Compassion comes at a cost
Mental health nurses are at the frontline of any mental health engagement. So, it’s an odd kind of disconnect when counsellors, psychotherapists and psychologists engage in compulsory regular debriefing sessions during their training yet a similar model is yet to be mandated for mental health nurses - the very people who are expected to respond to the mental health needs of their patients from shift to shift.1
Professor Allan Fels, Chair of the National Mental Health Commission, used the launch of the 2013 National Report Card on Mental Health and Suicide Prevention to call for political courage in reforming mental health and providing better outcomes for the 45% of Australians who will experience a mental health problem in their lifetime.
Prof. Fels said: “We speak about Australia as the lucky country, but mental health is a weak point in our society as well as our health system.
“For example, it’s scandalous that only seven per cent of the 340,000 people who have co-existing mental illness and substance use disorders each year are estimated to receive treatment for both problems. These people have their lives cut short by an average of between 20 and 30 years, they are more likely to be in prison or homeless, and they are more likely to take their own lives.
Criminalise Mental Health? Expect Poorer Outcomes
“The Commission is also highly concerned about how we as a society criminalise people who live with a mental health difficulty. People living with mental illness are over-represented in our prisons, in the number of police incidents and in the number of police shootings. We believe that each stage of the justice system needs significant reform.
“In 2012, 38 per cent of all people entering our prison system reported being told they have a mental illness, and 87 per cent of young people in the juvenile justice system in NSW alone were found to have at least one psychological disorder. “Compared to other prison entrants, people with poor mental health have more extensive and early imprisonment histories, poorer school attainment, higher unemployment rates and higher rates of substance abuse. Incarceration and their treatment in prison often makes their mental illness worse and rarely treats their illness appropriately.
“When we look at these issues … we see that there is a cycle of vulnerability that crosses generations, and current mental health systems and supports are not generally designed with the needs of people and families at its core.
Indigenous people are twice a likely to die by suicide than non-Indigenous
“Only 25% of young people and 15% of boys and young men with mental health problems receive treatment of any kind. Meanwhile, 44 Australians, on average take their own lives each week and Aboriginal and Torres Strait Islander peoples are two times more likely to die by suicide than non-Indigenous people. “There is a growing divide between those of us who are empowered to live a contributing life – and those of us who are disempowered by issues like unemployment, homelessness, social exclusion as well as a lack of the right support ”, Prof. Fels said.
A Contributing Life: The 2013 National Report Card on Mental Health and Suicide Prevention shines a light on the lives of people who are the most disadvantaged in society - economically, socially and because of the impacts of their mental illness. It contains personal accounts from people and families who have experienced mental illness through the prism of prison, homelessness, unemployment, discrimination and grief following a suicide.
Repeated calls for Early Intervention Funding
The Report Card highlights the need to increase investment in early intervention across a range of areas and across people’s lives.
Prof. Fels said: “Many of the recommendations we made last year relate to systemic reform that will take time. We need to make a start. This is about us – our family, friends and colleagues – and we are impatient for action on behalf of the millions of people and families we know are tired of struggling on.”
“We still have no public reporting on the number of people who are discharged from hospitals, custodial care, mental health or drug and alcohol related services into homelessness even though this issue has been named as a national commitment since 2008. “We observe a concerning trend of services retreating from their roles and governments retreating from funding commitments to support people in the community. Last year, we called on governments to ensure that mental health funding they publically announce is spent on mental health as promised, but we’ve seen no independent and transparent reporting on this. “Courage will also be needed to avoid tinkering with a disjointed collection of linear services and systems that have long been shown not to produce the outcomes people need. Success will rely on all levels of government, community agencies, and public and private services working together to make people’s lives better”, he said.
However, the Commission stressed that the news is not all bad. Professor Fels cited the public release of the first ever national data on seclusion by states and territories as a highlight of the year and a key step in achieving real reductions in this practice, which is not in line with human rights. The Commission is also pleased that psychosocial disability has been included in the NDIS, and applauded the work that non-government sector, the business sector and first responders such as Police have taken to address issues the Report Card and its broader work has raised.
Source: National Mental Health Commission Website - 27 November 2013 Media Release
Download A Contributing Life: 2013 Mental Health and Suicide Prevention Report Card
Need Help NOW?
If you have read this blog and you’re having suicidal thoughts:
1. Tell someone how you feel. A partner, friend, family member, school counsellor either face to face or on the phone.
2. If you have someone with you, ask them to stay with you until you get help. Being with someone, even over the phone increases your safety.
3. Call or talk to a medical professional and tell them it’s an emergency:
- Call your local hospital and ask to speak to the Mental Health Team
- Go to your GP or local emergency department and wait there until you are seen by a medical professional
- Call 000. The police or ambulance may be able to take you to hospital.
- Call your doctor, psychiatrist, psychologist, counsellor or case worker
- Call a Crisis Helpline
24 Hour Telephone Services:
- Lifeline 13 11 14
- Suicide Callback service 1300 659 467
- Kids/Teens Helpline 1800 55 1800
Read the SANE Factsheet - Finding help if you’re feeling suicidal
Go to the Lifeline Website
Go to the SANE Website
Go to the R U OK? Website
Kids can get helpful information on the Kids Helpline Website
ReachOut.com is an online support website aimed at Australian young people
This week our blog post comes from Ilana Green from Inner West Medicare Local. Ilana likes to talk…a lot…so she took part in ZipIt to raise awareness for World Mental Health Day on October 10th and to see whether she could keep quiet for 24 hours…
The ZipIt mental health campaign really appealed to me. For starters, I genuinely care about this cause and I’m a passionate advocate for mental health issues in both my personal and professional life. Secondly, I felt quietly confident that I could happily see through a period of time without talking, even though I knew it would be challenging. Had the fundraiser required me to physically exert myself I wouldn’t have been on the bandwagon; the genius who put the words ‘fun’ and ‘run’ together wasn’t fooling me. I also think people are more likely to donate to someone offering to do something out of character. To that end, ZipIt was a winner, because everyone who knows me is aware that I like to talk… a lot… all the time. Add to that my propensity for wisecracks and pranks and it becomes apparent that some of my family, friends and colleagues were throwing money at the cause for reasons additional to their benevolence.
One of my colleagues was kind enough to jump on board with me and together we formed a ZipIt team, naming ourselves Silence of the Clams. We agreed that if we reached over $750 worth of donations we would be quiet for the full 24 hours. We more than doubled that target, committing us to a full 24 hours of silence. So on October 10 my alarm went off and the challenge began. My partner declared we’d start the day with a game called “not answering means yes”. Round one went like this: partner asks me “would you like to let the dog lick you in the face”? After a moment of silence, my partner lifts our small dog to my eye level to allow him to give me a nice wet good morning kiss. I then walked away, only to run into our housemate who ad-libbed a song that happened to be about the beauty of speech, verbal self-expression and the right of reply, before asking me a series of questions that I couldn’t answer. This was a pretty good indication of how my day was going to play out.
After a couple of hours at work, the novelty of one-way taunts (albeit in good fun) seemed to wear off for my colleagues and I was left alone. Oddly, it was at that point things got hard. I waited to be thrown into some sort of zen-like meditative state; however without conversation, I retreated into my thoughts which had become more frequent and distracting. I started feeling a bit self-conscious about the attention I was drawing to myself and I developed a torturous internal monologue that seemed to narrate everything I did as if I was Kevin from The Wonder Years. I felt left out when people nearby gathered for conversations and I could not participate. I didn’t go out to get my daily coffee fix as it was easier to avoid people then to try and explain why I couldn’t talk. Lunch time rolled around and it was difficult to find anyone wanting to join me while I ate in silence; some said it would be boring, some said it would be weird and some declined without reason.
I had only been silent for 5 waking hours and I was already able to draw some similarities between what I was experiencing and what it is like for people who feel vulnerable, isolated, frustrated or embarrassed due to mental illness. The main point of difference was that I knew that after only 24 hours my life would return to normal. I had chosen to be in this situation temporarily, it had a clear end date and if it really got too hard I could always choose to break my silence. Anyone who has had an authentic experience with mental illness will be all too aware that mental illness is not a choice and you cannot simply choose to cease experiencing it.
ZipIt gives people a chance to consider how they would wish to be treated if they were amongst the 1 in 5 Australians who experience mental illness. Hopefully people will continue to ask such questions and engage in meaningful discussions well after they break their silence.
Like Zip It on Facebook
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Please visit the Silence of the Clams Fundraising Page
By guest blogger Susan Whitby - MClinSc (Lifestyle Medicine), Grad Dip (Biological Anthropology), BA.
With 20% of Australians suffering from a mental illness in the past 12 months1 and the cost to the Australia economy teetering around $20 billion2 it’s well worth paying attention to the body of research supporting exercise as a valid treatment option for those suffering a mental illness.
Now who am I to be saying this? Well yes, I’m a personal trainer, so of course I think that exercise is great! But let me share something with you. For many years I suffered from deep depression and crippling anxiety to the point that I was self-harming. After many years and many relapses, I spent years researching how exercise has the potential to reduce the symptoms of anxiety and depression.
Medical Practitioners are at the coalface when it comes to helping those with mental health issues. 70.8% of mental health sufferers present to a General Practitioner.3
Health professionals are in a perfect position to share this information. Sure, compliance may be an issue but there will also be people who take on board the messages gleaned from this research.
Here are five reasons why exercise could be an important part of a treatment program for your patients:
1. Regular exercise reduces inflammation in the body. Pro-inflammatory cytokines TNF- α are suppressed by regular exercise.4
2. Moderate intensity exercise has the potential to create a state of ‘flow’, a well-used Positive Psychology strategy for reducing the symptoms of depression.5
3. Exercise releases ‘happy hormones’. 5-HT is synthesised and metabolised immediately after a one hour bout of exercise.6
4. Exercise promotes a healthy and functioning brain by way of neurogenesis (synthesis of new neurons), the same as anti-depressant medication.7
5. Exercise increases self-efficacy. Mastering an exercise type is important in recovering self-esteem and rebuilding confidence.6
The type of exercise really doesn’t matter. Cardiovascular exercise works well for some while resistance training is preferable to others. What is important is that this information is shared. It could save millions of dollars and just as many lives.
- Mental Health Council of Australia. Fact Sheet – Statistics from the 2007 National Survey of Mental Health and Wellbeing. www.mcha.org.au
- Australian Bureau of Statistics (2007) Mental Health. Gender Indicators. ABS Cat No. 4125.0. Canberra ABS.
- Australian Bureau of Statistics (2007). National Survey of Mental Health and Wellbeing: Summary of Results. ABS Cat No. 4326.0. Canberra ABS.
- Petersen AMW, Pederson BK. The anti-inflammatory effect of exercise. Journal of Applied Physiology 2005;98: 1154-1162.
- Dey S, Singh RH, Dey PK. Exercise Training: Significance of regional alterations in serotonin metabolism of rat brain in relation to antidepressant effect of exercise. Physiology and Behaviour 1992;52(6):1095-1099.
- Black Dog Institute. Fact Sheet - Exercise and Depression www.blackdoginstitute.org.au/docs/ExerciseandDepression.pdf
- Ernst C, Olson AK, Pinel JPJ, Lam RW, Christie BR. Antidepressant effects of exercise: Evidence for an adult-neurogenesis hypothesis? Journal of Psychiatry and Neuroscience 2006;31(2):84:92.
Partners in Recovery: A Model for Collaboration Coordination Integration
Around one in three Australians will experience mental illness at some stage in their life. Mental illness is the largest single cause of disability. Around 600,000 Australians experience severe mental illness and some 60,000 have enduring and disabling symptoms with complex, multi‐agency support needs.1
Addressing severe and persistent mental illness requires a complex system of treatment, care and support, requiring the engagement of multiple areas of government, including health, housing, income support, disability, education and employment.1
What is Partners In Recovery?
Partners in Recovery (PIR) aims to support people with severe and persistent mental illness with complex needs - and their carers and families - by coordinating services across multiple sectors. The aim of PIR is to streamline systems to work in a more collaborative, coordinated, and integrated way.
PIR aims to support the multi‐service integration needed to ensure services and supports are matched to people’s need. In doing so, PIR hope to facilitate better coordination and access to the clinical and other services and supports needed by people who are suffering from severe and persistent mental illness.1
The ultimate objective of the PIR initiative is to improve the system response to, and outcomes for, people with severe and persistent mental illness who have complex needs by:
- Facilitating better coordination of clinical and other supports and services to deliver ‘wrap around’ care individually tailored to the person’s needs;
- Strengthening partnerships and building better links between various clinical and community support organisations responsible for delivering services to the PIR target group;
- Improving referral pathways that facilitate access to the range of services and supports needed by the PIR target group; and
- Promoting a community based recovery model to underpin all clinical and community support services delivered to people experiencing severe and persistent mental illness with complex needs.1,2
How social media can help promote PIR?
In the techno age, social media tools offer a powerful way for health professionals act as a public voice for health. Although the type of online conversations and shared content can vary widely, health professionals and health organisations are increasingly using social media as a way to share journal articles, post updates from conferences and meetings, and circulate information about professional opportunities, health initiatives, funded programs and upcoming events.
The Partners in Recovery program is fundamentally a network of community services and health organisations that have been brought together to advocate on behalf of people with persistent and severe mental illness. For this reason PIR is perfectly placed to utilise social media for networking and information sharing opportunities with community, health and mental health advocacy groups. Initial social media connections would include members of the PIR Network Organisations and area-based health consortia.
Partners In Recovery Roll-out
The Partners In Recovery Information Paper1 describes the PIR Operational model:
- Suitably placed and experienced non-government organisations will be engaged in Medicare Local geographic regions to implement PIR in a way that complements existing support and service systems and any existing care coordination efforts already being undertaken.
- PIR organisations will undertake a number of tasks, including engaging and joining up the range of sectors, services and supports within a region from which individuals may need assistance. They will work to build partnerships, establish (or improve) collaborative ways of working together, and establish the framework to oversee implementation of the initiative at a local level.1
If connecting a range of sectors, support services, advocacy and crisis-care groups is the principal aim of PIR, then strategic and responsible social media messaging is one of the most effective tools to achieve this aim. If used effectively, Twitter engagement for the Partners In Recovery program promises sustainable and long-lasting local, regional and community connections that have the potential to achieve and enhance PIR aims.
Disseminating PIR Information
When the Medicare Local Partners In Recovery Organistaion (PIRO) begin rolling out the PIR program they will host a series of forums around the local region (as a part of the PIR Communication Strategy) presenting information to consumers, carers, service provider staff, and others on:
- What PIR is;
- The importance of partnerships to the success of PIR and how the partnerships would be established, used and governed;
- The critical role of consumers and carers in the implementation of PIR within the region;
- The critical role of service providers within the partnerships and the benefits to be gained by active and sustained participation;
- The target population profile within the region; and
- The referral pathways into the initiative.3
Who are the state/territory based PIR Consortium members?
There are a number of sectors central to the success of this initiative including primary care (health and mental health), state/ territory specialist mental health systems, the mental health and broader NGO sector, alcohol and other drug services, and income support services, as well as education, employment and housing supports.
Organisations listed under Medicare Local Regions funded under stage 1 of the Partners In Recovery program, with existing Twitter accounts who are actively engaging with their local and regional communities include:3
ACT Medicare Local (783 Twitter followers)
Central Adelaide and Hills Medicare Local (389)
Central Queensland Medicare Local (209)
Country North SA Medicare Local (579)
Eastern Melbourne Medicare Local (1,237)
Hume Medicare Local (312)
Hunter Medicare Local (1,007)
Illawarra Shoalhaven Medicare Local (399)
Inner West Medicare Local (430)
Metro North Brisbane Medicare Local (731)
Murrumbidgee Medicare Local (361)
Northern Medicare Local (497)
South Eastern Melbourne Medicare Local (567)
Southern Adelaide – Fleurieu – Kangaroo Island Medicare Local (243)
Western NSW Medicare Local (375)
West Moreton-Oxley Medicare Local (650)
Wide Bay Medicare Local (685)
Medicare Local Twitter engagement potential: 9,454
Community Organisations and Stakeholders
Alzheimers Australia (3,747 Twitter followers)
Benevolent Society (2,721)
Care Connect (1,171)
CQ University (459)
Curtin University (10,782)
Mental Health Association (4,170)
Mind Australia (863)
Mission Australia (10,898)
Red Cross (11,894)
Schizophrenia Research Institute (1,201)
Schizophrenia Foundation of NSW (881)
Queensland Alliance of Mental Health (2,030)
Royal Flying Doctors Service (3,417)
Rural Mental Health (5,003)
St Vincent De Paul (2,583)
Salvation Army (9,045)
Uniting Care (2,946)
University of Western Sydney (4380)
YWCA QLD (846)
Stakeholder Twitter engagement potential: 88,619
Strategic Networking using Twitter
While the PIR roll‐out model may vary across regions depending on need and context, the common feature of all models will be the engagement of suitably placed and experienced non‐government organisations (PIR organisations) to deliver PIR across Medicare Local geographic regions: these will be the mechanism that helps ‘glue’ together all the supports and services the individual requires. PIR organisations will work at a systems level to drive collaboration, bringing together senior representatives from agencies with key responsibilities for the PIR target group. They will direct the strategies needed to achieve better coordinated services to improve overall outcomes for individuals referred to and accepted into the program.3
The Partners in Recovery model promotes collective ownership and encourages innovative solutions to ensure effective and timely access to the services and supports required by people with severe and persistent mental illness to sustain optimal health and wellbeing.1
Social media, in particular Twitter, has the potential to tap into existing networks at the local level while delivering innovative mental health solutions for people with severe and persistent mental illness. Daily, there are thousands of tweets from mental health organisations, drug and alcohol services, public housing, mental health advocacy groups, community and carers groups and health care stakeholders who are consistently sharing relevant, evidence-based mental health information. Many of these tweets are drilling down to the coalface, disseminating community service, and crisis-care information that can, in turn, be picked up by local networks and shared with mental health consumers on the ground.
Having explored the existing Twitter engagement potential of PIR organisations with over 98,000 active social media users, the question e-GPS would like to ask is: Why wouldn’t PIR consider engaging Twitter to maximize the accessibility and uptake of this invaluable program?
Wondering how best to utilise social media to assist with the roll-out of the Partners in Recovery program? e-GPS can help.
Contact us or find us on Twitter @eGPSolutions
1. Department of Health and Ageing: Partners in Recovery Information Paper 1, July 2012.
2. PIR Initiative website
3. Partners in Recovery Case Study Systems Perspective, July 2012.
4. Department of Health and Ageing Website – Partners in Recovery Stage 1
Image source: Blog: Nathan Coates Journalist