depression Archives - thegoodwills.com

Adopt a duck in mental health week

It’s Mental Health Week, aptly coinciding with a self-diagnosed bout of post-viral depression. Those of you who suffer the ‘Black Dog’ will know that a flu or virus can tip you into a depressive cycle. She Who Also Gets It commonly says: “Don’t be depressed – it’s boring.” Fine for her to say if she’s OK.

(Read to the end then come back and watch this 43 second video by Bob)

As my Ma would have said (and maybe yours too), ‘misery loves company’. Statistically-speaking, about 40% of my readers will have suffered from some kind of mental health episode in their lifetime. The other 60% will probably let this FOMM go by (“Why doesn’t he write something nice and fluffy, grumble, grumble, or at least say what he thinks instead of quoting other people?”)

The latest data from the Australian Bureau of Statistics (ABS) tells us that more than 40% of Australians aged 16-85 years have experienced a mental disorder at some time in their life. One in five (21.4% or 4.2 million people), had a 12-month mental disorder. Anxiety was the most common group of 12-month mental disorders (16.8% or 3.3 million people). Young people were most at risk with 39.6% aged 16-24 years reporting a 12-month mental disorder.

Note: 12-month disorders are categorised as including anxiety, mood, impulse-control and substance use disorders.

The latest national study into mental health and well-being was released in July. Among its findings are that 3.4 million Australians aged 16-85 years (17.5%) saw a health professional for their mental health in 2020-2021. Of these, 57.4% had a 12-month mental disorder, 17.7% had experienced a mental disorder at some time in their life and 24.0% had no lifetime mental disorder. (To quote the quintessential Aussie singer-songwriter Kasey Chambers- ‘If you ain’t worried now, you’re not paying attention..’Ed)

That latter cohort (the 24%) are probably those referred to in this World Health Organisation (WHO) report. The WHO said that in the first year of the COVID-19 pandemic, global prevalence of anxiety and depression increased by 25%.

“The information we have now about the impact of COVID-19 on the world’s mental health is just the tip of the iceberg,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This is a wake-up call to all countries to pay more attention to mental health and do a better job of supporting their population’s mental health.”

The WHO’s Mental Health Atlas showed that in 2020, governments worldwide spent on average just over 2% of their health budgets on mental health. Many low-income countries reported having fewer than 1 mental health worker per 100,000 people.

Australia stands out from the crowd in terms of investment. Government spending on mental health-related services in 2019–20 was estimated to be around 7.6% of total government health expenditure.

The Australian Institute of Health and Welfare says $11 billion was spent on mental health-related services in 2019-2020. Of the $11.0 billion, State and Territory governments spent 60.0% ($6.6 billion). The Australian Government’s $3.8 billion contribution covered Medicare-subsidised mental health services and prescriptions.

Australian Government spending on prescriptions equates to about $22 per person. Anti-psychotics (48.1%) and antidepressants (32.5%) accounted for the majority of mental health-related subsidised prescriptions.

That may well be, but I pay something close to full price for mine, mainly because my doctor told me not to accept the generic version. On the other hand, I paid $6.90 for the antiviral meds prescribed when I tested positive to Covid-19. The full price on the packet was $1,130, Now you see why Australia is so lucky to have Medicare.

Ah Covid, that was almost a month ago. I still have a cough and after walking the dog on the river circuit, I have to take some Ventolin and lie down. Multiple research reports have emerged which discuss the serious implications of ‘long Covid’ and lingering symptoms such as lung problems, fatigue and ‘brain fog’. Clearly there is much work yet to be done to establish the long-term risks of having had Covid-19.

And yet the collective Australian government response to Covid seems to be aligned to President Joe Biden’s recent claim that the pandemic is ‘over’. We shall find out after today, which is when Australian State and Territory governments agreed we should no longer be required to quarantine after testing positive. My view of it is simplistic. As of today, 10.3 million Australians have had Covid and 15,399 died with Covid – more than people killed on the roads in 2020.

Perhaps it was coincidence that the US health administration also eased its quarantine recommendations. The Center (US spelling) for Disease Control and Prevention said in August it was no longer recommending that adults and children quarantine at home after having been exposed to Covid-19. The CDC instead recommends those exposed wear a mask for 10 days and take a test on day five. The CDC is, however, saying that Covid is ‘here to stay’, recommending that people who have tested positive to the virus isolate for five days.

Greta Massetti, chief of the CDC’s Field Epidemiology and Prevention Branch, said the changes reflected data indicating 95% of the population has some protection, either from infection or vaccination.

On September 29, Australia’s National cabinet unanimously agreed to scrap the mandatory Covid isolation requirement, with exemptions for those working in high-risk settings such as health or aged care.

Prime Minister Anthony Albanese said (in the same breath) that disaster payments for workers diagnosed with Covid would end, with the same exemptions for high-risk workplaces.

As The Guardian reported, all State Premiers and Chief Ministers agreed to the change, claiming it was “not sustainable” for governments to keep paying workers to stay home.

Predictably, the Australian Business Council and the Chamber of Commerce and Industry welcomed the decision.

I was taken by surprise, not expecting a Labor Government to make what is clearly an economic decision, rather than support measures that lower the risk of the virus spreading in the community.

Chief medical officer Professor Paul Kelly cautioned that quarantine measures may be re-introduced if pandemic conditions such as transmission rates dramatically changed. (Something reminds me about stable doors and horses bolting..Ed)

“We wanted to make sure that we have measures which are proportionate and that are targeted at the most vulnerable,” Mr Albanese said after the meeting. “We want to continue to promote vaccinations as being absolutely critical, including people getting booster shots.

“We want a policy that promotes resilience and capacity-building and reduces a reliance on government intervention.”

(Ed: Capacity building is ‘the improvement in an individual’s or organization’s facility to produce, perform or deploy’.

Mr Albanese was asked whether casual workers would now be forced to work while sick. His response was that the government could not keep paying for such financial supports, comparing the strategy to influenza.

“The flu has existed, and health issues have existed, for a long period of time, and the government hasn’t always stepped in to pay people’s wages while people have health concerns,” the Prime Minister said at a press conference.

While the advice here and in the US is (still) to wear a mask for 10 days after contracting or being exposed to Covid, the mask mandate for public transport was removed in all Australian jurisdictions last month. Apart from medical centres, hospitals and aged care centres, mask-wearing has become optional.

I wore mine while filming the short duck video (above). Avian flu – you can’t be too careful.

Covid triggering depression and anxiety

covid-depression-black-dog — Image: The author and black dog, moving day 2019 (before Covid-19)

It’s the lead news story you’d probably never see on prime time TV, a focus on depression and anxiety and how Covid-19 and the control response has seen more of us succumb to the Black Dog.

Newsreader: “Researchers have published new data that show the incidence of depression and anxiety among travellers stranded in Queensland has soared in recent months.

“70% of those who reported acute anxiety or depression over the past six months were people from New South Wales and Victoria who find themselves exiled in Queensland.”

(Cross-over to interview)

Interviewer: Julianna and husband Dario* have been stranded in Queensland since a road trip north in June turned into five months in exile. Our correspondent caught up with them at Sapphire, after the couple had spent a fruitless week fossicking for opals.

Julianna: “It was fun until it wasn’t fun. I mean, how many times can you go to the Qantas Museum? I miss my grandkids and I miss Victoria, the markets and all the good foods you can’t buy in outback Queensland.

Dario: “Yeh, Julianna’s right And, you know, a 20-foot caravan might seem big until you have to live in it for months on end. It always smells like fried eggs.”

Interviewer: So you have both slipped into a state of anxiety and depression as a result of not being able to go home?

Julianna: “Yeh, well it’s not logical – I mean the sun’s shining and the birds are singing and every day we feel safe because there’s hardly any cases in Queensland. But I’ve been feeling increasingly sad and apathetic.”

Dario: “And I’ve been drinking more than I usually do…

Julianna: “You reckon?”

Satire it may be, but it’s no laughing matter, this dark mood which can inexplicably darken the sunniest Queensland day. The symptoms are not hard to read: feeling tired all the time, not going out much, feeling miserable, feeling that nothing good ever happens, relying on alcohol…

Sunday is World Mental Health Day, although why we only get one day a year is something to ponder.

Multiple studies have been carried out that link the increased incidence of anxiety and depression to the global pandemic and the response by authorities to control the virus.

Professor Richard Bryant from UNSW’s School of Psychology says people find it harder to cope as time goes by.

“We are having a longer and later lockdown experience than the rest of the world, due to the lack of people who are vaccinated and the Delta strain of COVID.

“What we tend to see is that people get anxious at the start, then when the effects of social isolation wear on, it becomes a depressive reaction: people’s coping resources get eroded over time.”

Prof Bryant said the Delta strain and the effect of younger people dying has elevated anxieties among that cohort because they thought COVID was mainly a risk for older persons.(Apparently not taking into account the possibility of their catching Covid and passing it on to older people, such as their parents. Ed)

He says we can learn about the trajectories of mental health in Australia by looking at countries that are somewhat ahead of us.

“For example, one study in the UK sampled people at varying points during the pandemic. This study found that two months into lockdown, which is approximately where much of Australia is positioned now, the rate of people’s anxiety had decreased marginally relative to earlier periods during the pandemic.

However, at that stage more than half of the people participating in the study were still reporting anxiety.”

Three months after lockdowns started in the UK and restrictions were beginning to ease, half of the respondents still reported being worried about the pandemic.

As always, those most vulnerable to mental health problems were young adults, the unemployed, single parents, and people with long-term health conditions.

A recent webinar hosted by Monash Business School explored the impact that deteriorating mental health is having on the Australian economy (estimated at between $40 million and $70 million a year). Covid-19 has driven a rise in the prevalence of depression and anxiety disorders, and is linked to an overall decline in women’s mental health.

Professor Jayashri Kulkami, Head of the Department of Psychiatry at Monash Central Clinical School, uncovered some striking findings from an online survey conducted by her research team looking at ‘Women, COVID-19 and Isolation’.

Professor Jayashri points out that the concept of quarantine is not new, and that isolation is intended to keep people safe. Paradoxically, for some women and children, being isolated at home is doing the opposite.

“The negative consequences include the risk of losing jobs, greater economic vulnerabilities, and psychological health issues resulting from isolation, loneliness and uncertainty.”

Statistics collated by Beyond Blue, one of the many support services people can turn to, show that:

l One in seven Australians will experience a depressive illness in their lifetime;
l One in 16 Australians is currently experiencing depression.
l One quarter of Australians will experience an anxiety condition in their lifetime.
l One in seven Australians is currently experiencing an anxiety condition.
l One in six Australians is currently experiencing depression or anxiety or both.

Fortunately, support-seeking appears to be growing at a rapid rate, with around half of all people with a condition now getting treatment.

Against those long-term stats, an Australian Bureau of Statistics survey published in July found that one in five Australians are reporting high or very high levels of psychological distress linked to the COVID-19 pandemic.

Lockdowns bring unexpected positives

The New Daily’s John Elder set out to find the hidden silver lining beneath this gloomy diagnosis. He examined a survey of 3,000 people by psychologists from the University of Strathclyde in Glasgow.

The May 2020 survey found that more than half reported positive changes in their lives since COVID-19 took hold. In particular, 87% of people were more appreciative of things usually taken for granted. Respondents reported having more time to do enjoyable things, spend more time in nature, pay more attention to personal health and pursue physical activities. (Our garden has never looked so good. Ed)

These changes in behaviour were still in train for half the participants who had reported positive effects.

A December 2020 study from the University of Sydney found that 70% of its 1,000 participants experienced at least one positive effect of the pandemic.

“The top three positive effects were having the opportunity to spend more time with family; having greater flexibility in working arrangements; and appreciating having a less busy life.”

The University of Bath and the University of Lisbon surveyed mothers with one or two children (in the UK and Portugal). Many of them were working at home on reduced wages, while 93% of their children were learning from home via remote learning.

“Nearly 90% of the women found that the hardships caused by the pandemic had provided valuable opportunities. More time with the family, rediscovering small pleasures – but also time to think about their one and only life, and its meaning.”

As Elder found, and you don’t know until you go looking, the Covid pandemic has been responsible for “post-traumatic growth”. This is a formal label for what happens when people undergo a transformation after suffering adversity.

“Many people say they have found meaning in their lives – or at least have begin to ponder more deeply about these big questions that are answered more by feeling, than thinking.”

Things to ponder on Sunday, when we reflect on the 300 million people who struggle with or just simply live with depression.

As we often say around here, when the sun is shining and the birds are singing, “Well, at least we don’t live in Afghanistan.”

*not their real names

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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 14^th 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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Movember and a short history of facial hair

Movember-moustaches — Grandad Wilson with a circa 1920 moustache

Fourteen years ago a couple of Aussies came up with ‘Movember’ – a campaign to raise awareness of men’s health issues including prostate cancer and depression. There are many ways to take part in Movember (which lasts for the month of November). The most visible way is to join other men who are growing a Mo for 30 days and ask people to pledge support.

No better time to introduce Grandad Wilson (;left), posing in his stonemason’s workshop in rural Scotland, circa 1920s. Now that’s what I call a moustache!

I have another, more sombre photo of Grandad in his WWI Corporal’s uniform in front of a small platoon of soldiers. Some of them are sporting a ‘Mo’, and, if I may observe, many of them are yet to make twenty years of age. I wonder how many of them made it to 20.

It was interesting to discover that from the Crimean war onwards, men in the military were forbidden to shave their upper lip. Attitude to hairy faces in the armed forces and police have changed many times since.

Moustaches were all the fashion in the early part of the 20^th century, thanks in part to silent era movie stars like Charlie Chaplin and Oliver Hardy. Both comedians’ sported Toothbrush moustaches – five centimetres of hair above the lip, trimmed vertically, thus mimicking the bristles of a toothbrush. This type of Mo virtually disappeared after 1945 because of the negative association with the toothbrush moustache cultivated by the defeated Chancellor of Germany, Adolf Hitler.

Chaplin wore his Mo with pride in the 1940 satirical film, The Great Dictator. He alternately plays a Jewish barber who loses his memory and finds himself subject to tyranny, and the tyrant himself, Adenoid Hynkel. Nearly 80 years on, Chaplin’s first full-length talking film is still rated at 93% by movie review site Rotten Tomatoes.

What got me thinking about Movember and moustaches in general was the November 2 appearance of rugby league coach Brad Fitler on TV, sporting the wispy beginnings of a moustache. Taking a gentle ribbing from panel commentators on Nine’s broadcast of the triple-header league international, Fitler said, ’it’s for a good cause’.

To become a Mo Bro, you must first sign up as a clean shaven dude as of November 1 then start growing and grooming a Mo.

The movement got its start in 2003 when mates Travis Garone and Luke Slattery met up for a quiet beer in Melbourne. The moustache was unfashionable at the time, but they found 30 blokes willing to take up the challenge. From humble beginnings, Movember has branched out into 20 different countries and raised $600 million for charities like the Prostate Cancer Foundation.

As Fitler says, it’s a good cause, raising awareness of men’s’ health issues, symptoms of which a lot of men ignore, often at their peril.

Cancer Council statistics estimate that 1 in 7 men will be diagnosed with prostate cancer. The good news about this form of cancer, which comprises 25% of all male cancers, is that it is slow-growing, so unsurprisingly there is a 95% chance of reaching the five year mark. Unlike some forms of cancer, prostate cancer can be quickly picked up by a blood test which all men over 45 should have every year.

Movember also aims to lift awareness about depression in men and the risk of suicide, still the leading cause of death in Australians aged 15 to 44. Men are three times more likely to commit suicide than women. It has been estimated that around 60,000 Australians attempt suicide every year. So it serves a useful purpose simply by putting these issues under your nose, as it were.

Movember’s rules quite rightly stipulate no fake moustaches, beards or goatees. They also state the Mo must be kept groomed and that participants must ‘act like gentlemen’.

Mo’s come in all shapes and sizes. In my experience of cultivating a Chevron in the 1990s (left), they take longer than a month to become vigorous, so don’t expect too much from Movember participants (especially those who start late). Film stars have helped to give the moustache some cachet through the eras where they were prominent on the silver screen. Clark Gable enhanced his suave country gentlemen looks in Gone with the Wind. His was a Pencil moustache, also favoured by actors including Errol Flynn and David Niven, writer George Orwell and musician Little Richard. The Pencil Mo is defined by a carefully shaved gap between the two sides.

Chaplin and Hardy, as we mentioned, wore the now-taboo Toothbrush Mo. Tom Selleck sported a handsome Chevron in Magnum PI, starting a 1990s comeback of the coarse-haired, thick moustache.

Wrestler Hulk Hogan is often mentioned for his magnificent Fu Man Chu that droops down either side of his mouth. Actor Sam Elliott has worn a Fu Man Chu for so long it is now snowy white, still enhancing his twinkling smile. And what a contrast between the suave, smooth-shaven 007 and Sean Connery’s moustachioed character in The Untouchables. Musician Frank Zappa gets a mention in this list by artofmanliness.com, but on Movember’s definition it’s a fail, as he also had a ‘soul patch’ under his bottom lip.

I recommend scrolling through this list of celebrities known for their moustaches. The impressive Handlebar moustache worn by German philosopher Frederick Nietzsche (left) stands out from the crowd. Imagine kissing that! In my long experience of having a beard and mo of varying lengths, there are certain foods that men with facial hair like Frederick should avoid:

Spaghetti bolognaise
Soup (minestrone in particular)
Tacos
Icecream
Lamingtons
Pavlova and cream cakes in general

It is interesting to note that the list of hirsute blokes listed by artofmanliness.com does not include Groucho Marx or famous fictitious characters like Hercules Poirot and Boston Blackie. As it turns out, Groucho’s famous set of bristles was fake (at least in the early days), which is curious when you think how his combination of eyebrows, glasses, Mo and cigar so often feature at fancy dress parties. Likewise, Chaplin’s Toothbrush mo was painted on in the early days of films featuring his character, The Tramp, mainly to disguise his age (he was 24 in the first silent film in 1914).

Poirot’s waxed moustache (often described in Agatha Christie’s books as ‘magnificent’, ‘immense’ or ‘splendid’), is an integral part of the series.As Poirot says to Hastings (in Peril at End House): “If you must have a moustache, let it be a real moustache – a thing of beauty such as mine.”

Kenneth Branagh’s turn as Poirot in the 2017 remake Murder on the Orient Express, acknowledged the importance of Poirot’s facial hair to the character’s character. To that end, numerous movie sites let it slip that Branagh had some cosmetic help with that.

I mentioned Boston Blackie, featured in Jimmy Buffet’s song ‘Pencil-thin moustache’, a tribute to the first half of the 20^th century.

Boston Blackie was a fictional character created by author Jack Boyle. A jewel thief and safecracker, Blackie became a detective in adaptations for films, radio and television. And yes, like Clark Gable, Errol Flynn and others, he had a Pencil moustache. It is not recorded whether his was au natural or faked with greasepaint.

As Buffett says of male grooming in an era ‘when only jazz musicians were smokin’ marijuana’ – ‘Brylcream, a little dab’ll do ya’.

(Live at the Byron Bay Blues fest, 2017) https://youtu.be/YKn15lEBL9s

Odd socks stamp out mental health stigma

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

FOMM back pages:

Bipolar disorder and gout

empty-chair-bipolar — Empty chair at Baroon Pocket Dam – Photo by Bob Wilson

This may seem an odd way to approach an essay about bipolar disorder, but I had forgotten that lithium was at one time prescribed for gout. Not that I’ve ever had gout, but a couple of relatives who do have it tell me it is not something you would wish upon your worst enemy – or even Donald Trump. Gout is a painful inflammation of joints caused by an excess of uric acid which forms needle sharp crystals in the joints, hence the pain.

The conventional solution is medication and avoiding rich, fatty foods. Traditional medications are allopurinol and colcochine although some GPs and naturopaths recommend low doses of lithium combined with vitamin C to make uric acid soluble and easier to expel from the body.

The point being, very few people would stigmatise gout-sufferers for taking medication to ward off the acute pain that comes from an attack. Yet lithium is the drug of choice dispensed by psychiatrists when diagnosing someone with bipolar disorder. The latter is very much a stigmatised condition. However, as we will see, some famous people are working to ‘normalise’ it through documentaries and speaking tours.

Author Edward Shorter traced the history of lithium in an article published by PubMed Canada and archived by the US National Library of Medicine:

A London internist, Alfred Baring Garrod, recommended lithium treatment for gout after discovering uric acid in patients’ blood. This was in 1847, 12 years before Garrod wrote The Nature and Treatment of Gout and Rheumatic Gout.

Lithium, a naturally occurring mineral, was used to treat mania in the 19^th century, particularly in Denmark, but did not emerge as a mainstream treatment until 1949, when Australian doctor John Cade was credited with re-introducing lithium to psychiatry.

Despite the development of pharmaceutical alternatives (valproate, lamotrigine, carbamazepine), it is still regarded as the ‘gold standard’ for mood stabilisation and treatment of major depression.

The gout sufferer, meanwhile, simply has to cut down drinking beer and avoid purine-rich foods (such as red meats, offal, some seafood and Vegemite). His or her sanity is unquestioned. If asked (say at a barbecue with friends and neighbours), they will freely talk about their swollen joints; knobbly elbows and inflamed big toes may even be shown.

No such empathy for the approximately 727,300 Australians (about 3% of the population), with some form of manic depression/bipolar disorder.

In 1980 the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), changed the classification system to bipolar disorder, a more clinical and less emotionally loaded term than the stigmatised ‘mania’ or ‘manic’.

Stigmas die hard. There are hard-to-shake myths, worst-case scenarios magnified in the press and on current affairs TV, which focus on the tragic cases that fell through the cracks in the system. We form fixed ideas about the mentally ill, shying away from people we see as ‘odd’.

I started exploring the subject (it’s Mental Health Week after all), after watching Stephen Fry’s Not So Secret Life of a Manic Depressive 10 Years On. Fry, originally diagnosed with the less disruptive form of bipolar (cyclothymia), made a controversial documentary series a decade ago where he interviewed well-known bipolar sufferers including actor Richard Dreyfuss. The psychiatric profession was generally dismayed with Fry’s (then) stance against taking medication.

In this update, Fry is diagnosed with bipolar 1 (the more serious type in which sufferers may have psychotic episodes) and he starts taking medication, although confessing to self-medicating (as many sufferers do); in his case with alcohol, diazepam or sleeping pills. In the hour-long ABC documentary, a range of people with bipolar disorder are interviewed and the nature of their disorder is laid bare. There’s a young woman who became a paraplegic after jumping from a balcony (in her manic state she thought she could fly). There’s a chef whose wildly swinging moods are endangering his job and his home life who finally decides to stick with lithium.

Although bipolar disorder afflicts only 3% of the population, the odds are that only 50% of these people will be able to hold down a job.

People who plainly don’t understand mental illness may react badly on seeing an apparently healthy 20-something man wandering around in the middle of a working day. Because he is taking medication to quell the various strands of his illness, he is not talking to himself, acting oddly or accosting people. But he is still (invisibly) unwell.

“He’s got two arms and two legs hasn’t he? Tell him to get off his arse and find a job,” some might say.

Ah yes, so he’s a ‘leaner’ not a ‘lifter,’ a polarising notion recycled in 2014 by former Treasurer Joe Hockey (borrowed from the lexicon of Liberal Prime Minister Robert Menzies).

As Fry’s documentary shows, some bipolar sufferers have ‘normal’ friends who support them through the worst of their illness and stick around during the well times.

Others not so fortunate retreat into their own heads while their friends may drift away. Fortunately, there are support groups which can help people struggling with the feeling they are on their own.

It is easy enough to find long lists of famous people who have ‘come out’ and declared themselves bipolar and one would hope this helps to push stigmas and myths into the corner.

Surrealist painter Edvard Munch (who painted “The Scream”), is on this list, so too Beach Boy singer-songwriter Brian Wilson. The late Spike Milligan owned up to it, as did former NRL star Andrew Johns and a long list of composers, writers, comedians, actors and celebrities.

Margaret Trudeau, mother of Canadian Prime Minister Justin Trudeau travels the world speaking out against the stigmas and myths surrounding this admittedly confronting disorder. If you are my vintage, you may remember reading about Margaret in the popular press, hanging out at nightclubs with famous rock stars and generally not living as one might expect of the first lady of Canada (then married to Prime Minister Pierre Trudeau). In hindsight, those florid 1970s reports of Margaret jiving at Club 54 with Mick Jagger and the Stones typify a person in the throes of a typical bipolar manic phase: disinhibition, impulsive behaviour, risk-taking, spending sprees and so on.

In a lengthy interview with Will Pavia in the Sydney Morning Herald, Trudeau, now 68, at one point began to talk about her passion for bringing mental health issues into the spotlight. From February to June she travels, campaigning about brain diseases, depression and her experiences of living without the medication she now takes. Trudeau says she is helping to break the last great taboo – “The thing people are most afraid of talking about”.

At which point Pavia observes: “She is certainly not afraid to talk about it. She talks at a rate of knots…if this is Trudeau on mood stabilisers, what must she have been like, for all those years, when the mania struck?”

Great question, Will, one which reminds me of an older chap I know who was diagnosed with bipolar in the 1960s.

“I took the lithium and after a few months I felt great so I said, Doc, I don’t need to take this anymore. At which point he looked at me and said: “Don’t be a f***’ng idiot!”

(What I wrote last year):

And on an entirely different note, Bird Week starts on Monday 17^th October- you’re invited to spend 20 minutes one day next week to count (and name, if possible) the birds in your backyard- check it out at this website. To get you started, this is a Rainbow Lorikeet – common, now that the Bottlebrush is flowering. (Ed.)

Talking to the empty chair

Chair on beach Jasleen Kaur — https://www.flickr.com/photos/jasleen_kaur/)

A good few decades ago, I’m having time off work; my more attuned friends describe it as ‘having a rest from his mind’.
Friends have come to visit. Some kind of coincidence, the four of them – all psychologists – sitting around the table on the back veranda. I’m wearing the top half of a pair of pyjamas, a Sulu (Fijian garment) and slippers. I’m doped to the eyeballs – diaze-something, a blobby sponge soaking up everything and feeling nothing.
The overwhelming memory is of these four psychologists, having a quiet glass of wine in the late afternoon, looking at me with this kindly detachment, a bit like a vet examining an old dog whose time has come.

Time to talk to the empty chair

Apparently it’s Mental Health Month in New South Wales – a bit of an improvement on raising the issue for a week, like elsewhere, then forgetting about it for the rest of the year. NSW Mental Health Commissioner John Feneley was making a case in a Sydney Morning Herald column on Monday asking people to think about people with serious mental health disorders – schizophrenia, bipolar disorder and unrelenting forms of depression – and try to get over the instinct to avert our eyes.
One in five Australians suffer from some form of mental health disease – be it one of the basket of ailments usually described as neurosis (depression, anxiety, OCD, phobias) or long-term psychotic disorders like schizophrenia.

So let’s talk about neurosis and remember we’re talking about a sliding scale here. When it comes to dealing with what my mother’s generation called ‘an attack of the nerves’, most of us take the medication the GP gave us and lie down until the feeling passes. Not going to work really helps.
Once you understand the nature of a panic attack and no longer feel you are going to die on the spot, a brown paper bag is a handy accessory.
Some decide they need to talk to someone about the root cause, so flick through the yellow pages looking for a registered psychologist. It shouldn’t be hard – there are 32,766 registered psychologists in Australia. There are many more whose expertise is not endorsed by the Psychology Board of Australia so they hang out the ‘counsellor’ sign.
I have had a few fruitful adventures with counsellors of one kind or another – talking to the empty chair, picking up the heavy rock (and putting it down again).

Blessed are the toast-makers

Psychologists know which buttons to press. Whenever I get up late at night for a snack, I still remember what one counsellor said about this nervous habit.
“What would happen if you didn’t eat toast?”
Before eventually ‘seeing someone’, I took refuge in daily journals in which I had been scribbling since the early 1970s. (Executors have been instructed to build a Charles Dicken-style bonfire with these diaries). Interesting now to find references to a ‘periodic head-check’ which was my way of dealing with psychological problems – to have an imagined conversation between your addled self and an older, wiser, sober self. The following is for entertainment purposes only; it may be a figment of the writer’s fertile imagination and should not be construed as advice, medical or otherwise.

Searching for Dr Zeitgeist

Dr Zeitgeist: It’s been a while.
BW: “Looks like rain – probably will.”*
Dr Z (consults file): Hah! You quoted Eeyore last time you were here. Is he a permanent fixture in your life then?
BW: (turns to examine his bottom) “It’s not much of a tail, but I’m sort of attached to it.”*
Dr Z: (aside) Did you know Disney has trademarked the names Pooh and Eeyore?
BW: But, but, – they belong to our childhood!
Dr Z: Anyway, I digress. What brings you here today, apart from the turned down mouth and slack-shouldered look of the long-term depressive?
BW: I take pills for that – this is more of an existential angst.
Dr Z: (steeples hands under chin) How so?
BW: Well I hear the ADF has carried out 9 ‘strike missions’ in Syria, adding to the general mayhem over there and at the same time we’re agreeing to accept only 12,000 of the 9 million Syrian refugees. I feel bad about that.
Dr Z: This is sublimation on your part – you are finding other reasons for your feelings of despair instead of confronting the root cause.
BW: Do you seriously think I’m going to get into this with several thousand readers looking on?
Dr Z: If you don’t use it, you lose it – very important at our age to remember that. Now, what’s really troubling you?
BW: I lie awake in the early hours of the morning, turning things over and over, like flipping pancakes.
Dr Z: So you ruminate?
BW: All writers ruminate. It’s how we write. And I don’t want to burn the pancakes.
Dr Z: But you’re not happy about it?
BW: I’d rather be asleep.
Dr Z: When you do sleep, do you dream?
BW: Do I dream! Technicolour, with music, dancing girls…
Dr Z: Tell me about one of these dreams.
BW: I have this recurring dream where I’m back at work and nothing is working out and I’m sort of aware, even though I’m asleep, that this is absurd because (a) it’s the last place in the world I want to be and (b) I was actually very good at the work.
Dr Z: (claps hands lightly and exclaims Mein Gott!): Classic! So this was the last time in your life you had great responsibility and success?
BW: I guess so.
Dr Z: You need to look at your life now and you may find an area of great responsibility where you are not having much success.
BW: I have this other dream where I’m driving too fast and my feet won’t reach the pedals or the brakes don’t work.
Dr Z: Do you go off a cliff into the ocean – dashed to pieces on the rocks?
BW: I thought maybe I’m trying to do too much for no good reason and need to scale down and take control of my life again.
Dr Z: Ah, like that line in your song where the swaggie staggering around in the desert has only one book, ‘The Theory of Control’.
BW: Sent you a copy, did I?
Dr Z: How’s the album going anyway?
BW: I think it’s what they’d call ‘a critical and artistic success’.
Dr Z: Have you seen the documentary, Searching for Sugar Man, about the singer-songwriter Rodriguez?
BW: He flopped in the US but was bigger than Elvis in South Africa, though everyone there thought he was dead. Meanwhile, he’s living in the USA and he didn’t know about any of it.
Dr Z: And then he was found and made famous again in South Africa, after giving up his dreams of a musical career and spending his life as a construction worker in Detroit.
BW: And we’re talking about this why?
Dr Z: I thought the analogy wouldn’t be lost on you, or your readers.
BW: Well, good to catch up, Dr Z. It still looks like rain.
“However, (brightening up a little), we haven’t had an earthquake lately.”*
*quotes from The House at Pooh Corner by A.A. Milne