Misleading claims in the mental health reform debate

The following article appeared in the Australian on August 07, 2010 and has been kindly provided by Melissa Raven. Below this article is a link to a more recent, in-depth opinion piece that has been co-authored by Melissa:

 

Dodgy facts no path to mental health reform

MENTAL health has a prominent profile in Australia. 

It's become a key election issue, creating opportunities to advocate for constructive reform of the mental health system. But some inaccurate claims are being made.

According to John Mendoza, former chairman of the National Advisory Council on Mental Health, more than one-third of Australians who take their own lives have been discharged inappropriately from hospitals. In fact, data suggests that less than one-third of those who commit suicide have had any recent contact with the specialist mental health system.

Inappropriate discharge is an important factor in only about 1 per cent of all suicides, so Mendoza's claim inflates the true figure by a factor of 30. Improvements in discharge planning and follow-up are needed, but would be irrelevant to most who take their own lives.

Mendoza's misrepresentation of the significance of hospital discharge misleads the Australian public and politicians, and has the potential to misdirect suicide prevention strategies and resources.

Australian of the Year, psychiatrist Patrick McGorry, claims there's a "waiting list of 750,000 young Australians currently locked out of the mental health care they and their families desperately need". Surveys do suggest that this many young people have untreated mental disorders at some point in a year. But diagnosis, particularly when made in surveys rather than clinically, isn't the same as treatment needs. Many disorders are mild and transient. Only 17 per cent of young people with disorders have severe impairment, and 51 per cent of them go in for treatment.

Undoubtedly, some untreated young people would benefit from treatment, but most are not "locked out" of treatment, and most don't "desperately" need it.

Not seeking treatment in the health system is an appropriate choice for many troubled young people. Many use appropriate self-management strategies, including exercise and seeking support from family members. Many at risk of mental disorders would benefit more from social and educational reform than from mental health reform.

It might seem churlish for a psychiatrist to draw attention to such inaccuracies. Does it really matter if some claims are exaggerated? The system is in crisis and radical change is needed. McGorry and Mendoza's proposals have the support of mental health community groups, the public and politicians, so shouldn't we make the most of the momentum, especially during the election campaign?

But it matters that we're being misled by authoritative-sounding claims without anyone bothering to check them.

Furthermore, as the debate is now framed, several crucial issues are being sidelined, including the role of social disadvantage in suicide, the need for early intervention with children and families, the rights of chronically mentally ill people to live with more dignity, and the need to respect and enhance the valuable contribution of GPs to mental health care. The mental health system badly needs reform, but too much is at stake to make rushed decisions based on inaccurate claims and populist sentiment.

Jon Jureidini is a child psychiatrist and associate professor at the University of Adelaide.

Click here for the opinion piece: http://www.onlineopinion.com.au/view.asp?article=10793