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.
“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.
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.