Treatment is better but system worse

Mental health stigma eases but resources relentlessly cut, says Martyn Goddard

WE’VE

got much better at talking about mental health but much worse at dealing with it.

Some of the stigma has been removed. More and more, we regard mental illness as a health condition, not as a strange and dangerous oddity. We no longer divide the world into loonies, cripples and normals. We’re all just people.

But while the society has advanced, the health system has become worse.

Although Tasmania has a greater prevalence of mental illness than any other state, the resources to treat people in need have been relentlessly cut by two successive governments.

There was a brief time, about eight years ago, when almost enough money was flowing into public mental health facilities to give Tasmanians the same level of care as other Australians. But it didn’t last.

The first big hit came with Lara Giddings’ disastrous 2011 budget.

Then, as patient demand soared, the cuts continued under the Liberals.

Even taking inflation into account, funding fell by over 16 per cent over five years.

Hospital-based services, where people in acute crisis are treated, have suffered the most.

Over those dreadful five years, their funding fell by a third. And in the last couple of years it has fallen again, with more beds being lost.

All the time, demand has risen. Over the five years to 2016-17, the number of psychiatric inpatients at the Royal Hobart Hospital rose by 51 per cent and at the Launceston General Hospital by 75 per cent.

Only for non-government organisations has state government funding been increased.

But the amount going in their direction is a tiny fraction of the amount taken out of the hospitals.

The stated objective is that putting money into the much cheaper services run by nongovernment organisations will prevent people getting to a crisis state and needing hospital care.

But there are serious doubts whether this can work — or to work well enough to justify the cuts to acute services.

It is not plausible that those massive increases in hospital admissions could ever be averted by prevention programs.

The evidence shows that most people with depression can be treated successfully and their condition permanently controlled.

But that’s not true for everyone.

Schizophrenia is harder. Anti-psychotic drugs can be patchy in their effectiveness and still, despite improvements, come with significant side-effects. The best evidence is that treatment is only partially effective and can be extraordinarily expensive.

As the crisis in the state’s hospitals escalates, the ripples of adversity spread.

Tasmania’s suicide rate is 30 per cent higher than the nation’s as a whole.

Suicide prevention programs have failed comprehensively. Every family, every circle of friends in which a member dies carries that tragedy with them forever.

People needing care, but finding care unavailable, are increasingly pushed into homelessness.

In those disastrous five years after 2011, the proportion of homelessness service clients with a mental health problem rose by 235 per cent.

All mental health services in Tasmania are underfunded.

Taking money out of one to give to another is plain dangerous and completely unnecessary. The government has the money to spend. It chooses not to do so. For 24-hour free counselling: Lifeline 13 11 14 www.suicidecallbackservice. org.au or 1300 659 467 For emergencies: 000