Last week, Australia’s Attorney General, Hon Christian Porter took leave to address mental health issues related to being identified as the politician accused of the historical rape of a sixteen-year-old girl in 1988. The alleged accuser is said to have had significant mental health issues and suicided in 2020.
Mental illness often lies at the bottom of many interpersonal tragedies. In most instances, it is the lack of mental health support or intervention that is the common factor but the flip side has become increasingly more common too.
Mental health issues can be blamed for poor choices, impulsive acts of behaviour or intentional actions towards that people are ordinarily supposed to care about, as a way of dodging responsibility and recourse. Even when there is no evidence of clear- cut symptoms or a history of needing services or interventions.
A symptom of a mental illness is not the same as an expression of a human emotion. Despite this, it seems that difficult emotions, terrible predicaments and shocking outcomes are easily pathologized to be components of an illness that can be cured by immediate access to overburdened mental health services.
However not all distress is related to a specific mental health issue. There exists a perception that when terrible predicaments occur, accessing a mental health clinician’s wise counsel will soothe anything that ails and the responsibility of empowering inherent coping mechanisms or employing self constraint is quickly made redundant.
Of course, there are always instances whereby seeking this counsel can support a person with limited coping skills until the event passes. Hence this is often diagnosed as a ‘situational crisis’. But psychiatrists cannot cure or keep safe those that cannot choose this for themselves, even when admitted to hospital. In addition to this, not every death related to a mental health condition is preventable. And not every death that occurs by suicide is due to a mental health condition.
Knowing that a mental health solution may or may not be required is one thing. But being able to access this solution is a whole different issue. In order to access urgent mental health care there must be a demonstrable clinical need, and an intent to mitigate risk to self and others. Triaging this should always govern who will receive access first and foremost.
Many people with mental health issues, usually if they are complex and persistent are turned away from emergency services as they are often deemed ‘not risky enough’.
Women who are victims of childhood sexual abuse, sexual assault or domestic violence are overrepresented here. Too often I have seen patients who cannot receive care in times of a crisis, cannot access ongoing psychological support and are vilified for presenting when they cannot manage risk.
Women would be more likely to tell nobody a thing for decades trying to survive the best they could until they couldn’t. This would have been most likely in past decades such as the 1980’s. Even the most sincere, valiant attempts at receiving help, after somehow having an awareness that help was needed rather than delving into terrible shame and victimisation, would be met with disdain or simply refusal. That is if there was anywhere to ask at all.
It is timely that while Christian Porter’s press conference was occurring in Western Australia, Victorians were provided the final report and recommendations of the Royal Commission that completed the inquiry into the state’s woeful mental health system. Many, such as myself, have been left wondering why resources for acute crises, more hospital beds, and funding for long term psychological support of victims of childhood trauma and abuse have again received little funding or recognition. Despite so much evidence given to the Royal Commission by those who have tried to access the system and failed, access block will remain a feature for the foreseeable future.
There is one single entry point for all public mental health services, regardless of need, age, context or risk. That is via the various psychiatric triage services housed within most major hospitals in Victoria.
On countless occasions, as a consultant psychiatrist, I have waited hours to make contact, only for the clinician on the other end of the line to try and dissuade me for asking for help with a very unwell patient. However, there remains the private hospital system, which does have access problems at times, but is more amenable to money or privilege.
There is relative inequity when other factors such as reputation and power are thrown into the mix while choosing who will be helped by this most under resourced area of health, especially in times of crisis.
Financial and gender disparity still governs who is deemed worthy of and entitled to timely mental health care in the time of a crisis. It seems many public figures are deemed entitled to the best care, while others with similar distress and ongoing risk are often shunned, dismissed and ignored by a system too exhausted to cope.
Dr Helen Schultz is a consultant psychiatrist in Melbourne, Australia with over 20 years of experience working in the public and private sector.