Mental health in the workplace.Â
Mental health is an increasingly important topic in the workplace.
It is estimated that, at any point in time, one in six working age people will be suffering from mental illness, which is associated with very high personal and economic costs.
Mental illness is one of the leading causes of sickness absence and long-term work incapacity in Australia and is one of the main health related reasons for reduced work performance.
And although there is increasing evidence that workplaces can play an important and active role in maintaining the mental health and well-being of their workers.Â We know that people with mental health challenges, and their families, are some of the most stigmatised and marginalised groups in the workplace and often miss out on the many benefits good work can offer.
Every business has a legal and moral responsibility to provide a safe and fair workplace, including creating a mentally healthy workplace.
How work affects a personâs mental health is a complex issue.
Findings from several systematic reviews have highlighted that work can be beneficial for an individualâs overall well-being, particularly if there are favourable workplace conditions.Â In addition, researchers have found that people frequently identify work as providing several important outcomes including a sense of purpose, acceptance within society and opportunities for development and may therefore play a pivotal role in a personâs recovery from mental health difficulties.
Research is great at helping us with our knowledge, its important and it can be interesting.
But with all this research, my peers across the world mostly just ask for one thing when it comes to how they would like to be treated in the workplace â the one thing they ask for is kindness
And I understand how they feel and why they value kindness so highly.
In 2010 I was off work and in hospital for a mental health condition for a period of time.
In my workplace I had made good friendships at my workplace over a long period of time.
Yet when I became mentally unwell and went to hospital, not one person from work rang me, sent a card or rang my family inquiring about me or inquiring about how my family were coping. Instead of get-well wishes from my work mates, silence was all I received.
On return to work some weeks later, it was like I was invisible, people would walk past me in the hallway with their eyes down. For many weeks I come to work to be isolated, alone and invisible.
At the time I was working in a clinical mental health service. I make note of that because its important. Even people working who are educated in supporting people with mental health conditions do not know what to say or do when their colleagues become mentally unwell.
One in four people in the world will be affected by mental health conditions at some point in their lives
Unfortunately, society is failing to respond to the wide and growing prevalence of mental illness particularly in the workplace.
Stigma, discriminatory policy, and social structures often deprive people with mental health conditions of their universal human rights, while also limiting their livelihood opportunities, thus compounding social inequities.
Their families suffer many inequities as well.
Having knowledge of this is very different to Understanding it; there are many people who know us but very few who understand us and what we have been though or are going though.
Current knowledge is, that Mental health conditions are believed to affect only a small group of people. The causes are seen to be mainly biological factors or personal experience.
BUT, if we seek to understand the knowledge, we know that EVERY human is vulnerable. Everyone of us.Â
So, there is an urgent need to rethink how we can normalize mental health conditions and re-design systems and workplaces so people are not isolated, alone and invisible.
Whilst there is a significant body of research on the challenges affecting the mental health system and our workplaces, there is a gap that is so glaring that it is almost invisible.
A lack of understanding of the problem from the perspective of people living with mental health conditions and their families or carers.
People affected by mental health conditions must have agency in decisions regarding their care and their life and be part of playing a significant role in ensuring transparency, protecting rights, co-designing policy and services, and providing peer support for those in recovery and those in the workplace.
This is not just about good policy implementation, having good strategies or situational analysis in the workplace. Itâs about Respect.
We have entrenched systemic cultural issues of providers, workplaces, organisations and government entities telling people what is good for them. It is past time to end that.
We must view the âproblems, issues, and solutionsâ, âthrough the eyesâ of the people who have lived the experience of mental ill conditions and their families or carers.
Respect means you think about others before you act.
Mental ill health is a major issue within Australiaâs working population.Â
Employers are in a unique position to have a positive impact on the mental health and well-being of their workforce, of the very people that make our economy come to life.
There is a huge opportunity for the workplace to
- Establish commitment and leadership support for a mentally healthy workplace
- To Identify and implement appropriate intervention strategies
- To review outcomes and adjust intervention strategies
And as we all go on a journey together to have mentally healthy work places across Australia,
PLEASE REMEMBER â¦.
- Kindness â the quality of being gentle, caring and helpful, should be a given
- Donât just know people you work with, seek to Understand them
- And Respect will always be the currency in which you give more than you will earn, not just in your workplace, everywhere.
So in closing
The way we ALL think;
The way we ALL act;
The way we ALL communicate;
Equals the values that we ALL have created in ourselves, in our homes, in our communities, and in our workplaces.
The values of Kindness, Respect and Understanding cost so little yet have such powerful impacts that last for a very long time.
Happy world mental health day/week/month Â
HOUSTEN WE HAVE A PROBLEM
Mental health leaders, policy makers and successive governments have tried countless incremental reforms â writing legislation, generating practice guidelines, producing national mental health standards, monitoring data, making patients better âconsumersâ , improving access to care whileÂ containing costs, implementing electronic medical records – but collectively, for all the effort, time and dollars spent, there has been little impact in terms of outcomes for people, families and communities.
A very long time ago a person described his journey from mental ill-health to mental health;
âToo many years lost, too much suffering, too many shut doorsâ.
He shared his pain and despair of recovering in a mental health system that was beyond broken and organised around clinician/service/organisation/government need.
Throughout the years his words have echoed over and over again in the stories of far too many people that have spoken of their heartbreaking experiences to me and in many national inquiries dating back to the Burdekin Report in 1993.
The progression of Australian governments has made significant policy, funding and legislative commitments in the effort to reform the mental health system or parts thereof.
The intent was not access to poor care, the objective not inadequate quality, the pursuit was not to deliver bad results or be misaligned with the interests of consumers and families.
Yet the reality of many historical and recent Australian independent inquiries into mental health have agreed; reform efforts have not made the transformations we should be seeing and giving people the outcomes we should be expecting.
To describe Australiaâs mental healthcare sector as a âsystemâ would be incorrect. We have a whole set of silos in health and mental health that barely connect.
The Rhetoric around better integration has remained a focal point since the 1992 National Mental Health Policy. However, the silo mindset did not appear accidentally and it does not maintain itself. Successive Government funding models have supported it, along with entrenched systemic cultural issues of providers, organisations and government entities. Many are wedded to old ways of doing business and far too comfortable with the construct of silos to want to change.
Youâve got to be a savvy consumer to make sure your needs are met in Australiaâs three-tiered system of health care. Coordinating care and service navigation can often become the domain of the consumer and or their family.
This is at a time when a person is unwell, may have multiple health, psychological or social needs, or be contemplating suicide and while their families are desperately worried.
I am often asked why â why after so many decades is Reform so endlessly slow?
The issue may lay in an unspoken critical element â the CULTURE of the way we do things.
AND ITâS TIME WE TALKED CULTURE â¦â¦.
Do Australian health and human service providers, organisations and government entities have the culture we need for the impact we want?
Above the sea is the way we think we do things and help people.
But below is the real heart of most health and human service providers, organisations and government entities. This is true for all of us â¦
We have always done it this way; Thatâs the way we do things around here, doesnât matter what we say, nothing will change anyway, donât set the bar to high, we have tried that, that wonât work here, your expectations are too high.
But it doesnât have to be that way.
Culture determines our client outcome â MY PERSONAL CULTURE CHANGE â
After 5 years of very poor mental health, I thought it was time to change what I was doing. I was constantly in and out of hospital, receiving ever increasing mental health labels that didnât help me which included more and more medications; I could not see a way out of it.
I also noticed that there was a change in attitude from the service provider.
I was being blamed for not getting a better outcome. The people and services that were there to help me seemed to have given up on me. I was being asked to give up my job â or I will never âget well and stay wellâ, I was being asked to just accept that this is how I will always be and I needed to learn to live the life that I was now in. I was being told this was as good as it gets. Learn to live with it.
After a particularly bad hospital experience, I had a choice to make â give up on me like the service providers had or do something different.
SO, I SOUGHT OUT A NEW THERAPIST.Â AFTER THE INITIAL CONSULT, HE DECLARED THAT HE COULD HELP.
I need to tell you how powerful it was for me to hear those words â âI can help youâ. It was not something that anybody else had ever said to me in all those years of seeking help.
He also said that he could cure me! Yes, Cure me. You never hear that in psychiatry. Recovery might be attainable but Cure? He also wanted to take me off all my medication, try an unevidenced based therapy, and said that he would never leave. If I wanted to end therapy for any reason that would be OK but he wouldnât.
Now some of you may think that I should have left and never go back. You canât tell patients you will cure them! ( or can you?) And what does he mean by HE will never leave?
And going off medication is risky, especially with a patient who has suicidality, isnât it? And this new therapy called TMS, was not evidence based in Australia at that time.
As he was talking I was reflecting on the just how different he was. He had a plan, and described a care pathway, but I donât remember what they exactly were. Because I had something better, I had a therapist that believed he could help me. I had a therapist that didnât blame me. I had a therapist that was not going to give up on me. I had a therapist who had a different culture to the ones I had been to see previously!
Fast forward 3 years, and with very much improved mental health, we were discussing a challenging topic that was afflicting me â my suicidality â in a moment of frustration and a touch of patient blaming he declared that I was expecting too much of him.
I reminded him of our first meeting and the cure thing he spoke about. In his refection, he declared that âthe statement was hastyâ Â â¦â¦â¦I declared that â âI was holding him to itâ.
At different points in time, we spoke together about what cure means â not cure of life â but of the negative impact of life events that had happened to me.Â I never gave up my job. I never gave up on my goals, and the life I wanted. And he never gave up on me.
So, does the place that you work in have the culture that is needed achieve goals, amplify success and have greater impact for people; giving opportunity for people to live contributing lives?
Great personal, practitioner and organisational cultures are intentional â they are built by design. NOT BY MAGIC.
Creating a healthy working culture is a matter of making it a focus point within the values, vision, mission and the strategy.
Put simply,Â people and organisations that ignore, or only pays lip service to culture, will be the beneficiary of an ineffective environment, and will wonder why.
To change practice, to change hearts and minds we have to look at our culture, in ourselves, in our workplace.
- What is it that we really do here?
- Are we all on board that boat?
- Are we all sailing in the right direction together?
- Do we all know where we are sailing to?
- And do we intentionally look at our cultures and have a plan to improve them?
HERE IS WHAT I BELIEVE â¦..
Strategy is What You Want to Get Doneâ¦Culture Determines How Well Your People Do It
Think about it â¦. Strategy is What You Want to Get Doneâ¦Culture Determines How Well Your People Do It
For decades, managers have focused their efforts on building more efficient business models or corporateÂ strategies asking people to be more efficient and effective.
This is not a good strategy for inspiring people.
And this means very little to people UNTILL they experience something that inspires their buy in.
We need to see Culture as an ecosystem.
The elements of culture interact with and reinforce each other. Weather itâs a toxic culture or a productive culture.
The Culture you have will trump the strategy you have every time if people arenât communicating with each other, engaged in their work or understand why they are doing their work.
Productivity and more importantly, the people you serve will suffer no matter how good your mission statement or value statement might be. A great culture is not easy to build BUT â
Organizations that build great cultures are able to meet the demands of the fast-paced, customer-centric, digital world we live in.
More and more organizations are beginning to realize that culture canât be left to chance.
BECAUSE –Â Strategy is What You Want to Get Done, Culture Determines How Well Your People Do It, Company Culture Shapes Employee Motivation.
Service providers, organisations and government entities MUST treat culture building as a discipline, not as magical thinking.
Of all Marin Luther Kingâs speeches, this is possibly the most well-known â¦well the first three words â¦I HAVE A DREAM
You didnât hear him say – I have plan, I have policy, I have roadmap or I have strategy.
They are needed, but not very inspiring if you want people to understand and come along on journey.
Many millions of people across the world were inspired by these three words. I HAVE A DREAM.
They wanted to; they were motivated to; they needed to do something that they knew was going to difficult, that could result in person harm; but they knew it was desperately needed
â the cultural change of a country.
We have no shortage of national, state and local policy, strategy and frameworks to guide us in our work.
Yet despite the work of well-intentioned providers, organisations and government entities, our fragmented âsystem of careâ is struggling with increasing costs, uneven quality, human rights issues, rising suicide rates and people unable to live a full contributing life of their choosing.
My question to you is – do we have the right cultures in our health and human services, as providers, organisations and government entities, to inspire people to do what we need to do, and to Reform our system, or our service or our practice?
I believe that the most obvious narrative about our reform agenda that is missing is the focus on the cultures we have.
If you want to achieve a sustainable, long term healthy culture that embraces change and truly puts people and their families at the centre of everything they do.
You need to take a deliberate and evidence-based approach to putting culture first in your business model decisions.
Culture does start at the top, the board needs to set the tone from the top, and itâs essential they model the values and inspire people with their vision and convey to mission.
Management must be onboard so they can support staff. And I mean every single person in the structure of the organisation. Organisations can easily forget the some of the most important people in the organisation â¦â¦â¦ the reception staff, the administration staff, maintenance and cleaning.
Â They are important because â¦..
The way we ALL think;Â â¦.. The way we ALL act; â¦..Â The way we ALL communicate; â¦..
= the culture that we ALL have created.Â
Culture is really created one conversation at a time and not just by the CEO or the Board or the management team.
Cultures that are win win have people all over the organisation that care enough to call others out when they hear damaging comments, and behave by being aÂ person that others shouldÂ emulate.
We should all take responsibility for continually working towards a better culture by modifying our own internal conversations and behaviours.Â
Have you have ever heard yourself say, internally or out loud, âthatâs just how I am,â or thatâs just how we do it around hereâ, âor that wonât workâ, when someone is asking you to consider how to implement a new policy or strategy or asking you to change the way you are doing something?
Â If you have, I urge you to consider the impact that kind of thought has on your interactions, individual improvement, on organisational culture on service delivery and on the people, we serve.
To change attitudes, we must challenge long-held assumptions, the culture and practice we have.
Â âCulture change is hard, but if you get it right, everything else gets a lot easier.â
We need to raise the issues and bring problems and potential problems to light. We need to conduct âsafe spaceâ discussions with thoughtful people, this includes the people who know what itâs like to be on the receiving end of service provision. We need to share all of our experiences.
What if we do nothing and wait out the changes or management or the government of the day
Advocates from all parts of the mental health sector, tired of mental health âreformâ too often amounting to no more than âre-arranging deck chairs on the Titanicâ, have been publicly critical of the system of care for decades. But Advocates from one sector alone will not within its self, change the status quo.
In recent times, there has been a noticeable unrest that is stirring within our communities, a budding revolution.
People, advocates and communities are expecting more.
They are demanding an open, transparent and seamless enabled system of care and support2153217237.
Where once mental illness was talked about in hushed tones and suicide never mentioned, consumers, families and communities are speaking out about their experiences from service provision, to recovery and system failure, publicly, to their communities and the world.
Aided by the evolution of the social web and mobile technology.
We are living in the largest increase in human expressive capability in history â â¦..the internet.
And it is turning advocacy as we know it and understand it on its head.
The proliferation of digital channels and devices gives people greater access to information, and the means for communication and collaboration.
This increasingly networked society, is a petri dish for engagement, connections and partnership advances and a revolution in mental health care.
Providers, Organisations and Government would be wise to pay heed. Forgetting to ask consumers and families to key activities can now result in a social media feed reminding the organisation of ânothing about us, without usâ. People are becoming increasingly active posting their thoughts, ideas and needs.
The challenge for Providers, Organisations and Government is how to face the implications of digital change, in particular, the loss of control over the consumer relationship and how to embrace what is coming.
Given a choice, most of us will opt for stability over change. Ignoring whatâs coming may not be wise.
Ask the taxi industry!
Technologies that have thrived, from electricity through to the digital age, have grown, not because they deliver more, but because they deliver better.
We can and should appreciate that the rise of a culture is the creation of good intentions that evolved in unexpected ways over time, both good and bad.
What we can fail to appreciate is that âculture will trump strategy every timeâ. If you let it!
Culture and its repercussions are often felt by consumers, families and carers; but rarely examined by the organisation, service, or practitioner.
In implementing mental health reform, policy and strategies we must look at current ingrained practices and attitudes, or what we would call âthe cultureâ in the organisation, service, or practitioner.
Â My question again to you is â¦.do we have the right cultures in our health and human services as providers, organisations and government entities to inspire people to do what we need to do and Reform our system or our service or our practice?
This article first appeared in Public Health Research & Practice, a peer-reviewed, Medline-listed quarterly online journal published by the Sax Institute
Mental health leaders, policy makers and successive national and state governments have tried countless incremental reforms. Yet, for decades in Australia, independent inquiries and reports have concluded that our mental health âsystem of careâ is a misnomer. It is fragmented, ineffective, inefficient and unfair. For far too long, people, families and communities have paid a heavy price for this. Reform in itself will not be the solution that we can hang all our hopes on. Disruptive innovations are now sneaking into the mental health sector and beginning to be taken up en-mass. Sitting alongside this is a budding revolution â an unrest stirring in our communities that has not been seen before in the history of mental health. People are raising their expectations and communities are demanding better. With external (revolution, disruption) and internal (reform) forces colliding at a similar time, a perfect storm is being created for what could be the long-awaited and much-needed change we have longed to see. But it will not be without pain because, given a choice, most will opt for stability over change. But ignoring what is coming may not be wise.
Despite the work of well-intentioned providers, organisations and government entities, our fragmented mental health âsystem of careâ is struggling with increasing costs, uneven quality, human rights issues, rising suicide rates and people who are unable to live a full, contributing life of their choosing.(562) 801-8588 314-480-8768 Mental health leaders, policy makers and successive governments have tried countless incremental reforms â writing legislation, generating practice guidelines, producing national mental health standards, monitoring data, making patients better âconsumersâ[iii], improving access to care while containing costs, implementing electronic medical records â but collectively, for all the effort, time and dollars spent, there has been little impact in terms of outcomes for people, families and communities.(323) 944-3898
A very long time ago, a person described to me his journey from mental ill health to mental health: âToo many years lost, too much suffering, too many shut doors.â He shared his pain and despair of recovering in a mental health system that was beyond broken and organised around clinician/service/organisation/ government need. Throughout the years, his words have echoed over and over again in the stories of far too many people who have spoken of their heartbreaking experiences to me and in many national inquiries, dating back to the Burdekin Report in 1993.[v]
The progression of Australian governments has made significant policy, funding and legislative commitments in the effort to reform the mental health system, or parts of it. The intent was not access to poor care; the objective was not inadequate quality; the pursuit was not to deliver bad results or be misaligned with the interests of consumers and families. Yet the reality is that many historical and recent Australian independent inquiries into mental health have agreed: reform efforts have not made the transformations we should be seeing, nor are they giving people the outcomes we should be expecting.939-417-2595 4102595469 406-306-4585 [ix]
Given the entrenched interests and practices of many decades, expecting mental health transformation that only comes from within (reform) is unrealistic.
Â PARTNERSHIPS ADVANCE REVOLUTION IN MENTAL HEALTH CARE
To describe Australiaâs mental health care sector as a âsystemâ would be incorrect. We have a whole set of silos in health and mental health that barely connect.[x]10 Rhetoric around better integration has remained a focal point since the 1992 National Mental Health Policy.
The silo mindset did not appear accidentally and does not maintain itself. Successive government funding models have supported it[xi] 856-314-8874, along with entrenched systemic cultural issues of providers, organisations and government entities. Many are wedded to old ways of doing business and are far too comfortable with the construct of silos to want to change.(217) 465-8433
Consumers need to be savvy to make sure their needs are met in Australiaâs three-tiered system of healthcare.289-577-4662 Coordinating care and navigating services can often become the domain of the consumer and their family. This is at a time when a person is unwell and may have multiple health, psychological or social needs, or be contemplating suicide, while their families are desperately worried.
Advocates from all parts of the mental health sector, tired of mental health âreformâ too often amounting to no more than ârearranging the deck chairs on the Titanicâ, have been publicly critical of the system of care for decades. But advocacy from one sector alone will not change the status quo.
In recent times, a noticeable unrest has been stirring within our communities: a budding revolution. People, advocates and communities are expecting more. They are demanding an open, transparent and seamless system of care and support.9206345280
Where once mental illness was talked about in hushed tones and suicide never mentioned, now consumers, families and communities are speaking out about their experiences with service provision, recovery and system failure to their communities and the world. They are aided by the evolution of social media and mobile technology.
The internet is the largest increase in human expressive capability in history, and it is turning advocacy as we know it on its head. The proliferation of digital channels and devices gives people greater access to information, and the means for communication and collaboration. This increasingly networked society is a petri dish for engagement, connections and partnership advances, and a revolution in mental health care.
RAPID IMPROVEMENT IN ANY FIELD REQUIRES MEASURING RESULTS
Measuring service activity provides little information about the consumer and family outcomes that are being achieved and the cost of that care. Advocates (especially consumers) have long emphasised and demanded a move from system inputs and outputs, and process measurement, to quality outcome measurements. To their disappointment, âquality outcome measurementâ has gravitated to the most easily measured and least controversial indicators.[xvi]
The true measures of quality are the outcomes that matter to the people who use (or will use) the service and their families. This requires a range of measures of consumer and family experience of care that are fit for purpose, and consumer self-rated measures. These measures exist in abundance, and are conveniently and widely available on the internet. The tragedy is the longstanding indifference to collecting and publicly reporting on outcomes. When outcomes are collected and reported publicly, providers, organisations and governments face both tremendous pressure and strong incentives to improve.
It is an uncomfortable truth that governments and private providers have continued to invest in reforming poorly performing information technology systems that are cumbersome and do not talk easily to each other (if at all). A new strategy is needed that incorporates networks of connectivity into all national and jurisdictional data infrastructure, and a new, more effective model where transparent, open-access, data are the default. Noting the utmost importance of protecting privacy and confidentiality, infrastructures that will act to both disseminate data and protect confidentiality are crucial.
WAITING TO BE INVITED TO PARTICIPATE? THE GAME HAS BEEN DISRUPTED
Consumer and family participation has been the foundation of all reform activities for decades. Although these have never been sustainably funded or supported, Australia can demonstrate some achievement in this space (with a big âbutâ attached). However, participation as we once knew it is now not equipped to meet the changing landscape.
Once it could take weeks, at the discretion of the provider, to get a response about a complaint. Now a strategic social media post can have the same service contacting consumers within hours to enquire about their experience. Social media has disrupted the way service providers handle complaints. In a similar way, blogs, social media and personal web pages are beginning to disrupt the way we think about how people can participate in service planning and improvement.
Providers, organisations and governments would be wise to take heed. Forgetting to ask consumers and families to take part in key activities can now result in a social media feed reminding the organisation of ânothing about us without usâ. People are becoming increasingly active about posting their thoughts, ideas and needs. The challenge for providers, organisations and governments is how to face the implications of digital change, particularly the loss of control over the consumer relationship. However, few realise how fast the change needs to happen, or how transformational it needs to be.
Increasing consumer, family and community involvement in all processes and at all levels will become the number one objective for services and organisations if they want to stay relevant and competitive in a changing market, where new technologies and digital tools are empowering people at a pace not seen before.
Â THE END OF BUSINESS AS USUAL
The pace of technological change is increasing exponentially. Digital services have become universal and changed every aspect of how we live our lives. Society is becoming increasingly familiar and comfortable with using technology for a wide range of transactions, including how we manage our physical and mentalÂ health.
Our smartphones can now know more about our physical and mental health and wellbeing than our primary healthcare provider or specialist. Both an imperative and a challenge for healthcare providers will be how to innovate and engage with the consumer and their family who are using digital health technologies for improved consumer outcomes. Unfortunately, solutions often focus on the risks of people using health technology or reinventing the wheel, rather than building robust platforms, infrastructure and shared services that complete the circle of care. Digital mental health must be seen much more as an opportunity to be tapped than as a risk to guard against.
Technologies that have thrived, from electricity through to the digital age, have grown, not because they deliver more, but because they deliver better.
Â UNIFICATION OF REFORM, REVOLUTION AND DISRUPTION
In industry, disruptive innovation sneaks in from below. In community, revolution starts with a few committed people and grows to a tipping point. System reform is built on past foundations. While providers focus on their services or products, their research, their education or training, their processes and procedures, and fitting people into their type of service, they can fail to see that the average consumer and their family does not want or like what is on offer. They miss the signs of disruption and revolution, and dismiss and resist reform in an effort to preserve their traditional market hegemony.
Given a choice, most of us will opt for stability over change.6132471667 Ignoring what is coming may not be wise â for the times, they have changed.
[i] Stange KC. The problem of fragmentation and the need for integrative solutions. Ann Fam Med. 2009;7(2):100â3.
[ii] Griffiths M, Mendoza J, Carron-Arthur B. Whereto mental health reform in Australia: is anyone listening to our independent auditors? Med J Aust. 2015;202(4):172â4.
[iii] Mold A. Making British patients into consumers. Lancet. 2015;385(9975):1286â7.
[iv] Medibank Private Limited and Nous Group. The case for mental health reform in Australia: a review of expenditure and system design. Melbourne: Medibank Private Limited and Nous Group; 2013 [cited 2017 Mar 9]. Available from: www.medibank.com.au/Client/Documents/Pdfs/ The_Case_for_Mental_Health_Reform_in_Australia.pdf
4073134397 Burdekin B. Report of the national inquiry into the human rights of people with mental illness. Sydney: Australian Human Rights Commission; 1993 [cited 2017 Mar 22]. Available from: www.humanrights.gov.au/publications/ report-national-inquiry-human-rights-people-mental illness
3105734136 Groom G, Hickie I, Davenport T. âOut of hospital, out of mind!â A report detailing mental health services in Australia in 2002 and community priorities for national mental health policy for 2003â2008. Canberra: Mental Health Council of Australia; 2003 [cited 2017 Mar 9]. Available from: mhaustralia.org/sites/default/files/ imported/component/rsfiles/mental-health-services/Out_ of_Hospital_Out_of_Mind.pdf
[vii] Mental Health Council of Australia. Not for service: experiences of injustice and despair in mental health care in Australia. Canberra: Mental Health Council of Australia; 2005 [cited 2017 Mar 9]. Available from: www.humanrights.gov.au/sites/default/files/content/ disability_rights/notforservice/documents/NFS_Finaldoc. pdf
(579) 779-8106 The Senate Select Committee on Mental Health. A national approach to mental health: from crisis to community. Canberra: Commonwealth of Australia; 2006 [cited 2017Â MarÂ 9]. Available from: www.aph.gov.au/ Parliamentary_Business/Committees/Senate/Former_ Committees/mentalhealth/report/index
(917) 783-0342 National Mental Health Commission. Contributing lives, thriving communities: report of the national review of mental health programmes and services. Sydney: NMHC; 2014 [cited 2017 Mar 9]. Available from: www. mentalhealthcommission.gov.au/our-reports/contributinglives,-thriving-communities-review-of-mental-healthprogrammes-and-services.aspx
(401) 409-5491 Â National Health and Hospitals Reform Commission. A healthier future for all Australians: final report June 2009. Canberra: Commonwealth of Australia; 2009 [cited 2017Â MarÂ 17]. Available from: webarchive.nla.gov.au/ gov/20140211213250//www.yourhealth.gov.au/ internet/yourhealth/publishing.nsf/Content/nhhrc-reporttoc
904-354-8183 Â Oliver-BaxterÂ J, BrownÂ L. PHCRIS research roundup: primary health care funding models. Adelaide: Primary Health Care Research and Information Service. Available from: www.phcris.org.au/phplib/filedownload.php?file=/ elib/lib/downloaded_files/publications/pdfs/phcris_ pub_8412.pdf
9023217280 WhitfordÂ H, BuckinghamÂ B, ManderscheidÂ R. Australiaâs national mental health strategy. BrÂ JÂ Psychiatry. 2002;180(3):210â15.
[xiii] Institute of Medicine (US) and National Academy of Engineering (US) Roundtable on Value & Science-Driven Health Care. Engineering a learning healthcare system: a look at the future: workshop summary. Washington, DC: National Academies Press (US); 2011. Chapter 3, Healthcare system complexities, impediments, and failures; p. 117â70.
[xiv] Â Health Issues Centre: consumer voices for better healthcare. Melbourne: Health Issues Centre. Understanding our health care system; [cited 2017Â MarÂ 3]; [about 2Â screens]. Available from: healthissuescentre.org.au/consumers/health-care-inaustralia/understanding-our-health-care-system/
(802) 536-3420 National Mental Health Commission. Contributing lives, thriving communities: report of the national review of mental health programmes and services. Sydney: NMHC; 2014 [cited 2017 Mar 9]. Available from: www. mentalhealthcommission.gov.au/our-reports/contributinglives,-thriving-communities-review-of-mental-healthprogrammes-and-services.aspx
[xvi] Rosenberg S, Hickie I, McGorry P, Salvador-Carulla L, Burns J, Christensen H, et al. Using accountability for mental health to drive reform. Med J Aust. 2015;203(8):328â30.
[xvii] Eidelman S, Crandall C. The intuitive traditionalist: how biases for existence and longevity promote the status quo. Adv Exp Soc Psychol. 2014;50:53â104
Itâs a dirty word â¦â¦. Itâs cowardly. Itâs a taboo. You donât stop your pain you pass it on to others after you have gone. Itâs a sin. Why arenât you stronger than that? Itâs selfish. Itâs a permanent solution to a temporary problem. Stop feeling sorry for yourself. You want to feel this way. You donât value your life.
So many passing judgments. So many theories. Yet, we have no strong evidence for what is really going on in the brain when it comes to suicidal thoughts and behaviours; insufficient empirically supported treatments for suicidality (Most of them come from a mental health context); and even less evidence based practice.
An awful shame
Historically, suicide attempt survivors, in particular, have spoken under conditions of anonymity in order to save them from being discriminated against. The silence and shame created in that act are dangerous6618892030. There is a lot to lose if you speak out about what happened to you.
It’s not an easy topic to discuss and because we, as a nation, as service providers, as practitioners, don’t know how to approach it, it’s easily swept under a mat. If mental health is the poor cousin of health then suicide prevention is the family member that has been disowned. All contact ceased, connection with or responsibility terminated.
And I get it, we are afraid of people who want to kill themselves. But avoiding it and pretending it doesnât exist is nothing more than wilful blindness. We turn a blind eye in order to feel safe, to avoid conflict, to reduce anxiety, and to protect prestige. But only greater understanding can lead to solutions.
Â Discriminatory attitudes & mental health laws that didnât protect
I have lived happily with my brain for 48 years, we have some fun together, and we have survived some horrifying abuse. And for over a decade I have lived with suicidal episodes â and as that is driven by the brain â we have, at times, had a tough time living together in harmony.
Seven years ago I sought treatment, care and support for an escalating suicidal crisis.
I was grappling with what I can only describe as a cyclone in my head. My own self talk and the external voice that only I hear were telling me to die. I also feel it my body â It grabs you and you are consumed by it.
Being self-aware of what drives these episodes and what works best for me. I told my husband that we should ring for assistance and advice.
It would be dangerous to do otherwise.
He rang the psychiatrist, as in the past he had dispensed medication, and that was enough to be treated at home where my support system was. But the psychiatrist was away. This time we were told to go to the nearest hospital.
My husband and I drove 1.5 hours from our home. My sanctuary. In silence. Holding hands. To an unknown hospital. Hoping for the best.
Upon arrival at the emergency department of the hospital they had the police waiting for me. I had never harmed myself or others and was seeking treatment so this didnât make any sense to me. Without being spoken to or being told, I was sectioned under the mental health act.
I remember the distress in my husbandâs voice as he begged them not to do this. As he questioned why they were doing this. The pain in his voice combined with him feeling like he had betrayed my, touched my heart, but not the health professionals who asked him to leave.
I could hear the despair in his voice as he said over and over and over that he loved me, as I was being taken away to be âmedically clearedâ. (I had not harmed myself)
I remember the doctor in the emergency room telling me that there were real patients dying in here. The look on her face was one of disgust.
Although distressed and with tears streaming down my face, I was quiet as the four security guards, men, walked me though the main hospital; past all the visitors and people coming and going from a busy rural hospital, to out the back where the mental health unit was.
âIt will be Okâ said my voice â âI will take care of youâ. I was thankful to my voice, the only one to say a kind word to me since I left my husband in the emergency department.
I was then marched through the Mental Health Unit into the High Dependency unit.
I scanned the small room – Two male patients pacing, agitated, one male staff member â on the couch watching the Friday night Footy on TV â it was the week before the AFL Grand Finale.
With barely a glance towards me, he pointed to a room.
There, they left me.
After a short while panic set in. I was trapped in a small room with three men, no one in that room was going to help me, all my natural supports taken away, my rights taken away, my dignity gone. This was the result of asking for help for my suicidality.
With increasing flashbacks of past abuse and being trapped, plus the noise in my head that was getting louder, the added noise from the other patients yelling, the TV blaring and the nurse yelling out when his team was doing well, I went into a complete sensory overload.
To try to block out some noise – I shut my bedroom door. The nurse came in and told me to leave it open. He went back to the patients couch to watch the TV. I shut the door again. He told me if I misbehaved he could seclude me. I could hardly get a breath. How did this happen, why was this happening.
At some point not long after that, the cyclone in my head stopped.
It was replaced with clarity and a loving voice that only I could hear, telling me what to do next. It was all so clear. There was only one way out.
That was my first suicide attempt.
I woke up hearing a man yelling âstupid womanâ, âstupid bloody womanâ. Followed by a few sharp stings on my check â Did he just hit me?
There was no debriefing â well not for me.
I became withdrawn, silent. I was shamed by others judgments.
The Politics of Suicide – Cultural Change That Sticks
There are too many in health and mental health that can only see a personâs suicidality though their own lens – Itâs a sin. Itâs a taboo. Itâs selfish. Itâs a Permanent solution to a temporary problem. â When they do this, they cannot see the person and what they need.
In the prevention of suicide, we must always talk about hope and have inspiring stories of lived experience who have climbed out of their suicidality; but to change attitudes we must challenge long-held assumptions, the culture and practice in health and mental health.
Too often our policy and strategies are imposed from above and a lot of the time at odds with the ingrained practices and attitudes or what we would call ‘the culture’ in the organisation, service, or practitioner. A culture will trump strategy every time and we often donât alter our behaviour even in the face of overwhelming evidence that we should.
So we need to have difficult conversations. We need to raise the issues and bring problems andÂ potential problems to light. We need to conduct âsafe spaceâ discussions with thoughtful people, this includes the people who know what itâs like to be on the receiving end of service provision. We need to share all of our experiences. As hard as they are to hear, it was harder living though it.
It is important though to understand that culture is a product of good intentions that evolved in unexpected ways and there will always be organisations, services, or practitioners with a deep commitment to the people they serve.
Health and mental Health professionals do frequently encounter people who are suicidal and therefore must be aware of their attitudes towards us as part of their professional and therapeutic role.
- Have the kind of culture where the person who is suicidal feels safe?
- not just a physical environment that is safe
- Have the kind of culture where families feel confident that the person they love will be cared for?
- The complexity of issues and decisions a family faces in relation to suicidal behaviour is enormous
- Have the kind of culture where families are supported?
- far too many families are finding themselves isolated in continuous loops coping on their own
- Have enough people at multiple levels exhibiting the behaviours that matter most?
- Ensuring the culture evolves in the right way.
When we don’t talk, when we don’t want to know what to say, when we don’t want to know what to do, when we don’t want to seek to understandâ¦â¦â¦
â¦..It matters to me
[i] Live Though This – /livethroughthis.org/the-project
Technology is changing the way Mental Health Consumers are doing business
Advances in technology and particularly mobile digital information and communication technology continue at an exponential rate. Now making it possible to communicate, obtain information and access and buy goods and services in new ways. Information Technology is reshaping economies and societies of many countries around the world. It has become universal and is changing every aspect of how we live our lives. Significant sections of society are becoming increasingly familiar and comfortable with using technology for a wide range of transactions including how we manage our health and mental health.
THE PERSONAL DIGITAL STORY
Imagine for a moment the life of a person with ongoing mental health challenges.
Her efforts to stay mentally healthy include reducing her paid work so she can attend a weekly three-hour round trip to see her Psychiatrist for 45 minutes. She tries to coordinate the day with a visit to her General Practitioner; to get a prescription discuss complications of medication issues and update him on other professionals that she has seen in the last month; Psychiatrist, Sleep Clinic, Dietician, Hospital admission and Psychologist. All in fifteen minutes.
The out-of-pocket costs to stay mentally healthy for her are in excess of $850.00 per month. Private health insurance is an extra $530.00 per month. And then thereâs the cost of travel and lost wages for time away from work
There is also the emotional cost of case managing the health professionals and keeping them informed of what each other is doing. She is financially, emotionally and physically exhausted keeping up with it all.
Frustrated with the endless health appointments, tired of coordinating her own care, worried about the rising costs of co-payments, but mostly frustrated at not having her mental health needs addressed adequately, she talks to her General Practitioner about better options. She leaves with a referral to a new psychiatrist and instructions to look up the psychiatrists address on Google. It was a then that she realized that in her community, at this point in time, her health professionals were in a method of working, that was just not working for her.
She goes home, acquires a recipe for dinner, and pays monthly the bills, books a hairdressing appointment and the cars next service, all online. She texts her cafÃ© to order her morning coffee and lunch, web-chats with a telco over a disputed bill, downloads the new Uber App and emails her overseas family about a good time to Skype them later; all completed in fifteen minutes.
In the evening she makes a start to google the new psychiatrist contact details to make an appointment â the web page says there is a 9 week wait for new patients.
Consequently she searches the internet for mental health solutions beginning with improving her motivation. After her last depressive episode that included dreadful suicide thoughts and significant time off work she still struggles with getting up and get on with the day. She discovers a well-being App. After three weeks the effectiveness was positive and powerful. The App monitored her activates during the day. The Fitbit monitored her sleep. The smart phone encouraged her, gave her tips and information.
Enthused to experiment more and becoming increasingly familiar and comfortable with using technology for her health and mental health, she downloaded an array of Apps to meet her needs that SHE identified as issues.
Now an App on her smart phone gently wakes her at 6:30 a.m. and guides her through an appropriate exercise routine. She then weighs herself on her WI-Fi-enabled scale and checks her blood glucose level using an attachment on her smart phone. All of these readings go straight into her smart phoneâs health and fitness dashboard. She charts her mood and food during her day as prompted by her phone and reads the regular motivational quotes and helpful well-being tips. When the sensor embedded in her watch detects a higher than usual heart rate, due to anxiety, she takes a moment for a five minute ‘guided mediation and breathing exercise’ delivered by another app on the smart phone.
On Wednesday evenings in a quiet place at home she opens the App on her computer for her personalized CBT lessons for her sleeping problems, delivered by a virtual sleep expert named -âThe Profâ. Â The Prof tracks all progress data and sleep stats throughout the week, sends emails and reminders and talks to her about these stats and progress. There is an option to talk to real people.
She is now âOnline and On-boardâ with a mixture of digital mental health, health and well-being technologies. They provide a wide range of behavioral health self-management services, anonymized peer support, and immediate 24 hour access to evidence-based tools via a digital platform.
For the first time she has multiple choice of mental health and well-being services from around the globe, delivered at a time and place convenient for her – at very little expense. She is empowered to take control and self-manage her condition. She knows what works and what doesnât in her treatment and care and the progress that she is making – based on real-time data on her smartphoneâs health and fitness dashboard.
She has replaced her traditional Psychiatrist, Sleep Doctor, Dietician and Psychologist with a mixture of digital technologies that perform similar tasks. She sees her General Practitioner online for check-ups and medication issues. Her General Practitioner emails her scripts to her pharmacy of choice and emails her the notes of the consultation. Now her out-of-pocket costs to stay mentally healthy are a total of $150.00 per month which includes IT data costs. (Private health insurance is still $530.00) (cost of travel is now nil)
She spends less time going to appointments, more time being with family and friends, working, sleepingâ¦â¦…..
â¦â¦……More time living life.
TECHNOLOGY IS CHANGING THE WAY MENTAL HEALTH CONSUMERS ARE DOING BUSINESS
Digital mental health, health and well-being technologies are disruptive to traditional offerings in mental healthcare in many ways:
- Offerings are simpler and empower the person using them.
- 24-hour digital services that are anonymous
- Offers personalized care pathways driven by machine learning
- Online free group courses on multiple mental health topics, led by trained, experienced professionals
- Digital libraries of evidence-based resource materials that help people to understand and self-manage their conditions
- Connection to peers across the world who understand and have valuable advice
To name a few.
While the potential is clear and technology is changing the way mental health consumers are doing business the reality is our mental health, health, social services and government services are still doing business in the traditional manner.
Our smartphones can now know more about our health, mental health and well-being status than our primary health care provider or specialist. Resulting in incomplete medical records. Unfortunately solutions to address this often focus on the risks of people using health technology or reinventing the wheel rather than building robust platforms, infrastructure, and shared services that completes the circle of care.
Strategies of combining digital service offerings with traditional offerings in healthcare will require new sets of competencies. Traditional organizations, especially those with bureaucratic structures, must now play catch-up. We need to reform our policies and practices to enable the most strategic investments in digitally supported development work, and to strengthen our capacity to implement against this new disruption.
Digital technologies are increasingly in the hands of people who stand to benefit from them the most. Technology is changing the way mental health consumers are doing business we now need traditional offerings in healthcare to catch up.
I enjoy engaging in differing views, so if you have an inquiring mind, feel free to respectfully share it.
When I started talking publicly and writing, I thought that throwing my thoughts out into the public domain might be an effective way of promoting mental health, suicidal anguish and raise awareness of the issues we face as patients/families/carers/clients/support people/consumers/lived experience/service users/survivorsâ¦â¦â¦ (The forever changing language of labels)
For far too long, people of all ages with mental health problems, suicidal anguish and their families have been stigmatised, marginalised and discriminated against, all too often experiencing service provision that treats their minds and bodies separately, that dismisses the value and power of families and community and rarely asks if the service, intervention, care or research has been helpful or of value.
I have, from a young age been a mental health advocate. In the beginning it was always and only from the perspective as a family member. For two reasons;
- Very early on I was asked to âchooseâ who I advocate for â Consumers or Carers. (Apparently you cannot advocate for both). At that point, I decided to be a family/carer advocate. I believe in the healing power of the family. I stayed silent on my own mental illness.
- In my work (within mental health organisations) I witnessed so much stigma, marginalisation, discrimination and abuse directed at people with mental health issues I became far too afraid to say anything. I stayed silent on my own mental illness.
But Iâve never been one to stay silent for long â¦..I am human. I am multifaceted. I have many perspectives. I live in a family that has times where mental illness is a daily focus of our family life mixed in with all the vast diversity that family life brings.
I have spent the past 15 years dedicated to encouraging greater understanding, compassion and respect for people affected by mental ill-health, the suicidal mind and the families, friends and carers who journey with them. I have been fortunate to work with many people in mental health and suicide prevention in various advocacy, advisory, public speaking, research, consultancy and commissioner roles â at the local, state, national and international. I combine all of my experience, understanding of the grass-roots and knowledge of high level strategic policy and planning, to shift thinking about mental ill-health and suicide.
This blog is about my inquiring mind â not defined by labels â not defined by theories â not define by fears â not defined by (many) diagnosis â not defined by opinions â¦but informed by them all.
I enjoy engaging in differing views, so if you have an inquiring mind, feel free to respectfully share it.