When Freedom Becomes A Prison: mental health and poverty
When Freedom Becomes A Prison: mental health and poverty
So, this week was Anti-Poverty Week, which ran right after Mental Health Week.
And why should we care?
Well, because there are some issues that will effect every single one of us at some point in our lives, either personally or through someone close to us – like mental health. There is also this fact to consider: Australia is an aging population. This means the proportion of the population with mental and physical health problems is on the rise.
This isn’t just a concern in regards to our overall wellbeing and sense of compassion. It is going to hit us in the back pocket. There’s a reason Former Treasurer, Peter Costello, once urged us to “have one for Mum, one for Dad, and one for the country”.
We’re just not breeding like we used too.
And if we don’t have enough people working, and if the people who are working are busy privately supporting and taking care of our unwell and elderly, it’s not going to be good for cash flow. You don’t have to be an economist to see that.
What we need to do is invest in public infrastructure and services that will take care of our increasingly vulnerable population because health is a matter of our wealth, and our happiness.
I went along to the both the opening of Mental Health Week and Anti-Poverty Week and what surprised me was that in the public discussion of one, there wasn’t much talk about the other – and vice versa.
At the opening of Mental Health Week, the focus was the reforms of the new Mental Health Act 2014 (the Act). Hon. Mary Wooldridge said that the Act would give people real choices. Wooldridge said that by placing mental health “consumers” – an alternative term for patients – at the centre of care, the Act would give individuals power, dignity and choice. What this means is a minimisation of compulsory treatment and an assumption of capacity, leaving individuals and their families free to make their own health care choices.
The problem is that nothing was said about how individuals are supposed to access services on their own, if they lack the capacity to do so. Giving families and carers more autonomy to make important health care decisions sounds great at first glance. However, the reality can mean that people in our communities who are already busy taking physical, emotional and financial care of a person they love, must now also find the time and the resources to be a caseworker and advocate as well.
Wooldridge explains the new reform as furthering a process of deinstitutionalisation (closing down large state-run institutions) that began 20 years ago. This is said to give people more independence, increased socialisation, and reduce costs. Community run organisations and services are supposed to be available to fill the gaps and support individuals in need.
A neighbour of mine was one such person being made “independent”. He was out of an institution and living in his own little unit. Sometimes he had good days. He’d wait in the driveway to chat with a neighbour about what they did at work. Other days weren’t so good. He’d be confused or angry, and the chats in the driveway didn’t go so well. Some days he would stand in the middle of driveway refusing to move. Someone would eventually call the police and he’d be carted off and return again a few weeks later. I never saw anyone come to visit him – other than the police or his caseworker, who would be lucky to get there once a fortnight. He was on his own, without access to the support and services he required, and without the capacity to contribute and connect with his community through employment or socialisation.
At the opening of Anti-Poverty Week, the questions asked by the audience were largely about economics and property, no one asked about mental health. Emma King, CEO of the Victorian Council of Social Services (VCOSS), noted the effects of poverty and trauma on the brain development of young children and stated that early intervention is key. John Daley, CEO of the Grattan Institute, said that the definition of poverty is not just economic. It’s about inequality of outcomes and inequality of opportunity. The detrimental health effects of loneliness caused by the lack of social connection felt when unemployed was also raised.
The outcomes for my neighbour are not equitable. His access to opportunity is not equitable. He is living in poverty – and he is alone.
It’s hard to see my neighbour as a mental health care “consumer”, empowered by the new reforms with the right to make his own mental health care choices.
The definition of choice is the act of making a selection. It implies that there are options, that there are alternatives, and that you are choosing said option because it is the most preferable. That is autonomy.
Let’s not pretend that not forcing people to do things is equal to giving them choices.
The big issue here is resources. How do we ensure that there are adequate advocacy and health care services available and accessible to those who need them? How do we make sure that the most vulnerable people of our community are taken care of, included and respected? How do we stop them from having nowhere to go except our hospital emergency rooms? How we do stop them from ending up living on our streets or locked up in our prisons?
Deinstitutionalisation has been described as a discharge policy that “opened the back door” and an admission policy that “closed the front door”. By reducing compulsory care and turning patients into consumers, are we just pushing our most vulnerable people into the centre of an imaginary consumer circle, with nothing tangible to choose from, no bargaining power, and no where safe and secure to go?
Lucy Adams, Principal Justice Lawyer, talked about the criminalisation of homelessness at the opening of Anti-Poverty Week. When you don’t have a private space, your actions become criminal; like drinking alcohol. When we criminalise homelessness, we criminalise poverty and we criminalise people with mental health problems.
What we need is an intersectional approach to our law and policy making. What we need is an intersectional dialogue about mental health, poverty and homelessness.
Australia has been a world leader in starting open conversation about mental health. World Mental Health Day began here. Mental Health Week has been running for 30 years and this year it was bigger than ever, with the support of the ABC through Mental As, which ran programs and mental health events throughout the week.
But we could do more than just start the conversation. We could set the tone.
We could have conversations that do more than “raise awareness”. We could have conversations of depth. We could start this by seeing people in their entirety and how their problems intersect. We could talk more about what we have to give to the most vulnerable members of our community – not just what we are taking away.
Dana Meads is a Melbourne-based writer, with a particular interest in health, psychology, politics and culture.
Dana has a BA in Political Science from La Trobe University and is currently studying the Graduate Diploma of Psychology at The University of Melbourne. She has a background working in International Human Rights and views equitable health outcomes as a fundamental human right.