On Monday 13 and Tuesday 14 April, ABC's Australian Story and The 7:30 Report ran stories that highlighted the nation's poor mental health system, resulting too often in people reaching crisis point and taking their own lives. The stories were very human accounts of the dislocation and disorientation wreaked by mental illness.
These stories foreshadowed the release of the National Mental Health Commission's Review of Mental Health Programs and Services, and the addition of mental health as an agenda item for the Council of Australian Governments (COAG). The review highlights waste in the mental health system, ambiguous reports and the inability to determine whether real and substantial change has occurred.
The review provides 25 recommendations across nine strategic directions which guide a detailed implementation framework of activity over the next decade. It includes almost 200 specific actions which provide concrete ways of making these recommendations a reality. The more weighty recommendations of the review are:
- for the Government to reallocate a minimum of $1 billion over five years from 2017-18 from hospitals to community-based services;
- an aim to reduce suicides and suicide attempts by half over the next decade;
- the inclusion of mental health in Close the Gap targets for Aboriginal and Torres Strait Islander health.
The recommendation to reallocate a minimum of $1 billion of mental health funds from hospitals to community-based services is interesting. While the best outcome for people with mental illness and their carers is to ensure adequate funding for both hospital and community sectors, in an increasingly cash strapped economy tough decisions have to be made about where to prioritise funding.
Community based responses to mental health have much to offer — particularly respectful, person-centred, and relational responses.
The importance of respecting people's strengths (recovery) and building strong compassionate relationships has been confirmed by research across cultures for over four decades and has reached its zenith in the work of Scott Miller and Barry Duncan. The key message of this line of research is that, according to the patients' and clients' perceptions, the theories and techniques of professional and clinical therapy have very little to do with therapeutic success.
Psychologist Michael Lambert's seminal findings attribute patients' and clients' perceptions of therapeutic success largely to non-clinical factors in the following proportions:
- 55 per cent to recovery factors (such as the client's ego strength, resilience, social support, hope and expectancy);
- 30 per cent to relationship factors (such as the therapist's/case manager's empathy, warmth, respect and encouragement of risk-taking);
- 15 per cent to clinical or professional techniques unique to specific therapies.
While the professional training of the clinician/therapist/case manager is very important, it only accounts for 15 per cent of what clients perceive is important in their improvement. Clients and patients attribute 85 per cent of their improvement largely to other factors such as their own resilience and the quality of their relationship with their therapist/case manager.
Recent studies have nuanced these findings by demonstrating that certain therapies may offer more effective treatment for specific mental disorders. Ted Asay and Lambert demonstrate a tenuous association between exposure and treatment for phobic disorders. Nevertheless, the authors contend that typically, there is little or no difference between therapies and techniques in relation to clients' perceptions of improvement.
Community based mental health providers focus on providing excellent services based on respect for the individual, a belief in hope and maintaining positive relationships.
Do these concepts sound familiar? They should. They are at the heart of the gospel and evident in parables like 'The Good Samaritan'. They are codified in Catholic Social Teaching principles like the dignity of the human person, respect for human life, human equality and participation.
Too often, faced with increasing complexity and professionalisation, the Church has backed away from engaging people with mental illness, thereby, unintentionally further marginalising them. The research above indicates that local parishes and faith communities may have an important role to play as they seek to live out the gospel and practice the principles of Catholic Social Teaching.
All of us can offer sincere respect and engage in genuine relationships as we support people with mental illness and their carers. When we feel out of our depth we can partner with mental health professionals — be they hospital and/or community based services.
For the Church it's also about recovering a confidence in the Gospel, the importance of the Church as a Eucharistic community of virtue, in part, as a broadly 'evangelical' response to Western Society's increasing wrestle with mental illness.
Paul Jensen is CEO of Centacare in the Catholic Diocese of Wagga Wagga.