The recent article by Jennifer Doggett stirred a response from Professor Pat McGorry. Now Emeritus Professor Ian Webster joins the debate, ahead of a report from the United Nation’s special rapporteur on health which argus that social inclusion is vital to protect mental health.
Ian Webster writes:
I chaired the initial national advisory councils for suicide prevention for about 15 years, starting with youth suicide. It was a pretty lonely experience. There were plenty of critics, predominantly academics, some of them identified, or implied, in Jennifer Doggett’s article. I found the mental health sector to be riven by competing fiefdoms. In spite of the negatives, suicide rates, especially for young people, fell but then plateaued and have risen somewhat in the part 5 – 10 years. There were several positive evaluations, but not many. John Howard’s ‘gun buyback’ scheme had an impact, although this is challenged by some.
Looking back, the activities were broadly public health and community initiatives. Australia’s approach to reporting in the media was internationally recognised and followed. However, there was constant pressure from mental health experts for targeted interventions despite the lack of evidence of what worked. Governments yielded to this pressure and changed direction to fund ‘targeted interventions’. The narrowing of direction weakened the public health and community orientation.
Last week, for three days, I was involved in a national conference on postvention: postvention deals with the aftermath of suicide in communities, individuals and families. People came from across Australia, New Zealand and other countries. There was a strong contingent of our First Nation’s people and their leaders.
Actions at the local level
More than others, these people know where the problems lie and, while they would endorse Doggett’s article, their enthusiasms and drives are elsewhere – how communities respond to suicide and mental health related problems (addictions, despair) and the capabilities and strengths at a community level – actions at the grassroots.
I have learnt that the most promising steps will not come from the health system but from community and social action. The “suicide prevention networks” sponsored by non-government organisations and supported by some state governments, notably South Australia, is an example of these developments.
The first two years’ work of the National Mental Health Commission was based on ideas, not from mental health experts, but from the disability sector and the mental health consumer movement – recovery in their terms – and the profound idea that everyone should be entitled to live “a contributing life”. Unfortunately, Peter Dutton, Health Minister in the Abbott Government, changed all that as he re-defined the role of the NMHC to focus on reviewing the efficiency and effectiveness of mental health services.
None of this is to dismiss medical and mental health interventions/treatments. They are essential for identified needs, but to look to these systems as the panacea for community and individual well-being and the reduction of the suicide rate is a pretty fruitless journey.
I agree that those with the greatest needs miss out. Commonwealth programs have never engaged with the messy tough-end of mental illness and related problems – policing, criminal justice, homelessness, emergency departments, mental health acts, public mental health services, admission units and income and social support for those impaired by mental disorders. I have seen this first-hand in clinics for homeless people in Sydney.
Ian Webster AO is Emeritus Professor of Public Health and Community Medicine, UNSW