Issue 40 / 21 October 2013

MENTAL health researchers have a clear message for the federal Minister of Health, Peter Dutton — treat mental health as central to all health, and outcomes will improve and money will be saved.

Associate Professor Felice Jacka, president of the Alliance for the Prevention of Mental Disorders, told MJA InSight that “there is no health without mental health”.

She was responding to an MJA article calling for greater national action on the prevention of mental disorders. (1)

The authors of the article referred to a recent survey that “highlighted the gap between mental health-related research funding and the priorities of stakeholders such as researchers, policymakers, health care consumers and carers”. (2)

“The divergence was most pronounced in the area of prevention and promotion, which, despite being the top-ranked priority for stakeholders, received low and diminishing amounts of funding over the past 10 years.”

Professor Jacka agreed, saying: “Promotion and prevention are critical in addressing the burden of disease attributable to mental disorders, but health service funding is almost completely focused on treatment.

“Many prevention interventions are both effective and cost-effective. It is much less expensive to avert mental disorders than to treat them.”

Professor Helen Christensen, executive director of the Black Dog Institute, told MJA InSight that there was a misunderstanding about the difference between the prevention of mental health disorders and early intervention approaches.

“I think people don’t understand what prevention is”, she said. “It’s not early intervention. Prevention is intervening before anyone develops any symptoms.

“It’s about mental health awareness, including literacy of the population — targeted interventions and specific programs for specific diagnoses at a particular time in the life cycle.”

Dr Lesley Russell, from the Australian Primary Health Care Research Institute at Australian National University, said mental health should be viewed as a public health issue. “It’s difficult because it is really hard to measure the effectiveness of preventive interventions and it takes a long time to measure them, but it’s important that we do so.”

Professor Jacka said when a person developed mental health disorders at an early age it had a significant impact on their participation in society.

“If Peter Dutton were sitting in front of me I would tell him the prevention of mental disorders needs a comprehensive, cross-sectoral approach because there are so many varied risk factors, for example, childhood abuse, poverty, violence, illness and disability.

“A large body of research now strongly suggests that lifestyle behaviours that are risk factors for non-communicable diseases — poor diet, physical inactivity, smoking — are also risk factors for mental health problems, including dementia.

“Mental health and general health have been artificially separated in approaches to public health, but there is no health without mental health”, Professor Jacka said.

Professor Christensen said her message for Peter Dutton was a simple one.

“Prevention works but people don’t believe it. There is plenty of evidence that prevention is cheap, better than cure, and it’s a no-brainer that it should start in school”, she said.

“Mental health is core to good health. The problem is we know a lot but we’re not implementing what we know.

“[It’s time] we [refocused our attention] from the pointy end of hospital beds and into prevention.”

 

1. MJA 2013; 199: 527
2. Aust NZ J Psychiatry 2013; 47: 355-362

6 thoughts on “Mental health vital in all health

  1. David Noble says:

    There is a much wider argument for a well resourced mental health strategy.  It is estimated that $29 billion is lost annually in Australia from depression alone.  The economic impacts to national prosperity are significant.  Prevention of disease will allow people to remain well, and in the workforce, and not become unwell, unemployed and welfare recipients.  As a nation we owe it to our youth to give them the physical, educational and mental toolkits to prosper. 

    There is currently some fantastic research underway in Australia.  The blue-sky ambition is to halve the global prevalence of the symptons of depression and anxiety within 25 years.  The question as to who will benefit from this research and innovation is an issue of both heathcare and entrepreneurship.

  2. Stephen Kilkeary says:

    For too long the biomedical view has dominated our thinking about and responses to people who become mentally unwell. One of the most attractive features of this view is that it is ‘no blame.’ We do not even need to think about the possibility that mental ill health is caused by others – parents who abuse their children, peers who bully each other in the school or workplace, women who are beaten by their partners, soldiers engaged in active combat, governments that fail to address chronic poverty, unemployment, exclusion, etc.

    We pour billions of dollars every year into treating by meds alone an ever growing army of pathologised people without ever asking the obvious question: what made this person mentally unwell? To ask that question, of course, is not merely to invite responses that point to context instead of biology or genes but further, it takes us into the unpleasant realm that mental ill health is our responsibility.

    If I could think of one thing that would dramatically improve the mental health of the population, it would be to ensure that all children are loved and cared for from the year dot. I find it extraordinary that in a supposedly sophisticated country like Australia, we can recognise the traumatic impact of child abuse and yet have no systems in place to respond therapeutically to the adult survivors of such abuse. It is perversely preferable to try and squeeze such survivors into diagnostic categories that do not fit and treat them with meds that do not work.

    Ultimately, as the cost of treating a rapidly swelling army of people deemed to be mentally unwell can no longer be afforded by government, not to mention the immense, squandered human capital, we might turn a critical eye once more to causation…

  3. Bruni Brewin says:

    As a Clinical Hypnotherapist, I pick up the clients that have been on Meds that have kept them coping but without releasing the feelings and emotions that caused the need for Meds.  I often deal with clients that know why they feel the way they feel which is a reaction to some traumatic happening – they understand that, yet they too have not been able to release the feelings and emotions from that/those events. 

    There are new therapies such as the Energy Psychologies of EFT or TFT that have shown the ability to release trauma – even meta analysis research on these have shown they work and we have not embraced these methods in Australia, and are only just coming to acceptance in the US.  But like all treatment, they only work by the experts that know how to use them in a way that they work – and that isn’t necesarrily someone in the medical field that has done a short course in the subject.

    Perhaps it is time that we have public reporting on the therapies being used to get a handle on what is really working for people.

  4. Ariane Cullen says:

    Increased funding clearly long overdue for preventative strategies in mental health. 

    Lets also push for more funding to (esp)cognitively rehabilitate those brave souls with chronic psychotic disorders- at present there is certainly a dearth of such programs, despite the huge cost to these individuals and to society at large.

  5. Wamono says:

    Health is like a Tripod stool balancing on three crucial factors of Physical, Mental and Spiritual welbeing. RCT show that 60 percent of Primary Care consultations deal with some form of Mental Health. Holistic approach to Mental health is the way to go that involves Primary Prevention. Current system puts Health Professionals under Stress themselves and many are struggling with Mental Health issues.

  6. P Morris says:

    As a contribution to the debate on the future of mental health services and psychiatry go to the web link below.

    http://www.drphilipmorris.com/the-future-of-psychiatry-and-mental-health-services/

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