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RUOK? won't fill mental health care gaps

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In an Australia where there are 3000 suicides every year, RUOK? Day asks us to look out for each other and respond to warning signs. Such upbeat efforts to raise mental health awareness and 'smash stigma' have saved lives.

RUOK? Day logoIf we want to save many more lives, however, we need sustained advocacy for people who are currently let down by the mental health system. Pathways to care based on ability to pay reveal the need for a redesign.

So what are the current avenues into professional help when a person is not okay? 24/7 telephone services include emergency assistance, the Suicide Call Back Service, Area Mental Health Triage, Lifeline, Beyond Blue, and Kids Helpline. A young person may seek out a local Headspace (or Orygen if they are living in western or north-western areas of Melbourne). A student at a university may make an appointment with an on-campus counsellor.

Another step may be visiting the local GP. She may provide a mental health care plan of ten Medicare-rebated sessions with an accredited psychologist and/or other allied health professional. If the GP considers it necessary, she may refer a given patient to a psychiatrist. If this person has hundreds of dollars available, they may see a private psychiatrist before receiving a Medicare rebate. If not, they may wait to see a hospital psychiatrist for a consultation at a public out-patient clinic.

But many of these steps assume that a person has insight into their own state of mind. When a person lacks this insight, they may resist these steps. In such a case, when family or close friends are seriously concerned for a loved one, authorities generally encourage calling the Area Mental Health Triage for a specialist response. If there is an urgent need, and beds available, the loved one may be admitted to a public mental health ward.

When the treating doctors are ready to release the patient from the public ward, they may be admitted to a private ward if the patient has private health cover. For patients without access to this cover, however, the return to life outside hospital poses an additional challenge.

Every single person should have ongoing quality care available to them in their community. Currently only some people can access private wards and regular follow up from psychiatrists and psychologists in private practice. Governments should draw up plans for a redesign of this tiered system.


"We need to make sure that care is also available for the huge numbers of people presenting with symptoms of mental illness and currently being let down. Recovery is possible if appropriate care is provided."


The movement Australians for Mental Health has been set up to create a groundswell of support for systemic reform and redesign commitments at upcoming elections. Every single person meeting the mental health system has a right to appropriate treatment via high quality early intervention, community, and acute services. Therefore the movement seeks fair access to mental health care, 'clear pathways to care', and 'improved prevention and early-intervention services'.

Australians for Mental Health want the Productivity Commission to conduct a review into a new financial model which reimagines the way services are delivered. Professor Patrick McGorry told Radio National that currently people 'seek care, but care quality has let people down'. They must receive 'help of the right quality, urgency, and expertise'. In this context 'community based hubs' for care could repair the broken middle of the mental health care system. Each comprehensive multidisciplinary team could offer tailored, 'developmentally appropriate' care to people of all ages. Headspace centres for young Australians provide a glimpse of what is possible. With four million Australians experiencing mental illness each year, this proposal deserves our enthusiasm.

Such a transformation in treatment channels would ensure that ongoing specialist care is accessible for people of all financial means, including those who live in rural areas and those from recent migrant backgrounds. Quality care hubs in every electorate would bring the necessary help to people in some of our most vulnerable communities.

In principle mental health conditions are just as treatable as physical health conditions. In practice, the current mental health system does not provide the same level of access to quality care as that provided to people with conditions such as cancer or heart disease. We need to make sure that care is also available for the huge numbers of people presenting with symptoms of mental illness and currently being let down. Recovery is possible if appropriate care is provided.

When we commit to asking friends, family, and coworkers about their wellbeing, we affirm that their safety matters, and that their life is of value. This same ethic of care calls on the governments formed in our name to provide community supports which send a signal: every single life can get better.

Lifeline 13 11 14



James O'BrienJames O’Brien is a graduate teacher and writer from Melbourne.

Topic tags: James O'Brien, suicide, depression



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Existing comments

A much needed and well-argued case for improvement in our mental health provision. Perhaps the key point you make, almost as an aside, is that, no matter how well provided are the services for people who need them, they have to recognise that need themselves in order to utilise them.

Paul Power | 13 September 2018  

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