Close the gap between public and private mental health care


I am an Australian mental health client who has been a consumer of both public and private inpatient service facilities. In my mid-20s, I was one of those people in the ‘lucky country’ who got ‘unlucky’ enough to be sectioned under the Mental Health Act into the public inpatient system. It was a harrowing experience.

The experience is so etched in my mind that it wasn’t until recently, at least half a decade on, that I finally managed to shake the residual anxiety. A single admission to the public mental health system saw me crippled by post traumatic stress disorder.

To this day I shudder as I recall wondering if I’d escape that place in one piece (while ducking flying furniture, in the line for use of a public phone). By contrast, I’ve never had an inpatient admission to a private psychiatric hospital where I haven’t been discharged in comparative good health.

The disparities between services provided in public and private mental health inpatient facilities are beyond remarkable. Never have I noted in Australia the difference between the ‘haves’ and ‘have nots’ to be so stark as in relation to private health insurance and subsequent quality of care. These disparities desperately need to be addressed with actual solutions and funding.

Many consumers who have experience in both public and private systems echo my sentiments about the need for public mental health reform. We believe the money spent by the Australian government on mental health (at just hundreds of dollars per person, per annum) is inadequate, especially in a day and age when Australian suicide rates are higher than the national road toll.

I feel for those experiencing admissions in public mental health services today. Beginning with sterile and uninviting (read: bolted down or stained) décor in some shared rooms, the public psychiatric wards are a volatile melting pot. There is violence and general aggression, exacerbated by lack of funding.

Even many staff in public settings would agree the facilities are far from idyllic and, at times, downright intimidating. Being within reach of people coming down from drug-fuelled benders or psychosis is not ideal even when you are well, let alone when you are feeling unsafe, nervous or paranoid. Add a lack of space and some general helplessness and isolation from loved ones, and you have a recipe for disaster.

During my own inpatient admission, rather than spending my time recovering in hospital, I became hyper-vigilant in regards to my own safety. Had I slept a wink during that ten-day admission, I would have done so with one eye open.

“Not everyone can afford the private health insurance required for a private admission, but everyone should have the right to be treated with dignity and respect.”

I felt beyond powerless, without a sense of self-actualisation and without independent decision-making options within practitioner service delivery. The general consensus among those at the helm at the time seemed to be that if you landed yourself in there in the first place, chances were that they (the mental health practitioners) would know best what was in your interests.

Dual decision-making between trained staff and consumers should be a matter of course, but sadly this is not commonly reflected in current public psychiatric practice. Autonomy is often sidelined in the name of medical intervention. Whether the sidelining of dual decision-making is due to a lack of funding, resources and limitations over beds and consequently short periods of admission is unclear.

Perhaps these factors, along with a steady flow of psychiatric patients presenting in emergency departments, means psychiatrists and management of clinical service delivery need to get consumers in and out as quickly as possible. Therefore, time spent negotiating a way forward with the consumer just doesn’t get prioritised. This lack of time and resources also means that compared to the private mental health system there is little attention given to education about treatment options, or even diagnoses, let alone prognoses.

Time and again, the words ‘public mental health system overhaul’ have been thrown around by respective governments. However, there are few tangible differences seen by our most vulnerable consumers. This is certainly not to undermine the progressive changes such as sensory room activities, greater consumer input (the employment of consumer consultants, educators and peers) and higher security measures for those with gender sensitivities. But since the basics of care within the public system were so lacking to begin with, there is a lot of ground to make up.

With the right investment, the services could be vastly improved and even save lives. The food could be edible. The staff could be more attentive. The psychiatrists could have more time than is required to write a script. Patients could be examined holistically. There would be a sense of self-actualisation, with treatment arrangements, even negotiations, to ensure they are amenable to all parties. It’s not a foreign concept. It already exists in private service delivery.

There needs to be some clear cut decision making on the way forward, with greater consumer input that allows for tangible changes more conducive to recovery. Not everyone can afford the private health insurance required for a private admission, but everyone should have the right to be treated with dignity and respect; the disparity between current public and private systems is little more than institutionalised discrimination. The government should be addressing the gaps and aiming to bring the public system up to par. We can do much better.

Originally published by Eureka Street 2017




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