EDITORIAL: Mental health problems

YEAR after year governments at every level make grand-sounding announcements about mental healthcare reform. More funds, more staff, better training and more facilities are promised.

And yet, in the community and in hospitals, little seems to change.

The brutal reality is that mental health runs a distant last in the competing priorities of those who determine how resources will be allocated. When – as now – government revenues are under pressure, even highly rated health priorities suffer and those at the bottom of the heap suffer even more.

It doesn’t help that mental healthcare often seems so changeable in focus. Emphasis shifts between prioritising major psychoses and the more widespread but less acute conditions like depression and anxiety.

The terrible constant is the difficulty sufferers face in obtaining timely, relevant and reliable care.

Few people seriously miss the bad old days when a bigger percentage of the mentally ill was institutionalised, but society has not recovered from the betrayal of the now-legendary Richmond Report in the 1980s that justified the closure of institutional beds in favour of community care.

The government pocketed the savings from the closures, but never properly funded the community alternatives. The mentally ill and their families have been paying the price ever since.

In the Hunter, the same general shortage of money, staff and facilities that plagues all healthcare affects the mental health sector.

A lack of acute care facilities means patients can’t always get help when they need it, and mental health crisis teams struggle to satisfy intense around-the-clock demand for their services.

Anybody with experience of psychiatric health problems will attest that an acute crisis in mental health can be every bit as frightening and dangerous as many more directly physical health crises.

The inability to get the right care when it is needed inevitably throws problems on other services, including the police, paramedics and emergency department staff in regular acute hospitals.

In that context it’s entirely predictable that the Hunter’s emergency departments are seeing considerable numbers of people suffering from mental illness.

The choice the health system needs to make is between alleviating some of the pressure by putting more resources into dedicated mental health services, or resigning itself to increased mental health presentations in general hospitals and adapting them to better suit the purpose.

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