Improving mental health

AAYLF delegate from Australia Christian Habla addresses the challenges that need to be overcome to improve mental health outcomes across ASEAN and Australia.

1.1 billion people experience mental illness globally [1]45% of Australians experience mental illness in their lifetime [2], and 8 million working days are lost in Australia each year due to mental illness [3]. The World Economic Forum predicts that the global cost of mental illness by 2030 will be greater than cancer, diabetes and respiratory illness combined. 

Globally there is a 20-year life expectancy gap between people with and without mental illness [4]. This is a global problem which, like other increasingly complex problems, does not respect borders and cannot be solved by drawing only on the ideas available in any one country. 

Australia has intermittently prioritised and ignored mental health. Despite this history, an opportunity for reform exists in Australia. A Prime Ministerial national suicide prevention advisor has been appointed, Australia’s Productivity Commission (a body of inquiry that often indicates government priorities) has been directed to report on mental health reform, and a State Government has commissioned a Royal Commission into mental health. 

Seizing this opportunity for change is important in Australia, as across ASEAN nations. The impacts of underinvestment in mental health, demographic changes, funding complexity, increasing inequality and the impacts of loneliness seem only to be increasing.

What may prevent change? Seizing this opportunity for change depends, in large part, on mental health stigma and its impact quashing personal and societal recognition and engagement with mental illness. 

Mental health stigma presents through structural stigma, public stigma, self-stigma, and stigma by association. Structural stigma involves private and public institutions intentionally or unintentionally restricting opportunities (e.g. discriminatory laws). Public stigma includes stereotypes, prejudice and discrimination (e.g. misinformed beliefs around criminality of people with mental illness). Self-stigma involves internalising stigma (e.g. not applying for a job or reduced help-seeking). Stigma by association is the stigma experienced by friends, family and carers. 

Most broadly, stigma contributes to the systematic lack of resource allocation to mental health—despite its significant impact—particularly when compared to issues of physical health. 

Adding complexity, assessing stigma is difficult. One method is measuring desire for social distance— willingness to make friends, become neighbours and marry people living with mental illness. Another is surveying views of mental illness, including views of personal responsibility, unpredictability and dangerousness of living with mental illness. 

Practicable interventions that address stigma are not readily identifiable. Whether because of the complexity of stigma or the stigmatisation of the issue itself is unclear. However, promising areas of intervention that that may gain traction are growing. Specifically, educational interventions, knowledge or information campaigns, improved media portrayal of mental illness and better enforcement of anti- discrimination legislation. 

Besides reducing stigma, educational interventions may improve mental health literacy, help-seeking and coping. As well as being politically palatable (information campaigns highlight government activity) campaigns may help reduce stigma. Encouraging responsible representation of mental illness in the media reduces misinformation. Better enforcement of often already existing but under-utilised anti-discrimination law—for example in travel insurance—will help change acceptable behaviour toward people living with mental illness. 

These examples may form part of any framework of stigma-reduction interventions implemented on community, state or national scales. 

Addressing stigma will help change erroneous yet prominent beliefs across ASEAN nations and Australia: uninformed beliefs that people living with mental illness are weak rather than sick, responsible for their illness, or dangerous. Further, it may reduce discrimination in finding a job, a house, and being falsely charged with violent crimes. 

Recommendations: 

Implement practicable interventions to reduce stigma and improve mental health outcomes.

References

  1. Helen Frankish, Niall Boyce, and Richard Horton, ‘Mental Health for All: A Global Goal’, Lancet, 392 (2018), 1493–94 (p. 1493). 
  2. Australian Institute of Health and Wellbeing, Mental Health Services in Brief 2018, July 2019, p. 1. 
  3. National Mental Health Commission, The Economic Case for Investing in Mental Health Prevention: Summary (Government of Australia, 2019), p. 2. 
  4. Firth, Joseph, Najma Siddiqi, Ai Koyanagi, Dan Siskind, Simon Rosenbaum, Cherrie Galletly, and others, ‘The Lancet Psychiatry Commission: A Blueprint for Protecting Physical Health in People with Mental Illness’, The Lancet Psychiatry, 6.8 (2019), 675–712 <https://doi.org/10.1016/S2215-0366(19)30132-4>; Royal Australian and New Zealand College of Psychiatrists, Keeping Body and Mind Together: Improving the Physical Health and Life Expectancy of People with Serious Mental Illness, 2015.