Tragedy must spur mental health reform in Australia

Two things can be true at the same time.

The first is that what happened with Dr Helen Haines MP should not have happened. It was a horrific tragedy that we are all grieving, and our thoughts are with Dr Haines, her family and her community at this extraordinarily difficult time.

The second is that the mental health system in many parts of Australia is gasping for air, and people living with mental health conditions are paying the highest price.

It is truly unfortunate that it often takes tragedy to put a spotlight on a broken mental health system that has not been fit for purpose for decades. And at what cost?

At the cost of contributing to the very stigma that has helped mental health remain neglected in the first place.

Rejecting mental illness stigma 

Whenever tragedy strikes, particularly when mental illness is mentioned, the public conversation quickly turns to blame. Before facts are established, assumptions harden into conclusions. Mental illness becomes shorthand for dangerousness.

This is profoundly unfair to the overwhelming majority of people living with mental illness, including schizophrenia and psychosis, who are not violent and are far more likely to experience violence, discrimination and exclusion themselves.

I was recently reading Richard Flanagan’s reflections on heresy, in which he draws on Voltaire’s Candide and the absurd belief that publicly punishing supposed heretics could somehow prevent another earthquake.

The passage stayed with me because it speaks to an enduring tendency to respond to uncertainty and fear by finding someone to blame. Centuries later, our methods may have changed, but perhaps some of those impulses remain. Vituperative language, public humiliation and the certainty of being right may offer a fleeting sense of righteousness while doing little to address the underlying problems.

As conversations gather momentum, judgements become more confident and assumptions harden into accepted truths. Psychiatrists like me understand how shame, stigma, humiliation and group dynamics can shape human behaviour and judgement, but even understanding these processes does not make us immune to them.

There is a palpable anger around us. Perhaps it reflects frustration, disillusionment, or powerlessness. Those emotions are understandable when things feel uncertain and frightening. But we still must decide what we do with them. 

We can grieve, we can be angry, and we can demand answers. We can demand that Australians are safe in their communities. And at the same time, we can resist turning an entire group of vulnerable people into objects of fear.

Demanding mental health reform

At the same time, there is another uncomfortable truth we must confront: Our mental health system has been failing Australians for decades. How much longer are we prepared to accept it?

There is most certainly a discussion to be had with our leaders about what they are doing about a mental health system being held together by carers and health workers, in the face of mounting pressure and rapidly diminishing resources.

Mental illness has the second-highest burden of disease, while suicide is the leading cause of death for Australians aged 15 to 44 and the leading cause of premature death overall for both males and females. Untreated mental illness harms individuals, families, communities and our economy. Yet mental health has still not been given the priority it deserves, and we continue to treat sustained mental health care as something we cannot quite afford.

And separately, Australians deserve to be safe in their communities. Women deserve to be safe. Politicians deserve to be safe.

Mental illness is complicated, and violence is complicated but never acceptable. The failures of our mental health system are complicated, but the solutions aren't. We do nobody any favours by collapsing them into one simple story.

Australians deserve safety. People with mental illness deserve care. 

So, this is my plea: do not allow a tragedy, however shocking and confronting, to become another reason to fear, shame or condemn people living with mental illness. They are already among those bearing the greatest burden of a system struggling to care for them. They should also not have to carry the burden of our collective fear.

And to our political leaders, my question is simple. Can you genuinely look Australians in the eye and say the mental health system under your stewardship is working for ordinary Australians?

Can you assure families they will not be left alone in a crisis? That someone experiencing psychosis will receive timely care? That people will not fall through the gaps between hospitals, community services and housing?

Stop telling Australians how difficult and expensive meaningful mental health reform will be. Tell us instead how much longer you are prepared to bear the cost of not delivering it.

We can demand answers and safer communities while demanding a fit-for-purpose mental health system capable of caring for people before they reach crisis. And we can do both without sacrificing compassion, nuance or the dignity of people living with mental illness.

Dr Astha Tomar is the President of the Royal Australian and New Zealand College of Psychiatrists.