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Relationships key to mental illness treatment


Human MindMental illness takes many forms and has many effects. One of its most painful effects touches both those who suffer from it and those who love them. People who are afflicted find it difficult to make deep connections with other people. They often withdraw into themselves. They need people to be there for them for the long haul, but their withdrawal into silence demands great understanding and endurance of their family, friends and carers if they are to stay close.

Although medical and psychological discoveries and better regulation have improved the treatment of mental illness in Australia, the need still outweighs the resources available. People with mental illnesses need others to help them build and develop relationships if they are to thrive. But the same trends that help the better treatment of people also tell against the crucial building of relationships.

The first trend has been to medicalise mental illness. This has had enormous benefits. It has encouraged researchers to identify chemical and genetic causes, and to find chemical ways of curing or lightening the illness. The lives of many people who suffer from mental illness have been greatly blessed. It has also lessened the stigma associated with mental illness by showing it to be understandable and open to cure.

But it has also increased the range of human discontents placed under the canopy of mental illness, and the expectation that these can be treated medically. This can lead to neglect of the curative and sustaining power of relationships from family and friends both in mental illness and in other conditions brought on by loss and trauma.

The second trend has been to commodify the response to it. The limited resources available to treat the mentally ill dictate a high level of efficiency so that as many people as possible might benefit. This demands that those working with the mentally ill account for the type of service they provide and the time spent on each person. This naturally leads them to focus on the material outcomes of each meeting and not on the quality of the personal engagement they have with their clients.

This trend allows more people to receive treatment, which can also be monitored. But it also makes it more likely that the human contact between people who provide the services and the people who are ill will be brief and focused on the service, not on the person who is ill. It makes it more difficult to build the trust necessary if the therapeutic relationship is to foster the connections of the mentally ill person with themselves and with others. Without support the patient may also be less likely to be faithful to medication, particularly if it has unpleasant side effects.

The third trend has been to criminalise the consequences of mental illness. Many mentally ill people neglect to take the medicine that holds their illness in check. They may then act violently or abusively. Others may become addicted to alcohol and other drugs, partly as a way of drowning out pain and loneliness. Their consequent anti-social behaviour, including violence and dealing drugs in order to sustain their addiction, brings them into the justice system, to criminal convictions and often to prison. That is why in prisons the proportion of people suffering mental illness is so high.

This trend is understandable and has some limited fringe benefits. In the absence of places where mental illness can be safely treated it responds to the demand made by society that people should be safe from violent and unpredictable behaviour. Prisons, too, may be relatively safe places where people may be provided with appropriate medication, and occasionally find help to deal with their illness.

But when the consequences of mental illness are criminalised, the stigma attaching to the mentally ill person is reinforced. Prison commonly diminishes people's self-respect and leaves them further isolated in a harsh environment. The relationships they need to nurture are diminished rather than enhanced. Imprisonment is not a favourable therapeutic environment. It also diminishes people's self-respect and isolates them further.

Mental Health Week is an occasion to recognise how, compared with 50 years ago, life has changed for the better for many people with mental illnesess. But it is also a reminder of how many people's lives are still blighted by mental illness. They would perhaps be cured were more resources available.

It is also a time to reflect on the importance of relationships in the lives and treatment of those who are mentally ill, and to value the care given by family and friends and in programs that are based on building relationships.


Andrew Hamilton headshotAndrew Hamilton is consulting editor of Eureka Street. This week is Mental Health Week.

Human mind and brain image by Shutterstock

Topic tags: Andrew Hamilton, mental illness



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Existing comments

I think the closure of the old mental hospitals, done with the stated aim of "moving people out into the community" left many seriously mentally ill people, especially if they had limited family support available to them, high and dry. Consequently they moved to those dreadful boarding houses in or near the inner city. The slide to homelessness; some sort of addiction and/or criminality was then so much closer. All these social problems we attempt to ignore or patch up with band aid solutions will come home to haunt us.

Edward F | 09 October 2013  

Thanks for this Andrew. I agree fully that sustaining relationships can be difficult for people with mental illness. I know from my own experience that the give and take of relationships is not so easy when battling seemingly insurmountable issues. I've been fortunate to have had patient (as in being shown patience) support at crucial times. On a positive note, I have also developed some empathy for people struggling with mental illness.

Pam | 10 October 2013  

Thank you for presenting this on World Mental Health Day, Father. I have been closely connected with the seriously/severely mentally ill (SMI) for over 20 years. During this time treatment has decreased, numbers and death rates increased, life expectancy decreased to about 55 years. NO MPs or bureaucrats have funded SMI well enough in these decades to obtain ANY improvement for them. They lack acute beds, rehabilitation beds and psychotherapy; they are given antipsychotics which increase natural deaths. They receive very few of the necessary personal and social therapies the author rightly sees as necessary for a better life...these are mainly the preserve of the 4 out of 5 persons who suffer from transient and curable mental illnesses. CHANGE THIS! The cry of government is "No money". So, for maybe 2 years, stop providing beds and essential care for acutely ill cardiac patients. Here, our readers are challenged. Is it stigma that we, seeing ourselves as more important than the SMI, have a cardiac blockage and expect to, and do, immediately have a bed and treatment available? YES. Or, in this land of the "Fair Go", we would fight for fair treatment of our severely mentally ill.

Caroline Storm | 10 October 2013  

Relationships are very important, I know that one of the reasons I've come through the 'mental illness' fog is because of the support from friends and family. It does depend on the type of 'illness' you are diagnosed with as there is such a range. Relationships need not be plentiful, they do need to be deep and meaningful. Another thing that has helped immensely is speaking about the experience and really highlighting that there are positives. I believe that the experience I had is one of the greatest blessings I've had in life. Also, taking responsibility is a big one, and that looks different for everyone. For me it was acknowledging what had happened and exploring causes that have meaning for me, and that I have the power to influence my own life. There is much to be learnt about this human experience.

Jen | 10 October 2013  

Re: the commodification of mental illness - couldn't agree more. If, like me, you can afford a private psychiatrist then you are lucky enough to be able to 'shop around' if needed until you find a specialist who meets your needs. If you can't afford this, then you take your chances in the public health system which has its strengths and weaknesses, but doesn't provide the scope of finding the right specialist. Meaningful choice is what is missing in the otherwise commodified public mental health system.

Michael Lockwood | 10 October 2013  

There is no disputing that a person`s lifetime context, including relationships since infancy, stress and drug use/abuse among others are extremely important for the balance of mental health and disease. And the divide between normal and abnormal in this context, as in medicine in general, is by no means absolute. What also need emphasis is the societal response to mental health in Australia...is it right that 60-80% of psychiatrists work mainly or wholly in (publically-subsidised) private practice, for example. Rich doctors treating the rich(er) 50% of the population, while the other poorer (and sicker!) 50% of us have to depend on under-manned and under-funded public psych services. Is anyone speaking out about this scandal?

Eugene | 10 October 2013  

Thanks, Andrew, I was working at Centacare when the psychiatric centre closed after searching around I discovered Grow and with people coping with mental illness we set up a Grow group. It really worked for many participants over the years and still does. Keep up your good work. R

Rita Hayes | 10 October 2013  

Compere is an excellent organisation that matches up friends, one of whom has a temporary or permanent mental disturbance. It works, and has the runs on the board. Well worth a try.

walter p komarnicki | 11 October 2013  

Amen, Amen, Amen: therefore the best remedy for mental maladies is friendship, companionship rather than psychologists and counsellors. The problem is many mental illnesses make friendships very difficult - either because the sufferer is unable to trust people, or the people around them cannot see past the symptoms on the surface and embrace the person warts and all. "He ain't heavy, he's my brother."

AURELIUS | 14 October 2013  

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