Independence Day of the Mind

An honour that is given out every year is Australian of the Year.  In the past sporting heros have been given the gong more often than any other group.  But the current holder, Professor Patrick McGorry, OA, is a champion for the betterment of mental health services.  Management is one matter, but McGorry is at the coal-face; intervention where it first affects most suffers of mental health issues at the beginning - the youth.

McGorry deserved without doubt his AotY 2010, and extra weight was given to his work by being awarded the Officer of the Order of Australia - second only the Companion to the Order of Australia - in June this year (roughly equivalent to the US Presidential Medal, a British OBE, or French Officier Ordre national de la Légion d’honneur).

Yet McGorry is constantly expressing his disappointment and frustrations at the lack of government resources to combat a stigmatised health issue.

I’m not a psychologist or a psychiatrist, but I do have enough knowledge of how lacking the system is; I’ve been on all sides of the fence as a patient of “normal” health services, mental health services and a critic of how government still continue to separate mental health from other heath budgets and programs.

Despite it’s stigma, I have no issue in declaring that I have mental health issues.  On more than a few occasions I’ve been hospitalised because of my depression (once involuntary).

Now, let’s get one thing quite clear, depression isn’t a prolonged sadness.  Being sad is normal.  It happens because of events that occur in life that are unavoidable.  Death of a family member or companion, even a pet, the loss of work, for example.  Eventually sadness goes away on it’s own accord.  Depression is more insidious that that.  Sometimes it comes without any notable trigger.  Sometimes the trigger can be what would be seen by others as a happy event.  An example case of this is crying at advertisements that portray happy events to sell a product.  But whatever the cause, it’s almost impossible to pinpoint and even if it can be pinpointed it’s of little value to the sufferer in understanding why their mood is so low.

Exacerbating low mood and low self esteem are glib remarks - intentional and unintentional - by family, friends, co-workers, acquaintances and even doctors.  “Get over it,” “build a bridge,” “put it behind you,” “think positive,” “sort yourself out” are just a few insensitive remarks I’ve heard when I least needed to hear them.

A situation can also affect a depressive episode.

Possibly the least understood aspect of depressive/anxiety disorders - yes, they are part of the same problem for many sufferers - by the public, government policy makers and health professionals is when a sufferer is suffering.  That might sound silly, how can a health professional not know?  Those that suffer from more than one episode learn to become excellent actors and liars.  It’s not at easy as it sounds, and is one of a set of skills sufferers learn in order to survive, ironically when they “plan” a suicide.

This is part of the reason, if not the biggest reason, depression is stigmatised.  Suicide is seen by many for various reasons such as religious or political doctrine as a sinful, gutless or illegal choice rather than a tragedy that could have been avoided if those with faux concern had acted with compassion rather than pontificate.

Getting patients in real need hospital treatment is difficult as there are too few beds, while beds in other departments remain unfilled as part of the required spare capacity.  Hospitalised patients are usually released too early because of the pressure caused by the lack of beds, often with only a bag of medication to last a fortnight without any ongoing support.  It is little wonder those most at risk of suicide are those discharged from hospital by an inexperienced intern.  The sufferers have no support outside the hospital system; many have no family or friends willing or able to give support during recovery.  It’s akin to a patient who has undergone major surgery after a near death car accident, and released after the surgeon has closed the wounds and the anaesthetist has left the theatre.  Such a policy in “mainstream” medicine would be unthinkable, but this is exactly what happens in the same hospitals that have a mental health facility.

To make matters worse, most interns, residents, even the family doctor, aren’t particularly clued up with medications and their side effects.  And this is where I enter the story.  I didn’t know I was depressed.  Nor did I think detailed thoughts of suicide was abnormal.  My only lasting memory of events is that I wanted the pain to end and that being end would mean relief to all that knew me.  It was my General Practitioner that hospitalised me, apparently after a very heated debate with the on-duty psychiatrist and added input from a friend who happens to be a nurse.

The only bed available was in the locked ward. It’s a ward that lives up to it’s name. Patients can’t get out, usually because they are a danger to themselves or others, or because of a court ordered psychiatric assessment required before the judge hands down the sentence.  It’s bad enough being forcibly imprisoned with every shred of dignity removed, and it can’t be worse than being surrounded by staff panic buttons and psychotic - often violent - criminals; a Victorian age asylum but with clean floors and super-sedation rather than irons.  Welcome to the road to recovery.

A week later, I was given a plastic bag full of an anti-depressant and told “Good luck.”  Good luck?  I now imagine the over-worked nurses - who chain smoke to cope with the stress - having a ledger of wagers on how long it will be before the police return with a former patient.

Unfortunately the anti-depressant in vogue at the time actually caused my anxiety and depression to worsen.  Fortunately, or rather due to excellent training, my GP noticed I was getting worse, not better (I found out later that the drug had been implicated in murder-suicides in the UK and US, although I hasten to add these events are statistically insignificant compared to the amount of patients that are prescribed the drug, and therefore I won’t name it’s marketed name nor it’s pharmacological name.)  Another period of hospitalisation was required, and to be honest I don’t remember very much about that month.

Since then family, friends and my GP have been superb monitors of my depression, and I’ve learned to look out for the little things that let me know where I stand on the razor line of health; the tipping point for me, like many sufferers, is often a hair trigger and mostly beyond my direct control.  It’s not as simple as taking more medication since the half-life is between 10 and 16 days, and dependant on many factors.  However I have learned to live around some limitations, even accept that I may not be in the best position to judge.

Despite what some people may think or say, I’m not insane and nor do I feel stigmatised.  Anymore.  I say that because for many years I felt ashamed about my episodes, would even deny they exist.  But no more.  Here I am, running naked down the streets shouting “Eureka!” because there are so many people suffering needlessly, afraid of social stigmas - rightly or wrongly - and if I remain silent on the matter for much longer, I would be just as guilty as the faux concerned pontificators for doing precisely nothing remotely positive.

There is an upside to to all this.  When I’m suffering from an episode I’m strangely more productive with my creative writing.  Not only more productive, but it’s of a better quality.  I’m not an orphan nor a pioneer here.  It simply just is.  Which is how I’d like everyone to rethink depression and anxiety disorders, as well as mental health in general; don’t think of the why - or who - but rather as it just is, and that there can be a truly wonderful upside to it.  Think about it the next time you read a novel, or watch a movie, or visit a gallery of art.

Addendum 11/07/2010: The Government of Western Australia has a published a discussion paper WA Mental Health Towards 2020: Consultation Paper and I urge all residents of Western Australia or Australia to read it and make a submission.

Health reform: a good place to start is to remove homeopathy

Australia has one of the finest health care models in the world, yet it is under constant reforms and tweaks that aren’t always in the patients’ best interests.

Every citizen and resident is entitled to the very best in health care at any public hospital; a universal health care.  Complimenting the public system are the private hospitals, which cater for those who don’t need emergency surgery or care, or want a “better” standard of care, or wish to avoid being on a waiting list for non-essential or minor surgery, or even prefer to use their health insurance than use the tax-payer funded public system.

The use of the private hospital system is made more affordable by “reforms” introduced by the Howard Liberal-National government by giving a tax deduction of 30% for private health insurance.  It was one piece of many of the Howard government’s middle class welfare program.  When the Rudd Labor party swept into power (even unseating Howard, something that is almost unheard of) the middle class welfare didn’t end.  The 30% tax deduction for private health cover remained to anyone who had it.  In fact, the extra Medicare Levy imposed on the highest income earners would also be reduced to the same percentage Medicare Levy as the lowest income earners as a reward for having private health insurance.

The health insurance industry is also a strange beast.  Providers are almost exclusively Not-For-Profit Mutual Funds.  Further, their rates are capped and each year negotiate with the Federal Health Minister through the department on any increase in rates for services.  The arguments by the Funds are the same; without an increase the Funds won’t be able to provide the services resulting in a loss of membership and thus more pressure on the public health system.  The government’s position is almost always the same, claiming that most Funds are gouging their members for services they don’t need or won’t use.

This raises an interesting point.  Should these Funds be free to offer a range of products for a discerning public can pick and choose from, or should they be restricted to services that are only covered by Medicare?  (Currently dental is not covered by Medicare, but each State has a system for dental subsidy for those least able to afford dental care.  A plan exists to bring Dentistry into Medicare.)

Before the Coroner of Western Australia, Alistair Hope, is a case that raises very serious issues for the Health Fund industry.  The death of Penelope Dingle highlights the damage homeopaths can do in a self-regulated industry.  Yet it is almost impossible to be a member of a Fund without having the option of at least one “alternative medicine” in the bundle.

While Mr Hope has yet to hand down a finding, it is time for the Federal Health Department to refuse Health Funds any increase in fees until they remove any unproven medicine from their packages; naturopathy, homeopathy, in short, woo.

This isn’t the first time a Coroner has had to deal with the effects of homeopathy, but hopefully it will be the last.  As long as Health Funds package “alternative medicines” with basic cover, or even Ancillary cover, it legitimises the woo.  If any citizen or resident wants to have homeopathy or any other unproven medicine included in their insurance, then why should it be subsidised 30%?  If such treatments did work, we wouldn’t have a regular stream of Coroner’s Reports condemning the practice and practitioners, nor would we have families begging for justice.

This is a challenge for the new Gillard Government and for Health Minister Nicola Roxon in particular; stop the Health Funds from bundling woo into their packages.  The next time the Funds cry “we need to increase our premiums” the government should stand firm and suggest the Funds could save money if woo wasn’t automatically bundled with services that are legitimate, and remove the 30% refund for any service that cannot prove its efficacy.

That should save Medicare enough money to finally include dental services.