Human relationships and efficiency don't mix

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Relationships paper cutout

The test of a good society is the attentiveness it shows to its most vulnerable members.  But when it comes to budgets and budgeting, the most vulnerable usually miss out.  This is certainly the case of  disadvantaged young people with mental illnesses in Victoria. State funding and the Federal Budget will further disadvantage them.

A recent report from Mission Australia and the Black Dog Institute has shown the challenge in treating mental illness in young people. The stigma and the loss of self-confidence associated with mental illness make them hesitant to seek help or to admit their need for it. They are also intimidated by large clinics and confused by a multitude of carers, each of them focusing on one aspect of their need.  So they easily isolate themselves or decline to commit themselves to therapeutic programs. 

Many have been helped, however, by the opportunity to have a place they can drop into offering educational and cultural activities and access to services. The key to such programs lies in the relationships that they build with dedicated members of staff. Such programs have been successful in enabling young people to make connections to society that flow into education and work opportunities.  

Tragically, young people with mental illnesses have now been caught in a pincer movement between the Federal Budget and changes to the way the Victorian State Government funds its welfare services. The Shergold Report commissioned by the State Government emphasised efficiency in service delivery by developing partnerships and simplifying a system in which people were referred to many different agencies working independently of one another. Underlying the Report was the determination to ensure economic sustainability. 

The Victorian Government has started to recommission its community sector programs. The first to be affected were the community mental health services. The outcome saw  a simplification of administration into a smaller number of areas, with tenders being awarded to a few large tenderers in each region. These included some large community organisations.  

But funding was withdrawn from small innovative programs directed to people who are mentally ill. St Mary’s House of Welcome, Jesuit Social Services’ Connexions Program and the Artful Dodgers Studio and other specialised programs lost funding for interventions that were effective because of the quality of the relationships they had built up. 

The young people affected by these changes will be put at even greater risk by the Federal Budget. The restrictions on benefits and the harsh and unrealistic conditions imposed on people in order to receive benefits will affect particularly those with mental illness.  They will increase anxiety, the stigma and the feelings of worthlessness already afflicting these young people, and make it less likely that they will trust or seek help from large services.  Financial efficiency and managerial simplicity may be gained, but it will be at the expense of  hard-won wisdom and personal resources.  Those who lose most by the changes will be the most vulnerable members of society.

Mental health, particularly of young people, ranks low in the priorities of voters, and these changes will be little noticed.  Yet if the measuring stick for any government is indeed the way in which it attends to the most vulnerable members of society, this inattention is deeply regrettable.

How are these harmful changes to be explained? The common thread running through the measures adopted both at State and at Federal level is the commodification of services and benefits. The business of government is the prudent management of its economic resources.  Services are seen as commodities to be produced at the lowest possible cost and distributed in the most economically efficient way, and to be paid for by tokens of involvement in the economy. Vulnerable people who are mentally ill, lack social skills and live in poverty cannot respond in an economically acceptable way.  So they will lose access to benefits.

When services and benefits are commodified, too, their delivery will be evaluated primarily in terms of economic efficiency.  Inevitably large agencies which promise to deliver economy of scale will win contracts. The public service can shrink, and eventually will lose the stored wisdom necessary for regulating services for the common good.

If human beings were widgets to be traded this would not matter much.  But for vulnerable mentally ill young people the goal of their healing is to build connections with themselves, others and their world.  It is about relationships.  And the way in which this best takes place is through good relationships.  Relationships are incorrigibly inefficient things.  That is why they are disregarded in budgets and tendering.  And the consequence of that is that people are disregarded. 



Andrew HamiltonAndrew Hamilton is consulting editor of
Eureka Street. By way of disclaimer, he also works as a media assistant at Jesuit Social Services.

Relationships image from Shutterstock

Topic tags: Andrew Hamilton, mental health, community sector, efficiency, budget, Victorian Government, JSS

 

 

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As an undergraduate, I did a study of charity assistance in the 1890s downturn in Victoria; a pretty nasty slump – arguably worse than the Great Depression of the 1930s – and caused in no small measure by government tolerance of fractional reserve banking. I focused on Protestant charities – mostly ladies of wealth from Hawthorn and Kew, coming across the Yarra to locate and assist the most affected in Collingwood and Abbotsford. I was overwhelmed by their meticulousness and their concern in particular for the very poorest and needy. Somewhat in the vein of modern nursing practice, they would week upon week diarise the conditions of every client. But the appearance is deceptive. Unlike modern hospital nurses (no offence intended whatsoever), and as is clear from their notes, their documentation was not for the purposes of avoiding law suits as is the case under today’s obsessively litigious medical regime, but rather for the purpose of meeting the charity’s ends with respect to the most hopeless clients, whom they grew to know and obviously care for on a very personal basis. A virtuous mix, I would have thought, between human relations and efficiency, and one replicated on a plethora of levels in voluntary society – most notably, in the typical family, and in history by such voluntary entities as religious orders (among others, the Cistercians in their prime were extolled for their efficiency, as were the Jesuits.) Do wealthy ladies from Hawthorn now go and care for druggies in Fitzroy? I have no idea. But if not, perhaps it's because they think the welfare state is looking after all that – as it will undoubtedly seek to boast that it is. But whatever one thinks about the benefits of taxpayer-funded assistance to the poor, there are an array of beneficial relationships generated between private charity and its recipients which are simply non-existent when a 9 to 5 unsackable bureaucrat directs taxes, invariably at the whim of a politically-driven policy, to legally designated – and I thank Fr H. for the term – “widgets”.
HH | 03 July 2014


"When services and benefits are commodified... their delivery will be evaluated primarily in terms of economic efficiency...But for vulnerable mentally ill young people the goal of their healing is to build connections with themselves, others and their world." The main problem with this concept of economic efficiency is that it simply is not efficient. Production of cars that frequently break down is never regarded as efficiency, no matter how good the economic tally of financial cost against hours worked might look - because the product is not effective. Why do we not require at least the same effectiveness of service provided to the mentally ill as we require of the manufacture of cars?
Ian Fraser | 03 July 2014


Andrew, your article reminded me of the story of "Mike",a shy,quiet,sporty 15year old. His parents marriage broke down,he was bullied at school ,suffered abuse on social media. Like a battered child he struck out. Firstly at his mother and younger sister and finally at himself and tried to take his own life. Rage filled him. He was placed in state protection. Due to an innovative program being envisioned and implemented and accompanied by appropriate funding, a special projects team took over Mike's care. A team of people walked with him through his issues. They set up appropriate health professionals,watched over him,reintroduced him to living in community, taught him soccer skills,taught him to budget, shop , cook ,take care of his personal hygiene, got him into a bridging program in a school. These people were devoted to this very like able boy. Mike knew this and responded well. Abruptly the team was notified there was no more funding. Mike was to be cast adrift . Their jobs were to be terminated. The project was over. A specialized program that was building relationships was lost. Not sure if the helpers got other jobs or what happened to Mike.l
Celia | 03 July 2014


I cannot really express my dismay properly, so thank you Fr Hamilton. After 23 years volunteering with a small community based service for those with a serious mental illness, I am amazed to find it has been re-commissioned and virtually all the services closed down. Where are the 'clients' to go now? What about the loss of experienced and dedicated staff? The mental illness of a young person has a wide ripple effect, and so the carer services are also lost to a wide range of people who are often so affected by the tragedy that they themselves need help! The Board of this particular service were the last to know about the decision. This all indicates a disturbing element in our society where the money of the society is not being used to assist those in terrible need.
Jennifer Raper | 04 July 2014


Human relationships are the most important. Any disability is only a small aspect of the total person. Two often we focus on treating the disability but not promoting the healthy and inclusive society that everyone needs. I have great hopes for the person-centred values of the NDIS but we can't leave everything to the welfare state. It is up to our community as a whole to provide the relationships and support that we all need. But does this mean we need to radically change our very private and isolated culture where everyone works full time, watches tv at night, and dashes to a couple of activities on the weekend.
Dan | 06 July 2014


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