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Why we fail at mental health

Patrick McGorryPatrick McGorry

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Matt Smith:

Welcome to the La Trobe University podcast. I will be your host, Matt Smith. And I'm here today with a special guest. It's Professor Patrick McGorry. He is a mental health advocate and professor of youth mental health at the University of Melbourne and also the 2010 Australian of the Year. Thank you for joining me, Patrick.

Prof. Patrick McGorry:

Thanks a lot.

Matt Smith:

Can you please tell me about the mental health situation in Australia? And is it a problem and is it a well-known problem?

Prof. Patrick McGorry:

Well, unfortunately, people with mental ill health in Australia, and that's between 4 and 5 million Australians every year, have got very poor access to health care. We've just been through an intense period of debate on health reform culminating in the COAG Agreement two or three weeks ago. And despite the fact that only 1/3 of people with mental health get access to care compared with 90% of people with physical health problems, mental health was left out in the cold once again in terms of funding growth. So people with mental ill health are getting a very raw deal in Australia at the moment.

Matt Smith:

You said 4 to 5 million people in Australia, that's about a quarter of the population more or less?

Prof. Patrick McGorry:

Let's say 20%. It goes up to a quarter when we focus on teenagers and young adults. It's one in four young people, but it's one in five many given year of the whole population. So let's say 4 million conservatively.

Matt Smith:

That's a large chunk of the population. Is it well known that's a problem?

Prof. Patrick McGorry:

I think people don't understand that mental ill health is a spectrum. So it extends from people who have got maybe temporary periods of mental ill health like maybe a few weeks of anxiety and depression, perhaps something goes wrong in their life, maybe a break-up of relationship and so on. They might need something fairly simple like support and information and maybe a little bit of counselling. That extends right through to the more serious forms mental ill health like anorexia nervosa, schizophrenia, bipolar disorder, substance use disorders and personality disorders. So there is a severe end of the spectrum and then there is a whole series of grades right through, just mild to moderate mental ill health. And that in total is about 4 million people. If we look at the more severe end, there is about 600,000 Australians affected by serious mental illness.

Matt Smith:

Has the definition of mental illness become too broad?

Prof. Patrick McGorry:

Well some people are worried about that. But I think if we just define it in terms of common sense rather than worrying about diagnostic subcategories and we just try to imagine if someone is distressed, their functioning is impaired, their relationships are being damaged by their state of mental ill health and they're just not flourishing and their lives are going through a very difficult period, that's probably a reasonable working definition.

Now obviously if that was only happening for a day or two, it wouldn't be over the line, but if it's happening for weeks on end, not only does it show a need for care, but it's a risky situation because people can be quite depressed during these periods. And the depression can take very sudden dips which can result in risks in terms of suicidal thinking and suicidal behaviour.

So if we don't actually recognize the early stages of these problems, then we're laying a path of trouble really.

Matt Smith:

You just mentioned suicidal behaviour, how much is that is a problem amongst mental ill health?

Prof. Patrick McGorry:

Well suicide is the tip of the iceberg of mental ill health. People don't attempt to commit suicide if they're mentally healthy. It's pretty obvious that it's not just a very mentally healthy thing to do. Suicide is a huge public health problem in Australia. It's not understood or recognized by the population. Someone dies of suicide in Australia every four hours. Someone attempts it every 8 minutes. And it's a 40% bigger cause of death in Australia than the road toll. So between 2200 and 2800 people every year die of suicide. It's a much bigger cause of death than the road toll particularly in young people. It's the main cause of death in adolescents and young adults up to the age of about 30 to 40.

Matt Smith:

Is the problem with mental health illness more prevalent in young adults in Australia than it is amongst the older population?

Prof. Patrick McGorry:

Yeah, very much so; 75% of mental health problems and disorders will appear before the age of 25 mostly during adolescence and early adulthood. The main adult type disorders really appear like schizophrenia, depression, eating disorders and so on. It's really a disorder of young people. And obviously if proportion don't get better, then it accumulates and you do see people in midlife who've had maybe 10 or 20 years of chronic mental illness. So the appearance of these disorders is very much a young person's thing.

In a positive way, perhaps mental health improves with age. So older people in general are mentally healthier than younger people unless they develop some kind of brain disease like Alzheimer's or dementia or something like that.

Matt Smith:

Can I ask where do you draw the line between a mental health problem and a moody teenager then?

Prof. Patrick McGorry:

Yeah, that's a great question. That's the one that parents often ask. I think the confusion has arisen because people have accepted it as sort of norm to be moody or perhaps even depressed during young teenage years. I think they're confusing something being common with being normal. It's certainly very common. Probably one-third of young people by the time they reach the age of 25 will have had a period of mental ill health. But that doesn't mean it's normal or acceptable. It's actually quite risky.

And what we're saying is that if someone has a lowered mood or disturbance of mood and distress particularly if it's impairing their functioning and their relationships, perhaps their schoolwork or their work functioning, and particularly if there is suicidal thinking associated with it, that's clearly not normal. A happy, healthy teenager isn't in that state. That is what we should regard as the normal teenage state. It doesn't mean that you're not going to have stressful times during that period of life. But if that stress translates into clear distress and disorder which is persistent for more than a few days and let's say for a few weeks, that's clearly something for concern.

Matt Smith:

What kind of change needs to happen then and where does the leadership come from?

Prof. Patrick McGorry:

Well first thing we start with recognition. So we actually understand as your question pointed out how do we recognize mental ill health? That's the first step. Then how do we talk about it? More openly. And then where do we go for help? One of the problems has been that there hasn't been anywhere appropriate for young people and their families to go for help because the health system is designed around the needs of young children and old people, whether that's primary care or hospitals. So we haven't had a health system that responds to the main health issue of young people which is mental health and substance use. Young people have got the worst access across the lifespan to health care and particularly for their main health issue which is mental ill health.

Now the leadership has got to come from the field I suppose, this new professional field of youth mental health. We desperately need the support of the community, the young people themselves and their families who know what we're talking about here and know about the access problems. It needs from our health planners and policymakers and from our politicians. But in my experience they won't act unless they are convinced that the public expect them to act. We don't see enough leadership from our political leaders on these issues. They really have to be led in the same spot of community on these issues on my opinion.

Matt Smith:

Why should people give this issue a priority when there's many other issues in our day-to-day life that need to be given focus as well?

Prof. Patrick McGorry:

Yeah, I think that's a really good question. I've asked the question myself, why should anyone care about this? Well we can care like we do for all issues that are being neglected, social exclusion, injustice and marginalization. We can care about it on altruistic grounds because we're concerned about other people. That's one way but that's not enough. I think the most potent argument is that it's something that affects all of us. It's a self-interest argument. If you are a young person, you've got a reasonable chance and then given a year of being affect by mental ill health perhaps a one-in-four chance. And accumulatively over the period of life, teenage, young adult life, it's going to affect you at some point maybe a chance of 1 and 3 across that whole period.

So it's common. You're likely to benefit from it yourself. So it's in your interest to actually insure that this issue gets addressed. Same with families; I mean if you've got three kids, chances are one of them is going to have a significant period of mental ill health during that period. So if you care about your kids, then you should care about this issue.

Matt Smith:

When you were awarded your title, you described detention centres as ‘factories for producing mental illness and mental disorder’. What prompted you to say this and have you had experience of this firsthand?

Prof. Patrick McGorry:

Going back to the 1980's, I was one of the people who established the Victorian Foundation for Survivors of Torture, which is a refugee health service and social service in Melbourne. It's now called Foundation House. Basically I've looked after from a mental health point of view a lot of asylum seekers over the years and also former detainees. I've been in detention centres and I've seen the damage that they do. So it is something that is very close to my heart. I felt that when I was asked the question, I had to basically tell a story on behalf of those people that have been through those appalling experiences.

What has happened is that vulnerable people that have come to Australia who were genuine refugees have been put through a process which actually created new forms of mental ill health on top of what they were already struggling with. It's completely indefensible. It's unnecessary. And they're otherwise managing this process in terms of determination of refugee claims and supporting people as they're going through that process.

It has become a political football as I so predicted when I made the comments. I was warning against the government going down this track that the previous government had gone down. Unfortunately they have gone down that track again for the same reasons because they think that it's electorally sensitive. And unfortunately the media and the politicians have almost conspired to reinforce that prophecy actually. So now we're seeing a real deterioration again. That's a problem because we're about to create a new way of a mental ill health amongst this current cohort of asylum seekers.

Matt Smith:

How would you like to see the problem dealt with?

Prof. Patrick McGorry:

Obviously there's got to be a structure and a process that manages people who are seeking asylum. There is no question about that. No one is saying just let everyone in. We've got to determine who has the right to protection. That's being done very badly at the moment.

I don't agree with the fact that people are being processed offshore. That's a device to avoid their responsibilities. I think it should be done onshore. It should be done perhaps initially with a period of initial detention while we work out safety and health issues, contagion and infectious diseases, those sorts of things.

But then once people are safe and deemed to be no threat, then the determination of refugees status should happen within resident in the community as it happened in every other western country in Europe in particular with much larger numbers and it should be done in a prompt way. So the period of uncertainty is kept to a minimum. It's the uncertainly and also the coercive aspects of the policy which cause the mental ill health in the asylum seekers.

Matt Smith:

Do you think that Australia has a problem with asylum seekers in boat people?

Prof. Patrick McGorry:

Well I'm not an expert in the politics or the broader policy aspects of it except that I could say that it does appear as many other people have made the point that we have a relatively small problem. It's only 2,000 or 3,000 people a year with an immigration cohort each year of up to 200,000 people coming into Australia.

So it's a fraction of the people coming in. It's hardly contributing to our overpopulation issues. These are people who are most in need of our help and also who turn to be some of our most positive citizens. I know many of these people who once they've got through the ordeal of asylum seeking and are accepted here, they've gone on to make an amazing contribution to Australian society. They're very strong people. So I think that it's a small problem in terms of unauthorized arrivals. But it feeds into people's fears and unfortunately rather than calming the fears, our political leaders have fanned them.

Matt Smith:

By entering the refugee debate, do you think that your mental health care reform message was maybe a bit lost?

Prof. Patrick McGorry:

Well I did worry about that. As I say, I had to answer the question honestly. It wasn't a trick question really. People knew that I have a background in refugee mental health. So I think it was a legitimate question to ask. I was concerned and even more concerned now about the way the policy direction is going. So you're probably right; it did distract a bit from my main message. But ever since then I've been focused very strongly on the main mental health message.

And if you look at what I said, it was actually a mental health message, too. I didn't buy into the whole policy debate. I recognize I'm not an expert on that area and other people are much better qualified to talk about the political and policy aspects. But the one thing that is very clear is that it's extremely bad for mental health of vulnerable people to manage them in the way that we have been managing them.

Matt Smith:

If you could achieve just one thing as Australian of the Year, what would that be?

Prof. Patrick McGorry:

To make some major steps to ending the inequity, the apartheids of the system that we have in Australia for people suffering mental ill health. The access and quality of care they experience is way below in terms of standards that we see in the rest of the health fields. So if some substantial steps were taken to end that and targets set to completely bring that to an end by let's say 2020, that's what I would be aiming for. And obviously that requires a dominant focus on teenagers and young adults because that's where the problems surface for the first time and that's where we can do the most effective work I think.

Matt Smith:

Professor Patrick McGorry, thank you for your time today.

Prof. Patrick McGorry:

Thanks a lot.

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