Close the gap between public and private mental health care



I am an Australian mental health client who has been a consumer of both public and private inpatient service facilities. In my mid-20s, I was one of those people in the 'lucky country' who got 'unlucky' enough to be sectioned under the Mental Health Act into the public inpatient system. It was a harrowing experience.

Anxious looking womanThe experience is so etched in my mind that it wasn't until recently, at least half a decade on, that I finally managed to shake the residual anxiety. A single admission to the public mental health system saw me crippled by post traumatic stress disorder.

To this day I shudder as I recall wondering if I'd escape that place in one piece (while ducking flying furniture, in the line for use of a public phone). By contrast, I've never had an inpatient admission to a private psychiatric hospital where I haven't been discharged in comparative good health.

The disparities between services provided in public and private mental health inpatient facilities are beyond remarkable. Never have I noted in Australia the difference between the 'haves' and 'have nots' to be so stark as in relation to private health insurance and subsequent quality of care. These disparities desperately need to be addressed with actual solutions and funding.

Many consumers who have experience in both public and private systems echo my sentiments about the need for public mental health reform. We believe the money spent by the Australian government on mental health (at just hundreds of dollars per person, per annum) is inadequate, especially in a day and age when Australian suicide rates are higher than the national road toll.

I feel for those experiencing admissions in public mental health services today. Beginning with sterile and uninviting (read: bolted down or stained) décor in some shared rooms, the public psychiatric wards are a volatile melting pot. There is violence and general aggression, exacerbated by lack of funding.

Even many staff in public settings would agree the facilities are far from idyllic and, at times, downright intimidating. Being within reach of people coming down from drug-fuelled benders or psychosis is not ideal even when you are well, let alone when you are feeling unsafe, nervous or paranoid. Add a lack of space and some general helplessness and isolation from loved ones, and you have a recipe for disaster.

During my own inpatient admission, rather than spending my time recovering in hospital, I became hyper-vigilant in regards to my own safety. Had I slept a wink during that ten-day admission, I would have done so with one eye open.


"Not everyone can afford the private health insurance required for a private admission, but everyone should have the right to be treated with dignity and respect."


I felt beyond powerless, without a sense of self-actualisation and without independent decision-making options within practitioner service delivery. The general consensus among those at the helm at the time seemed to be that if you landed yourself in there in the first place, chances were that they (the mental health practitioners) would know best what was in your interests.

Dual decision-making between trained staff and consumers should be a matter of course, but sadly this is not commonly reflected in current public psychiatric practice. Autonomy is often sidelined in the name of medical intervention. Whether the sidelining of dual decision-making is due to a lack of funding, resources and limitations over beds and consequently short periods of admission is unclear.

Perhaps these factors, along with a steady flow of psychiatric patients presenting in emergency departments, means psychiatrists and management of clinical service delivery need to get consumers in and out as quickly as possible. Therefore, time spent negotiating a way forward with the consumer just doesn't get prioritised. This lack of time and resources also means that compared to the private mental health system there is little attention given to education about treatment options, or even diagnoses, let alone prognoses.

Time and again, the words 'public mental health system overhaul' have been thrown around by respective governments. However, there are few tangible differences seen by our most vulnerable consumers. This is certainly not to undermine the progressive changes such as sensory room activities, greater consumer input (the employment of consumer consultants, educators and peers) and higher security measures for those with gender sensitivities. But since the basics of care within the public system were so lacking to begin with, there is a lot of ground to make up.

With the right investment, the services could be vastly improved and even save lives. The food could be edible. The staff could be more attentive. The psychiatrists could have more time than is required to write a script. Patients could be examined holistically. There would be a sense of self-actualisation, with treatment arrangements, even negotiations, to ensure they are amenable to all parties. It's not a foreign concept. It already exists in private service delivery.

There needs to be some clear cut decision making on the way forward, with greater consumer input that allows for tangible changes more conducive to recovery. Not everyone can afford the private health insurance required for a private admission, but everyone should have the right to be treated with dignity and respect; the disparity between current public and private systems is little more than institutionalised discrimination. The government should be addressing the gaps and aiming to bring the public system up to par. We can do much better.


Naomi FryersNaomi Fryers is a freelance writer and editor from Melbourne, Australia. She has been published by a number of US and Australian publications and is a former editor of Lot's Wife and The Good Men Project.

Topic tags: Naomi Fryers, Mental Health



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Existing comments

A brilliant account of the disparity between the private and public sectors in mental health care from a women who has fully realized the problems and formulated a number of viable solutions and alternatives. I do hope her voice is heard and heard well.
Bary Sands | 09 February 2017

It's a number of years now since Patrick McGorry's role as Australian of the Year highlighted mental health issues, especially for young people. The particular vulnerability of mental health patients requires deep understanding and responses that are strong and stable. There is a disparity between public and private hospital experiences, even though eminent specialists work in both spheres. A brave, and eloquent account, Naomi.
Pam | 09 February 2017

Many mental health patients, through no fault of their own, would lack your intelligence, guts and powers of expression. Sadly, public mental health services, through no fault of those working in them, are woefully underfunded. What will change the situation? The only thing which moves most politicians seems to be self-interest. Hence effective, long term lobbying by the likes of Patrick McGorry appears to work. The Power of Shame is a wonderful thing: we need to make our politicians feel so ashamed on this that they actually do something.
Edward Fido | 10 February 2017

Naomi , your account was a sobering read. Your experience outlined the way we in Melbourne treat our vulnerable, Ill citizens when they are in need and cannot afford private mental health treatment. As a visitor for six weeks over six years ago to a young man who had been involuntarily admitted to a mental health facility , I simply as a visitor am still traumatized by his treatment and the absolute despair and humiliation he suffered. Repeat I was only a visitor. Our frustration at the lack of an individualized program , sensitivities to his particular needs and the transition program doomed to lead to the "revolving door syndrome" left us gasping. The trauma the young man experienced is echoed in your article Naomi. How can we work for any change? Your suggestions could be implemented. If Patrick McGory can get no immediate action, and the injection of much needed funds what can we do? In the meantime lets at least stand near the disturbed mentally ill people in need of love and support . Let's at least try to include them in our community, simply pass the time of day with them and try to make them feel a little loved with a smile and a word. Keep up the heartfelt ,much needed work Naomi. Love and my prayers for you the "salt of the earth".
Celia | 13 February 2017

A sad and distressing revelation of the legacy of the Whitlam government's disruption of mental health services with the introduction of the original national health insurance scheme, Medibank, in the wake of the Richmond report. [It was, and still is as Medicare, an insurance scheme, not a health care scheme]. The reason why you found the private system better, Naomi, is that it provides a health scheme with its major interest in your well-being rather than an accountant driven budget saving scheme for government. In the private system you are treated more as a patient should be - not as a consumer, the description the bean counters in government administration understand. Before Whitlam, violent patients were confined in specialist mental health facilities where they couldn't throw furniture at you and could be restrained when violent and destructive. [Some 30% of hospital beds were occupied by mental health patients in the 1960s] The Whitlam government closed all those facilities down and many poor patients were released into the community to wreak havoc. And health other that mental health has fared no better but the immediate effects are not as dramatic as emergencies in mental health. In general health issues it comes down to not being able to get into hospital, being sent home from emergency departments sometimes to die, your emergency surgery being delayed because of economic restrictions closing operating theatres and bed unavailability due to deliberate cost saving bed closures. In the main the doctors and nurses in both systems will always treat you as a patient. The government and its agents will always treat you as a consumer, keeping to their budgets and earning a Christmas bonus in return. A sad state of affairs directly and irrevocably created by the Whitlam government, not with the intent of earning a bonus it seems but rather earning sainthood in the eyes of the public. Time for the sacred cow to be seriously revised in the interests of patients not consumers. It would not be a difficult job and one the true doctors and nurses would engage with relish.
john frawley | 13 February 2017

Thank you, Naomi, this was a moving and insightful account. Somehow the expectation has shifted from the public sector exhibiting a caring, generous attitude to the public sector being akin to the workhouse - a form of punishment to force people back into the market place. People needing mental health support, and indeed all citizens, deserve better.
Adrian Glamorgan | 13 February 2017

Hi Naomi, I couldn't agree more both professionally and personally my experience with the public health system in terms of mental health has been horrendous. Add to this people with intellectual disability suffering mental health issues as well - the public health system fails miserably. Thank you for your courage in sharing your personal experience. Cathy Hassarati
Cathy Hassarati | 13 February 2017

Naomi it didn’t use to be like this. 30 years ago I had 2 lengthy admissions to a public hospital and the treatment was brilliant. These days I would be terrified to be in a public hospital. We must agitate for more money into the public health system as a whole and educate the public that this is what our taxes should be for, not for flash new sports complexes and politician perks.
Kim | 22 February 2017

I think perhaps Australia should increase taxes as done in Sweden where everyone is well cared for regardless.
Cam BEAR | 28 March 2017

Well said-Cathy Hassarati.
Aaron | 14 August 2017


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