Since the initial announcement of the Victorian Mental Health Royal Commission last year, the limitations of it were clear. The Andrews Labor government set out to ensure that this would not be a ‘blame game’. The chief commissioner Penny Armitage made it clear that this was about “looking to the future, not the past.”
One of the most striking things about this commission is the determination of the government to not investigate the past. But how can we make the changes necessary without first understanding what happened in the past?
10,000 submissions were made to the commission over 19 days in Melbourne. 96 witnesses where called. These included mental health care recipients, their families, carers, professionals delivering mental health services, bureaucrats and hospital administrators.
Those that gave testimony of mistreatment in the mental health system described how incredibly difficult it is to get help. Many family members spoke of loved ones that had sought help for suicidal thoughts and were turned away, only to later take their own lives.
A general theme was of people’s frustration at not being admitted to hospital because they weren’t ‘sick enough’. People spoke of being forced to wait and see themselves deteriorate, or to watch their family members become so unwell that they were finally admitted.
Mental health professionals spoke of the frustration of working in a system where there are very few options to help people. Maybe they could find a bed in the ward if one was available, maybe two weeks follow-up in the community, or maybe people could be sent to a GP that could spend a mere 8 minutes with them in an appointment.
The 2014 Mental Health Act places enormous restrictions on mental health professionals. It essentially says that if a person is not ‘sick enough’, they can’t be admitted against their will. It is clearly best to avoid forced admissions where possible, but without adequate support, families and carers become solely responsible for a person who may be in serious crisis.
Crisis support can range from adequate in some metropolitan areas to extremely poor or non-existent in rural and remote areas. Often, family members are placed at risk while waiting for support.
Most people know someone who has had experience with the system, sometimes positive, but most often negative. The positive experiences are often thanks to individual workers. Mental health workers often work tirelessly to make something of this broken system.
The commission will release a preliminary report in November, with the final recommendations to come in October 2020. There was much talk of other ways of doing things, such as the model used in places like Trieste in Italy, or in the Netherlands, where drop-in centres are provided.
In these places there is a move away from an in-patient medical model of psychiatric care, instead to community-based supported care. Drop-in centres are designed to promote a social base and sense of community and belonging.
Currently in Victoria, $1.5 billion is spent on clinical care, but only $99 million goes towards community-based care. The number of people who are turned away from mental health services is a testament to the overall inadequacy of funding across the board.
But for a real solution to the mental health crisis we need a lot more than just an increase in funding. While more money is needed, for real lasting change, and an improvement to mental health across the board, we need a complete system change.
Mental ill health is not simply a product of genetics or other biological factors. Mental health is significantly impacted by our social conditions. It is affected by everything from housing to education, financial stability, adequate nutrition, social connections, a sense of belonging, having experiences of abuse and more.
A profit-oriented society places enormous burdens on ordinary people. Clearly the royal commission’s scope of investigation will not touch on these wider, but fundamental issues. While the commission may well bring some issues to light, only system change and the creation of a society that prioritises people’s needs will lead to a major improvement in mental health and wellbeing.
By a public mental health worker