MATTHEW FISHER. Australia’s policy failure on mental health.

Dec 14, 2017

Australia rates highly on international measures of physical health status such as life expectancy at birth, suggesting we are healthier than ever before, but the data on mental health and illness tells a very different story. On measures of mental health and illness we are doing poorly and compare badly to other OECD countries. Despite a large body of evidence on social determinants of metal health and illness, our policy responses are overwhelmingly dominated by individualised responses such as drug treatments, counselling and resilience programs. This unwillingness to recognise major social causes of mental illness is a national policy failure. 

The most common forms of mental illness are anxiety disorders, affective disorders and substance abuse disorders. These conditions affect over three million Australians every year, and contribute substantially to the $60 billion annual cost of mental illness. Mental health problems among adolescents are high and increasing. There is clear and compelling evidence to tell us that the incidence of these common forms of mental illness are strongly influenced by the social and economic conditions in which we live; that being exposed to certain kinds of demanding conditions in life is a contributing cause of these forms of mental illness. What is this evidence? We know that mental illness is more common among those who are lower on the income scale, and this is the case in most countries, and that OECD countries with higher levels of income inequality (including Australia) have higher overall rates of mental illness than more equal countries. Research (summarised here) has also identified a range of specific social factors that increase the risk of mental illness including poverty; debt; unemployment or insecure, low-paid work; low education; housing stress; racism and discrimination; exposure to violence; and child abuse or neglect.

In addition to the public health evidence which demonstrates the impacts of social factors on mental health in populations, we also know how these factors have their effects. In basic terms, when people are faced with certain kinds of demands in life – at work, within a family or other relationships, with money, through social isolation, or exposure to racism, just to name a few – and they cannot find a way to readily control or resolve these problems; this is a recipe for chronic stress. The functioning of the brain-body stress system is very well-understood in science, and we know that chronic (long-term) arousal of this system can lead to changes in the brain and the onset of a mental illness. One basic reason that people at the lower end of the income scale or facing other life challenges have higher rates of mental illness is simply because the conditions they experience are more likely to cause chronic stress.

If we put together what we know about social causes of mental illness with the data on rates of illness in Australia, the conclusion is clear: the everyday social, economic and cultural conditions of our lives – despite claims that we are better off than we have ever been – are causing chronic stress on a huge scale, contributing to some three million of our fellow citizens every year going through the pain and strife of chronic anxiety, depression or some form of substance abuse. The appropriate, preventative social and political response to this conclusion is equally obvious: it is to understand the social causes of mental illness and take action in all spheres of our lives to create social conditions that support wellbeing by avoiding causing chronic stress and enabling people to exercise a sense of control in their lives.

However, this conclusion and the response it implies – although perfectly recognisable in the evidence – are subject to a deafening silence from the politicians, organisations and key individuals who shape Australia’s policy discourse and action on mental health. It is not that we do nothing of course; on the contrary, we do a great deal and spend a lot of money in the process. The issue lies in the fact that what we do about mental health and illness almost entirely consists of activities that define the essential problem and the preferred ‘solution’ in individualised terms. This approach (tacitly or explicitly) says that the problem of mental illness exists in the psychological and behavioural symptoms of this person (and this one, and this one…), and thus the solution lies in using drugs or cognitive behavioural therapy (or what have you) to ‘fix’ this person, or using resilience training (or similar) to equip this person with improved coping skills. Within this formulation one can readily discern that the social causes of mental illness and their impacts on populations, as something we might act on, are largely hidden; they are excluded from the definition of the problem and thus from what then seems the ‘right’ solution.

With this dominant conception in view, it then is no surprise to see that calls for action to address Australia’s huge and growing problems with poor mental health predominantly take the form of proposals for more mental health (i.e. illness) services, or more early intervention services or more resilience programs. The intrinsic limitations of such services and programs is demonstrated most vividly in the fact that – despite all this well-meaning activity – we are making no dent at all in the scale of the problems. Without concomitant action to address social determinants of mental health, the implicit claim from our policy leaders that more individualised services and programs are somehow an adequate response to the problem of mental illness is in effect a grand deception.
Worse, the continuation of this approach acts a barrier to a deeper understanding of wellbeing, and to development of policies to create social and economic conditions that support wellbeing for all.

Matthew Fisher is an artist, political philosopher and public health researcher. He works as a Senior Research Fellow with the Southgate Institute for Health, Society and Equity at Flinders University in Adelaide.

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