Mental Health Challenges Aplenty in 2020

mental-health-depression
Nibbler feeling blue after a visit to the vet

Over the past six years, I have written at least 20 blogs about mental health and my particular affliction, anxiety/depression. The Black Dog Institute says one in seven Australians will experience depression in their lifetime. It carries the third-highest burden of disease (in terms of cost to the community), in the country.

So if it has never affected you, be aware. The Black Dog can sneak up on you, as we can see:

  • One in five (20%) Australians aged 16-85 experience a mental illness in any year;
  • The most common mental illnesses are depression, anxiety and substance use disorder(or all three at once);
  • Of the 20% of Australians with a mental illness in any one year, 11.5% have one disorder and 8.5% have two or more disorders.
  • 54% of people with a mental illness do not seek treatment.

And those were the statistics before the pandemic came along in March and set anxiety and depression loose.

To its credit, the Australian Government stepped up in August to offer people an extension on the subsidised specialists’ scheme.

Under Medicare, a GP can refer you to a psychologist or other mental health specialist under a plan which will pay $124 per session for a maximum of 10 sessions a year. This means if your counsellor charges $165 (the going rate for a clinical psychologist), you will be $41 out of pocket, or $410 over the course of treatment.

The Federal Government extended the scheme by an additional 10 sessions for people whose plan had run out, and whose lives were directly affected by COVID-19 lock-downs.

The extended scheme, which cost $7.3 million, will run out in March 2021.

The front line treatment of a mental illness like anxiety and depression is medication, counselling and cognitive behaviour therapy. The latter means trying to change your reactions to things that trigger your moods. Increasingly, GPs and specialists will try other methods before they resort to medication. It depends if your mood disorder is bio-chemical or triggered by trauma or personal circumstances.

I recently read the biography of now-retired rugby league great Darius Boyd, who spent the latter half of his career in therapy and then became a mental heath ambassador. For much of this season, social media trolls posted nasty things about Darius, whose form fell off (as it can do with players past their peak), as also happened to his team, the once-mighty Brisbane Broncos. Darius now spends a lot of his time as a mental health ambassador, important work when you consider that 72% of men do not seek help for mental health problems.

Men are also at greatest risk of suicide but least likely to seek help. The Black Dog institute says that in 2011, men accounted for 76% of deaths from suicide. Other groups at proportionately higher risk include indigenous Australians, the LGBTI community and people in rural and remote areas.

You may know that this is Mental Health Week, which includes community activities to bring these still-stigmatised illnesses into the daylight. There’s the One Foot Forward initiative, where people volunteer to walk a certain number of kilometres through October and raise money through sponsorship for the cause.

An Australian survey of 5070 people found that 78% said their mental health had worsened during COVID-019. One in four were worried they would be infected and one in two worried that families or friends would be infected. Psychological distress levels were higher, with raised levels of depression (62%), anxiety (50%), and stress (64%).

A World Health Organisation report in May warned that significant investment in mental health support was needed owing to COVID-19. Those at particular risk of COVID-related psychological distress include children, women minding children and/or working from home, older people, those with existing mental health disorders and front-line health-care workers.

Depression, or what Winston Churchill famously dubbed the Black Dog, comes and goes, whether you take medication or not. The severity might be dampened down, but you still don’t want to get out of bed or finish reading the second or third book you started.

I find walking, bird-watching and playing guitar the best diversions and, surprisingly given my tendency to introversion, I rarely knock back opportunities to socialise, even when I’m feeling off the boil. It’s not quite ‘snap out of it’ – unhelpful advice too often doled out by people who don’t understand mental health – but it is something.

If you could capture the molecule that for no reason decides to tell your brain “ wake up, you are no longer depressed”, I’d bottle it and give it away free to fellow sufferers.

Periods of respite come along; I felt momentarily cheered when a young friend told me she was with child for the second time. I was cheered further when seeing my fledgling rose garden start to bloom. Cheerfulness came with two snail mail letters, one from a friend in her mid-80s, who wrote a long letter for my birthday, which she never forgets. She befriended our family in Scotland (I was five) before we emigrated. Mary posted the letter in New Zealand on September 22 and it turned up on the 14th October – just one example of how COVID-19 has broken down communications with family and friends.

I know people who have new grandchildren they are yet to meet, and people who would have liked to be at particular funerals and could not go. Then there were the people who could not visit a loved one who was dying of the virus because of restrictions on hospital visits.

So yes, snap out of it indeed.

But then I accidentally tuned in to ‘Dr’ Trump, self-diagnosing himself as ‘immune’, followed by the Gladys and Daryl fiasco, which tipped me back into the pit. I’m also aware that the passing of my peers – loved ones, friends, acquaintances and fellow musicians – remind me that I’m nearer the end than the beginning.

So I was sad to hear that Irish songwriter Kieran Halpin had died aged 65, and offer this brief tribute. Kieran, who graced our lounge room on several occasions, was a dedicated FOMM reader. He sometimes emailed to say how much he enjoyed particular outback travel pieces. A long while ago, Kieran and family spent a year touring Australia in a motor home, guitar in back. He loved the wide open spaces and the starry nights of the outback and drew inspiration there. An inventive and prolific writer, he had the happy knack of writing songs that other singers wanted to cover. Kieran’s songs like Nothing to Show for it All, Angel of Paradise and All the Answers were covered by artists including Delores Keane, Vin Garbutt, Niamh Parsons, The Battlefield Band and Dutch singer Ilse De Lange. As is often the case, the songs were better known that the man who wrote them.

When I call you in the morning tell you everything’s alright

I can’t see into the future I don’t see the danger in the night

Cos when I hear the siren wailing

I see the flashing of the light

I know that there is trouble there is a battle yet to fight

I may not have all the answers no

I wouldn’t have it any other way

http://kieranhalpin.com/

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Odd socks stamp out mental health stigma

mental-health
Odd socks for mental health, photo supplied by www.grow.org.au

My choice to wear a matchless pair of socks today was a deliberate tribute to Mental Health Week. Odd Socks Day is just one of the many events sponsored through October to remind us that one in five Australians suffer a mental health disorder in any 12-month period.

I’d never heard of Odd Socks Day, but spotted a flyer in a café somewhere and tucked it away for future reference. It’s a national anti-stigma mental health campaign now in its fourth year, using odd socks as a metaphor that anyone can have an off day.

Despite the fact that the majority of people visiting GPs are consulting them about mental health or psychological issues, those with physical ailments are not confronted with the same level of discrimination, stigma and social shame.

Young people are particularly vulnerable to stigma. Research in 2016 uncovered some alarming facts about stigma and what an obstacle it is to people trying to recover from a mental illness. Headspace found that 26% of young people aged 12-25 would not tell anyone if they had a mental health problem and 22% would be unlikely/very unlikely to discuss it with their family doctor.

Fifty-two percent of young people (12-25) identified with having a mental health problem would be embarrassed to discuss the problem with anyone and 49% would be afraid of what others think.

The Royal Australian College of General Practitioners recently found that 62% of people (via the traditional 10-minute consultation), were seeking support for mental health disorders.

The most common mental health ailments likely to afflict people are depression, anxiety and substance abuse. Sadly, many people struggling with depression use drugs and/or alcohol to self-medicate, often with negative results.

In my former work life, the notion of taking a ‘mental health day’ was anathema to your average hard-bitten journalist, for whom the deadline reigns supreme. But in recent years the previously taboo subjects of depression and suicide are now being freely publicised and debated. The hidden cost of not properly dealing with workplace mental health problems is now an $11 billion problem for Australian commerce. There is now an argument that $1 spent on mental health services equates to a ROI (return on investment) of $2.30. So why aren’t we spending?

If there is one indicator to show how stigma and mental health ratio is shifting, it is the NRL ‘casualty ward’, which lists rugby league players and their injuries. Through the season I recall at least six players said to be having counselling for ‘psychological’ or ‘personal’ issues, the latter covering a range of non-physical traumas. Dragons half Ben Hunt spoke candidly to the media this year about seeing someone to help overcome a slump in confidence. Armchair critics (virtual bullies) did not help Ben’s situation, with a steady stream of vitriol posted on social media.

Suicide is often the end-game for people fighting ongoing battles with mental health disorders. Australia’s standardised statistics on suicide are not as high as some (11.7 per 100,000 people). Lithuania (28.6) and South Korea (26.3) head the World Health Organisation list, but Australia is nonetheless in the list of 10 countries with a suicide rate in double figures and has been for a decade.

In Australia, men are three times more likely to commit suicide (17.8 deaths per 100,000 people) than women (5.8 deaths per 100,000 people). More than 75% of all severe mental illnesses occur prior to the age of 25, and youth suicide is at its highest level in a decade.

The telling statistics revealed by the Royal Australian College of General Practitioners clearly show that the system is under untenable strain.

Author Jill Stark wrote about it in a Sydney Morning Herald opinion piece – ‘What happens when the answer to R.U.O.K is no and there’s nowhere to go?’

Stark wrote from a first person perspective, after  fronting up to a GP with what she suspected was an acute recurrence of anxiety and depression. She was handed a form to fill in – a routine step in such a consultation, so the GP can make a more objective assessment of the patient’s mental health state. As Stark related, she scored 25 ‘mild to moderately depressed’ and was prescribed medication (after first being asked if she was suicidal).

The answer was no, but on the way home Stark reflected that should she indeed want to kill herself, she’d been prescribed with something well-equipped for the job.

As Stark bluntly pointed out, the time for wristbands and hashtags has passed. Doctors need the financial support Medicare can bring by allowing longer consultations for patients with complex psychological problems.

“As a matter of urgency we must stop rationing psychological services to 10 subsidised sessions per year,” she wrote.

So that was Jill Stark, wearing her odd socks in public. Bravo.

People like Jill who are having an acute mental health crisis need expert support at least once a week for as long as the crisis lasts.

The Black Dog Institute reminds us that 45% of Australians will experience a mental illness in their lifetime. One in five mothers with children younger than two will be diagnosed with depression. At 13%, depression has the third highest burden of all diseases in Australia (burden of diseases refers to financial cost, mortality, morbidity etc).

The World Health Organisation (WHO) estimates that depression will be the number one health concerned in both developed and developing nations by 2030.

That gloomy prediction was no doubt behind the WHO’s decision in 2013 to introduce an eight-year plan to change the direction of mental health in its 194 member states. The plan’s main objectives are to:

  • strengthen effective leadership and governance for mental health;
  • provide comprehensive, integrated and responsive mental health and social care services in community-based settings;
  • implement strategies for promotion and prevention;
  • strengthen information systems, evidence and research.

Global targets and indicators were agreed upon as a way to monitor implementation, progress, and impact. The targets include a 20% increase in service coverage for severe mental disorders and a 10% reduction of the suicide rate in member countries by 2020.

These are noble aims, but as the WHO observes, it requires effective leadership and governance to implement meaningful change.

Odd Socks Day is one of the rare light-hearted efforts to raise awareness of mental health. Grow, the organisation behind the campaign, runs an in-school peer program that helps young people support each other through their issues.

The overall cost of unmanaged or mismanaged mental health in the Australian workplace is approximately $11 billion a year, according to Dr Samuel Harvey. Dr Harvey, a Black Dog Institute consultant, leads the workplace mental health research program at the school of psychiatry for the University of New South Wales. He was the lead author for research published in The Lancet which found that workplaces that reduce job strain could prevent up to 14% of new cases of common mental illness from occurring.

Quite clearly, we all need to pull up our socks, odd or not, and change our attitude. If only 35% of Australians in need are actively using mental health services, we need to do more than ask R.U.O.K.

Resources: Lifeline 13 11 14, beyondblue.org.au

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