Today’s Guest Blogger is Dr Vyom Sharma is a GP in Melbourne and a health commentator and he writes passionately about the crisis in our mental health system.
What, precisely, is a crisis? Generally, things have to get pretty bad to be defined as one. “Housing”, “North Korean”, and ”global financial” have all seemed to earn that suffix. The problem with defining “crisis” is partly one of banality through overuse – if you believe even half of what you read, we are perpetually beset by it, in one form or another. So hearing the c-word in a context anything less than epic tends to be accompanied with a faint echo of hyperbole, and twinges of cynicism.
This cynicism can be a trap – it certainly was for me. Within the last decade of practicing medicine, I felt like if I had a dollar for every time I heard the words “mental health crisis”, I could single-handedly fund its fix. The phrase became a cliché. Over time, experience within the system bred familiarity, which spawned complacency.
Crisis is a word without a standard metric, common barometer, and sharp threshold. Its precise definition is akin to asking how long a piece of rope is. The only true answer is that it depends. But you know when you have enough to tie a noose. This week we’ve learned precisely how long that piece of rope is: a Victorian man who killed his mother amid a psychotic episode had to wait 14 months for a bed in a psychiatric hospital.
This is a new low. It’s bad enough that people die without getting adequate psychiatric help. But it turns out even killing someone else isn’t enough to qualify for psychiatric care. This is about as clear a demonstration of a “mental health crisis” as we will get.
To attribute this failure to an unfortunate lapse is to deny the very real, systemic problems that arise from mental healthcare being underfunded. This event did not occur in a vacuum. A deeper look exposes how the system, in its current state, is geared to end in such horrors.
Often the people most seriously afflicted by mental illness are the poorest, who cannot afford private psychiatric care. The problem is that publicly funded outpatient clinics are in very short supply. So often the only way to access psychiatric care out in the community is through “Catt” – Crisis Assessment and Treatment Team. That’s right, the only guaranteed way to be quickly linked in with publicly funded psychiatric care is to be in crisis. That’s how the system works.
Many patients have only this option available because they are in a strange chasm – not unwell enough to warrant a 000 call, but too unwell to wait weeks to see a private psychiatrist even if they can afford to see one. So the Catt service is often overburdened. GPs around Australia have a morose, longstanding joke about this; we say that the letters in Catt stand for “Can’t Attend Today Team”. When the “crisis” team is too busy to attend, you know there’s a problem.
This is not an indictment on the service – far from it. To say it is “overloaded” is like calling an acrobatic plate spinner “busy”. It is a job requiring a rare constitution – infinite patience, high stakes decisions, the ability to treat people who are of threat to themselves and others, and being firsthand witness to tragedy after tragedy. I’ve often seen Catt workers as patients for their own mental health. It might be a crisis in and of itself.
Depressingly, it seems the people viewing the situation with most clarity might be our youngest. Findings from Mission Australia Survey published this week show that Australians aged 15 to 19 ranked mental health as the issue of greatest national concern. Most worryingly, they identified mental health as an impediment to their future pursuits. The nurturing of at-risk adolescents through mental healthcare ought to bolster their optimism, but the failings of our system might be eroding it.
Statistics and position statements fail to capture these moments of clarity about our health system. And sometimes, reading cold statistics on per-capita funding, or wait times, without having to personally experience their impact, lulls you into the trap of confusing complaints for hyperbole.
There is another trap we can fall into. It’s one I was in for years. That trap is the belief that Australian healthcare, ranked consistently within the top-ten in the world is, overall, brilliant. That statement is undeniably true, and yet the key word here is “overall”.
If you forget those with mental illness, Indigenous Australians, LGBTIQ community, refugees and other at-risk groups, we’re doing spectacularly. The problem is that we are a country largely composed of at-risk groups. If you aren’t marginalised in this country, chances are you once were, or are descended from someone who was, or are shoulder-to-shoulder with someone who stands at the margins. And it’s at the margins where crisis thrives. That’s where we have to look to see the crisis for what it truly is.