Coming off the back of Mental Health Week, I am finally dredging up and editing a rant that I wrote well over a month ago. At the time, I was struggling to get my head around what steps were needed for me to recover from a 'breakdown' (I don't know what else to call it). I felt frustration towards and confusion about the system that I was being tumbled around in. It was meant to help me, yet it seemed to be intentionally getting me nowhere.
Flash forward to the present moment and I have been accepted into a DBT program (Click here for info) starting next month, and am attending regular therapy. I wouldn't say I feel happy, but I do feel like I have more control of my life, rather than being victim of my emotions. I also feel like I have a better understanding of what my needs are and what it means to take ownership of them. I'm returning to work part time next month, a plan which I took charge in negotiating with my employers.
The road to get here was not a well marked path. I have been in and out of therapy, and on and off medication, since I was 19. Usually I would attend therapy in crisis mode as part of the 10 sessions offered through medicare in a 'mental healthcare plan'. Either the therapy would stop after those 10 free sessions due to cost, or I would stop attending because the crisis would die out and I no longer knew what to do with the therapy. At the moment, I have been seeing my current psychiatrist for over a year, along with regular G.P. visits. It wasn't until 3 months ago, when I became a genuine suicide risk, that I was given a Personality Disorder diagnosis and directed to a more appropriate course of treatment.
I brought this up in one of my assessments for the DBT program. I wanted to know why my psychiatrist hadn't referred me there earlier? Why it took me ending up in hospital and being assessed by a psychiatrist there to be referred to this program? Even then, I needed to specifically seek the referral to the program, it was not offered independently. Her response was that I was lucky, most people will be admitted to hospital, with suicide attempts, multiple times before they find their way to a program like DBT.
As I said, I was classed as a suicide risk, but did not attempt. By the numbers she gave me, I am beyond fortunate to ALREADY have been directed to DBT. To think that some people had to attempt to take their lives more than once to find a program like this was unbelievable to me. That I had to find myself in hospital from a risk of suicide before getting this support should be the height of unacceptable situations, but instead I find myself in a world where I am the lucky one.
When professionals have discussed DBT with me, it often comes with very positive phrases like 'this program works' and 'it has been proven effective for many mental health conditions'. I rarely hear anyone speak with such certainty as I have with regards to DBT (I'll let you know if these are true statements for me once I've done it). To take an evidence based approach, here is a study conducted in Berlin from 2014. This study showed that after a 1 year DBT cycle participants experienced reductions in self-harming behaviours, hospital admissions and the severity of their symptoms. To top it off "77% of the patients no longer met criteria for BPD diagnosis". Looking locally, this abstract of a similar Australian study from 2011 indicates similar results in regards to self-harm, hospital admissions and improvement in depression and anxiety symptoms (Unfortunately, I couldn't get the full study). The authors conclude that "providing DBT to patients within routine public mental health settings can be both clinically effective and cost effective".
After my reading, I am amazed that this program is not being better utilised, especially if it is both "clinically effective and cost effective". To consider why it is not, there are certainly reasons that it would be problematic if it were rolled out the way, say Cognitive Behaviour Therapy is. Firstly: DBT is a 1 year commitment. Understandably, it would be very difficult to guarantee or enforce attendance for that amount of time, most people barely utilise the gym memberships they are paying for. Imagine trying to attend something every week, especially if it were government subsidised and didn't leave you out of pocket? This leads to the second point: to gain results you have to put in effort. If a person is not willing or ready for life changes, they will not get much out of the program. They could even do the opposite and prove disruptive for other participants. This is why I underwent assessments, to determine if I am ready to commit and if I really want it. Attendance has to be driven by a willingness to change. Other issues which could arise are things like cost, personal support networks available and the risk of putting people into the program who are not suitable or not ready. There are probably countless others that I am not qualified to even invent. No doubt there would be many little details that had to be nutted out before it was pushed as a high priority recommendation or even government subsidised, but surely it is a possibility that would be worth considering
The issue is that our system wasn't designed with mental health built in. It was designed around physical illness- it is difficult to fit mental illness into this system because it presents uniquely in each case. In an interview with Hack, the the federal health minister, Sussan Ley said that reforms to the mental health system are "long overdue". How these reforms will look is currently anyone's guess, and that is why the public discussions that happen during times like Mental Health Week are so important.
This sentiment, of why our health system treats mental health the way it does, was voiced very well in an interview with Hanna Pickard on "the Philosopher's Zone". Perhaps it rang more true to me because she was talking about people with BDP. Often patients will attend a session presenting with self-harming behaviour, suicidal attempts, depression, anxiety or many other symptoms. She explained that these symptoms can be interpreted as a loss of control and the attending professional may stop viewing the patient as a person with the ability to change and will move to the role of rescuer.
Rescuing works very well with a medical model. Medical models identify an issue and then take measures to fix it. For example, you have a broken arm, I will put a cast on it. You have bronchitis, I will give you medication. We can do things to help healing along, like resting, eating healthier foods, or increasing fluids but the bulk of the problem is solved by medicine- which is utterly amazing when you really think about it!
A large part of psychological intervention is the belief that all people have the ability to make positive change, and it is important to not only believe in them, but to help them believe in themselves (Google 'Person-Centred Therapy' if you want to learn more). As mental healthcare is part of a medical based system, it is geared towards fixing people, not supporting them to fix themselves. I should clarify here that this does not mean I am against medication or medical support for mental illness. I believe medication can be vital and effective, but can be more effective when used as a tool rather than a cure. The reprieve and stability that can come from the correct medication and medical care can provide a space of clarity where new skills and ideas can be nurtured. This may mean needing medication for a lifetime or a few months, it may mean needing therapy for a lifetime or a few months. Everyone is different, there cannot be one set procedure for dealing with all mental illness.
At this point in my original rant, I opened into a glorious tale of a wonderful furture that would need 'Imagine' by John Lennon sung in the background by a choir of multi-ethnic children wearing the clothes of their heritage. I find that unnecessary because my idea of an ideal will be different from yours. What I do want end on is this- What I have outlined here is just one possibility for different ways we can move forward in treating mental illness. Possibility is where discussions can happen, ideas can emerge and plans can be made. We are at a unique point in the mental health arena in Australia where how the future system looks can be decided by the people. Keep the conversation going and the kind of change we want will happen.
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