Reducing the Stigma of Mental Illness

Mental health problems have got more attention from the government and the public. It is said that “About one in five Australians will experience a mental illness, and most of us will experience a mental health problem at some time in our lives” (Australian Government Department of Health and Ageing, n. d, p. 1).

In 1992 a National Mental Health Policy was adopted by all Australian governments which then the policy has been implemented through a series of five years National Mental Health Strategy (Whiteford & Buckingham, 2005). An important goal of the Mental Health Strategy was the improvement in the quality of mental health services.

This paper argues the position that the number of mental illnesses patients has decreased over the last two decades. The purpose of this essay is first to examine whether the changes in services provision which have taken place since 1992 to the mentally ill have been positive. Secondly, it will investigate changes in social attitudes towards people with mental disorders in this period. It also provides the reasons why more people experience a mental disorder, particularly among the young nowadays. Surveys have been done to explain the number of reasons why more people are at risk of mental problems in modern life.

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It is said that people living in the remote area; Indigenous people; prisoners and refugees have a higher rate of mental illnesses than urban community due to the lack of access to mental health services and socioeconomic disadvantage (Sankaranarayanan, Carter, & Lewin, 2010; Sawyer, Guidolin, Schulz, McGinnes, Zubrick, & Baghurst, 2010; Savy & Sawyer, 2009). Unemployment is another problematic issue for mental health which accounted for 29% of mental cases in total in 2007, as people worry about financial situations and it would also lead to mental distress and depression (Australian Bureau Statistics (ABS), 2008; Cvetkovsk, Reavley, & Jorm, 2012; Butterworth, 2012).

In fact, university students with the financial burden are often faced with a greater risk of distress and other psychotic disorders (Cvetkovski et al. , 2012; Savy & Sawyer, 2009). In addition to the employment status, some people might not be able to afford adequate housing, experience social isolation or stress and end up with sustained abuse and behavior disorders (Lee, et al. , 2010). It is undeniable that eating habits would impact human health physically.

However, it is interesting to note that eating habits might also contribute to mental health status. Recent research shows that there is a link between soft drink consumptions and mental health problems among adults. The study found that “those who consumed more than half a liter of soft drink per day had approximately 60 % greater risk of having depression, stress-related problem, suicidal ideation, psychological distress or a current mental health condition, compared with those not consuming soft drinks” (Shi, Taylor, Wittert, Goldney, & Gill, 2010, p. 1073).

Nobody would deny that there is a big effort from the government toward mental health. It is reflected in the amount of money that has been invested in mental health. A sum of 2. 2 billion has been funded for mental health in 2011 over 5-year reform, in conjunction with 3. 1 billion in 2002. However, the question is whether the money is being spent in the right place or is all of that money actually used for mental health only (Whiteford & Buckingham, 2005). The survey conducted in 2007-08 and 2004-05 shows that there were no differences in the percentage (11%) of people who reported suffering from chronic mental problems (ABS, 2010).

It is shown that the young were more likely to experience a mental health problem than the elderly, at the rate of 26% compared to 6%, respectively (ABS, 2010). The number of people who had anxiety disorder increased from 5% to 10. 8% between 2004 and 2007. Another common type of mental illness is depression, which affected 5% of people in 2004 and rose to 10. 8% in 2007. There is an increase of 5. 7% yearly from 2005-06 to 2009-10 in cases of mental health-related GP encounters. Nearly seven times more people reported that they had psychological distress in 2007-2008 than in 1997. ABS, 2008; ABS, 2010; Savy & Sawyer, 2009; Australian Institute of Health and Welfare (AIHW), 2011.

One of the major transformations under the National Mental Health Strategy (NMHS) has been the shift in the provision of mental health services from a psychiatric hospital to a range of community-based services (Savy & Sawyer, 2009; Short, Thomas, Luebbers, Ogloff, & Mullen, 2010). Twenty-four-hour mobile community-based services have been trialed in Australia since mid-1966 (Rosen, Gurr, & Fanning, 2010) and it has become the predominant form of service in the last fifteen years.

The United Nations in 1991 recommended that the facilities for support, treatment and rehabilitation of persons with mental illness should be as far as possible within the community they live (Rosen et al. , 2010). Under the NMH strategy, the direction of resource allocation changed in favor of community-based services. For instance, whereas in 1993, community-based services received only 29% of state mental health services; by 2002 its share jumped to 51%. In the same period, the share of resources for stand-alone hospitals decreased from 73% to 29%.

During the early part of this century, two federal government policies have been implemented as the result of pressure from the interest group. Firstly, in 2001, following a campaign led by beyond- blue: the national depression initiative, the government introduced Better Outcomes in Mental Health Care program (BOiMHC) (Hickie, Rosenberg, & Davenport, 2011). Under this program, psychological services and skilled professionals delivering mental health services were financially supported through the Medicare system.

The program encouraged collaborative care by general practitioners and mental health professionals (Hickie, et al. , 2011). Secondly, largely in response to lobbying by professional groups, the Australian Government replaced BOiMHC with the Better Access initiative, which extended the scheme to non-medical providers on the fee-for-service basis (Hickie, et al. , 2011). Better access improved access to mental health and general practitioner (GP) services to all sections of the population including those in socio-economically disadvantaged areas (Jorm, 2011a).

A recent study in the pattern of mental health service use in the state of Victoria showed that in 2009, 88. 7% of patients with psychotic disorder received outpatient treatment compared to 60% a decade ago (Short et al. , 2010). The National Survey of Mental Health and Wellbeing, 2007 reported that only 2. 6% of people with a year-long mental health disorder had at least one admission to the hospital in the past 12 months. In the same period 70. 8% consulted GPs, 37. 7% consulted psychologists and 22. 7% consulted psychiatrists (ABS, 2008).

Thus, while the hospital-based mental health services continue to play an important role in providing in-patient services to severe cases. Community-based services increasingly important in offering 24-hour mobile services, respite accommodation, supported residential facilities, case management teams and GP shared care (Rosen et al. , 2010). Such community-based programs encourage community collaboration and have demonstrated to increase consumer satisfaction, which are more likely to stay in touch longer, willing to make return visits and reduce family burden (Rosen et al. 2010).

A few recent trends in primary health care changes are worth noting such as The Federal Government GP super clinic which brings health care professionals together or the “Health One” initiative in New South Wales to integrate GP and community health services with a focus on rural and remote areas. Since 1997, there have been major changes in community-based mental health services and significant improvement in service provision (Jorm, 2011b). There has also been an improvement in unmet needs for mental health care (Meadows & Bobevski, 2011).

However, there is evidence, contrary to improvement in service provision and reduction in unmet need, that there is no overall improvement, and in some areas, worsening of outcome (Jorm, 2011b). Jim argues that improvement in services has been counteracted by other risk factors and that the quality of services has declined. He also claims that in Australia less has been invested in prevention than in treatment services. The use of public mental health services by people with mental illness and substance use disorder is low. This indicates that mental health services are not the primary service point for illicit drug users (Short et al. 2010).

On the other hand, the alcohol and drug sector is also failing to service comorbidity sufferers. Despite government initiatives to minimize barriers to treatment and encourage collaboration between drug treatment and mental health services people with substances use and co-occurring mental disorder are “falling through the gap” (Merkes et al. , 2010; Short et al. , 2010) It is also hypothesized that with increased awareness of symptoms as a result of increased literacy about mental health and increased media coverage, people are more likely to report mental disorders than previously, thus counterbalancing the true improvement (Jorm & Reavley, 2012a).

Due to increased awareness of medications such as anti-depression and availability of psychological services, there is a substantial increase in their use and it does not necessarily indicate that all users suffer from a mental disorder (Harris as cited in Jorm & Reavley, 2012a) Societal attitudes towards mentally ill, can have an adverse impact on the sufferers’ wellbeing as well as on responding, prevention and treatment of the illness.

The sufferers may be reluctant to seek help, feel marginalized and generally “looked- down upon by society”. Moreover, others may stigmatize sufferers by avoiding contact with them, regarding them as dangerous and incompetent (Savy & Sawyer, 2009; Reavley & Jorm, 2012b). The sufferers may suffer compounding problems of discrimination, diminished social and economic participation and financial hardship. In severe cases, their social contact is often with few people other than their welfare workers, family, or carers (Savy & Sawyer, 2009).

The results of a national survey in 2011 (Reavley & Jorm, 2012b) showed that between 2003 and 2011 there was an increase in the perceptions that those with symptoms of depression and schizophrenia were dangerous and unpredictable. On the other hand, there was a slight decrease in the desire for social distance from someone with depression. It is not clear whether such a positive attitude is a general trend in Australia or a result of campaigns by organizations such as beyond blue to reduce stigma about mental health (Reavley & Jorm, 2012b).

A 2011 study about young people’s stigmatizing attitudes reported that responders were most unwilling to work on a project or develop a close friendship with other people who suffered from mental disorders (Reavley & Jorm, 2011). There is increasing use of media to inform the general public about prevalent. Media plays an increasingly important role in public literacy and awareness of mental illness. A research in 2009 portrayal of mental disorder on television media reported that young sufferers did not fare as well as adults (Henson, Chapman, McLeod, Johnson, & Hickie, 2010).

Programs related to older Australian with mental illness included more positive themes (66% vs 29% for youth) and less frequent negative themes (9% vs 26% for youth). Importantly, the 2009 study revealed fewer negative themes than a 2002 study of Australian print media (Henson et al, 2012). Mental Health First Aid (MHFA) designed, initially in 2001, to train those who assist sufferers of mental illness has shown to have an added role in developing more positive, stigma reducing attitude in those working in mental health sufferers (Jorm & Kitchener, 2011).

In conclusion, it is evident that positive developments have taken place in the service provision of the mentally ill in Australia since 1992. However, the improvement has not been equitable in all aspects of these complex disorders. The existing programs are failing to fully meet the needs of socio-economically and geographically disadvantaged Australians and these suffering from comorbidity affections. These stigmas of mental disorders were a severely negative impact on the patients both for their self-esteem and their well-being.

Societal attitudes towards mentally ill patients are more difficult to accurately assess. There is no clear evidence that the societal attitude has changed much since 1997 although there are greater awareness and understanding of more common disorders such as stress and depression.

References

1. Australian Bureau Statistics (ABS). (2008). National Survey of Mental Health and Wellbeing: Summary of Results (no. 4326. 0).
2. Canberra, Australia: Author Australian Bureau Statistics (ABS). 2010).
3. National Survey of Mental Health and Wellbeing: Summary of Results, 2007-2008 (no. 4364. 0). Canberra, Australia: Author Australian Government Department of Health and Ageing. (n. d). What is mental illness? Retrieved 10th May, 2012 from http://www. health. gov. au/internet/main/publishing. nsf/content/B7B7F4865637BF8ECA2572ED001C4CB4/$File/whatmen. pdf
4. Australian Institute of Health and Welfare (AIHW). (2011). Mental health services—in brief 2011 (no. HSE 113).
5. Canberra: AIHW. Retrieved 10th May 2012 from http://www. aihw. gov. au/WorkArea/DownloadAsset. aspx? id=10737420123
6. Butterworth, P. , Olesen, C. S. , & Leach, S. L. (2012). The role of hardship in the association between socio-economic position and depression. Aust N Z J, 46, 364-373. doi:10. 1177/0004867411433215
7. Cvetkovski, S. , Nicola J Reavley, J. N. , & Jorm, F. A. (2012). The prevalence and correlates of psychological distress in Australian tertiary students.

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