Mental wealth (Part 1): Ian Hickie – How we fix the national crisis.

Contributors

Ian Hickie

Professor of Psychiatry, University of Sydney

How do you build the mental wealth of a nation? Mental ill health is costing us about 4% of GDP, a figure that one of Australia’s best-known researchers in the field, Professor Ian Hickie says holds its own meaning:

“It clearly points a chaotic system, that’s poorly funded and was never designed to deliver mental health for those who are in trouble or mental wealth for the nation in the 21st century.”

Professor Ian Hickie

As Australians wax and wane between life under lockdown and learning to manage our ‘new normal’, what’s happening with our mental health? Join Ian for the first of our two-part mental health special as he talks with journalist Ginger Gorman on mental wealth, the need for public debate on mental ill health, and some potential solutions to a ‘frog boiling’ problem.

TRANSCRIPT FROM THIS EPISODE:

Ginger Gorman:    Hello there and welcome to Season 2 of Seriously Social. This is the podcast where we use the lens of the social sciences to help us consider all kinds of challenging 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. As Australian society takes a long road to recovery after the devastating summer fires and the global pandemic, for the next two episodes, we turn our focus to the shaky mental health of the nation and what solutions we can find to invest in the country’s so‑called mental wealth.

With me now is Professor Ian Hickie, Codirector of Health and Policy at the University of Sydney’s Brain and Mind Centre. He’s also a Fellow of both the Academy of the Social Sciences in Australia and the Australian Academy of Health and Medical Science.

Ian, thank you so much for joining me.

Ian Hickie:            Pleasure.

Ginger:                  Let’s take this idea of mental wealth apart. What does it constitute in your mind? What are the facets of it?

Ian:                        I’m a person that’s been concerned for many years about how do you grow the mental wealth of Australia? That is all of the cognitive and emotional resources of our country that will contribute to its future. Much of our mental wealth isn’t under the ground in Western Australia. It’s actually inside people’s heads and it’s particularly inside the developing heads of young people, children, young people, young adults, as they pass through education, employment skills training and create our economic future.

So, the OECD classically says the future wealth of a country, including its cognitive and emotional resources is largely a consequence of what’s going on for 15 to 30 year olds, their participation in employment, in education, in social development because that is our future. That’s the investment we make from minus nine months to about 25 years and then the rest of us live off that investment as our population ages.

So, the mental wealth concept is in a sense accumulated cognitive and emotional behavioural resources of all of us. It’s not simply the loss of mental health or loss of productivity due to mental ill health. It’s how good can we all be to be as productive as we can be. Now, that takes a tremendous amount of social investment in health, in education and welfare from minus nine months until about 25 years. So, we grow up independent, capable young Australians, who can then lead the future wealth of our society.

So, the concept is really one of investment in people and their capacities and the social fabric in which they actually are embedded to maximise future wealth. Now, it overtly monetises what is otherwise a behavioural and social concept to grab the attention of the economists.

Ginger:                  Ian, if we just put aside the pandemic for a moment, where were we up to in terms of mental wealth before the COVID-19 crisis?

Ian:                        Because of the increased awareness of mental health and modelling by the OECD by other people around the world, the global burden of disease and other sets of issues, we’ve seen over about two decades an incredible interest in mental health and mental ill health and growing awareness of not just the social and human and health costs, but the economic cost.

And this peaked in Australia really during the Prime Ministership of Malcolm Turnbull, who quite overtly started using the term ‘mental wealth’ and the chairmanship of Allan Fels of the National Mental Health Commission, of which I was a member, to actually say, “We’ve got to look at this area. Mental ill health is costing us about 4% of GDP, but if we actually increased our total mental wealth, dealt with that through better services and development, but also we all improved our cognitive and emotional forces and our social connectedness, we’d probably see up to a 10% growth in GDP.” Big economics. Not little economics.

And so, the challenges were there to lift our game because, on the downside, we weren’t providing the health services, education and emotional support. We already had problems in education, increasing youth unemployment, lack of skills training for many young people, disintegration of the vocational education training sector, the VET sector, pressure on university places and quality of education before the COVID-19 crisis.

So, we had issues, insufficient mental health resources, insufficient investment in early childhood, insufficient attention to actually the mental health and fitness of all of us, but particularly of young people in their developmental years.

Ginger:                  I’ve seen the interim productivity report that came out in October last year. And actually, it’s pretty damning of the state of the mental – I mean, it’s very complex findings, but it’s pretty damning of the mental health system and the way that it’s going. And obviously, those findings came out before we even had heard of COVID-19.

Ian:                        So, classically, in Australia, we had stacks of awareness raising, which is a good thing. Let’s assume awareness of a problem precedes action on the problem. So, we had seen in the early childhood years, childhood mental health problems of young people, issues with people being disconnected from employment and education due to mental ill health, increasingly the subject of public attention not only in Australia, but across the G8 and in the G20 and increasing movements to say we should certainly help people with mental health and cognitive problems earlier in life.

And in fact, Australia’s really led the world in early intervention for young people with major mood and psychotic disorders, but also investment in early childhood care to turn that into early childhood education, to increase family support and to attention of those who are most disadvantaged, including Indigenous populations.

So, stacks of awareness raising, stacks of discussion of the problem. Not a tremendous amount of investment in fixing the problem prior to this current crisis.

Ginger:                  And to me, it really pointed to systematic failings to give people long-term support. It was very patchy in terms of delivery.

Ian:                        So, the period of increased awareness and I make great credit here to Prime Minister Gillard and Prime Minister Turnbull for driving that process forward, resulting in Allan Fel’s great plea, just like the National Disability Insurance Scheme, we needed a productivity commission review to put this on a firm economic basis because the current system is so dysfunctional from a funding and organisational point of view.

So, the PC draft report out last year and the final report out and due now, clearly, clearly points a chaotic system, poorly funded, poorly invested, never designed to deliver mental health for those who are in trouble or mental wealth for the nation in the 21st Century.

Ginger:                  You said on The Drum, quoting Roy and HG I think that Australians are cautiously optimistic in a sea of complacency, which did make me laugh. But what did you mean when you used that quote? Why were you saying that?

Ian:                        So, in the mental ill health sector, we’ve got to patch them up, get them out and hope they get better. And particularly for young people, particularly for early intervention and particularly for children, “Not too much to see here. Let’s not dwell. Let’s hope they grow out of it.” All the evidence is the opposite. Unless you intervene early, provide continuing support and that support needs not only to be health based, but education based, social services based to persist.

I mean, one of the really interesting issues with the brain sciences that I’m tied up with is how long it takes to grow a brain. It’s not something that’s over in the first six weeks of life or first six months. It’s something going on from minus nine months to about 25 years. And the later phase of development in the late‑adolescent and early-youth period is particularly important for higher cognitive abilities. So, education and support and treatment of mental ill health is critical in the adolescent and early adult years, just as it is in the childhood years. So, a system not fit for purpose prior to COVID-19.

Ginger:                  Why in your mind, Ian, is there a failure to connect the economic crisis with mental health outcomes?

Ian:                        Because of the lack of alarm at the moment about where we are faced. Australians have the idea that we’re exceptional, that we’ll get through, that we’ll pull through, nothing ever really goes wrong, despite evidence to the contrary, for example the bushfires last year. Every bushfire would just be a local thing and the states will cope. When they went across states, we had no national plan, actually, to cope when the system was overwhelmed.

Australia’s great on Plan A. No Plan B. And so, the size of the crisis and the extent of the crisis really matters. We have not seen an economic threat like the one we are facing. There’s a misunderstanding in much of the literature at the moment around the mental health challenges, the mental health situation. Through both good fortune and good governance, we’ve been able to avoid the health impact that’s been devastating elsewhere in the world. But there’s no avoiding the economic impact.

So, the issue here is we pretend it’s all like, “Hey, look, the health thing wasn’t so bad. The economic thing’s not going to be so bad.” So, we’re optimistic, but actually, the truth is what’s revealed and is underneath is the usual Australian complacency. “Ah, somehow we’ll muddle through and everything will be okay.”

Ginger:                  And I think you described this as being in the eye of the storm when I was talking to you previously.

Ian:                        Historically, we put everything in a separate basket. Health has nothing to do with education. Education has nothing to do with economics. Economics has nothing to do with welfare. What I love about mental health, why I’m so proudly a member and both a Fellow of the Academy of the Social Sciences and of Health and Medical Sciences is mental health is that area of health, which most obviously sits within its social, educational and economic context.

You can only grow a productive brain and live in a productive society if in fact those social, economic, educational opportunities sit alongside the neurobiology of brain development. So, the complexity is actually at the heart of the matter. When something goes really wrong, and now the economic crisis we face and the related economic, educational and social crisis potentially has a devastating impact on that which matters most: the cognitive and emotional development of young people in this country.

Ginger:                  What is allowing the rest of the country then to almost turn a blind eye to it and still somehow hang onto this optimism?

Ian:                        Yes. This comes back to the sort of cautious optimism and complacency. “Oh, dodge the health board. Perhaps we’ll just dodge the economic board as well,” when clearly every signal at the moment is, “We have done well in the health crisis.” And there, people think the COVID-19 thing’s over. “We will all be back to work shortly. Everything will return to normal. There’s been no impact on the economy.”

We haven’t actually seen the collapse of tourism, hospitality, the higher education sector, retail, the creative arts. Even though we can see clear drops of 10% in employment in most coastal regions of South Eastern Australia, the international tourism situation’s not returning. The higher education sector, which has been a major income earner is devastated by the lack of international students.

So, we know that these things are not changing and that many people who are most affected are young people. So, of the 830,000 jobs lost in April and May, not only were 52% in women, 45% were in young people. And of course, it’s devastating for casual employment, for part-time employment, for people who are combining education with employment, who don’t yet have the skills, the assets, the careers to simply sail through this crisis relatively unscathed.

Ginger:                  And also, Ian, I know you’ve done a lot of work on suicidality in regional and rural areas. And I presume that that is also one of the sections of the community that will be really hard hit by this.

Ian:                        I think there’s a disconnect between a very narrow economic narrative. I just recall prior to this happening, there was a preoccupation with a balanced budget. Most economists would accept an almost meaningless concept in the modern world, but a balancing a budget rather than investing in the social, emotional and resources that we require, rather the structural reform that’s required to produce high‑paying jobs in a highly-connected and secure society in the future.

So, I think this is still an economic discussion of debt, a discussion of GDP, a discussion of jobs. We see those jobs endlessly referring to the construction sector, or the mining sector or certain kinds of areas that miss the tremendous number of jobs that are in the healthcare industries, that are in childcare, that are in ageing. We’ve seen other issues. We can’t pay nurses and teachers more in a crisis, but we can invest in other industries.

There’s some disconnect between a very narrow and I’d say male, middle‑aged, business preoccupied GDP concept, and actually, how the economy actually functions in the modern age, but also how society functions in the modern age and who is really most effective. Clearly, if you look at the job figures, it’s women, it’s young people, it’s casual employees. It’s those who are marginalised, it’s those without assets, but does a national narrative talk to those people? No.

We’ve heard endlessly about construction, about tradies, about certain kinds of businesses that need to be protected, about the mining sector, about resources. We’ve heard a tremendous amount about rugby league and the AFL and sport. Almost nothing in relation to the creative arts, to entertainment, to those areas that engage people. We’ve been told that the higher education sector must remain budget neutral at a time when we are spending billions, tens of billions on investment in jobs.

So, there’s something really fundamentally sick about the national narrative, the connect between where people are really at. So, I’m afraid it’s not good enough for our Prime Minister [inaudible 14:22] to say, “Well, it’s just tough days. There are going to be dark days.” People are looking for a story of how do we get from where we are now to the other side. And how do we respond to those who are most marginal because recessions kill the vulnerable.

They’re not like wars. People talk about war on the virus all the time and I find it very frustrating. In wars, unemployment goes to zero, suicide rates go down, societies pull together in the face of tremendous trauma and tremendous difficulty, but the social fabric is drawn together and is closely knit. Recessions tar the social fabric apart and they abandon the most marginal. At the moment, there’s a great reluctance to talk about those who will undoubtedly be most affected by a prolonged economic crisis.

We talk about Australians and Australia as if we’re one set of White people living in cities with high-paid jobs, we’re connected businesses. We’re not. We’re very place-based. There are about 55 functional regions in Australia, different [demographies 15:26], different population mixes, different educational and employment opportunities.

So, this is something we’ve been studying or many years. In fact, we presented to Malcolm Turnbull during the 2016 election suicide rates by electorate, which [inaudible 15:40] affected employment rates, youth employment rates and educational achievement in those areas. In other words, where unemployment is high and education achievement is low, suicide rates are already two to three times the national average.

So, the work we’ve been doing in Northern Rivers in New South Wales, the suicide rate is 40% above the national average prior to COVID-19. So, not only are there issues about young people, about women, about marginal, if you live in rural and regional Australia, if you live in one of the electorates being decimated by the loss of tourism and hospitality and you don’t have higher education, this crisis is much worse for you.

Ginger:                  And also, interesting, given what you’ve just mentioned regarding higher education, and universities and courses that are going to end up costing more and so forth. So, you’ve got a generation of young people, who are already struggling. They are already lonely. They’re already socially isolated. You put a pandemic on top of it and then you’re making it harder for them to access higher education. It’s going to be very difficult for this generation.

Ian:                        Very sadly, this is a perfect storm for young people. Pressure on the higher education system, pressure on the employment system, pressure on social connection during this particular [time 16:54] pressure on families, who otherwise get left to pick up many of these issues. You’ve got to have family and be connected. Pressure on mental health because of lack of mental health services, which of course are a young person issue, again, neglected for a very long time, largely because they’re about young people. Largely they’re not the voting population. They’re not the self-funded retirees that seem to be the preoccupation of many governments. They’re the other group.

So, it is very bad and it’s very interesting to look at the research here. What we wish in Australia is a bit of pragmatism based on evidence. If you look at the 2008/2009 global financial crisis, young people were the most affected. Look what happened in Europe when youth unemployment went as high as 50% in countries like Spain and was then followed by austerity by governments who would not invest in education and employment support. The mental health effects were ongoing. The productivity losses were long over the next decade as a consequence of that.

So, we think it’s a time for governments to get smart. It’s exactly the time when you invest in education. It’s exactly the time when you invest in skills development. It’s exactly when you expand both the quantity and the quality of university training, but also vocational educational training and tying that to industries that actually have high productivity gains. You want to see more nurses. You want to see more teachers. You want to see more scientists. You want to see more health researchers. You want to see more IT. It isn’t just about tradies.

It’s about all those independent skillsets, and they’re mixed skillsets. They’re skillsets of the humanities plus STEM-related subjects. Not one versus the other. They’re a mix of skillsets that create workforces that are required worldwide and are high value. This is exactly when you would expand your investment.

And I must say, in related issues, like the creative arts and industries as well that have a lot of self-funded people, who have worldwide appeal when they are successful and actually drive the cultural creative life. And in fact, encourage us to actually act together.

Government keeps telling you to act together. Well, one of the ways to act together is through the creative arts and industries and expression, and the sharing of that distress in appropriate ways and in responses to it. How do we culturally come together to respond to the crisis we face?

Ginger:                  Ian, to what extent do you think our failure to deal with this crisis is actually related to stigma in the sense that this is a mental illness we’re discussing and not a physical illness?

Ian:                        I think this is where we test whether all the awareness raising around mental health is serious, or it’s token, or it’s superficial. So, we in Australia, and someone put it out there recently, in New Zealand, we lead the world in mental health awareness. But do we mean it?

Now, we have seen in New Zealand the prime minister say, of course, the emotional wellbeing of the country is now part of their national budgeting and GDP. She really means it. It’s part of the whole economic plan.

In Australia, I must say to their credit, Scott Morrison, and Greg Hunt and the national cabinet have all said that mental health matters. But here we need actions, not words. We need serious, deep and continuing investments in the hard issues. Not platitudes. Not, “We care, but actually we won’t act.”

Now, whether that’s stigma, I actually think there is inbuilt structural discrimination in the system, which has never been sort of – so, my earlier reference to rampaging Roy and tranquil sea of complacency is, you know, in Australia, we never fix it. We haven’t fixed the national bushfire response. We haven’t fixed the national higher education system. We haven’t fixed the national energy system. We haven’t responded to the climate change emergency. We’re pretty much, “Bung it together. Stick it together. We’ll get by because of the natural resources that we live on.”

Again, as Malcolm Turnbull noted, there are more resources inside people’s heads than there are under the ground in Western Australia. But given the option, we’ll dig up Western Australia first and sell it because that’s easy, and it gets us quick cash. And we’ve over many, many decades now invested in the mining industry as a quick way out and not dealt with serious structural issues for the 21st Century.

Ginger:                  Let’s talk about possible solutions. I know you’ve said that you’re disinclined to rely on government money and that you think perhaps that solutions are going to come from civilised society. So, talk me through this idea of yours.

Ian:                        One of the reasons I think we’re so complacent in Australia, we have this idea that, “Oh, Central Government probably at the end of the day, it will wander across the right solution. We shouldn’t get too involved.” Now, I think at this stage, that’s wrong-headed.

I think what has happened particularly over the last decade is, in truth, our parliamentary and governmental issues have responded to issues that have been put on the agenda by civilised society. They’ve been late to adopt the legislative changes required.

I think you could say this in relation to the same sex marriage. You can see the unresolved issues around indigenous issues. You can see issues around climate change. You can see the issue in the transition from resources-based economy to a smart economy. Basically, leadership doesn’t come from Canberra. A civilised society needs to actually take action first to indicate then which leaders are required from our national governments and perhaps in this situation, our national cabinet.

So, I think at this stage, what’s really required is those who are in business, in higher education, in social agencies, who are in their own local communities. We see a lot of this at local council and place-based initiatives. A lot of local communities I’m working with are taking actions themselves and then saying to Government, “What we need you to do is support these various areas.” And we have seen, I think, sadly, in aspects of this crisis, but certain recent crises in Australia, Government is the last to respond. So, I think if people are relying on Government to be the first here, I think that’s very wishful thinking.

I think that’s also complacency. I think responsibility lies with the rest of us to actually indicate those areas that demand attention and where it is contentious, like higher education policy, like ongoing energy policy, like investments in young people, like investments in mental health. Then I think we need to have that public discourse, put the evidence on the table, debate the issues, consider the options and actually engage with that particular area.

I’m glad to see in some ways, a greater respect for expertise emerging. Funny how a virus in a real medical crisis – you can be Trump here and say what you like and 100,000 Americans will die, or you can act on medical advice, like people did Australia. It wasn’t that easy and we’ve had only, and sadly, 100 die, but we easily could have had 10,000 people die and we would have had greater economic dislocation than we’ve already had.

You can see the situation now in the United States and the Americas and in Europe. Not only have they got an economic crisis, they’ve got an ongoing health crisis and one is going to continue to make the other worse.

So, I think the issue here is those with expertise, with plans, with experience, with a local connection to place also have an obligation to be active and not passive.

I’m the first to be critical of Government where necessary, but I think the other issue is to say, “Well, if that’s not right, what do you think is right? What are our options?” And I must say, these are complex decisions. There are trade‑offs. There are no easy answers here in the particular sets of issues. We’re going to have to cope with quite difficult issues on an ongoing basis. And that’s going to cause difficulties in difficult areas.

You already see the difficulties, for example, in the aviation sector. We can’t simply reopen our international borders. Clearly that would be too risky. That has devastating effects. We’ve closed our second national airline. Of course, we’ve seen Qantas, our major airline now shed 6,000 jobs and have 15,000 more workers stood down. So, devastating effects on some areas as a consequence of government policy. So, there are hard decisions to be made.

On the other hand, why would higher education remain budget neutral? Why would you try and distort the actual provision of services in that particular kind of sector at this point? Why wouldn’t you massively invest in the creative arts, which employs many young people in self-employed ways, growing particular skills at this particular time? Why wouldn’t you have targeted employment schemes, particularly for young people in key industries, particularly in the healthcare industries and particularly in the educational industries, so in teaching, and nursing, and aged care and early childhood education, major issues for the future.

Surely, if you were thinking about the future mental wealth of this nation, these are areas that would be top priorities, but this is a public debate we need to have. So, if I hear one more discussion of infrastructure, of bridges, of airports, which are actually low in jobs, and high in costs and slow to respond to participation, that may have been what the Government should have done five years ago or two years ago. But now, it’s all about people and the social fabric.

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

Ian:                        Thank you for the opportunity.

Ginger:                  Thanks again for listening to Seriously Social. Next week, we continue our two‑part focus on mental health with esteemed youth mental health expert, Professor Pat McGorry. He is questioning why, as a community, we are so willing to spend billions preventing loss of life from things like heart disease and cancer, but not when it comes to mental illness. And Pat offers us possible solutions.

Don’t forget that 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. See you next time.

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