Friday, October 9, 2015

Mental Health, Poverty and Life Expectancy – A decades-long Crisis which finally Demands our Attention

above: Stigma is a major problem with mental illness ; But arguably there is another neglected crisis - mental health related life expectancy - which results in hundreds of thousands dying decades before their time...

Tristan Ewins
Last week was ‘Mental Health Week’ in Australia. Importantly this has drawn attention to related issues such as poverty, stigma and a decades-long crisis in mental-health-related life expectancy.
 According to a study from The University of Queensland and The University of Western Australia mentally ill Australians are on average dying 16 years earlier than the general population. This would include sufferers of Depression, Bipolar, and Anxiety. The study noted that the vast majority of cases of early death actually related to “physical causes such as cardiovascular disease and cancer, rather than from suicide or accidents.” Medication can certainly play a role in promoting obesity – which as noted can lead to heart disease, but also diabetes.
Also despite this, recent research has established that suicide claims approximately 2,500 lives a year. Proportionately the most likely to commit suicide were elderly men.
What is more, regarding mental health related life expectancy, “the gap is growing”. And the figure for sufferers of Schizophrenia – which is estimated to be a minimum of 200,000 Australians (some say closer to 300,000) – is 25 years. That is, those with Schizophrenia in Australia die on average 25 years earlier than the general population.
Also according to the UQ/UWA study this result was worse than that experienced by smokers, and comparable to that suffered by indigenous Australians. Indeed, research on Indigenous Australian life expectancy revealed a gap of around 10.6 years. The figure for indigenous Australia is of the highest concern and demands a significant commitment of resources. But the comparison begs the question why mental health related life expectancy does not attract the same relative amount of attention given the numbers, and given the dire plight of those involved. Indeed, both indigenous and mental health related life-expectancy warrant a very significantly increased amount of resources.
Furthermore the statistics on mental health related life expectancy have not improved in 30 years revealing gross negligence by governments of all stripes.
In early 2014 Ryan Bachelor of the Chifley Research Centre condemned apparent moves by the Abbott Government to vilify and scapegoat disability pensioners. This approach was reinforced by a disgraceful campaign by Australia’s Murdoch tabloid press. Bachelor also emphasized that while the figures for the Disability Support Pension (DSP) were high (approximately 800,000 people), more recently these figures were slowly declining. The cost to the Budget was approximately $15 billion in a $1.6 Trillion economy. And the proportion of Disability Pensioners with a psychosocial disorder was 31 per cent.
Considering life expectancy statistics, no – sufferers of mental illness are not ‘having us on’ when it comes to the Disability Support Pension. As Frank Quinlan of the Mental Health Council of Australia argued in 2014, many amongst the mentally ill want to work – but cannot do so on account of discrimination. And they are also deterred because of severe means testing of their pensions. As Quinlan explained elsewhere:
“The reality of the experience of severe and persistent mental illness is that it can have a profoundly disabling impact on day-to-day living and social functioning, leaving some Australians requiring ongoing financial assistance despite their eagerness to work independently."
It may not be so popular to draw on Karl Marx in this day and age. ‘Marxism’ as such has been so distorted by those who claimed to act in his name that many would not give his ideas a second thought. But Marx’s maxim: “From each according to ability, to each according to need” should seem an eminently reasonable basis on which to fairly organize an economy and a society. And it is a perfectly reasonable basis on which to organize pensions, and the social wage and welfare system more broadly. This should mean an end to severe means testing, more positive incentives to find flexible work (rather than ‘punitive welfare’), emphasis on fighting mental health related discrimination, and positive incentives for employers to provide suitable flexible employment.
Specifically, Disability Pensioners have trouble maintaining any kind of social existence; not only because of illness, but also due to poverty. Poverty means it is often difficult or even impossible to run a car, for instance. This impacts on ability to even search for suitable work. There’s the option of public transport ; but that is not always available. This can also make it difficult to keep friends, or to find friends in the first place. Poverty also makes fitness a more difficult prospect. Again, ill health, obesity etc can contribute significantly to early death, while the mentally Ill need to work so much harder to maintain health and fitness due to the side-effects of medication. Due to poverty Gym memberships are generally out of the question. And health costs can also be prohibitive. Consider Dental and Optical just to start. This affects all pensioners, but the disabled are likely to be dependent long term with no way out.
Also many experiencing mental illness are stuck in substandard and insecure accommodation. Further, not all the mentally ill have support from Carers, and many ‘fall through the cracks’ into homelessness. A 2002 report had also noted:
“many people with mental illness are unable to afford stable housing or make their own housing choices, and frequently have problems accessing appropriate housing and difficulty maintaining tenancies because of disruptions caused by their illness.”
  New Turnbull Government Health Minister Susan Ley says there are “no easy fixes” and that the system must “[catch] people before they fall.” (“The Age”, 5/10/15) This implies some insight as to what people actually go through. Though while early intervention is crucial in preventing such suffering few can really conceive of, healing for the afflicted is just as necessary. Expecting people to just “pull themselves together” demonstrates an appalling lack of empathy, understanding and humanity. So if Minister Ley is serious she must decisively reject the disgraceful stigmatization and vilification of Disability Pensioners conducted by the Murdoch Press, and by some elements in her own party. 
We are yet to see whether or not there will be a decisive change of direction under the new Turnbull leadership. Resolve to achieve the following will comprise the degree to which we can judge the extent to which the Turnbull Government is meaningfully addressing the crisis:
  •  Increase the Disability Support Pension by at least $35/week indexed. To begin, this might make it possible to run a vehicle and to eat better quality food ; Improve support for Carers as well

  • Implement anti-discrimination legislation and provide positive incentives for employers to offer flexible work

  • Provide much more generous means-testing of Disability Pensioners – especially the mentally ill, slowing the rate at which the Pension is withdrawn ; and make it easy for those affected to immediately re-access the pension even if they had found full-time work – but relapsed into illness       

  • Provide comprehensive Medicare Dental and Optical – ideally on a universal basis – but if this is not possible under the current government, then at least offer it to those in poverty, including those on welfare
  • Provide access to ‘physical health case managers’ – who assist in improving the physical health of the mentally ill – a dimension which is commonly neglected by mental health professionals

  • Provide funding so the mentally ill can actually act on such advice: subsidised access to health and fitness facilities, gear and services.

  • Condemn any stigmatisation or vilification of the mentally ill in the media, including the Murdoch tabloids       

  • Subsidise internet access to help maintain social-connectedness       

  • Promote social-connectedness for inpatients as well by enabling access to internet and social media where viable

  • Increase social expenditure on mental health to make it reflect its proportion of “the country’s health burden”; ie: raise it from 7 per cent to 14 per cent of the Health Budget ; but achieve this by increasing the investment; and not through cuts elsewhere

  • Finally follow through on the demand by ‘Australians for Mental Health’: for “improved access to mental health services, clear pathways for treatment and support, more early intervention and prevention services, and service integration”
Again the mentally ill are not ‘having us on’ when some of them can expect to die on average 25 years earlier than the general population. We have to hope that the new Turnbull Government will mark a shift in attitude. But what is actually necessary is an increase in funding for programs assisting the mentally ill. (as considered in the dot points above) We must judge all the political parties and independents on the basis of action and not just words.

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