tag:theconversation.com,2011:/uk/topics/mental-illness-cost-6125/articlesMental illness cost – The Conversation2018-04-13T10:42:14Ztag:theconversation.com,2011:article/948932018-04-13T10:42:14Z2018-04-13T10:42:14ZMariah Carey says she has bipolar disorder; a psychiatrist explains what that is<figure><img src="https://images.theconversation.com/files/214596/original/file-20180412-584-19xinx1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mariah Carey in Inglewood, Calif. on March 24, 2018. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/2018-Kids-Choice-Awards-Arrivals/a7b54ffb5e92447fabbc5f2b31bc4c8f/4/0">AP Photo/Jordan Strauss</a></span></figcaption></figure><p><a href="https://www.nytimes.com/2018/04/11/style/mariah-carey-bipolar-disorder.html">Mariah Carey</a> recently opened up about her struggle with bipolar disorder.</p>
<p>As an assistant professor of psychiatry, I see her courage as an opportunity to explain <a href="https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml">bipolar disorder</a>, a mood disorder that includes episodes of elevated mood, as well as episodes of depression. </p>
<p>There are two common types: Bipolar I disorder includes <a href="https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml">manic episodes</a> in which a person experiences heightened or, at times, an irritable mood, for at least a week. This includes high energy, inflated self-esteem, reduced need for sleep, talkativeness or pressured speech, overspending, reckless risky behavior, racing thoughts, increased goal-directed behavior and a substantially increased sex drive. Symptoms are a clear departure from person’s baseline behavior. A patient in a manic episode may have all or some of these symptoms, none of which are induced by drug use.</p>
<p>Bipolar II disorder includes <a href="https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml">hypomanic episodes</a>, a mood episode that includes the same symptoms at lower severity for a shorter time (four days at least) and without significant impairment of person’s functioning.</p>
<p>It is important to note the required duration of days to avoid a common mistake: Too often people are labeled with this diagnosis because of emotional instability or changes in mood over the course of hours, as a result of stressful events or other psychiatric conditions. I always make sure patients who believe they have this condition know the definition and substantial sustained nature of the episodes.</p>
<p>Diagnosis is mostly based upon psychiatric interviews and a review of the history of previous episodes or current symptoms, if the patient is experiencing a manic/hypomanic episode at the time of psychiatric examination. Historical data could be based on patient’s report, collateral information from family members, or psychiatric records. A history of a manic or hypomanic episode, not justified by medical conditions or drug use, is enough to make the diagnosis.</p>
<p>It is also important to know that the majority of the episodes of mood change in a person with bipolar disorder are of the depressed nature and not manic/hypomanic. That is, a person with bipolar disorder usually experiences more depressive episodes than manic ones. </p>
<p>Treatment is vital to prevent future manic or depressive episodes and to reduce the severity of those that emerge. A manic episode can ruin a marriage, a bank account, or a job, or it can even lead to legal consequences.</p>
<p>Treatment usually involves mood stabilizer medications that reduce the chance and severity of future episodes. Mood stabilizers often are the same medications that are used for treatment of epilepsy, and some belong to other categories of psychiatric medications. Reduction of stress and close monitoring of mood by the patient, their family and physician can prevent the emergence of a new episode or its exacerbation.</p><img src="https://counter.theconversation.com/content/94893/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arash Javanbakht does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Bipolar disorder is an often misunderstood psychiatric illness. An expert defines it and explains how it is diagnosed and treated.Arash Javanbakht, Assistant Professor of Psychiatry, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/536422016-02-02T19:05:53Z2016-02-02T19:05:53ZAustralians are spending more on mental health services and employers need to take notice<figure><img src="https://images.theconversation.com/files/109951/original/image-20160202-32222-1d55bnm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are definite costs of mental illness in the workplace but the return on investment in a mentally healthy workplace can be a big boost to the bottom line.</span> <span class="attribution"><span class="source">Rob/flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>New data <a href="https://mhsa.aihw.gov.au/resources/expenditure/">released by the Australian Institute of Health and Welfare (AIHW)</a> shows that Australians spent an estimated A$8 billion on mental health related services in 2013-14. The <a href="https://www.headsup.org.au/docs/default-source/resources/beyondblue_workplaceroi_finalreport_may-2014.pdf">direct financial impact on Australian business</a> is in the vicinity of $11 billion every year, largely due to absenteeism ($4.7 billion) and reduced productivity ($6.1 billion) from unwell workers still attempting to work. </p>
<p>All this shows that mental health is more than a social issue. It should also be right at the top when we are thinking about which factors influence productivity and prosperity.</p>
<p>At the launch of the government’s response to the National Mental Health Commission in November last year, Prime Minister Malcolm Turnbull said:</p>
<blockquote>
<p>“ Mental illness gnaws away at participation, it gnaws away at productivity.”</p>
</blockquote>
<p>Federal and State Government spending on mental health services has steadily increased over time although what’s not known is how much employees are spending out of their own pockets.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/109945/original/image-20160202-32231-6lwqq8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/109945/original/image-20160202-32231-6lwqq8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=656&fit=crop&dpr=1 600w, https://images.theconversation.com/files/109945/original/image-20160202-32231-6lwqq8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=656&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/109945/original/image-20160202-32231-6lwqq8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=656&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/109945/original/image-20160202-32231-6lwqq8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=825&fit=crop&dpr=1 754w, https://images.theconversation.com/files/109945/original/image-20160202-32231-6lwqq8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=825&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/109945/original/image-20160202-32231-6lwqq8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=825&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>In recent years, the big implications mental ill-health has on economic productivity and production have become clearer. Of the 3.7 million Australians who have mental health problems in any year, some 3 million have a mild to moderate condition. Many of these are in paid work but they are not there as often as they should be, or contributing as much as they would like when they are there.</p>
<p>A <a href="https://www.headsup.org.au/docs/default-source/resources/beyondblue_workplaceroi_finalreport_may-2014.pdf">2014 report from PricewaterhouseCoopers (PwC)</a> found mental health conditions result in around 12 million days of reduced productivity for business in this country each year. And, given one in six people in employment experience a mental health issue every year, those millions of days are being lost across the economy; in every sector and among organisations of all sizes. This is not just an issue for the big end of town.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/109930/original/image-20160202-32247-c3hzx2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/109930/original/image-20160202-32247-c3hzx2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=347&fit=crop&dpr=1 600w, https://images.theconversation.com/files/109930/original/image-20160202-32247-c3hzx2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=347&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/109930/original/image-20160202-32247-c3hzx2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=347&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/109930/original/image-20160202-32247-c3hzx2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=437&fit=crop&dpr=1 754w, https://images.theconversation.com/files/109930/original/image-20160202-32247-c3hzx2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=437&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/109930/original/image-20160202-32247-c3hzx2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=437&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>A <a href="http://www.oecd.org/els/mental-health-and-work-9789264124523-en.htm">2012 OECD report</a> also sought to quantify the productivity losses caused by mental ill health. It found workers with a mental disorder are absent for work for health reasons more often than other workers (32% versus 19%), and they are away for longer (six days versus 4.8). The report also concluded that 74% of workers with a mental disorder reported reduced productivity while they were at work in the previous four weeks, compared to 26% of workers without a mental disorder. </p>
<p>So what can business do to reduce those losses? Plenty. </p>
<p>A few years ago the National Mental Health Commission joined with the business sector, the mental health sector and the government to form the <a href="http://www.mentalhealthcommission.gov.au/our-work/mentally-healthy-workplace-alliance.aspx">Mentally Healthy Workplace Alliance</a>. It commissioned a study that combed peer-reviewed literature to find what workplaces can do in relation to stress, mental strain, psychological health and wellbeing. That report, <a href="http://www.mentalhealthcommission.gov.au/media/116332/Creating%20Mentally%20Health%20Workplaces%20-%20A%20review%20of%20the%20research.pdf">Creating Mentally Healthy Workplaces</a>, concluded there were six key areas and strategies for business to explore. </p>
<p>Many of the report’s recommendations are common sense measures. Things like smarter work design and positive work cultures, for example, were found to be key to preventing mental health problems. Similarly, promoting resilience and early intervention can help reduce the impact of mental ill health, and promote recovery. </p>
<p>In 2014, the Alliance teamed up with beyondblue to launch Heads Up, a national campaign for mentally healthy workplaces. The response of businesses that have signed up has been encouraging. They report lower turnover rates, less time off due to stress related injuries and find staff are managing their own mental health “up front”.</p>
<p>All of this makes good business sense. In fact, <a href="https://www.headsup.org.au/docs/default-source/resources/beyondblue_workplaceroi_finalreport_may-2014.pdf">the PwC research</a> suggests the average return on every dollar invested in improving mental health yields a $2.30 return. It also compared the return on investments in mental health for small, medium and large organisations. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/109952/original/image-20160202-32231-1hbga5z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/109952/original/image-20160202-32231-1hbga5z.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=985&fit=crop&dpr=1 600w, https://images.theconversation.com/files/109952/original/image-20160202-32231-1hbga5z.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=985&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/109952/original/image-20160202-32231-1hbga5z.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=985&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/109952/original/image-20160202-32231-1hbga5z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1238&fit=crop&dpr=1 754w, https://images.theconversation.com/files/109952/original/image-20160202-32231-1hbga5z.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1238&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/109952/original/image-20160202-32231-1hbga5z.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1238&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Across the country, our awareness of the importance of mental health is gradually improving. People are taking stock. A <a href="https://www.headsup.org.au/docs/default-source/resources/heads-up-employer-of-choice-study---instinct-and-reason.pdf?sfvrsn=2">Heads Up survey of 1000 Australian workers</a> found workers will leave jobs they judge to be mentally unhealthy. </p>
<p>So the evidence is in and smart employers are taking action. It makes sense on so many fronts. If we enable people to live contributing lives – to lead the type of fulfilled lives we all seek in terms of relationships, family and jobs – we can lift national productivity and make our country a kinder, better place to live.</p>
<p>One word of caution however. Creating a mentally healthy workplace is not a set-and-forget type action. It takes ongoing care and attention. And, like all key areas of organisational culture, change has to come from the top. </p>
<hr>
<p><em>This article is the first in a <a href="https://theconversation.com/au/topics/mental-illness-and-the-workplace">series on mental illness and the workplace</a>.</em> </p>
<p><em>If you are distressed by this story or want to seek help for someone you know, please contact Lifeline 13 11 14 <a href="http://www.lifeline.org.au">lifeline.org.au</a> or SANE Australia 1800 187 263 <a href="https://www.sane.org/get-help/">sane.org/get-help</a></em></p><img src="https://counter.theconversation.com/content/53642/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Allan Fels does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New data shows Australians are spending more on mental health services and with costs to business in the millions, it’s time employers realised good mental health is good for the bottom line too.Allan Fels, Professorial Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/463452015-09-15T03:38:56Z2015-09-15T03:38:56ZFrom asylums to GP clinics: the missing middle in mental health care<figure><img src="https://images.theconversation.com/files/93116/original/image-20150827-15397-1jjia4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A new approach should include social supports, such as living skills and assistance obtaining housing and employment. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-134991908/stock-photo-homeless-man-sitting-on-a-bench-in-a-park.html?src=vDPLrYtwlu-l1An8OzviKg-1-22">Ollyy/Shutterstock</a></span></figcaption></figure><p>Quizzed in parliament recently about what the government was doing with the National Mental Health Commission’s <a href="http://www.mentalhealthcommission.gov.au/media-centre/news/national-review-of-mental-health-programmes-and-services-report-released.aspx">review into mental health services</a>, health minister Sussan Ley said she would be making “strong statements” about mental health before the end of this year. </p>
<p>Let’s hope so. There were <a href="http://trove.nla.gov.au/work/182790613?selectedversion=NBD51753898">32 reports and inquiries into mental health</a> between 2006 and 2012 alone. The common finding – including from the Mental Health Commission, which released its report in April – is the characterisation that Australia’s mental health system is in crisis. </p>
<p>One key reason for this is the “missing middle”. Most of Australia’s asylums were closed by the 1990s, though the <a href="https://mhsa.aihw.gov.au/home/">Australian Institute of Health and Welfare reports</a> there are still 1,831 acute and sub-acute beds operating in specialist psychiatric hospitals (as opposed to general hospitals), costing more than half a billion dollars annually.</p>
<p>It is <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Former_Committees/mentalhealth/report/index">widely accepted</a> that on closing the asylums, Australia failed to invest in an alternative model of community mental health care. This means that for people seeking mental health assistance, there are few alternatives between the GP’s surgery and the hospital emergency department.</p>
<p>These alternatives reflect the financial demarcation between the federal government, which pays for primary care, and the states and territories, which manage hospitals. Nobody currently “owns” or has responsibility for community mental health services. </p>
<p>The federal government has been ramping up investment in primary mental health care. This has been principally through the <a href="http://www.health.gov.au/mentalhealth-betteraccess">Better Access</a> program, now costing taxpayers more than A$15 million per week, mostly in payments to psychologists. Apart from a <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/mental-ba-eval-a">small sample</a> of selected consumers in 2010, we know little about the merit of this spending other than it has continually increased since the program was introduced in November 2006. </p>
<p>In relation to hospitals, costs increase but the <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-report13">rate of access to care</a> does not. People often refer to the grim term “the revolving door”, when people are admitted with acute symptoms of mental illness and are at risk of harm to themselves or others. They are commonly stabilised, provided with some medication and then discharged with little or no ongoing community support. They can become unwell again quickly and need re-admission. </p>
<p>Connections to <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-report13">community services</a> within a week of discharge vary wildly depending on where you live. In Victoria, this connection is made in around 72% of all mental health hospital discharges. In New South Wales, it’s only around 48%, which is almost exactly the national average.</p>
<p>It is this middle ground of community support that is missing in Australia’s approach to mental health care. But what exactly does this look like? </p>
<p>A new approach would have a much greater role for the range of mostly non-government organisations which, over many decades, have built deep skills in the provision of <a href="http://www.mhcc.org.au/media/5649/mhcc-social-inclusion.pdf">psycho-social support</a> – living skills, housing and employment support, increasingly mixed with specialist and even clinical skills. These organisations receive only around 7% of Australia’s mental health budget.</p>
<p>Another element of contemporary community mental health is <a href="http://www.psychosocial.com/IJPR_19/Adult_Step-up_Thomas.html">step-up/step-down services</a>. These generally provide short-term supported accommodation options to either prevent further escalation of problems and hospitalisation, or smooth transition to home following discharge. They are not overflow wards from acute care. </p>
<p>There would also be much greater involvement from multi-disciplinary <a href="http://bjp.rcpsych.org/content/178/6/497.short">community mental health teams</a>, operating from the “high street” not the hospital campus. Such teams are multi-disciplinary, comprised of social workers, psychologists, peer workers, occupational therapists, nurses and medical professionals. </p>
<p>These teams provide assessment, treatment, case management and support services to people with a mental illness. They could also have a capacity to assist in responding to crises. Ironically, such teams did exist in Australia 15 years ago but have been largely dismantled. </p>
<p>Community mental health nurse outreach services would add considerable capacity to the system, as already proven by the success of the <a href="http://www.acmhn.org/career-resources/mhnip/background">Mental Health Nurse Incentive Program</a>. This program is currently tiny, however, costing just over A$40 million a year. </p>
<p><a href="https://www.hwa.gov.au/sites/default/files/HWA_Mental%20health%20Peer%20Workforce%20Literature%20scan_LR.pdf">Peer workers</a> would also be a much greater element in our service system, ensuring our scarce and valuable professional staff can work to the top of their practice. There are programs such as <a href="https://www.dss.gov.au/our-responsibilities/mental-health/programs-services/personal-helpers-and-mentors-phams">Personal Helpers and Mentors</a> and <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/mental-pir">Partners in Recovery</a>, which aim to help fill this void in community care, but these now look likely to become restricted to recipients of support under the National Disability Insurance Scheme.</p>
<p>With community mental health falling between federal and state governments, there is a lack of leadership to address the problem. Despite this, I am aware of at least four different approaches being taken to fill in the missing middle: </p>
<ol>
<li><p>A large metropolitan hospital, keenly aware that the existing “revolving door” approach is unsustainable and results in poorer care, is establishing new relationships with new partners in the community to keep people well.</p></li>
<li><p>The New South Wales government has introduced social impact bonds, a new mechanism to finance innovative alternatives to hospitalisation. </p></li>
<li><p>A new primary health care network has similarly concluded that the current funding and service system is inefficient, wasteful, creates duplication and provides disintegrated care. It is exploring pooling existing funds to create new approaches. </p></li>
<li><p>A regional health district has invested considerable resources in establishing a new collaborative forum to engage the community sector in a dialogue about better organising mental health care in the community.</p></li>
</ol>
<p>There are differences between all these approaches but they all share some characteristics. They are borne from a frustration with existing policy and funding approaches, which are viewed as inadequate, siloed and unsustainable. They seek to create local solutions and not rely on any central government planning or intervention.</p>
<p>What they also reveal is that despite our leadership vacuum, 20 years after the asylums closed people working in the system recognise the situation is too serious to wait any longer.</p><img src="https://counter.theconversation.com/content/46345/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sebastian Rosenberg has worked as a consultant to several organisations in the community mental health sector.</span></em></p>On closing the asylums, Australia failed to invest in an alternative model of community mental health care. So there are few alternatives between the GP surgery and the hospital emergency department.Sebastian Rosenberg, Senior Lecturer, Brain and Mind Centre, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/404442015-05-11T20:07:20Z2015-05-11T20:07:20ZMental health care spending saves money, and that’s worth investing in<figure><img src="https://images.theconversation.com/files/81175/original/image-20150511-22730-13qxdv9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Unlike other chronic diseases, targeted spending on mental health care keeps people in the prime of their lives in the workforce.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-265381013/stock-photo-hardworking-dedicated-businesswoman-sitting-at-her-desk-in-the-office-with-her-head-in-her-hands.html?src=7MgY5d9HYfreMEc92tV8bA-2-98">Sebastian Gauert/Shutterstock</a></span></figcaption></figure><p>Mental health has become the awakening giant of health care, as Australians realise how ubiquitous mental illness really is in their everyday lives. But there’s a growing disconnect between this grassroots awareness and decisive action towards providing the full spectrum of care for those in need.</p>
<p>The prevailing consensus of the mental health sector is that we need progressive growth in investment to reach parity with the other major threats to human health, such as cancer and heart disease. But binary debates and false dichotomies have plagued progress.</p>
<p>Futile arguments about hospital versus community care, for instance, or prevention versus treatment, and the needs of children and young people versus older Australians prevail, all fuelled by scarcity and fiscal neglect. There’s undoubtedly a need for sectoral changes to help obtain value for money at the front line of care, but real growth is vital. </p>
<p><br></p>
<iframe src="https://d3602hfvnbc5pq.cloudfront.net/8Kzh3/1/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="420"></iframe>
<p>And this puts the sector at odds with the widespread view that growth in health spending is unsustainable; that the current fiscal climate cannot support growth in investment. Mental health has to be an exception to these arguments, because it is, in fact, a key solution: it will save money if we reach the sweet spot of sufficient investment. We need growth in direct care so we can save in other government expenditures.</p>
<h2>Youth and productivity</h2>
<p>Unlike the other non-communicable diseases, such as diabetes and heart disease, where costs are rising rapidly, targeted spending on mental health care keeps people in the prime of their lives in the workforce. Because unlike cancer, diabetes and heart disease, which strike in later life, 75% of mental disorders emerge in young people on the threshold of productive life.</p>
<p>We invest heavily as a society in young people so they can contribute to the common prosperity and fulfil their potential. But at least half of them will experience at least one period of mental ill-health during their transition to adulthood. </p>
<p><br></p>
<iframe src="https://d3602hfvnbc5pq.cloudfront.net/IpA72/1/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="400"></iframe>
<p>If they die tragically from suicide, develop a sustained mental disorder, or even underachieve because of the vocational derailment that even a mild to moderate disorder can produce, then the human, social and economic impacts last for decades. </p>
<p>Current under-investment in mental health care is also creating huge new costs in welfare payments and in incarceration, to name two obvious examples. As the <a href="http://www.mentalhealthcommission.gov.au/our-reports/review-of-mental-health-programmes-and-services.aspx">National Mental Health Commission’s recent report</a> highlighted, the result of inadequate investment in timely, effective care means almost half (48.8%) of the Commonwealth’s funding is now accounted for by A$4.7 billion in disability support pension payments.</p>
<h2>New allies</h2>
<p>This all means that the best allies for the millions of Australians with mental ill health and poor access to quality care are increasingly economists rather than health professionals. </p>
<p><br></p>
<iframe src="https://d3602hfvnbc5pq.cloudfront.net/IXcaJ/1/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="480"></iframe>
<p>In 2011, <a href="http://www.weforum.org/reports/global-economic-burden-non-communicable-diseases">the World Economic Forum produced a report</a> showing that of the five major non-communicable diseases, mental illness had the biggest impact on the world economy in terms of reducing gross domestic product (GDP). While heart disease reduces global GDP by 33% and cancer by 18%, mental ill health does so by 35%. </p>
<p>The OECD joined the fray in 2015 with its report <a href="http://www.oecd.org/els/health-systems/Focus-on-Health-Making-Mental-Health-Count.pdf">Making Mental Health Count</a>, which showed only 10% of people in the OECD with clinical depression were receiving even minimal care. This, despite the fact that we have as strong an evidence base for effective care in mental health as there is for other non-communicable diseases. It’s just not available in a timely and sustained way that most ordinary people can engage with.</p>
<p>Clearly, the return on such investment will be enormous. But mental health remains the poor cousin to other heath care, leading to poor morale and dysfunction in much of the existing system. </p>
<p><br></p>
<iframe src="https://d3602hfvnbc5pq.cloudfront.net/sGxtL/1/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="400"></iframe>
<p>And threats to the sector are set to increase as Commonwealth contributions to hospitals fall from 2017. Mental health care, especially in the community, is certain to suffer further as cash-strapped hospitals struggle to sustain other health services. </p>
<h2>Getting worse</h2>
<p>Few people realise how vulnerable the public mental health system has become since it was embedded in and yoked financially to the mainstream public hospital system. Not only is it not growing in line with population growth, it’s steadily shrinking and likely to shrink further.</p>
<p>We need both a renaissance of the culture and therapeutic quality of acute settings, which now often resemble clearing stations and custodial holding environments, as well as the creation or revival of proactive well-resourced community mental health services that are optimistic, responsive, and recovery focused.</p>
<p>Australians with mental ill-health deserve a fair deal. We can deliver this with more investment, and the strategic, sequential targeting of a modest number of “best buys” within an initial phase of reform, starting today.</p><img src="https://counter.theconversation.com/content/40444/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pat McGorry
works for:
Executive Director of Orygen, the National Centre for Excellence in Youth Mental Health
Founding Director of headspace, the National Youth Mental Health Foundation
Professor of Youth Mental Health, University of Melbourne
Receives funding from:
NHMRC
Colonial Foundation
Stanley Foundation
Also
President, Society for Mental Health Research.
President-Elect, Schizophrenia International Research Society
Treasurer, International Early Psychosis Association
Editor, Early Intervention in Psychiatry
</span></em></p>There’s a growing disconnect between grassroots awareness of mental illness and decisive action towards providing the full spectrum of care for those in need.Pat McGorry, Professor of Psychiatry , The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/342982014-11-26T10:25:51Z2014-11-26T10:25:51ZStigma about mental illness steers medical students away from psychiatry<figure><img src="https://images.theconversation.com/files/65377/original/image-20141124-19615-rq5lgo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Physician attitudes towards mental illness can reflect the general public's prejudice. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-115145464/stock-photo-lonely-man-sitting-on-the-stairs.html?src=dt_last_search-1">Image of man on stairs via Dariush M/Shutterstock</a></span></figcaption></figure><p>Mental illness is a major public health problem in the United States. Suicide alone takes the lives of <a href="http://www.nimh.nih.gov/health/publications/suicide-in-america/index.shtml">38,000 Americans</a> each year, more than double that from homicide. Medical and surgical patients who also have mental illness often experience worse outcomes. And yet, in the face of these glaring challenges, we struggle with an ongoing shortage of psychiatrists. </p>
<p>Psychiatry, as it happens, is not a popular specialty among medical students. Only about 4% of US medical graduates <a href="http://www.nimh.nih.gov/about/director/2011/psychiatry-where-are-we-going.shtml">choose psychiatry</a>. As a result, <a href="http://www.nrmp.org/wp-content/uploads/2014/04/Main-Match-Results-and-Data-2014.pdf">close to half</a> of psychiatry residency positions in the US are filled by international medical graduates, compared to roughly a quarter for general surgery or obstetrics and gynecology. Why is there so little interest in psychiatry?</p>
<p>Psychiatry offers a lower income the relative to other specialties. Our health-care system disproportionately rewards doctors for performing procedures, as opposed to talking with a patient and prescribing a medication or a behavioral intervention. This means that specialties like surgery, dermatology or cardiology can offer higher incomes because they involve more procedures. And as medical student debt has soared in the past few decades, potential income looms large for students deciding on a specialty. But there is a deeper problem.</p>
<h2>Stigma and prejudice</h2>
<p>Mental illness remains one of the most entrenched areas of stigma in contemporary perceptions of disease. People with mental illness face prejudice in employment and in housing that result in real obstacles to fulfilling the basic goals of a functional life. And many people with mental illness internalize this stigma. They can suffer lower self esteem, lower expectations and a worsened prognosis for their recovery.</p>
<p>The insidiousness of this stigma is such that it even infects health-care providers. Physician attitudes towards mental illness – even after their medical education – reflect the general public’s prejudice. As a result patients with mental illness <a href="http://www.medicalnewstoday.com/releases/74958.php">typically</a> <a href="http://bjp.rcpsych.org/content/194/6/491.long">do not receive</a> the same quality of care for their medical illnesses compared to their peers without mental illness.</p>
<p>The bias against those with mental illness within the health care setting can seem paradoxical. On one hand, there is the tendency to see those with mental illness as not having “real” diseases. By extension one will hear casual asides to the effect that psychiatrists aren’t “real” doctors. </p>
<p>On the other hand, there is the idea that mental illnesses are particularly frightening and disturbing, and have a potentially dangerous effect on those who work with them. A study by psychiatrists at Columbia University <a href="http://www.ncbi.nlm.nih.gov/pubmed/18766453">summed</a> up this attitude by quoting one blunt student: “Working with ‘crazies’ will make you ‘crazy’”. </p>
<p>It really shouldn’t surprise us then that the stigma of mental illness has been particularly hard to eradicate. Mental illness attacks the very aspects of a person that differentiate us from other species and make us human: reason, empathy and language. It also attacks those qualities that make us unique as individuals: memory, character, the integrity of the boundaries between self and others, and the sense of a narrative built on choices rooted in authentic feelings. In demonstrating the fragility of these fundamental aspects of our identity, those with mental illness inevitably serve as disturbing and frightening “others”. </p>
<p>In the light of all this, perhaps it is understandable that medical students haven’t been breaking down the doors to sign up. But none of this is reason to despair. </p>
<h2>Education and changing attitudes</h2>
<p>Attitudes towards some mental illness, particularly depression, do seem to be shifting as a result of education, and the increasing openness of people suffering from the condition. There is plenty of evidence that learning about or meeting someone with mental illness <a href="http://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201100529">decrease stigma</a>.</p>
<p>During a recent election campaign in my own state of Texas, a candidate was attacked for receiving hospital treatment for depression years before. It <a href="http://www.texastribune.org/2014/05/16/possible-dewhurst-involvement-patrick-revelations/">backfired</a>, and was seen as a groundless and desperate ploy by his opponent’s camp. </p>
<p>And there is certainly reason to be hopeful that current progress in neuroscience genetics and epigenetics (how our environment effects our genes) will decrease our perception of mental illness as unexplainable. The mysterious nature of mental illnesses historically made these diseases more frightening, and more of a “blank screen” for people to project their most disturbing fears on. Perhaps, as we are able to explain more and more of the causes of mental illness, these conditions will not be so demonized.</p>
<p>If we’re going to make progress in recruiting the psychiatrists that we need, we need to make sure that students have plenty of opportunity to meet patients who are reclaiming their best selves in recovery from mental illness and addiction. We also need to make sure they can work with psychiatrists who are proud to work with people who are living with such disturbing and frightening, but ultimately treatable, illnesses.</p><img src="https://counter.theconversation.com/content/34298/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Brenner does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Mental illness is a major public health problem in the United States. Suicide alone takes the lives of 38,000 Americans each year, more than double that from homicide. Medical and surgical patients who…Adam Brenner, Associate Professor, UT Southwestern Medical CenterLicensed as Creative Commons – attribution, no derivatives.