The study, led by researchers from the NICM Health Research Institute at Western Sydney University, found that deficiencies, particularly in folate (vitamin B) and vitamin D, were “significantly” more likely among those experiencing early psychosis.

Nutrients support our mental and physical health. Photo: Stocksy

The same deficiencies (along with, to a lesser extent, vitamins C and E) have previously been linked with long-term schizophrenia and depression.

“There’s more evidence arising that nutrition and particularly poor nutrition may be impacting on people’s mental health and conditions like depression and low mood,” said lead author, postdoctoral research fellow Joseph Firth.

For the first time, through a metaanalysis of 2612 individuals, they found that many of those experiencing psychotic episodes (which may be a one-off instance or may develop into schizophrenia, which is the longer-term condition) are dangerously deficient.

National MP Llew O’Brien has been campaigning for more scrutiny of the insurers’ claims processes, particularly relating to mental health issues. Andrew Taylor

Renegade Nationals MP Llew O’Brien has been assured by Treasurer Scott Morrison that the government’s royal commission will examine mental health insurance claims despite the terms of reference not specifically mentioning it.

Mr O’Brien, who played a critical role in setting up the royal commission by throwing his weight behind the push for commission of inquiry into the financial services sector, said it would look at cases relating to “discriminatory practices involving insurance cover, including both denial of cover and denial of claims.”

A spokeswoman for Mr O’Brien told the AFR Weekend the member for Wide Bay, Queensland had “been assured by the Treasurer that mental health matters can be considered under the [royal commission’s] terms of reference.”

On Monday Mr O’Brien thrust the treatment of mental health by life insurers into the spotlight, saying he would cross the floor to provide the numbers needed for a private member’s bill for the commission of inquiry if its terms of reference were widened to include discrimination by insurance companies and other financial service providers.

(Joe Houghton)

And all of us will go through periods of stress, sadness, grief and conflict.

We’re better able to navigate these periods when we are able to access the right support, medication or services. Sometimes the right treatment is lifesaving.

There are a range of people who can help with mental health issues. But it can be hard to know who is best to turn to, as practitioners vary widely in their training, experience, and expertise.

Some are trained to offer support for psychological issues, like grief and stress, others specialise in more serious mental illnesses such as depression, bipolar disorder or schizophrenia.

So where do you begin when you’re looking for a mental health professional?

Your GP

If you’re feeling stressed, anxious, depressed, or having difficulty coping, your GP can be a good first port of call.

Figures suggest Australians see their GPs for mental health issues more than any other health concern.

“It is not musculoskeletal problems patients are presenting with most often, or cardiovascular disease — the stock standard medical presentations we always hear about,” Dr Bastian Seidel, the president of the Royal Australian College of General Practitioners, said.

“It is psychological issues GPs are dealing with most of the time.”

All GPs have mental health training, and for most of us they are the health professional we know best and the one we see most often.

If you know you’re going to see your GP about a mental health issue, it can help to plan ahead and book a double appointment. It will give you a bit more time to talk about what’s going on, and what might be the best treatment options for you.

Depending on your situation they may refer you to a psychologist, psychiatrist, counsellor, or other mental health practitioner. They may also put you on a GP Mental Health Treatment Plan, which gives you access to subsidised care.

If your GP doesn’t refer you to a mental health professional, you can go directly to a psychologist or counsellor yourself.

Psychiatrists are medical doctors who specialise in diagnosing and treating mental illness.

They tend to treat complex and serious mental illness, and have a deep understanding of physical and mental health, and how they affect each other.

“Psychiatrists have a broad knowledge of biological factors as well as psychological and psychiatric issues,” says Dr Gordon Parker, professor of psychiatry at the University of New South Wales and founder of the Black Dog Institute.

Psychiatrists are the only mental health practitioners able to prescribe medication, which they commonly do (if appropriate) alongside their use of psychological treatment (also known as psychotherapy), and brain stimulation therapies.

“If somebody walks in with a biological problem — they’ve got schizophrenia or bipolar disorder — a broad-based psychiatrist is likely to prioritise medication as part of their treatment.

“But if somebody walked in with an existential midlife crisis, a psychiatrist wouldn’t prescribe a medication, but would counsel, and give psychotherapy advice,” Professor Parker says.

Psychiatrists work in public and private hospitals, community mental health services and private consulting rooms. You’ll need a referral from your GP or another medical doctor to see a psychiatrist.

What’s their training? In total, at least 11 years.

Psychiatrists train as doctors: they spend four to six years at medical school, followed by a one-year internship at a hospital, then a speciality training registrar program. Then it’s post-graduate psychiatry training: they work as registrars in hospitals and clinics for another five years under supervision of the Royal Australian and New Zealand College of Psychiatrists (RANZCP).

Are they regulated? All psychiatrists must be accredited by RANZCP before they can practise, and be registered with the Australian Health Practitioner Regulation Agency.

How much do they cost? Costs vary. If you see psychiatrist in a public hospital or community health service, you generally don’t pay. If you see a psychiatrist privately, there will likely be an out-of-pocket cost. Medicare rebates may be available — see details below.

Psychologists

Psychologists are experts in human behaviour. They use scientific methods to study the factors that influence the way we think, feel, learn and behave.

Psychologists work in a variety of settings with a vast range of people: they deal with everything from depression, anxiety and eating disorders to relationship problems and personal growth.

That’s because psychologists don’t just provide counselling and therapy to people with diagnosed mental disorders; they also work with mentally healthy people to help them function better.

They can provide guidance and support, give perspective, and teach coping strategies to people experiencing things like significant change, stress, illness, grief, learning difficulties, behavioural problems, substance abuse, relationship breakdowns, and so on.

Psychologists use different types of psychological treatment (or talking therapies) to help people explore and challenge their behaviour and thought processes.

“Cognitive behavioural therapy is central to that, because over the last two decades or so, it has been the most evidenced-based treatment for a wide range of mental health problems,” says Alice Shires, director of the Psychology Clinic at the University of Technology Sydney.

When it comes to dealing with more acute mental health concerns, clinical psychologists (and other specialised psychologists) are best placed to assist: they have additional training in assessing and treating severe mental illness.

Under the Australian Psychology Society’s (APS) Code of Ethics, psychologists must provide services only in their areas of competence.

Because it’s unlikely any psychologist will have expertise in all areas of mental health, it’s important when approaching a psychologist to check that they work in the area in which you need assistance.

The APS’s Find a Psychologist service is a good place to start.

What’s their training? At a minimum, psychologists complete a four-year degree, followed by two years of supervised postgraduate training — although many hold masters or doctoral degrees. Some psychologists have an endorsed area of practice, meaning they have completed additional training and supervised practice in that particular area (e.g. clinical psychology, neuropsychology, forensic psychology).

Are they regulated? To use the professional title ‘psychologist’, practitioners must meet the requirements of the Psychology Board of Australia, and be registered with the Australian Health Practitioner Regulation Agency.

How much do they cost? The APS recommends fees of $133 for up to half an hour or $241 for up to an hour, although it’s up to the individual practitioner. If you have been referred, Medicare rebates may be available — see details below.

Counsellors

Counsellors use talk-based therapy to help people to develop self-understanding and make changes in their lives.

A counsellor will allow you to talk through your personal concerns, gain perspective, develop coping strategies, and increase self-awareness.

Counsellors can also take on a case-management role.

“This means they look at a whole support plan — including talking to other services, making referrals for support around housing or support around something else,” Jayne Ferguson, counsellor and senior clinician at Relationships Australia Victoria, said.

Unlike psychiatry and psychology, counselling as a profession is not formally regulated. This means anyone can call themselves a counsellor — whether they’ve done a short online course that teaches the basics, or six years of university training.

“While a high percentage of counsellors would have some formalised education and training in counselling, a significant percentage do not,” Professor Parker says.

But counsellors can still play a really important and very valuable role — especially those who have many years of experience in talk therapy.

“Everybody has a different personality, everybody has a different style, so it’s about finding someone who you feel comfortable with,” Ms Ferguson said.

If you’re looking for a counsellor check out the Australian Counselling Association (ACA) or the Psychotherapists and Counsellors Federation of Australia (PACFA).

What’s their training? In Australia, there is no mandated minimum training or qualification framework for counsellors. However, both ACA and PACFA have a national voluntary register of counsellors who meet minimum training and ethical standards.

How much do they cost? According to PACFA, the cost of one session can range from $60 to $150, though some practitioners charge outside this range. You may also be able to negotiate a fee based on your capacity to pay. Medicare rebates are not available for counselling.

What is a life coach?

• A life coach is employed to help people attain their goals in life.
• They might help you to get motivated, set goals, and hold you to account.
• Life coaching is not regulated, so anyone can call themselves a life or personal coach.

Medicare rebates

If you’ve been diagnosed with a mental health issue, you’re entitled to subsidised mental health care through the Better Access to Mental Health Care scheme.

Under the scheme, Medicare rebates are available for up to 10 individual and 10 group sessions per calendar year with a psychologist, occupational therapist or social worker.

To be eligible, you must visit your GP who will assess whether a GP Mental Health Treatment Plan is appropriate, or refer you to a psychiatrist who may prepare a psychiatrist assessment and management plan. Psychiatrists and paediatricians are also able to directly refer patients for Medicare rebate-able mental health services.

If you live in a remote area and find it hard to see a psychologist near you, seven (out of a possible 10) sessions can be done via video conferencing, although one of the first four sessions must be face-to-face.

For more information, check out the Better Access fact sheet for patients.

If you or someone you know needs help, support is available from Lifeline on 13 11 14.

 This piece by Olivia Willis was first seen on ‘ABC News’ 4 November 2017.

The term psychologists use for negative problem sharing is “co-rumination”. Co-rumination is the mutual encouragement to discuss problems excessively, repeatedly going over the same problems, anticipating future problems and focusing on negative feelings. It is more about dwelling on problems than solving them.

Research shows that co-rumination is a double-edged sword. In a study involving children aged seven to 15 years of age, researchers found that co-rumination in both boys and girls is associated with “high-quality” and close friendships. However, in girls, it was also associated with anxiety and depression (the same association was not found with the boys).

And studies suggest that co-rumination isn’t just a problem for girls. Co-rumination with work colleagues can increase the risk of stress and burn out, one study suggests. Maybe it’s not always helpful to have a good moan with a colleague.

How you co-ruminate matters too. In a group of adults, the effects of co-rumination was compared between face-to-face contact, telephone contact, texting and social media. The positive effects of co-rumination (closer friendships) was found in face-to-face contact, telephone contact and texting, but not in social media. The negative aspects of co-rumination (anxiety) was found in face-to-face communication and telephone contact, but not texting or social media.

Verbal forms of communication seem to enhance both the positive and negative aspects of co-rumination more than non-verbal communication.

Warning: this could cause stress and burn out. gpointstudio/Shutterstock

Why we co-ruminate

If we look at the theory behind why individuals ruminate, it may shed some light on why friends co-ruminate. According to a leading theory on rumination, people believe that it will help them find answers and make them feel better. So if two people believe rumination is beneficial, then working together to co-ruminate to find answers may seem like a useful thing to do, as two heads may appear better than one. But focusing on problems and negative emotion together can increase negative beliefs and moods – and result in a greater need to co-ruminate.

Traditionally, therapy has not prioritised tackling rumination or co-rumination directly as maintaining factors in psychological distress. Instead, approaches such as cognitive behavioural therapy (CBT) have aimed to challenge only the content of rumination. Humanistic approaches (such as counselling) have provided conditions to potentially ruminate on the content of problems. And psychodynamic approaches (such as psychoanalysis) have aimed to analyse the content of rumination.

Focusing on the content of rumination, as all three approaches do, runs the risk of fostering co-rumination between client and therapist. If this occurs in therapy, a strong therapeutic relationship may well be a positive outcome of co-rumination – regardless of whether the client’s symptoms improve or not.

More modern treatments, such as meta-cognitive therapy, developed by Adrian Wells at the University of Manchester, specifically target beliefs about rumination. It is designed to help people understand the negative effects of rumination, its ineffectiveness as a coping strategy and as something people have control over. Results indicate the superior effectiveness of this approach in tackling anxiety and depression compared with CBT.

And, on the social side, discussing problems with friends doesn’t always have to lead to worsening mental health, as long as the discussion involves finding solutions and the person with the problem acts on those solutions. Then, relationships can be positive and beneficial to both parties, and a problem shared can really be a problem halved.

This piece was first seen on ‘The Conversation’ 28 November 2017.

Alcohol-fueled parties might be seen as a rite of passage for many high school students, but they have an unexpected impact: binge-drinking behavior as teenagers can lead to problems with alcohol and other drug dependence later on in life.

That’s according to researchers from the University of Adelaide, who are making advances in an emerging field of research highlighting the importance of the brain’s immune system in our desire to drink alcohol.

The Adelaide researchers have made a discovery that may eventually help to switch off binge-drinking behavior in adults who used to binge during their adolescent years.

This research has been published in the journal Neuropharmacology.

“Adolescence is a vulnerable time during the brain’s development – and that’s something most teenagers won’t be thinking about when they indulge in binge drinking,” says lead author Jon Jacobsen, PhD student in the University of Adelaide’s Discipline of Pharmacology.

“During our teen years, the brain is still in a relatively immature state. Binge drinking worsens this situation, as alcohol undermines the normal developmental processes that affect how our brain matures.

“Therefore, when an adolescent who has been binge drinking becomes an adult, they’re often left with an immature brain, which assists in the development of alcohol dependence,” Mr Jacobsen says.

In their laboratory studies, researchers observed that adolescent mice involved in binge drinking behavior developed an increased sensitivity to alcohol as adults and engaged in further binge drinking.

“Even a small amount of alcohol during adolescence can alter the way mice respond to alcohol later on in life, suggesting any amount of alcohol is potentially detrimental to normal brain development,” Mr Jacobsen says.

The researchers were able to prevent some of these detrimental behaviors observed in adulthood, by giving mice a drug that blocks a specific response from the immune system in the brain.

The drug is (+)-Naltrexone, which is known to block the immune receptor Toll-like receptor 4 (TLR4).

“This drug effectively switched off the impulse in mice to binge drink,” says senior author Professor Mark Hutchinson, Director of the ARC Centre of Excellence for Nanoscale BioPhotonics at the University of Adelaide and leader of the Neuroimmunopharmacology lab in which this work was conducted.

“The mice given this drug still sought out alcohol, but their level of drinking was greatly reduced.”

Professor Hutchinson says this research is among the first of its kind to show a link between the brain’s immune system and later-life problems caused by binge drinking during adolescence.

“We’re excited by the finding that we can potentially block binge drinking in an adult after they have experienced such behavior during adolescence, by stopping the activation of the brain’s immune system. It’s the first time this has been shown, and gives us hope that our work has implications for the eventual treatment of alcohol addiction in adults,” Professor Hutchinson says.

###

This research has been funded by the Australian Research Council (ARC), the US National Institute on Drug Abuse (NIDA) and the National Institute of Alcohol Abuse and Alcoholism.

This piece was first seen on EurekAlert!

Public Release: 2-Nov-2017.

Why do they do it? This is a question that friends and families often ask of those who are addicted.

It’s difficult to explain how drug addiction develops over time. To many, it looks like the constant search for pleasure. But the pleasure derived from opioids like heroin or stimulants like cocaine declines with repeated use. What’s more, some addictive drugs, like nicotine, fail to produce any noticeable euphoria in regular users.

So what does explain the persistence of addiction? As an addiction researcher for the past 15 years, I look to the brain to understand how recreational use becomes compulsive, prompting people like you and me to make bad choices.

Myths about addiction

There are two popular explanations for addiction, neither of which holds up to scrutiny.

The first is that compulsive drug taking is a bad habit – one that addicts just need to “kick.”

However, to the brain, a habit is nothing more than our ability to carry out repetitive tasks – like tying our shoelaces or brushing our teeth – more and more efficiently. People don’t typically get caught up in an endless and compulsive cycle of shoelace tying.

Another theory claims that overcoming withdrawal is too tough for many addicts. Withdrawal, the highly unpleasant feeling that occurs when the drug leaves your body, can include sweats, chills, anxiety and heart palpitations. For certain drugs, such as alcohol, withdrawal comes with a risk of death if not properly managed.

The painful symptoms of withdrawal are frequently cited as the reason addiction seems inescapable. However, even for heroin, withdrawal symptoms mostly subside after about two weeks. Plus, many addictive drugs produce varying and sometimes only mild withdrawal symptoms.

This is not to say that pleasure, habits or withdrawal are not involved in addiction. But we must ask whether they are necessary components of addiction – or whether addiction would persist even in their absence.

Pleasure versus desire

In the 1980s, researchers made a surprising discovery. Food, sex and drugs all appeared to cause dopamine to be released in certain areas of the brain, such as the nucleus accumbens.

This suggested to many in the scientific community that these areas were the brain’s pleasure centers and that dopamine was our own internal pleasure neurotransmitter. However, this idea has since been debunked. The brain does have pleasure centers, but they are not modulated by dopamine.

So what’s going on? It turns out that, in the brain, “liking” something and “wanting” something are two separate psychological experiences. “Liking” refers to the spontaneous delight one might experience eating a chocolate chip cookie. “Wanting” is our grumbling desire when we eye the plate of cookies in the center of the table during a meeting.

Dopamine is responsible for “wanting” – not for “liking.” For example, in one study, researchers observed rats that could not produce dopamine in their brains. These rats lost the urge to eat but still had pleasurable facial reactions when food was placed in their mouths.

Rat receiving optogenetic stimulation of the brain using laser light to produce focused and compulsive reward-seeking. Mike Robinson, Author provided (No reuse)

All drugs of abuse trigger a surge of dopamine – a rush of “wanting” – in the brain. This makes us crave more drugs. With repeated drug use, the “wanting” grows, while our “liking” of the drug appears to stagnate or even decrease, a phenomenon known as tolerance.

In my own research, we looked at a small subregion of the amygdala, an almond-shaped brain structure best known for its role in fear and emotion. We found that activating this area makes rats more likely to show addictive-like behaviors: narrowing their focus, rapidly escalating their cocaine intake and even compulsively nibbling at a cocaine port. This subregion may be involved in excessive “wanting,” in humans, too, influencing us to make risky choices.

Involuntary addicts

The recent opioid epidemic has produced what we might call “involuntary” addicts. Opioids – such as oxycodone, percocet, vicodin or fentanyl – are very effective at managing otherwise intractable pain. Yet they also produce surges in dopamine release.

Most individuals begin taking prescription opioids not for pleasure but rather from a need to manage their pain, often on the recommendation of a doctor. Any pleasure they may experience is rooted in the relief from pain.

However, over time, users tend to develop a tolerance. The drug becomes less and less effective, and they need larger doses of the drug to control pain. This exposes people to large surges of dopamine in the brain. As the pain subsides, they find themselves inexplicably hooked on a drug and compelled to take more.

The result of this regular intake of large amounts of drug is a hyperreactive “wanting” system. A sensitized “wanting” system triggers intense bouts of craving whenever in the presence of the drug or exposed to drug cues. These cues can include drug paraphernalia, negative emotions such as stress or even specific people and places. Drug cues are one of an addict’s biggest challenges.

These changes in the brain can be long-lasting, if not permanent. Some individuals seem to be more likely to undergo these changes. Research suggests that genetic factors may predispose certain individuals, which explains why a family history of addiction leads to increased risk. Early life stressors, such as childhood adversity or physical abuse, also seem to put people at more risk.

Addiction and choice

Many of us regularly indulge in drugs of abuse, such as alcohol or nicotine. We may even occasionally overindulge. But, in most cases, this doesn’t qualify as addiction. This is, in part, because we manage to regain balance and choose alternative rewards like spending time with family or enjoyable drug-free hobbies.

However, for those susceptible to excessive “wanting,” it may be difficult to maintain that balance. Once researchers figure out what makes an individual susceptible to developing a hyperreactive “wanting” system, we can help doctors better manage the risk of exposing a patient to drugs with such potent addictive potential.

In the meantime, many of us should reframe how we think about addiction. Our lack of understanding of what predicts the risk of addiction means that it could just as easily have affected you or me. In many cases, the individual suffering from addiction doesn’t lack the willpower to quit drugs. They know and see the pain and suffering that it creates around them. Addiction simply creates a craving that’s often stronger than any one person could overcome alone.

That’s why people battling addiction deserve our support and compassion, rather than the distrust and exclusion that our society too often provides.

This piece by Mike Robinson was first seen on Genetic Literacy Project 30 November 2017.

Mike Robinson is an assistant professor of psychology at Wesleyan University. His research focuses on conditions and brain structures that exacerbate reward and the motivational value attributed to a cue, particularly in the context of addiction, craving and relapse. He also focuses on how excessive desire may impact risky decision-making.

A version of this article was originally published on the Conversation’s website as “The real reason some people become addicted to drugs” and has been republished here with permission.

A screening program at the Royal Women’s Hospital in Randwick flagged Emily as being at high risk of developing perinatal depression and anxiety when she was in the early stages of her second pregnancy.

New guidelines recommend screening all pregnant women for perinatal depression. Photo: Christopher Pearce

The Sydney professional had a history of mental health conditions, her pregnancy was unplanned and her mother had experienced severe postnatal depression and psychosis.

Emily also carried a foreboding memory of her husband coming home one afternoon when their daughter was six months old. He said he wanted to kill himself, that he had not been going to work and instead had gambled away their baby bonus.

“I took that trauma into my second pregnancy.” 

Emily’s experience is not uncommon. One in five women during perinatal period (the weeks before and after the birth of their baby) will experience mental health problems.

Now, new national perinatal guidelines recommend every woman be screened for mental health issues during pregnancy and after their baby is born as part of routine maternity and postnatal care.

A growing body of research has exposed the critical effects of maternal depression, anxiety and other mental illnesses on both the mother and baby.

Most cases cases of perinatal mental health conditions go undetected, with fewer than 20 per cent coming to the attention of health care practitioners. Even fewer will get treatment, according to research that underpinned the guidelines.

The perinatal mental health service at the Royal Women’s Hospital rallied around Emily.

She had regular sessions with a psychologist who visited her at home once her son was born. The service continually monitored her emotional as well as physical maternity care, and helped manage her anxiety medication.

“For me it was a huge relief,” Emily said. “Because things did deteriorate.”

Emily’s husband had started gambling again. He lost his job and her close friend died suddenly when she was about 36 weeks.

She was sleep deprived and struggling to pierce through intrusive thoughts that fixated on her husband’s gambling, her first traumatic birth and anxieties about leaving work and financial instability.

“Once things got really bad I felt like I was just holding onto reality,” Emily said.

“The fact that I had so much support probably saved my life. I’d never before had that continuity of care.”

“That I was picked up early made all the difference … that level of care should be available to all pregnant women, wherever they go,” she said.

The perinatal guidelines commissioned by the federal government include a standard questionnaire to help doctors, nurses and midwives better gauge a woman’s symptoms and risk in the early stages of her pregnancy to identify those likely to develop mental health problems and intervene early.

The guidelines also stress the importance of assessing a woman’s psychosocial risk factors.

“It’s about screening for symptoms but also considering the context of a woman,” the chairwoman of the guideline’s expert working group and St John of God chairwoman of Perinatal and Women’s Mental Health Research Unit at UNSW Professor Marie-Paule Austin said

“If there are aspects of her life that make her more likely to develop these problems,” said the psychiatrist, who developed the risk factor questionnaire at the Royal Hospital for Women.

By embedding mental health screening as a routine part of maternity care, the authors hoped to cut through the entrenched stigma that often prevents pregnant women from seeking help.

“We are validating their right to talk about these things … our surveys found a huge proportion of women are really glad they are asked these questions,” Professor Austin said.

The guidelines went beyond the prevailing focus on depression and anxiety, the most common disorders among women during and after pregnancy.

But a smaller group will develop more severe psychiatric conditions, including postpartum psychosis, and an estimated 5 per cent of women of child bearing age have borderline personality disorder.

“These women can experience intense and severe fluctuations in mood, self-loathing, even self-harm and feel a great sense of alienation,” Professor Austin said.

“It’s hugely challenging to take on the parenting role.”

The guidelines were also designed to debunk ill-informed clinical advice, notably the pervading belief that women should come off medications for psychiatric conditions when they become pregnant.

“Often clinicians will tell women to stop taking their medications, predominantly antidepressants … and it’s not uncommon for them to relapse,” Professor Austin said.

But antidepressants are not associated with birth defects and there was a lack of robust research linking them to child’s emotional and behavioural outcomes.

The desire to stop taking medications must be weighed against the negative effects of mental ill-health in pregnancy, Professor Austin said.

The guidelines also consider role of a woman’s partner as support person, potential antagonist, as well as the effects of the pregnancy on their mental health.

Initially screening a woman without her partner present gives her the privacy to talk freely, before the partner is invited to join the consultation, with her consent.

From November, all women have access to free depression screening and psychosocial assessment through Medicare.

The move, in step with the guidelines was the “final piece of the jigsaw,” Professor Austin said.

PANDA Helpline: 1300 726 306

* Not her real name. 

This piece was first seen on ‘The Sydney Morning Herald’ November 12 2017.

The same is true of health and other government systems. The present Victorian Government in late 2016 acknowledged that Victoria’s mental health system had reached the point of a breakdown. A breakdown is costly and it takes time to recover, but also represents a chance to create a better future.

Twenty years ago Victoria was the envy of Australia and the world, with an innovative new mental health system that had swept away the 19th century asylums, built new inpatient units in acute hospitals, had begun to build a dynamic community mental health system and pioneered early intervention for psychotic illness. With the promise of further growth and investment the future for Victorians with mental illness and their families looked genuinely hopeful. This promise was broken. Toxic complacency and neglect set in, with a slow dismantling of the assertive community mental health system and a corresponding retreat into emergency departments. This dismantling, combined with major population growth – more than half a million people since 2011 – has created a perfect storm. Increasing numbers of people with mental illness are consigned to the streets, to prison or the morgue at immeasurable human and financial cost.

Victoria has slipped from the highest funder per capita for mental health in Australia to the lowest. Compared to the national average, Victoria covers half as many people, a mere 1 per cent of the Victorian population, for their mental illness needs, with greatly reduced community mental health care and fewer beds. The target should be 3 per cent, reflecting the proportion of the population who experience serious mental illness every year and who should expect access. Victoria’s mental health system is turning away around two-thirds of those who need expert care.

Many Victorians are unable to access the community mental health care they need and deserve. (Source: Sydney Morning Herald)

In our own service, Orygen, which is meant to cover more than one million people in Melbourne’s west, three out of four young people with serious mental illness are turned away each year because we don’t have the people, money or facilities to support them. Access to care is only possible in desperate circumstances, typically via emergency departments, often involving police and/or ambulance, and even then this is limited to crude risk management and of short duration. Access typically requires violent or suicidal behaviour rather than preventing it. Inevitably preventable deaths and incarceration rates have increased substantially.

Public mental health staff have been forced into survival mode. Unable to deliver expert care they are increasingly demoralised as they witness the weekly death toll, and are unfairly blamed by the media and relatives for something that is largely beyond their control. High-quality clinical expertise, public or private, is increasingly hard to find in our prosperous society. If this were happening in any other area of health care, e.g. cancer or heart disease, there would be a public scandal, and it would be immediately addressed.

In the wake of the “Targeting Zero” report on hospital safety by Stephen Duckett in 2016, the current Victorian government has found the courage to openly acknowledge that the system has broken down, and the consequent threats to the health and safety of the Victorian public. The only question now is, will the Victorian government invest promptly, decisively and strongly enough in a fully redesigned system scaled up to respond to the unmet need?

We can no longer accept the confetti and band-aids of the past 20 years. This is well beyond “awareness” and “conversations”, which, in giving the impression that the issue is being addressed, are now a distraction, even a barrier, rather than an enabler. What we need is a radical redesign, as well as major and rapid investment, to turn around 20 years of decline.

Too many Victorians are currently being let down by our fraying mental health system, unable to access the assertive and responsive community mental health care they need and deserve. Their untreated conditions are currently escalating in severity and impact until they present to an emergency department at a point of crisis. This situation must be addressed.

Professor Patrick McGorry is the Executive Director of Orygen, The National Centre of Excellence in Youth Mental Health; and Professor of Youth Mental Health at The University of Melbourne. This is an extract from the Redmond Barry lecture he will give tonight at the State Library of Victoria.

This piece was first seen on ‘The Sydney Morning Herald’ 29 November 2017.

You might imagine that the way our parents behave towards each other and how they behave towards us ought to be a major factor in how we develop as teenagers. After all, our parents are the most important people in our lives. We see them at close range more than we see anybody else. They are the people who made us, who care for us most, who act as primary role models for us, who spend most time with us, and who we want most to love us.

So it makes sense that if they treat each other well and show us – their children – love and safe boundaries, then the odds are that most of us will turn out fine. If they fall short on any of these areas – they show contempt for one another, they fight or blank each other, they can’t make their relationship work so they split up, or they can’t show us the love and safe boundaries we need – then it makes sense that the odds start building up against us.

How we see the world is bound to be framed first and foremost by what we experience at home.

And yet the prevailing view in government circles is that whether the parents are married or not, or stay together or not, isn’t important. What’s most important, apparently, is whether they fight.

Parental conflict is certainly unpleasant and well known to have unpleasant consequences for children. Yet our previous research has shown that only 2 per cent of parents quarrel a lot and only 9 per cent of parents who divorce quarreled a lot before they split up. These numbers alone suggest that parental conflict is an insufficient explanation for the prevalence of teenage problems. In any case, children are often better off out of a high conflict relationship.

Is parental conflict really it?

I and my colleague Professor Steve McKay at the University of Lincoln released a new paper  this month that blows this narrow view out of the water.

We wanted to investigate the influence of family background and upbringing on teenage mental health. To do this, we used the rich data source of the Millennium Cohort Study that surveyed some 12,000 mothers soon after their children were born, most of whom in the years 2000 and 2001, again several times thereafter, and most recently when their children reached age 14.

In our analysis, we concentrated on the first and last of these surveys, looking firstly at whether the mothers were married or cohabiting when their child was born, how happy they said they were in their relationship with their husband or partner, their age, education and ethnicity. Then we jumped forward fourteen years, looking at whether the parents had stayed together as a couple or not and at how well their children were faring in terms of mental health.

To measure mental health, the parents were asked twenty five questions in a ‘Strengths and Difficulties Questionnaire’. These questions cover potential problems with emotional well-being, hyperactivity, conduct and peer relationships. Each of these has a threshold score that is considered to represent a high or very high level of problems.

So what did we find?

Our first finding is that mental health problems among teens are even more prevalent that is currently reported. Altogether 27 per cent of both boys and girls are deemed by their parents to have a high or very high level of problems in any of these areas. That’s higher than is usually reported because other researchers look at a total difficulties score. The Office for National Statistics, for example, says that 12 per cent of children have mental health problems on this basis. But when 16 per cent of girls have emotional problems and 16 per cent of boys have peer problems, as we found, this would seem to understate the problem. It does.

Second, girls are more likely to exhibit emotional problems whereas boys are more likely to exhibit behavioral problems. This is not a new finding. But it confirms what many people might naturally suspect. Teenage girls worry about problems. Teenage boys act them out.

Third, marriage and family breakdown do indeed have a big impact on teenage mental health problems. Among intact married families, 20 per cent of 14 year olds exhibit high level of mental health problems, compared to 27 per cent among intact cohabiting families. Among divorced families, 32 per cent exhibit problems, compared to 38 per cent among separated cohabiting families. So there’s a difference between married and cohabiting parents whether or not they stay together. But the bigger gap depends on whether they stay together. Even after taking mothers’ marital status, happiness and background into account, not having a father in the house remains the number one predictor of teenage problems.

Fourth, our finding that having parents who were married when the children were born means fewer problems when they became teenagers – even among parents who stay together – is a completely new finding. Previous research with the same children when they were aged five and seven suggested there were no differences. By age 14, the children appear to notice something different.

Overall, what these findings show is that all aspects of family life influence how the teenage children turn out. Whether parents are married or not, whether they stay together or not, how happy they are in their relationship, these all make a difference that is independent of all the others.

There were a couple of extra findings that added even more colour.

One, it wasn’t the unhappiest parents whose children did worst. it was the parents who were neither unhappy nor happy, especially if they were married. The unhappiest seem to find ways of sorting things out. We’d already found this phenomenon applies to parents who stay together. It’s not the unhappiest who are least stable. But this is an area we will be exploring further.

Two, when we looked further into what the families look like when the children were aged 14, we found that family breakdown seems to play itself out via family income and how close the children are to their parents. Families who split up inevitably become poorer. And this can have a big effect on the children. But parents also become less close to the children. When the parents stay together, family income still plays a big role, but so does the parents’ marital status and – this time – closeness to the opposite parent but not the same sex parent. This also merits further investigation.

All in all, our analysis highlights what most sensible people might expect, that the way parents structure their family plays at least as important part as how they relate to each other.

Britain already has one of the world’s highest levels of family breakdown. Nearly half of our teenagers are not living with both natural parents.

Our study shows beyond doubt that this matters. The next generation of children won’t thank us if our policy-makers and their advisors continue to close their eyes to this reality.

This piece by Harry Benson was first seen on ‘Mercatornet’ 29 November 2017.

Harry Benson is Research Director of the UK-based Marriage Foundation. Republished with permission.

Be aware: Dr Cathy Allen encouraged employers and employees to be aware of the warning signs of a mental health issue in the workplace.

A Wollongong medical practice has been doing its bit to help raise awareness about early warning signs that can lead to a mental health issue.

Ochre Medical Centre held a mental health event last month to help people in the Illawarra community identify eight symptoms that can include memory and concentration changes, appetite loss and poor sleep.

The practice also identified other risks for mental health issues such as diabetes, heart disease and obesity.

On October 25 Ochre Medical Centre and psychologist Nic Sullivan held a free event on Mental Health in the Workplace for employers and employees.

Principal doctor Cathy Allen said it was an important issue because 45 per cent of Australians were expected to experience a mental health issue in their lifetime.

And more than 40 per cent of Australians with a mental health condition also have a chronic physical illness such as diabetes, heart disease, osteoporosis or even arthritis.

Research shows that rates of depression are four times higher among people with chronic pain and 50 per cent of diabetes patients experience depression or anxiety.

Diabetes is one of the country’s biggest health concerns with more than one million Australians diagnosed.

Last year, the suicide rate among young Australians reached a 10 year high, increasing by 32 per cent in just over a decade.

And the suicide rate in rural Australia is around 40 per cent higher than major cities. 

Dr Allen said it is important to be aware of some of the early warning signs of a mental health issue, which can very often be mistaken for something else.

“There are many signs of mental illness that are subtle and can easily go unnoticed,” she said.

“Wollongong residents shouldn’t be afraid to seek help in improving their mental health. Receiving treatment for a mental health issue can greatly improve a person’s overall quality of life, and make a lasting difference to their lifestyle, work and relationships”.

Eight early signs of mental health issues:

1. Memory loss or a short attention span. Changes in cognitive behaviour can be a tell-tale sign of a mental health condition. If someone you know starts to experience frequent memory loss – such as forgetting appointments – this could be a sign of depression. Likewise, if they begin to have difficulty concentrating at work or school, thinking clearly and making decisions, it may be time for them to make an appointment with their local GP who may refer them to a psychologist.
2. Weight gain or loss. Most people are aware that weight loss and a loss in appetite could be one symptom of a mental health issue – but it’s not well known that overeating and a lack of willingness to exercise could also be an early symptom of depression. In many cases, the weight gain itself is caused by depression, not the other way around.
3. Irritability. Sadness is associated with depression and anxiety, but irritability in men can also point to a mental health issue. While everyone can be irritable at times, frequent or easily provoked irritability in men can be a sign of a deeper issue. If you’re noticing a lot of conflict at home especially, it might be time to talk to a mental health professional to see if something else is going on.
4. Fauxcialising (or social withdrawal). If you have a friend that starts to cancel plans with you in favour of staying in (fauxcialising) or they become less willing to participate in social activities, it may indicate that something is up mentally. It’s worth making an extra effort to talk with any of your friends who exhibit this behaviour, as it could be a silent cry for help.
5. Anhedonia. A lack of enjoyment in activities that once gave a person pleasure (anhedonia) is another subtle but common change we see in sufferers. It’s advisable to speak with your doctor if you start noticing these changes, as they can recommend a variety of treatment or lifestyle changes which can make a big difference, like trying yoga or meditation.
6. Conflict in the workplace. Employees who instigate conflict in the workplace can be suffering from an underlying mental health issue. Businesses should work towards providing mental health support to employees, especially with regard to stress.
7. Loss of productivity. The number one cause of reduced productivity at work is mental health, which costs the Australian economy more than $12 billion per year in lost work and has significant impacts on staff morale and organisational performance. There are simple techniques that a local psychologist can explain to you, to help employees cope and boost morale.
8. Insomnia. Difficulty sleeping can also point to wider mental health issues, such as stress, anxiety, schizophrenia, bipolar disorder and depression. It is estimated that 60-90 per cent of patients with depression have insomnia, with the cost of depression and anxiety attributed to sleep disorders thought to be more than $170.8 million.

The top 3 therapies trusted by psychologists to improve mental health:

• Cognitive behaviour therapy. This treatment involves the use of practical self-help strategies, which are designed to teach patients to think in a positive way and reduce negative mood.
• Acceptance commitment therapy. This therapy focuses on applying acceptance and mindfulness skills to uncontrollable experiences in order to increase psychological flexibility.
• Mindfulness. A form of therapy centred on gaining awareness of the present moment through paying attention in a purposeful manner. It can be used to treat a range of mental health issues including depression and anxiety.

This piece by Greg Ellis was first seen on the ‘Illawarra Mercury’ 14 November 2017.