What should psychiatrists be doing to improve the mental health of the community?

It is so refreshing to see debate being seen as a key role of the Australian and New Zealand Journal of Psychiatry. And debate not just about clinical trials and science, but more broadly about services and service delivery, education and advocacy, lobbying and politics.

Allison and colleagues (2014) have taken some of these issues forward in responding to an initial piece in the Journal by Jorm and Malhi (2013) and subsequent articles by Carr and Waghorn (2013), Whiteford and colleagues (2013) and Castle (2013). The initial call was to reflect on where psychiatric services are going, in Australia. More broadly, though, there was an implicit question about what we as psychiatrists should be doing to influence the course of mental health service development.

Allison et al. (2014) are quite correct to take the 2014 Federal budget as something of a watershed, as it seems to have within it overt or covert challenges to many aspects of our society, not least welfare, education and health. Of course, psychiatrists should vociferously advocate for our patients in response to the proposed budget cuts in as far as they are likely to have a negative impact on people with a mental illness. Not only will there likely be fallout for our patients’ mental health but also for their physical health. For example, we are very conscious of the appalling statistics regarding unmet need in terms of cardiovascular risk factors in Australians with a psychotic illness (Galletly et al., 2012; Morgan et al., 2014) and many of us have been trying to encourage patients to establish better links with GPs and to have metabolic monitoring performed more regularly (Organ et al., 2010). The proposed AUD$7.00 co-payment for GP visits and laboratory tests will undoubtedly undermine these efforts. The Government needs to hear this and to hear it very loudly. But who should be doing the shouting? To its credit, our College has been advocating for our patients in this regard, but to be truly effective we should, in my view, do these things in conjunction with other Colleges such as that of the General Practitioners and with organisations such as the Australian Medical Association: these groups should be very nimble and, importantly, united in conveying this sort of message. They should also be involving non-government organisations with an interest in mental health as well as advocacy groups and consumers and carers. It is much more powerful having a single strong message than many smaller disparate voices, often with somewhat dissonant views. For this, we need very effective lines of communication across cognate groups in order to deliver strong clear views along with specific advice as to what needs to be done in a timely manner. Use of media should augment this, but care always needs to be taken that the message that gets through is ours rather than that of the journalists or editors interested in controversy and the sensationalism of clashing perspectives.

We also need to be much more proactive about articulating what we believe in, regarding mental health service delivery. Again, I believe our College should lead this. If our professional body does not, we inadvertently perpetuate a situation where the Government turns inevitably and repeatedly to a small, select group of our colleagues who have made it their business to play politics. That these individuals have been effective should be an encouragement to the rest of us that we could actually make a difference with government in a big way if only we were united and articulate and develop the right contacts on both sides of politics.

To me, reliance on lobbying is a poor way to run a country, but, as Allison et al. (2014) reflect, it is the game that is being played and we simply have to be good at playing it. Some individuals amongst us are already proficient at playing this game, but for the sake of achieving broader and truly representative advocacy we require our representative bodies to take on this mantle and regard it as a core component of what they do and, indeed, stand for. And, as individuals, we need to be in lock step with them.

See Viewpoint by Allison et al., 2014, 48(9): 802–804.