Abstract
This month’s issue has a diverse range of articles, with a broad focus on public health. A number of these papers leap out as having something surprising or controversial to say, and have the potential to both influence and reflect public policy, a key function of this Journal.
The first of these is a controversial Perspectives article by Professor Anthony Jorm and Dr Nicola Reavley (2012) dealing with the use of the term ‘mental illness’ when communicating with the public. They provide data showing that the term mental illness conjures up for the public an image of a severe mental disorder, such as chronic schizophrenia. Surprisingly low proportions of people regard mood and anxiety disorders as ‘mental illnesses’. When psychiatrists use national survey data for advocacy purposes and state that one in five adults or one in four young people have a mental illness, this can lead to a gap in credibility if alcohol and anxiety disorders are being included in the figures. It may also stigmatise people with common mental health problems and substance misuse to label them as ‘mentally ill’. This has implications for anti-stigma campaigns: since the public largely associates the term mental illness with severe disorders, the term mental illness is more appropriate for anti-stigma campaigns that focus on such disorders, whereas campaigns focusing on high-prevalence disorders should use specific labels, such as depression and anxiety (Reavley et al., 2010; Reavley and Jorm, 2011). There is an important message here for how we communicate with the public when advocating for greater resources in an under-resourced area of healthcare (Jorm, 2011).
A second paper of substantial policy implications is that by Western Australian politician Martin Whitely (2012). He analyses the reasons for the rapid rise and subsequent fall of prescribing for Attention Deficit Hyperactivity Disorder (ADHD) in Western Australia. This article clearly shows that political factors can have a major influence on treatment patterns. Whitely argues that this influence has been a positive thing, reducing use of medications that can adversely affect cardiovascular and educational outcomes in children. By contrast, a companion piece by Professor Florence Levy (2012) takes the perspective of the clinician faced with managing children with ADHD and reviews evidence that the risks are not as great as Whitely suggests. In particular, Levy argues that the clinical value of treatment has stood the test of time, and unbalanced criticism deters the use of evidence-based therapies (Prosser and Reid, 2009).
A thematically related article by Atlantis and colleagues (2012) also deals with the impact of psychotropic prescribing on the population as a whole. Using data from three large, Australian, national surveys, they show that antidepressant use declined over the period between 2001 and 2007/2008, but the prevalence of psychological distress did not change over this period. This finding is consistent with other research published in the ANZJP which shows that the prevalence of psychological distress did not reduce during periods when the availability of mental health treatments was increasing (Reavley et al., 2011; Reavley and Jorm, 2012). It is possible that clinical services alone are not enough to reduce the prevalence of common mental disorders, and that complementary population mental health approaches dealing with lifestyle and social factors that drive distress are also needed (Jacka et al., 2010; Pasco et al., 2011).
Continuing with this theme, the article by Cvetkovski and colleagues (2012) also takes a population health perspective. They analysed national data on the mental health of tertiary students, in whom previous research in ANZJP has found a high prevalence rate (Leahy et al., 2010). This new research shows that tertiary students have higher rates of moderate psychological distress, but not of high distress. Financial factors were identified as an important determinant of high distress, showing again that a purely clinical approach may not be enough to improve the mental health of this population as a whole. Together with the paper by Atlantis in this issue, this adds to the growing sense that population level approaches to mental health need to be examined as a research and policy priority.
Some good news comes from the article by Leach and colleagues (2012) on equality of access to mental health services. There is a long and continuing political debate about the relative merits of a universal health insurance scheme versus private insurance schemes. Australia has accommodated this debate by developing a hybrid scheme. One of the concerns raised by the opponents of private insurance is that it will increase inequalities, particularly in disadvantaged groups who cannot afford private cover. Leach et al. (2012) show that people with mental health problems have a lower rate of private insurance. However, this does not adversely affect their access to mental health services.