Mental relief

ON the morning of New Year’s Day, I met our emergency mental health access team to talk through what had happened the previous night.

It had been a pretty standard 24 hours. While much of Geelong was welcoming in the New Year watching fireworks, with friends at a party or with an early night, our team had been busy at work, many people had come to our Emergency Department for mental health assistance, and a couple were still there.

Their reasons for coming in were different — some felt suicidal, others lonely. But they had two things in common — their problems were not new, and they felt there was no better place to go for help.

Anyone working in the mental health system knows it can be better.

When announcing the Royal Commission into Mental Health, due to start this year, Victorian Premier Daniel Andrews acknowledged that getting treatment and support for mental illness should be easy, but often is not. The cost of this is high and is clear to see.

On average, our team of Emergency Department mental health staff assessed and treated 10 people each day last year, an increase of more than 15 per cent on the previous year.

In 2018, we had about 3700 people attend for help, about 3200 in 2017, and just over 3000 in 2016. We expect to be busier than ever this year.

People come to the Emergency Department at the urging of concerned family, at the direction of concerned police or they come alone. Inevitably, this is not their first attempt to get help. It is rare to see a person whose mental health problems are not in some way connected to issues with drugs or alcohol, the effects of gambling, homelessness or social isolation.

However, the Emergency Department, with bright lights and frenetic activity akin to a casino, is not the best place to provide care, but this is where people are coming in higher and higher numbers.

More than 20 years have passed since the institutions were closed and mental health care moved to the community. Since then, there have been many advances in care that we should celebrate. Early intervention, reduction of stigma, enhanced community and primary care treatment options, and the contribution of those with lived experience of mental illness in service design, have all added value.

At Barwon Health, we have evolved from the days of Dax House to now have teams spread across the region working with our whole community — from mothers adjusting to life as a new parent, adolescents with eating disorders and severe anxiety, to adults with schizophrenia and alcohol issues, and retirees with emerging dementia.

We work with partner agencies, such as those that provide direct care such as Barwon Child Youth and Family, Bethany Family services, psychologists and GPs, to those whose interaction is secondary to the social consequences of mental illness, such as Victoria Police, Ambulance Victoria and those who provide homelessness support, such as the Salvation Army.

Great work is done, and many people have good outcomes and get on with their lives. However, despite the best work of trained and dedicated professionals, things do not seem to be getting better. Suicide rates in Victoria are essentially the same as they were seven years ago. Rates of anxiety and depression in Greater Geelong are increasing, and more people are coming to our Emergency Department with mental health issues than any previous time. The Royal Commission into Family Violence was able to successfully articulate the broad factors that contribute to genderbased violence. Its recommendations for greater investment, and changes that will allow people in the field to better work together, including our own mental health services, will have an impact. The Royal Commission into Mental Health can do the same. The stories that emerge will no doubt be uncomfortable to hear. However, as a community we should embrace the opportunity the royal commission brings wholeheartedly and get involved. As a first step, I encourage everyone from our community to contribute to the development of its terms of reference at engage.vic.gov.au.

Associate Professor Steve Moylan is clinical director of Mental Health, Drug and Alcohol Services at Barwon Health