mental illness – the blog no one wants to write.

so i woke up this morning to news that there’s to be a rally in melbourne highlighting the human rights violations of the mentally ill. at first i thought. yeah, good, it’s about time someone considered it. Then I thought hang on. what. there needs to be a RALLY  about this.  the words mental illness and human rights violations shouldn’t belong in the same sentence. But they have, and they do, for decades if not centuries in this country and under the current neoliberal economic climate we find ourselves in it is only disintegrating further.

I’d like to speak personally and both politically on the topic as for me the two are intrinsically linked.  I have mental health problems that severely encroach on my life  and at times have made me wonder about ending it, or attempt ending it.  I have endured a re-traumatization at the hands of the system – a system that many refuse to acknowledge is in severe disrepair and needs not just money, but immediate restructuring in a way that puts people before the profits of private health companies and individual clinics. I have been told many a time that the issues that I suffer are simply not within the scope of the system. they can’t be dealt with by the structures that already exist. I often rely on the kindness of friends who have no training in mental health first aid but act out of a sheer desire to protect and enable me to survive.  I have been passed from doctor to doctor without any acknowledgement of my strengths but rather my humanity reduced to a set of pathologies. It takes incredible courage and survival skills to be able to navigate a world in which you are vulnerable and often unable to advocate for yourself. 

I consider the mental health system, despite the existence of some well meaning individuals as a highly exploitative system. The voices of the mentally ill are amongst the most unheard and the most marginalized within society yet given half a chance, they are amongst the most productive, creative and wonderful voices I have ever encountered.  Police harrassment of the mentally ill is rife.  No extra training is provided on how to approach someone in the street, immediate hospitalization often occurs if the police encounter a mentally ill person and that is often against the person’s will.  The way the Mental Health Act is structured deems it possible for a person to be forcibly detained in a facility if they are at risk to themselves or others.  The assessment of this risk is often done in a hospital emergency  setting, when a person is at an acute level of crisis, by a doctor who has none if not very little of the patients holistic history (sometimes by a registrar who has even less of an idea of the person’s history).  It is often not in the patient’s best interest to be hospitalized and hospitalization in itself can have a traumatizing effect and impede a person’s “recovery” .  Public psychiatric wards are an absolute shambles. not enough beds to cater for the needs of patients, an increasing number of acutely ill patients left to be with those deemed to be of “low risk” putting both staff and patients alike at risk.  Many a time emergency short stay units are proxy psychiatric units as beds are found for acute patients or patients await assessment.  This is simply not a situation that fosters anyone’s sense of dignity or humanity. It is a situation that detracts from the humanity of patients.  Patients are also at an increased risk of suicide if they are discharged prematurely with little follow up, as is often the case due to pressure for scant resources. 

I am also against the use of forcible seclusion or restraint. A study conducted by the Alfred Hospital in Victoria in 2010 concluded that the number of patients needing restraint in emergency departments or seclusion within psychiatric wards was on the increase with the number of acutely psychotic or “violent” patients  rising.  I don’t believe the numbers of those suffering pychosis  are rising, but I do think restraint is rising because staff do not have the time or resources to “talk down” a highly distressed patient. Several  complaints of physical assault by hospital security staff who are responsible for restraint despite a lack of medical training are yet to be investigated by Victorian mental health and medical bodies. It is once again, extremely difficult to maintain a sense of dignity and humanity and agency when it is often physically, forcibly removed from you.

The focus of the mental health system has also changed, and has left severely ill patients in the lurch.  Not only has the government restructured funding to the public psychiatric inpatient system it has restructured access to public psychologists, Occupational Therapist and other allied health professionals. The “Better Outcomes” Scheme was introduced in 2006 and entitled sufferers to 12 sessions with a professional per calendar year, and under exceptional circumstances a further 6 could be obtain, taking the total to 18.  Under the recently passed Federal Budget,  from November, the amount of sessions will be reduced to 10 with the exceptional circumstances clause removed. The rationale was that severely ill patients or patients requiring more than 10 sessions have “complex” needs and should be referred to the private psychiatric system for further assistance and have funelled the money into early intervention. WhilstI am all for early intervention, the whole purpose of the scheme was to increase access to professionals for those who could not afford to enter the private system. Most private psychiatrists charge between $200-300 per consultation and despite a significant medicare rebate this is simply beyond the reach of the most vulnerable.  What this will result in is further pressure on the public inpatient system, and will render access to help virtually inaccessible to those who need it the most.  Once again, this further decreases the societal value of those who suffer. We are seen as expendable, and often our care is seen as a drain on the system and governments past and present have washed their hands of us.  Any National Disability Network needs to include those with psychiatric disability, not just physical. There should be no delineation between what constitutes disability and what doesn’t and no scheme that removes pressure on hospitals should be defunded or scrapped.

And finally, (as if this rant wasn’t long enough) in order to create a world where those of us who suffer mental illness are valued, I do believe there needs to be an emphasis on holistic service provision – that is services that look at the person’s whole environment, and every aspect of their lives.  There are very little services that provide this approach, although ironically, mental illness doesn’t often exist in a vacumn. A strengths based approach is also needed.  Start with what a person is good at, look at the things they have done in order to navigate and survive their illnesses. Many people with a mental illness are highly motivated, creative individuals yet their strengths are not recognized.  Ask someone what inspires them, what makes them tick, what makes them dream, because chances are you will get an incredibly thoughtful, insightful answer that will take you far beyond anyone’s pathologies. Our humanity, dignity, strength, survival, and courage is often times just as evident as what ails us. It is this that needs to be brought to the fore, rather than the violence, humiliation and stigmatization many of us suffer.  

If you are reading this and have depression, anxiety or any other condition, you’re not alone. you’re amazing. you are here. you are living, and you are extremely loved. by me, and by many people. you are not any of the labels you have been given and I think the day will come when we will set the agenda for our care, and it will be about fucking time.

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