The spotlight on mental health in recent years has been a great gratification to mental health professionals. Increased attention to issues that affect more people than cancer or heart disease should not be a surprise, but, after so many years of sustained neglect, those working in this arena or affected by mental illness could be forgiven for thinking it might be the norm. Increased awareness of depression and anxiety, led by organisations such as Beyond Blue and Headspace, have made it easier for thousands of people to seek mental health care.
Yet it is important that in our rush to normalise these conditions we do not forget their identity as illnesses. And that, like many illnesses, there are those that are easier and less easy to treat. While nearly 50 per cent of us may experience a mental illness in our lifetime, the great majority of these illnesses will be short-lived and successfully treated. However, we need to make sure we don’t forget about those who are not in this category.
Hospitals remain choked with the comparatively small number of people with severe or enduring mental illness. These illnesses make managing a normal life extremely difficult, often because they are combined with serious physical health conditions. These comorbid conditions are not unusual or coincidental, yet their cause is rarely discussed. As doctors, it may be a sense of shame that prevents us from highlighting that medication for serious psychiatric conditions can cause other life-threatening conditions such as diabetes or renal failure. We wish we had better medication options, but for many with schizophrenia or intractable depression these medications are an immediate saviour, and it is imperative to win the battle at hand.
Psychiatrists throughout Australia would like to see improved access to better medication. Pharmacological treatments for many conditions have been largely unchanged since the 1960s. And it seems a great irony that as a society we try to prevent diabetes in one group of people while potentially creating it in another.
For many years we have accepted the shortened life expectancy of people with serious mental illness. The 30 per cent reduction of life expectancy of people with schizophrenia in Australia, as well as other parts of the world, is on par with the tragic life expectancy of Australia’s indigenous people.
The situation for indigenous people with serious mental illness is even worse.
People with severe and enduring mental illness are represented in all our most disadvantaged groups — often homeless, imprisoned or unemployed. They are male and female, young and old.
The episodic nature of even severe mental illness is not well understood. While the illness may flare up episodically, care generally needs to be constant. This requirement for regular medication, check-ups, blood tests and ongoing therapy can make it even harder to manage on a very small income, especially with the necessity for co-payments for appointments, pathology and medication.
For this reason we are very concerned about the impact of the government’s proposed alterations to the disability support pension that exclude people suffering an episodic illness from being classified as disabled and receiving badly needed support.
Psychiatry training aims to instil several different areas of expertise and responsibility in every specialist doctor. These include caring for patients, managing complex medical conditions, providing clinical leadership, teaching and training other psychiatrists and advocating for our patients.
Traditionally we have focused on advocating on a patient-by-patient basis, but increasingly our members are encouraging proactive advocacy addressing the systemic obstacles between our patients and their health and happiness.
Being a psychiatrist is a privilege — an opportunity to help people at their most vulnerable. With modern medicine and appropriate healthcare, we can help people with severe and enduring mental illness to get and stay well.
Murray Patton is president of the Royal Australian and New Zealand College of Psychiatrists.
This article first appeared on ‘The Australian’ on 7 October 2014.