suicide crisis numbers and contacts.

Here is the latest compilation, covering articles posted between 11 April and 3 September. As always, thanks are due to the many contributors who generously volunteer their time to research and write articles.

The latest readership figures are available here, showing that Croakey has had 95,554 unique visitors so far this year. You can also see snapshots showing the ten links that received the most hits, over this period and over the previous three months (the Naked Doctor column by Justin Coleman has drawn a lot of attention).

The links below have been grouped into these categories:

• Racism and health
• Indigenous health
• The unhealthy trifecta: tobacco, alcohol and pokies
• General public health matters
• Rural and remote health
• Mental health
• Journal watch (public health highlights)
• Social determinants of health
• Primary health care and Medicare Locals
• Health reform and health policy
• Aged care reform
• Dental reform
• Social media and media-related issues
• Pharma

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Racism and health

Shame on Facebook, but let’s not forget that racism is a wider public health problem
Tim Senior

One more reason to stop discussing health as a “lifestyle issue” (racism)
Jerril Rechter

***

Indigenous health

Is the media juggernaut sidelining good policy in Indigenous affairs?
Tim Senior

Indigenous health professionals working in the alcohol and drug field deserve better
Kate Conigrave

For your viewing pleasure: hip hop meets Indigenous health

From Songlines to Twitter: communicating and connecting for Aboriginal health
Justin Mohamed

Why do I work in Aboriginal health? (And more news from the world of social media and health)
Tim Senior

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The unhealthy trifecta: Tobacco, alcohol, and the pokies

A wrap of reaction to the High Court decision on plain packaging

What have the tobacco and pharma industries got in common?
Marita Hefler

Medicines Australia: we support plain packaging of tobacco products

Will social change help reduce smoking rates amongst disadvantaged Australians?
Billie Bonevski and Amanda Baker

The corporate interests that harm health: from the Olympics to closer to home
David Thomas

Support Big Tobacco (it’s fun)

Anti-smoking campaigns should focus on how big companies are using young people
Rick Turner

Naming and shaming irresponsible alcohol advertisers
Rebecca Johnson

A 7-point plan for tackling the grog toll; a memo for the NSW Premier; and the shop keeper who has taken a stand
Anthony Shakeshaft

Can bloggers help to change our drinking culture? Is alcohol your best friend? And a few other questions still to be answered…
Margo Saunders

To tackle our drinking problem, look to Newcastle – and closer to home too
Laurence Alvis

The new Clubs Australia campaign borrows heavily from tobacco industry strategies
Charles Livingstone

The unhealthy trifecta: tobacco, alcohol and gambling industries
Charles Livingstone

***

General public health

ACT prisons announcement hailed as an “historic” decision for public health and human rights
Michael Moore

Public health is in the firing line in Queensland

A mega-wrap of recent news on climate change and health

On carbon tax eve, how is the health system placed?
Prue Power

Leaked letter reveals pressure on NHMRC from the anti wind farm brigade
Simon Chapman

Why is it so hard to be a public health hero in Australia? (And more reading on “Nanny Bloomberg”)
Margo Saunders

If New York City and Mayor Bloomberg are the trend-setters for public health in the US, where are their equivalents in Australia? Any suggestions?

Using the law to create healthier environments: recent developments from NYC to Victoria
Jane Martin

A local council takes on fast food: is this the future for improving public health?
Jane Martin

Why health claims may not be good for your health
Rosemary Stanton, Jane Martin

Call for crackdown on “bargain” deals for solarium visits
Jen Makin

Standing up for the sake of employees’ health. Literally.
Todd Harper

How best to improve management of childhood obesity and related health problems?
Amanda Carne

Does the ‘fat tax’ measure up?
Suzie Ferrie

For those interested in research dissemination, knowledge translation and giving better presentations…

Marking International Chagas Day and creating some noise about a silent disease
Unni Karunakara

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Rural and remote health

Some solutions to health workforce shortages
Richard Murray

Remote health conference calls for regulatory action on quad bike safety

A red letter day for rural and remote health – provided these questions can be answered
Gordon Gregory

Why health promotion campaigns in rural and remote areas must be “fit for purpose”
NRHA

Sustaining small rural primary health care services
Olga Anikeeva

Pros and cons of telehealth for people in rural areas
Rachel Katterl

***

Mental health

What does it take to improve mental health? Some insights from three voices of experience
Trevor Hazell, Ian Fels, Jack Heath

Over the past 17 years, what has changed for people with mental illness?
Q and A with Barbara Hocking

Some recent reports on preventing suicide, and providing better support to the bereaved
Jaelea Skehan

To improve men’s mental health, focus on education, employment and providing services that men want to use
Sebastian Rosenberg

An important policy gap: mental health in early childhood

***

Journal Watch

A call for more research and planning to deal with the public health challenges of mega-events
Melissa Stoneham

Environmental factors that promote cycling
Melissa Stoneham

A focus on the corporate practices that contribute to poor health
Melissa Stoneham

A wrap of recent news on McDonald’s, marketing and health (and some parallel universes)
Melissa Stoneham

***

Social determinants of health

Will the Senate inquiry lead to action on the social determinants of health?
Fran Baum

What are the signs of a healthy #goodsociety?
John Falzon

What have the Olympics got to say about social justice and health inequalities?
Marie McInerney

Health experts support calls for increase to unemployment benefits
Andrew Podger, Vern Hughes, Gawaine Powell Davies, Mary Chiarella, Hal Kendig, Tim Woodruff, Justine Caines

Where is the health sector when it comes to addressing poverty?
Tessa Boyd-Caine

What are the health implications of building more prisons?
Jonathan Heller

When will policy catch up with the science on drug prohibition?
Alex Wodak

In case you missed this series on the need for drug law reform
Andrew Jakubowicz, Alex Wodak, Monica Barratt, Alison Ritter, Mike Pottenger, Alex Steel, Justin Norrie

New book investigates the links between power and health
Luke Slawomirski

Reporting on a recent forum on health inequalities and the social determinants of health
Deborah Lupton

Pressure mounting for action on health inequities
Rebecca de Boer

A new report highlights the cost of health inequalities: but what’s the real story?
Gavin Mooney

Is the post-budget “class warfare” discussion helpful for public health?
Gavin Mooney

Do doctors treat their better off patients differently? Plus a wrap of Australian and global news on health inequalities
Mae Hurley

Raising awareness of the health needs of homeless people
Debra Cerasa

Some news for those with an interest in the arts and health
Gordon Gregory

Breaking down the digital divide: two case studies
Mark Egan

The digital divide and its implications for health, services and conferences. And a prediction for the future…
Caroline Chen

What does the NSW review of health and medical research say about a critical health concern?
Sally Redman

***

Primary health care and Medicare Locals

 Some reports from a recent primary health care conference – and who is standing for the Australian Medicare Local Alliance board

A critical challenge for health reformers: how to hear from those with the greatest need?
Vahid Saberi and Lesley Barclay

The great adventure story of Medicare Locals: will it have a happy ending?
Jennifer Doggett

Memo to Peter Dutton and others who don’t “get” Medicare Locals: this is what they’re doing and where they’re heading
Vahid Saberi, Tony Lembke

Federal Opposition rebuked over plans to abolish Medicare Locals
Jon Wardle

Peter Dutton urged not to “turn back the clock” on primary health care reform
Mark Harris, Daryl Sadgrove, Australian Medicare Local Alliance, Carol Bennett, Prue Power, Vern Hughes, Gavin Mooney, David Briggs, Marilyn Wise, Rosemary Stanton, John Dwyer, Gawaine Powell Davies.

Learning from the “pioneers of ehealth” in general practice
Samantha Smorgon and colleagues

Ehealth records: too important to muck up
Robert Pask

Sounding the alarm over cutbacks to Qld organisation for lesbian, gay, bisexual and transgender health
Daniel Reeders

Should your doctor be asking after your pet too?
Amanda Carne

Nurses add value to chronic disease management
Petra Bywood

For patients to play a more active role in managing chronic health conditions, some changes are needed
Olga Anikeeva

***

Health reform and health policy

Health Workforce Australia report gives the nod to physician assistants
Ben Stock

Tweet of the week…Stephen Duckett on health reform

A wrap of health policy reading
Jennifer Doggett

Engaging leadership – what does it mean for health reform in Australia?
Daryl Sadgrove

Some metaphors for the future of healthcare: from tsumamis and trains to frogs, bikes and jigsaw puzzles
Fiona Armstrong, Chris Rissel, Tony Webber, Andrew Roberts, Merrilyn Walton, Gab Kovacs, Jon Wardle, Ron Batagol, Hudson Birden, Vern Hughes, John Menadue, Peter Sainsbury,Ben Harris-Roxas, Alan Rosen, David Gillespie, Gawaine Powell Davies, Amanda Wilson, Kishan Kariippanon, Ian Cameron, Ian Hickie, Wendy Oakes, Lesley Barclay, Yvonne Luxford, David Briggs Rob Loblay, Gavin Mooney, Ken Hillman, Gawaine Powell Davies, Stephen Leeder, Ken MacWilliams, Ed Butler, Simon Chapman

A leader’s reflection on health reform: the merits of “muddling through” and more
Stephen Leeder

Out-of-pocket health costs: adding to the burden on patients
Kellie Bisset

What can we learn from the history of health reform in the UK? (part 1)
Terrie Paul

What can we learn from healthcare reform in the UK? (part 2)
Terrie Paul

Tasmania’s healthcare system: it needs more than money
Rebecca de Boer

The Tasmanian health rescue: don’t break out the champagne just yet
Martyn Goddard

The financial crunch and its impact on health – globally, nationally and locally (with particular reference to Tasmania)
Martyn Goddard

What is the evidence on knowledge translation strategies?
Christina Hagger

Some useful tips for finding health policy information on the web
Christina Hagger

Informed consent: it’s not a reality for too many patients
Carol Bennett

Have we reached a critical tipping point with healthcare?
Alan Cassels

Overuse of healthcare: some suggestions for how to tackle it
Tim Woodruff

Are Australian women’s birthing rights now perched on a slippery slope?
Hannah Dahlen

*** 

Aged care reform

Aged care reform: it needs careful monitoring (and adjustment, where necessary)
Rebecca de Boer

Aged care reforms an important step in the right direction, but many questions and concerns remain
Hal Kendig

An indepth analysis of aged care reforms, covering community care, rural/regional concerns and more
Rebecca de Boer

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Dental reform

Wrapping the news on dental reform into a rather pretty image

On dental reform: there is plenty more to do
Jennifer Doggett, Alexis Zander

 http://blogs.crikey.com.au/croakey/2012/08/30/on-dental-reform-there-is-plenty-more-to-do/
A cautious welcome for dental reforms, but concerns remain about underlying systemic problems with health “system”

A wrap on the dental health reform package – an overview, analysis & some reaction

Should dental reform aim to benefit dentists – or the community?
Tim Woodruff

Better oral health for all: what will it take?
Lexia Smallwood and Gordon Gregory

Why has dental health been getting the brush off?
Gordon Gregory, Tessa Boyd-Caine

Dental reform: a work in progress
Amanda Biggs

Lack of access to dental care is putting children in hospital and entrenching disadvantage
Johanna de Wever

 ***

Social media and media-related issues

An idea for harnessing the expertise of departing journalists – and providing a powerful health service to local communities

Could this be the beginning of a new online publication covering climate change and health? (And would you like to help kickstart it?)
Help create an online publication covering climate change and health
Introducing a wealth of ideas for new online health-related publications
Any ideas for a new online publication covering a health-related area of need?

AMA says “uninformed” attacks on Tim Flannery are a “disgrace”
Steve Hambleton

The media & healthcare industries: some challenges and opportunities from the digital revolution

Never mind the barriers to the health sector’s uptake of social media – here are some useful resources and examples
David Corbet

How Ramsay Health Care is embracing digital transformation
Damon Klotz

Is this a digital media innovation? Or a health innovation? Or something in between?

What has social media got to do with blood transfusions, haematology and the like?
Carolyn Der Vartanian

What does social media mean for health and medical education?
Mavis Duncanson and Dr Zelda Doyle

What can bloggers do for public health and the greater good?
Cairín Conway

Will social media prove useful in efforts to tackle antibiotic resistance?
Lynn Weekes

Join a Twitter chat about involving children and parents in research and service development
Eva Alisic

Know of any public health courses focused on new media?
Becky Freeman

Why aren’t more academics making their own apps and getting digitally savvy?
Deborah Lupton

What does it take to get our media to cover health issues affecting low and middle income countries?
Michelle Imison

Should this headline about the swine flu pandemic be really alarming or just a bit worrying?
Julie Leask

Efforts to minimise harm from media reporting of Breivik trial may have wider application
Marie McInerney

Profiling a new media outfit that focuses on ehealth
Mark Jones

Wraps of reading from The Conversation: July, August

What’s on the menu for Queensland’s new Health Media Club? Some Ministerial grilling, perhaps
Jane Milburn

A proposal for some online sharing to help people with disabilities
Niki Ellis

Some developments and opportunities in health and the media

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Pharma

Consumer group raises concerns about pain medicines – and the company responds
Carol Bennett

For more information on GlaxoSmithKline and the biggest healthcare fraud settlement in US history

A multi-national MasterChef for Medicines?
Gavin Mooney

Advertising a prescription medicine to the general public: what’s going on?

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Wrap of Federal Budget coverage

Health and the Federal Budget: a wrap of links, news and reaction

Let’s “streamline” some of the Budget’s Weasel words

The budget failed to address health risks from climate change
Fiona Armstrong

Budget cuts to foreign aid: what will they mean for global health?
Joel Negin

Mental health and the federal budget
Sebastian Rosenberg, Pat McGorry

At last, a REAL cancer breakthrough (and why some politicians deserve a cuddle)
Terry Slevin

The Federal Budget and health: what’s on the table (or not)
Sebastian Rosenberg