NOT WAVING, DROWNING

Correspondence

Jennifer Doggett

For those (like me) who work within the health sector, mental health is a puzzle.

It’s an area where there is a surprising level of agreement among stakeholders. Politicians (from both sides of politics), clinicians and consumers all seem united in their concern about the rates of both mental illness and sub-clinical mood disorders in Australian society. It’s also an issue which has been a high personal priority for individual health ministers (including the recent federal Minister for Health, Greg Hunt), who have allocated significant policy, political and financial resources to improve our mental health outcomes.

In any other area of health, these factors would have resulted in substantial progress. But in mental health, they appear to have delivered only marginal gains.

Also puzzling is that, unlike the other public health challenges we face (such as obesity, smoking and Covid-19), the causes of our seemingly intractable mental health problems are murky.

From the outside, there is no clear reason why Australians are experiencing so much mental distress. Australia outperforms the OECD average in income, jobs, education, health, environmental quality, social connections, civic engagement and life satisfaction. Even accounting for the impact of the Covid-19 pandemic, Australians have never lived longer, with greater health and more material wealth than they do today.

Yet rates of depression and anxiety are at record levels, seemingly even higher than those of many other countries with materially worse living standards and conditions – Indonesia, Nigeria and Mexico, for example (although, due to data quality issues, it can be difficult to make accurate comparisons across countries).

Suicide is the leading cause of death among Australians aged fifteen to twenty-four, with rates among young Aboriginal and Torres Strait Islander people double that of non-Indigenous young people. Domestic violence (which often results from and in turn causes or exacerbates mental health problems) is a national emergency: on average, one woman a week is murdered by her current or former partner.

Everyone agrees that these are serious and urgent problems. But disagreements arise as to their cause and therefore possible solutions. People on the left cite social determinants such as rising inequality, poverty and racism as the main drivers of mental health problems. Those on the other end of the political spectrum point to the shift in social institutions such as marriage and family or our changing views about gender. Others suggest environmental issues and the existential threat posed by climate change. It seems that mental illness is a mirror which reflects back to the viewer their existing concerns, anxieties and ideologies. In this way it reinforces the ideologies and worldviews which divide us, making it difficult to work together to develop a common response.

Sarah Krasnostein’s thoughtful and wide-ranging essay sheds some useful light on this problem and suggests where our previous approaches to mental health may have gone wrong. By stepping outside the conventional, individualistic and health-centred approach to mental illness, she draws connections between our traumatic past as a nation and our current struggles with mental illness today. She highlights the importance, at both an individual and a social level, of naming and responding to trauma, and describes how this can contribute to our understanding of mental illness.

Obviously, mental health policies, programs and services can be important in addressing mental health needs, and Krasnostein is certainly not suggesting otherwise. But her essay also makes clear how anaemic these responses are when they are seen outside of a broader context: the traumas of our past, the fault-lines of race, class, gender and sexuality, and our collective anxieties about existential threats of climate change, the Covid-19 pandemic and global conflicts.

As we grapple with the findings of the Royal Commission into Victoria’s Mental Health System, Krasnostein demonstrates why this issue is too important to be left to the policy-makers, clinicians, bureaucrats and politicians.

It illustrates how desperately we need the knowledge and wisdom of those not generally included in the mental health debate: the historians, the storytellers, the educators, the grandmothers and elders. It reminds us how much we can learn from the resilience of Indigenous, migrant and refugee communities about the strength of shared stories and the healing power of relationships.

Most significantly of all, Krasnostein highlights the importance of listening to the voices and experiences of people living with trauma and mental illness – people like Eliza, Daylia, Rebecca and Codey, whose stories Krasnostein respectfully and sensitively shares. Along with her deep insights and thoughtful analysis, their stories provide a powerful and valuable reminder of the human and social cost of our failure to address the impact of mental illness on the Australian community.

Jennifer Doggett