"Help is the sunny side of control" - drawn by participant at community consultation forum on mental health

Parts one and two described an application of Open Space Technology for community consultation on the subject of mental health, touched on possible vested interests within the structure of the mental health marketplace, and proposed a thought experiment: wouldn’t it be great if the mental health profession could cure all mental health problems so successfully that the industry wasn’t needed any more?

This idea was pitched to participants at the mental health forum like this:

Vision: to reach a point where mental health services are no longer needed.
Provocation: do some aspects of the ‘mental health industry’ create an incentive for treatment instead of prevention?

The conversation benefitted from the experience of mental health professionals such as (in no particular order): Ann White from the WA Association for Mental Health (WAAMH); Rory Stemp from the South West Area Health Service (WACHS-SW); health professional Cresswell Surrao; John Curtin Medallist Lynne Evans; Positive Parenting specialist Joanne Mizen; counsellor Graeme Lamont; Community Link and Network (CLAN) CEO Stuart Tomlinson; and community worker Audrey Parnell from Narrogin.

NB: while the comments here benefited heavily from the combined wisdom of that group discussion, any mistakes or omissions are strictly my own and I apologise if I misrepresent or mangle the views of any of the other, much more knowledgeable group members.

Mental health spectrum

If mental health is a spectrum from ‘healthy’ to ‘chronically ill’, the resources tend to be focused at the chronic end of the spectrum.

As one of the participants described it, a huge injection of funding and resources kick in at the point when a crisis starts happening. Obviously this is too late.

Relatively few resources are available either side of the crisis. This is not an efficient way of allocating resources. It’s fairly well documented, in many different settings, prevention is not only better than cure, but also much cheaper.

Most of the resources are allocated immediately after the onset of a crisis. Outside the health system, this is commonly known as shutting the gate after the horse has bolted.

The benefits of prevention may extend further. A Japanese studyfound “Individuals with mental health issues both before and after intervention required more outpatient consultations than those without. The importance of considering mental health in preventing lifestyle-related diseases was confirmed.”

In other words, ensuring a high standard of mental health could have benefits across the health system.

So if promoting mental health is so much more beneficial and cost effective than diagnosis and treatment of mental illness, why don’t we allocate our health resources accordingly?

There was strong agreement within our little focus group that the current system provides incentives for more diagnosis, more treatment, and more prescription of drugs, with little incentive for prevention of root causes.

There are essentially two ‘camps’ in the mental health system: one concerned with treatment of classifiable mental illness, and one concerned with proactively developing mental health. The health debate in Australia is heavily dominated by the AMA, which is heavily skewed to the diagnosis and treatment end of the spectrum.

There are also some practical issues. Potential customers may not be aware of the range of services on offer. Or they may only present themselves for treatment at a late stage, or not at all, partly because of the social stigma attached to mental health.

One Flew Over the Cuckoo's Nest. Everyone's worst mental health nightmare, and the underlying power imbalance between mental health professionals and their customers still has currency today. (And yes, it was a book before it was a film - remember books?)

There’s also a power and control issue. I personally know at least two people whose interaction with the mental health system has resulted in some deprivation of personal freedom. I know others whose experiences have caused at least as many problems as they solved. Where do those people go for a refund?

The classical allusion here is ‘One Flew Over the Cucko’s Nest’. (For Gen-XY readers, check the episode of the Simpsons when Homer is declared insane after Bart completes his psych evaluation.)

It’s also true some of the underlying root causes of mental illness are poorly understood. Although there is an understanding of certain minimum conditions to support mental health, these conditions are not evenly distributed across socio/geographic areas, and that’s not easy to fix.

Pharmaceutical companies and doctors are only paid for the work they do, not the work they have prevented.

And so the list goes on…

Waxing lyrical about the issues can be cathartic, but not necessarily constructive. So, in part four, let’s get creative and think about some possible solutions.

More on mental health: [Part 1] [Part 2] Part 3 [Part 4]