Need for a rethink (and clarity about terms)

While everyone would agree with Martin Whitely that mental health needs a rethink, some aspects of his recent opinion piece in the West Australian require clarification.

Firstly, Mr. Whitely incorrectly labels one of the policy directions currently on offer as “preventive psychiatry”. In fact what the Gillard government has funded, and the Coalition, the Greens and all State governments strongly support, is a more modest yet overdue early intervention strategy designed to ensure timely access to care for a broad range of young people who are already experiencing mental ill health, significant distress and measurable damage to their social and educational prospects, and who have an undeniable need for and right to care. Young people are voting with their feet and are readily seeking help in large numbers through headspace centres across Australia with encouraging results.

Secondly, early intervention and recovery are not separate or competing “directions”. They are interdependent. Recovery is the key goal of early intervention, and in large part depends upon it as in all other areas of health care. Early intervention reduces the risk of a range of poor outcomes. People experiencing mental ill-health have just as much right to expect timely assistance as when they experience physical health problems. We cannot allow fear and stigma to deprive people of this fundamental right any longer.

Without such models of care we know that long delays, patchy treatment, and much suffering and thwarted lives will occur. Overseas and Australian experience has now shown that many of the disabling consequences of psychotic illness can be minimized by specializedearly psychosis programs. While this is not prevention, more recoveries occur, with much less need for medication and there are also substantial financial savings made through early intervention. More resources are freed up for those with severe and enduring illnesses. Far from a sense of doom, this approach breeds hope and optimism, vital therapeutic ingredients to counter stigma.

I agree we must reject the Americanisation of Australian mental health. Semantics and diagnostic terminology are of secondary importance and we need a simpler, not a more complex approach to diagnosis, which does not lock people with emerging and less severe forms of mental ill-health out of the care they need. A stepwise or staged approach in which medication is not first line treatment is something we should all be able to agree upon.