When “R U OK?” isn’t enough

Content warning: mental illness, suicide, eating disorders

Today is R U OK? Day, the day upon which you are encouraged to ask your friends how they are going. It is a day focused on suicide prevention, and aims to encourage those who are struggling to seek help. It is also a day that makes me extremely uncomfortable about our society’s relationship to mental illness.

A graphic with four steps for asking someone if they are OK, from the R U OK Day toolkit.
From the R U OK? Day toolkit.

“How can you shit on R U OK? Day, you bitter hag?,” you might be asking. “What’s wrong with asking friends if they are OK?” Absolutely nothing. I have written at length about the necessity of social support for those with a chronic illness, and strongly encourage anyone who has a friend who is going through a rough time to enquire after their wellbeing and offer support.

My beef with R U OK Day, and other awareness campaigns like it, is what comes next. The ultimate goal of R U OK Day – suicide prevention – is a noble one which should be embraced wholeheartedly. But what happens when you enquire after a friend’s wellbeing, encourage them to seek help – and those services aren’t there? Mental health services are chronically underfunded in Australia due to systemic slashing by consecutive Federal governments. Complex social factors are also a major contributor to suicide rates. Yet a focus on individual responsibility ignores these structural factors which contribute to mental illness and a lack of accessible treatment options.

I can’t blame those behind R U OK? Day for a failed healthcare system. Even they admit that a conversation is just a starting point, and that professional help is often needed. I can, however, blame politicians like PM Malcolm Turnbull, who create slick promotional “R U OK?” videos reminding us of our obligation to look out for each other, while continuing to allocate a meagre pool of funding to mental health services.

An image of opposition leader Bill Shorten and Prime Minister Malcolm Turnbull shaking hands.
He also held a press conference with Opposition Leader Bill Shorten, blaming suicide rates on “stigma”, lack of acknowledgement, and social media – in short, anything but public policy.

 

Here’s the problem with “awareness”: most people with mental illnesses, you will find, are already well aware they are unwell. They might have been seeking treatment for years, they may have tried every single antipsychotic medication under the sun, seen countless psychiatrists and psychologists, and for the most part, have worked really fucking hard at being well.

The idea that someone will have an enlightening conversation, stroll to their GP, be medicated and hooked up with services that will help them, then recover and get on with their lives does not correlate with the experience of anyone I know with a mental illness (myself included). Healthcare in Australia is increasingly inaccessible, particularly for those lower income earners who are more likely to be disproportionately affected by mental health.

Funding has been cut to the point where most GPs do not bulk bill, and not everyone can afford to pay the outright fee and wait for a paltry Medicare rebate. Mental Health Care Plans are limited to a meagre 10 psychologist visits a year  – not nearly enough for those who need intensive treatment. Private psychiatrists are prohibitively expensive.* And good luck finding help in the public system, where the attrition rate is so high you might have a new case worker a month – hardly conducive to a smooth recovery.

Psychiatrists themselves admit that the public sector does not have sufficient resources to offer psychiatric patients proper care, due to “grossly inadequate” funding. So even if a person found themselves seriously mentally unwell and did seek help, that help is not necessarily available. Nothing crystallises this catastrophic failure of funding more than the fact that nearly half of all those admitted to hospital after a suicide attempt receive no follow up care.

 

At the young age of 25, Raia died from suicide. She had lived with anorexia nervosa for much of her life, a devastating condition which has the highest mortality rate of any mental illness. Despite Raia actively seeking treatment for many years, by the time she passed away, her family was expecting it. As her sister Este said, “the health system had failed early on so that was what we were faced with at the end.”

A systemic failure in Australian healthcare has led to what Christine Morgan from The Butterfly Foundation describes as an “unacceptable” number of deaths of eating disorder patients. However, she insists the story can end differently and there is hope for those with an eating disorder, so long as there is access to adequate treatment.

 

For Raia and others like her, awareness was not enough. Awareness is never enough if there is no follow through: if, in well-meaning conversation, you encourage your friend with a mental illness to access services which do not exist. As a Crikey commenter quipped, “you don’t tell someone with cardiac disease that you understand they aren’t well, you pay for them to get some bloody treatment.”

When you ask your friends, co-workers and family R U OK?, don’t let the government off the hook. Defunding healthcare, denying people life saving treatment in the name of austerity, blaming individuals for their mental health concerns while actively working to make conditions harder for people who are most likely to be affected by mental illness: none of this is remotely OK.

 

Feel free to let Health Minster Greg Hunt know this isn’t ok through his website.

For help or information contact Lifeline on 13 11 14.

 

 

 

*There are two private psychiatrists in our town. One charges $300 a session, the other $400. TAKE YOUR PICK.

 

Author: Siobhan S

20 something, living in country Australia. Spoonie profile: ME/CFS, dysautonomia, anxiety. All about sewing, knitting and food. Unapologetic feminist and disability advocate.

8 thoughts on “When “R U OK?” isn’t enough”

  1. I There was a time when I seriously was thinking of suicide due to loneliness, abandonment, and cult shunning. My husband called the suicide hotline here in the US and handed me the phone. I talked to a very nice and caring woman. Then, I called later and got a different woman who gave me information to local help. I called up one place that helps out financially and told the receptionist I had suicidal thoughts and needed someone to work it out with. She told me there was a 6 month wait or more to get in. I later was hospitalized for actually trying. If I had the means to pay in full, I could’ve seen someone immediately. One thing I’ve learned from my own experience is that a person can seem happy at that moment, but not really be. I have a very tough time making and keeping friends being on the autistic spectrum. Feeling unwanted leads to a lot of depression. I wish I had friends who cared. I wish people wanted to do things with me. I wish I didn’t always mess up. I wish I wasn’t such a failure as a human.

    Sent from my iPad

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    1. Susie, I don’t believe you are a failure as a human. I know it might seem like that right now, but you can’t trust your thoughts when they say things like that. Because it’s just not true. ❤❤

      I am very sorry to hear of your experiences with the healthcare system. It is a sick joke that accessibility in healthcare is based on how much money you have. I truly wish there were more services for you and others in your situation. You’re absolutely right in saying that people don’t always present the way they feel inside. And I’m not convinced that if someone in a workplace setting asked me if I was OK, when I was actually very unwell, that I would answer truthfully.

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  2. As the mother of a daughter and son with Bi-polar depression, also having a sister with Bi-polar depression, and my mother with chronic depression the first 16 years of my life, plus the daughter-in-law of a woman with schizophrenia. All treatable illnesses.
    I am quite sick to hear that your Country is just as stupid about this as my Country. (USA) I don’t know if its Are you o.k. Day here. But we do have the whole Are you o.k. BS. :o( And no funding, and no one cares, and no help whatsover. YES! I want to scream! :o) Mental health neeeeds Medical Care! We need it Now, not after my daughter died during a manic phase, and my son heads to prison because he refuses meds.
    Oh I have cried over how we have failed many precious people. And then to hear its not just failing here in the USA. I’m so sorry to hear this.
    O.K. I am off my soap box. Didn’t mean to get so personal, but I feel so helpless. And no one hears us
    ((((HUGS)))) :o)

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    1. Oh, I am so, so sorry to hear this. You are absolutely right in saying mental illnesses are treatable illnesses, like any other, yet there is no *accessible* treatment. The system failed you, your daughter and your son. I wish there was more support for you all and that people would actually listen to those with experiences of mental illnesses. I feel like days like this aren’t about people with mental illnesses at all. Hugs and love to you xxxxx

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  3. Amen, this is so true! I’m in America, but it isn’t any better here. They don’t provide health care here so we have to buy it individually and many plans have shoddy or almost no mental health care coverage, it is a little better with Obamacare rules, but those look like they may be overturned soon. Here in America they always sell our healthcare system as “freedom” and “choice”, but what is often boils down to is the choice to feed yourself and house yourself or get medical care. Most of the homeless here we have are actually mentally ill in one way or another (many are veterans with severe ptsd), but instead of helping them, they (the media and government) try to shame and name call them. My sister died of suicide (she was bipolar), and while she actually did have decent healthcare, it just wasn’t enough. I know that happens sometimes, but I’m glad at least she had the chance to try.

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    1. The US healthcare system is absolutely abysmal. In many ways we are lucky, but our system is not good enough either. Mental illness and homelessness go hand in hand here too. The Mayor of Melbourne has been trying to push the homeless out of the CBD and into the suburbs for a while – not to help them, just to place them out of sight, out of mind. It’s disgusting.
      I am very sorry to hear about your sister. That must have been (and I’m sure still is) horrible for you. The death rate from mental illness is far too high.

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  4. Unfortunately, healthcare is a business – not a means for people to get and stay well. I’m pretty lucky in that I’m in the US and have full access to pretty much every service and specialist I need, despite being poor and not having any money for health insurance. My state has the money and inclination to make this available to its residents. But I’m afraid of leaving my state because I know I won’t have healthcare this good anywhere else, because I am poor.

    I did wonder what R U Ok day was all about; it wasn’t clear from the few blurbs I happened across. Aside from not having structural resources in place to actually help anyone who isn’t okay, I have learned from personal experience that most people who are not suffering from mental illness/distress are not able to handle the pain and frustration of someone who is, and can often make someone feel worse with their unintentional callousness, or shallowness, or impatience. I’m glad we don’t have R U Ok day here. I shudder to think of the awkward and potentially triggering conversations that could come of it.

    Thanks for sharing your opinion on this. I really enjoy reading your blog – your posts on health and medical care as much as sewing. It’s nice to come upon an unapologetically authentic voice in the blogging wilderness. 🙂

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    1. I didn’t realise some states in the US provided public healthcare. I’m glad for you that you have access to this service, but it’s a sorry state of affairs when you have to be wary of moving for fear of losing your health cover.

      I agree that well-meaning conversations can often make things worse for someone who is in a bad place mentally. There were a lot of articles published on the day, from people who had experience with mental illness/suicide, writing that they would never answer an “R U OK” query honestly, and the whole idea was quite distressing to them. There is a reason psychologists have 6+ years of training.

      Thanks for reading and your kind comments 🙂

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