Mental Wealth (Part 2): Pat McGorry – How we fix the national crisis

28 minutes

Contributors

Pat McGorry

Professor of Psychiatry, University of Melbourne

Pre-pandemic Australia was seen as an epicentre of hope – that despite high rates of loneliness and suicidality, we were getting buy-in on the important work to be done in mental health.  Mental illness is costing Australia thousands of lives each year, as well as counting for 35% loss of GDP from health problems.  So why, despite the daily reminder from COVID that prevention is better than a cure, are we not doing more? Join Professor Pat McGorry and journalist Ginger Gorman in this compelling discussion, the second half of our mental health special.

TRANSCRIPT:

[Start of recorded material]

Ginger Gorman:    Hello, and lovely to have you with us for this episode of Seriously Social. This is the podcast where we use the lens of the social sciences to help us consider all kinds of tricky aspects of Australian society, our relationships, human connections and societal structures. We get experts to give us new insights and help us think about things in new ways.

This season, we are focusing on our world in transition and we’re kicking off with a two-part mental health special. Last week, I spoke to esteemed mental health expert, Professor Ian Hickie. And he suggested that rather than looking at this issue in deficit, we need to instead, focus on building the mental wealth of the nation.

With me now is another eminent mental health expert, Professor Pat McGorry. He is Executive Director of the Orygen Centre for Youth Mental Health at the University of Melbourne and he’s also a Fellow of the Academy of Social Sciences in Australia, the Academy of Health and Medical Sciences and the Academy of Science.

Pat, thank you so much for joining me.

Pat McGorry:        Thank you for having me, Ginger.

Ginger:                  Let’s just rewind a little bit and think about how things were in regards to youth mental health before the pandemic. I wonder if you could kind of help me take the vital signs of the nation and encapsulate that for me?

Pat:                        I think we were in an encouraging position in some ways because our successive Federal Governments and our Victorian Government in particular had recognised that youth mental health was the vanguard of reform and the absolutely key period of life to focus on, if you were going to actually turn the public health problem of mental illness and mental health morbidity around.

And we as a country had embraced that reform for probably nearly 20 years through programs like headspace, through building Orygen as a very significant medical research institute now in Victoria, and focusing on this transition period from puberty through to mid-20s when all the major psychiatric illnesses that affect people across the decades of adult life emerge and entrench themselves if they’re not treated properly, or prevented in the first place.

So, we as a country in the world, who ascends the epicentre of this reform front, if I can put it that way, and it gave a lot of hope and confidence to the mental health field with the idea of early intervention and changing the course of these illnesses from the beginning of the first symptoms.

So, we had pioneered that in Australia, getting reasonably good support from government. It’s still nowhere near enough, obviously. We’ve got a basecamp, but we hadn’t actually climbed the mountain, but we were making progress before COVID-19.

Ginger:                  You say that, Pat, but there were quite high rates of loneliness, quite high rates of suicidality in that particular age group.

Pat:                        Yeah. I guess what I’m talking about there is the response is encouraging. The actual problem is huge. It’s the major health problem of young people. It’s the biggest killer of young people up to the age of even 40. And it’s a problem that was getting worse.

The mental health of young people, when you look at the indices, emergency department presentations, surveys of distress in young people, fears for the future with climate change and insecurity of life with casualisation of the workforce, all of these megatrends swirling around, creating a bit of a perfect storm around young people and undermining their mental health. That’s the kind of drivers of it.

And maybe we weren’t doing too well in a preventive sense to reduce those trends, but we had recognised that something had to be done to support young people and give them expert help to recover from the impact of these things. And the scale of the problem definitely dwarfed the response despite the positivity of the response up to a point.

Ginger:                  It sounds like though, you did have some hope prior to when the pandemic really hit us in kind of February, March.

Pat:                        Yeah. And the hope is sort of reflected in the fact that our Victorian Premier launched our World Economic Forum project that Orygen had with the World Economic Forum for the last 12 months where we’re trying to globalise momentum and also models of care for young people. That was launched in May with input from Geneva and from UNICEF and World Economic Forum; thirty-one countries involved in the consultation, ninety-two countries involved in the launch.

So, we were getting tremendous buy-in in that sense. But still, I don’t think politicians or even the public have realised the scale of the effort that’s going to be necessary to turn this around. But also, are they willing to look at the drivers of worsening mental health in young people or not?

Ginger:                  I want to get back to that in a minute because I think those are really crucial questions in terms of actually seeing positive change in the face of this enormous problem. But I spoke to you early in the pandemic in March while I was doing this investigation for the ABC about youth mental health and how the pandemic was starting to affect young people. What did you tell me back then regarding your specific concerns about this age group?

Pat:                        Well, in relation to the pandemic, we’ve seen already that the mental health impacts are universal pretty much on the whole general population, but particular subgroups, like young people, and women and marginalised groups are affected in a more sever way.

And part of the reason why young people are affected in a more severe way isn’t because they’ve got more anxiety about the pandemic so much, although they have been affected through the responses, isolation and disruptions to their education and so on, but it’s actually more the economic effects.

The unemployment rate in young people has just gone through the roof. It’s probably two or three times what it is for the general population already because of the casualisation and the kind of precariousness of the employment situation of young people at that stage of life. Their education’s been massively disrupted. Universities are in deep trouble now. So, the whole future of our tertiary education sector is really under a cloud. Young people are feeling all of that.

So, I think there are practical reasons why young people are affected in a worse way. And we know that in an economic recession that mental ill health and suicide really rises very sharply. We’ve modelled that, so we’re predicting a perfect storm.

Ginger:                  Pat, when I was speaking to you on the phone ahead of this interview when we were chatting through the topics, you mentioned some really interesting research that came out of Spain in regards to the global financial crisis. Why did you mention that research to me?

Pat:                        In the wake of the GFC, we have got a fair bit of data on what an economic recession will do to mental health and suicide rates. So, that’s one thing that we can draw on here, although this one is likely to be much, much worse than what’s being predicted in terms of its severity and also the fact that the recession’s being caused by, A, a pandemic and, B, government responses to the pandemic. So, it’s kind of different in some ways.

But you get some clues. In Spain, with austerity policies, youth unemployment reached about 50% in Spain, which pretty much wipes out a whole generation, a good 10 years of people’s lives at their most crucial, formative period for their trajectory in life. So, that’s what this generation of young people is facing if the recession is severe and prolonged enough.

Ginger:                  And why do you call this a perfect storm?

Pat:                        Well, I guess it’s the combination of the pandemic itself with the anxiety and disruption that that causes and the responses to it, causing isolation and damage to the peer group and connection and all those sort of things. The fact that all the normal sources of social enjoyment in life are reduced. All the things that keep us mentally healthy are being affected, really. So, that’s one thing.

And then you’ve got, as I say, the economic effects. We’re probably fairly fortunate in Australia. We’ve got reasonably good political leadership around this at the moment, but if you look at the rest of the world, it’s not handling it very well. And so, there’s a wider concern about what’s going to happen to society around the world and human progress over the next decade or so. Maybe we’re going into a period where we’re really going to go backwards in terms of our physical and mental wellbeing.

Ginger:                  So, Pat, when I spoke to young people for that article in which you were also interviewed, they were really describing layer upon layer of distress. So, they were describing social isolation, they had lost their jobs a lot of them, a lot of them were being forced to return home and so forth. So, they were losing their independence, they were losing their futures potentially. And so, I see why you would describe it as a perfect storm, but I wonder why in your mind it’s perhaps worse than what happened in Spain.

Pat:                        Well, I suppose maybe it’s not worse because maybe Spain was so severe at that time, maybe that’s a bit of a barometer of how bad it can actually get this time around, but perhaps affecting Australia and many other countries as well. Maybe the policy responses need to learn from that, how that whole GFC was handled with austerity measures. That’s just my personal view. I think the austerity made it a lot worse.

And Government here so far has not gone down that track, actually. They’ve actually been proactive on a range of fronts to kind of soften or throw in a safety net, not just for the health consequences, but actually the economic ones as well. And you can see that the Prime Minister’s wrestling with that, the balance between managing the pandemic and the risk on the one hand and trying to keep the whole of society afloat and recovering on the other.

So, it’s very, very challenging, but I think it is a perfect storm and it’s a perfect storm that you’re facing with one arm tied behind your back in some ways.

Ginger:                  Let’s talk a bit about the government response, seeing that you’ve just brought it up. When I spoke to you last time, you were calling for a huge injection of funds in terms of mental health and you could see this kind of crisis tidal wave almost coming our way and you were also calling for a national body, much like the National Cabinet to deal with the mental health crisis.

So, the Government didn’t create that body, but they did inject something like $48 million worth of funding into mental health. How would you respond to those things?

Pat:                        I think that the economic impact is the most important threat to mental health and I suppose suicide risk. If a recession can be reduced in severity or softened, that’s a very, very important thing for mental health.

I know that what we’re doing here is trading off lives lost from viral infections with lives lost from mental illness and suicide. I’ll just make the point that as a result of the Government’s response, we’ve only lost a bit over 100 lives from the COVID pandemic.

In the same period of time since COVID began four months ago, we’ve lost around 1,000 people from suicide. Now, that happens every year. It might be higher this year. We just don’t know because we don’t measure it in real time, but if we project the last sort of several years, four months’ worth of suicides is about 1,000 people. So, it’s 10 times more lethal, mental illness.

And the point I want to make is that our approach to mental illness in this country was already fairly inadequate as the Productivity Commission and Royal Commission into Victoria have shown. So, we’re already way behind the eight ball in trying to build – and hopefully these enquiries would lead to a significant injection of funds and reform and so on. That’s even more necessary now with COVID because we’re expecting maybe a 20% or 30% increase in need for care on top of that, let alone the neglect that was there before.

The Productivity Commission estimated about a million people at least miss out in this missing middle group between primary care and specialist care. I think it’s much bigger than that actually. But we already had a system that was not fit for purpose in scale or quality and then we have extra demand placed on it. So, that’s what the Government needs to do and needed to do it anyway, but it’s even more vital that they do it.

Now, you can’t do it rapidly. It has to be built up over a series of stages. But the question to the Government is are you committed to doing that? Do you realise that that is needed as much, if not more than the response to COVID? And I don’t know because with COVID, you’ve got a sense of immediacy and urgency that people are going to die next week if you don’t do something. With mental illness and suicide, it’s over the next few months and next few years. But every week, we lose something like 50 people from suicide.

Ginger:                  What is making you doubt though that the Government isn’t serious about tackling mental health, given that they did put in this huge amount of funding actually not long after you called for it.

Pat:                        I wouldn’t say it’s a huge amount of funding. It’s a very modest amount of funding, actually. Tens of millions of dollars for a whole country and spent on awareness campaigns and helplines, that’s really like sandbags in the flood or band aids on a wound. That’s necessary. You’ve got to stem the bleeding in an emergency sense, but it’s not fundamental reform. It’s not fundamental growth and building a system. That’s the bit I’m not sure that they are committed to yet. And I’d love to be reassured about that that they are.

And the treasurer the other night on a webinar did assure me when I asked him a question, it’s a very high priority for the Government. But you have to see the tangible commitments of funding, timelines, strategies. They have to be designed, funded and delivered before we’re going to see those changes.

Ginger:                  Pat, just so I’m clear in my mind, the funding, in your view, was given to projects, which were more like window dressing than actually dealing with the fundamental issues here.

Pat:                        That’s a bit harsh. I think they were worth doing. They were things that needed to be done and they were appropriate. Symbolically, it was good that Government did actually speak about mental health in a policy and strategic way. Not many other countries have done that, so I’m not being critical. I’m just saying there’s a lot more to do and the question is will it be done?

They did the NDIS, the Federal Government, some years ago, $22 billion a year for 400,000 people. There are four million people affected by mental ill health in Australia and we spend about $9 billion or $10 billion on it every year. So, it’s a massive mismatch in terms of need and funding.

Ginger:                  Yes. And I think you mentioned to me a figure previously that startled me, which said, actually, one in two Australians would be affected by mental ill health in their lifetimes. I thought it was much less than that, actually.

Pat:                        Well, in any one year, the one in five figure comes up. But cumulatively, over the lifespan, it’s at least a half. And, actually, a study from New Zealand, which followed some children from childhood through to age 45, just normal populations, a sample of about 1,000 followed right through their lives, they were assessed every year or two very carefully as to their mental health status, 85% of them crossed the threshold into mental ill health requiring a need for care at some point during that period.

So, you can’t live through life without needing medical care for physical health problems. It’s not possible. A 100% of people need that. So, I suspect that we’re going to see that mental healthcare is exactly the same. Everyone is in need of some sort of mental healthcare at some point in their lives.

Ginger:                  If like you’re saying mental ill health affects most of us, why is the national response so relatively pale then, compared to something like cancer? I have had cancer and I’ve had mental ill health and I can tell you, the responses are not the same on an individual level, but they’re also not the same on a societal level. So, why?

Pat:                        That is the million-dollar question and I’m sorry you’ve had those dual experiences, but I’ve heard a number of people describe the chalk and cheese effect where you have cancer or you have heart disease and then you have a significant mental health problem. And in the same hospital system, the same health system, you get completely different responses, often quite negative and inadequate and poor-quality responses in the mental health side. So, why is that?

I think it goes back to the fact that mental illness, mental ill health has only just been accepted as a serious health problem in recent times. It’s been hidden away before and minimised and not spoken about. It’s been stigmatised. And I was just looking at some comments too I’ve had. I wrote for The Australian today and there was a whole bunch of commentators, just normal people, responding to the article and they’re saying, “Well, this is all rubbish. Where’s the data? Why don’t you all just pull yourselves together? Back in the Second World War, we were much tougher.”

So, in other words, a denial of the problem by a significant percentage of the public. And even the people who are affected are kind of disempowered by it. They don’t feel they’ve got a right to kind of expect anything better. It’s like the soft bigotry of low expectations.

And the final ingredient is that people have not organised themselves in campaign mode to demand a better deal in their own self-interest, like they did with disability, with the NDIS, and like they would do it in cancer, if cancer services were not provided. The public doesn’t actually assert itself to the extent that politicians have to respond.

Ginger:                  But it’s amazing to me that the stigma is such that we’re failing on such a huge level. The interesting thing, Pat, about that Productivity Commission interim report that came out in October last year was the staggering figures. This isn’t just about people’s hurt feelings.

Pat:                        No.

Ginger:                  The Productivity Commission found that up to $51 billion a year is what this costs. So, it’s actually not just costing lives and it’s not just costing hurt feelings. It’s a massive economic impact from not dealing with this.

Pat:                        Yeah. Well, that’s why we had this World Economic Forum project because the World Economic Forum realised the loss of productivity amongst the non‑communicable diseases, like cancer and heart disease, mental illness, diabetes, mental illness is the dominant one, which explains 35% of loss of GDP from health problems. It’s twice as important as cancer in that respect. So, it makes absolutely no sense to neglect it.

The only other reason that I think people or governments actually don’t spend appropriately on it and don’t address it properly is because I think fundamentally, they may not believe that spending more money will actually lead to health gain, which is not true because there are lots of economic studies which show if you do invest, particularly in early intervention in young people and those sorts of foci that you will actually get a major return on investment, even as high as 17 to one.

So, the facts don’t seem to be able to change the perception that this is like a black hole. It’s a wicked problem that we just pour money into it and nothing will happen. But the reason you think that nothing will happen is because it’s so underfunded it doesn’t look very effective what is being done. And that’s why the consumers, who have used the system don’t have much confidence that spending more money on a health system is going to help the outcomes because they’ve had a bad experience. But the reason they’ve had the bad experience is because the whole thing is not fit for purpose.

Ginger:                  It’s interesting to me how much you relate this back to the economy. So, if we don’t do anything about it, it has this huge economic cost, but also if the economy isn’t strong, the problem gets a lot worse. Could you talk me through that because most people don’t necessarily think about this in an economic or dollar sense?

Pat:                        Yeah. Well, like as you just pointed out, it’s a bit of a vicious circle, isn’t it? It’s a spiral that if you don’t fund it, then it weakens the economy and if the economy is weak, then mental health gets worse and suicide gets worse. So, I think that’s interesting.

The thing that I kind of resent in a way as a doctor, and as a clinician and a researcher is that we have to use economic arguments. We’ve got great economic arguments in mental health; better than cancer, as I just said, better than heart disease, but why should we have to use them? In cancer, you don’t have to use cost effectiveness or economic arguments to justify or to persuade Government to invest heavily in that area.

Or in COVID-19, COVID-19’s a classic. We’ve spent a fortune saving lives there and we’ve crippled our economy. It’s going to cost us an absolute fortune, like tens of billions of dollars, maybe trillions of dollars to save lives from this threat. But with mental illness, we’re losing the same lives. They’re still human beings, who die from mental illness or they died prematurely from the medical consequences of mental illness, but those lives don’t seem to be worth spending money on, whereas the COVID-19 lives are at a premium and cancer lives are a premium. So, that is a form of discrimination, actually, which society is inflicting on itself.

Ginger:                  And it’s interesting being someone who, like I said, has a foot in both those cabs. So, in one instance, my life was very worthwhile and worth saving immediately, but in another instance, it was much harder to get help and I paid for it all myself.

Pat:                        Yes. [inaudible 22:00].

Ginger:                  You said, Pat, something really interesting to me when I spoke to you previously. You said this is a much less substantive society and it’s difficult to connect to community because of this kind of neoliberal agenda that society has and its constant privatisation. In your mind, how does that connect to this problem that we now have of unprecedented issues of mental health in the youth sector?

Pat:                        I’ve got to say this is a personal opinion and it’s obviously a political opinion as well. But what I see as having happened to society over the last 30 or 40 years is a loss of trust in Government and in political leadership and the whole push to sort of shrink Government and privatise a public sector approach to everything, whether it’s education, whether it’s health, whether it’s even the public service itself, which gets contracted out to big firms, like KPMG and PricewaterhouseCoopers.

So, the public service doesn’t feel empowered to do anything anymore. They have to get these consultants to come in and do a piece of work for them. And they usually hire ex-public servants and people from the public sector to come and do it under a private sort of contract. So, everywhere you look, including prisons, secondary education in Australia, tertiary education, everything’s been privatised to the extent that it can be because, as government funding is reduced to these areas, proportionately speaking.

So, I think that affects the value proposition in the society, the sense of public trust. You see it with the young people in the workforce where everything is casualised where it possibly can be. Everything’s on a contract. The insecurity in the medical research field is also another insecurity that’s there. So, we almost now know the price of everything and the value of nothing.

But that’s just my personal opinions and there is a body of scholarship in politics and economics that supports that perspective. And I know it’s been tested because obviously, the dominant paradigm is for this neoliberal philosophy, which began with Triech, the philosopher back in the ‘60s I think, or maybe earlier, and then embraced by Thatcher and Raegan, and that really transformed the way western society has operated.

I know we’re getting into kind of matters of opinion and politics here, but I personally think that that’s something that’s really the contributor to the worsening mental health of the population.

Ginger:                  Now, we’ve done a lot of talking about the difficulties here, but I know you do believe there are solutions despite what you call the strong headwinds. So, what are the solutions here? How can we dig our way out of this?

Pat:                        Obviously, prevention is better than cure. So, if we can tackle some of these megatrends, like security of vocational pathways, employment, education. If we can reduce the harm that comes from substance misuse, if we can reduce family violence, if we can reduce childhood abuse and childhood sexual abuse, those are kind of key risk factors.

And I think, coming back to the previous discussion, inequality is shown to be a predicter and a cause of a whole range of nasties from social outcomes, whether it’s teenage pregnancy or mental illness or drug abuse. That’s all about prevention and they’re hard things to change. So, you can’t rely just on group prevention, like we just don’t rely only on prevention in cancer and heart disease. We also provide early diagnosis and we provide comprehensive, proactive pre-emptive care to try to reduce the impact of the illness once it starts.

And that’s where I think in mental health we’re already on very strong grounds if we invested in it and the early intervention of psychosis with the youth mental health models that we’ve been developing, building the whole spectrum of the youth mental healthcare so that we do everything we can in partnership with young people and their families as kind of lived experience and allies in the whole process. We build systems that are determined to give them the best chance of recovery and a normal life.

And all of that’s possible. I’ve seen it with my own eyes. I’ve been involved in programs that do that and we’ve got scientific evidence to support its value. So, I feel very confident that we can make big inroads into these problems if we invest appropriately and we also implement them effectively because a lot of things that we do, and we’re seeing this now with primary health networks, these models are being devolved to them to implement and they sludge up.

The bureaucracy screws it up. They don’t have the capacity to actually translate what we can do into realities. We need a much better system of commissioning, more centralised commissioning with local adaptation and not the other way around. So, implementation’s failure is a big risk even when we have the solutions.

Ginger:                  Pat, thank you so much for talking to me today.

Pat:                        Thank you, Ginger. I really appreciate it.

Ginger:                  Thank you again for listening to Seriously Social. As you’ve heard, mental health is critical to our survival as a strong and healthy community and we will be coming back to this topic later in the season when we talk to Professor Jane Pirkis. She is Director of the Centre for Mental Health in the Melbourne School of Population and Global Health.

Don’t forget, if you like what you are hearing, share our podcast with your friends and on your social channels and rate us wherever you get your podcasts from.

[End of recorded material]