Is the Royal Commission into Victoria’s Mental Health System an anti-stigma intervention?

‘There were monsters’ and ‘Victoria’s Mental Health System is broken’. These are just two of the newspaper headlines from the first few days of the Royal Commission into Victoria’s Mental Health System. The first of these, in the online version of Melbourne’s The Age newspaper, was taken from a description of experiences in an NSW inpatient unit in the 1970s.

While headlines like these may be a powerful tool for those advocating for much-needed reform and increased funding for mental health services (Whiteford et al., 2016), they also directly counter the key messages of decades of mental health awareness campaigns designed to close the ‘treatment gap’. These typically emphasise the effectiveness of psychological therapies and medications and urge people to seek professional help.

As a population mental health researcher working in the area of stigma and discrimination and mental health literacy, I was invited to give evidence to the Commission and did so on its second day of hearings. My research has two broad aims: to encourage people to recognise when they have a problem and seek professional help and to mitigate the discrimination and social exclusion often experienced by people with mental health conditions. As I listened to the witness testimony and read the media coverage, I wondered: what might be the impact of these headlines on a young person who, for example, is distressed, hearing voices and weighing up whether or not to ask for help?

Giving evidence involved careful preparation of a witness statement and several discussions with the lawyers assisting the Commission. During this process, one of the lawyers suggested to me that this Royal Commission might be an anti-stigma intervention. Indeed, on its own website, the Victorian Department of Health suggests that the Royal Commission ‘provides an opportunity for a wider community conversation about mental health – toward ending stigma and discrimination’ (https://www2.health.vic.gov.au/mental-health/priorities-and-transformation/royal-commission).

Perhaps, this view was inspired by the recent Royal Commissions into Family Violence and the Institutional Responses to Child Sexual Abuse (Berk et al., 2014). Although not designed as public awareness campaigns, these inquiries have led to increased awareness of the issues and public vindication of people who have experienced abuse and violence. Interventions promoting reporting or help-seeking and ‘bystander interventions’ encouraging people to help others have followed.

High-quality, accessible services are essential to reducing the burden of disease related to mental disorders. But people with these conditions need to seek help from services and actively engage with treatment. Particularly for common mental disorders, durations of untreated illness are often measured in years.

All those involved in this Royal Commission, including witnesses, lawyers and staff, can play a key role in ensuring that an unforeseen side effect of the process is not to increase stigma and further discourage professional help-seeking by those who need it most. Careful selection of witnesses with recent experiences of the Victoria’s Mental Health System and a focus on what does work, as well as what does not, are likely to be central to this. While no one would question the need for mental health service reform and, critically, increased funding, members of the public are far more likely to report positive experiences than negative ones when they are asked about their treatment by health professionals (Reavley and Jorm, 2015).

Media reporting of the evidence given to the Commission is also likely to be critical to ensuring that stigma and low levels of help-seeking are not exacerbated. The need for responsible media reporting is recognised in suicide prevention. In line with the Mindframe (https://mindframe.org.au/mental-health/communicating-about-mental-ill-health) guidelines, journalists are discouraged from using language that sensationalises suicide or reporting details of suicide methods. Every article on suicide or mental health now provides phone numbers for Beyond Blue and Lifeline.

When people do not have personal experience of something, they are more likely to rely on stereotypes. In our work, we have looked at the impact of media reporting or personal experiences on views about people with mental health problems (Reavley et al., 2016). In the case of depression, people are much less influenced by the media than in the case of schizophrenia. Because schizophrenia is less prevalent, people are less likely to know someone with the problem and are more likely to have stereotypical views informed by other sources, such as media reporting. This is likely to be particularly critical in any media reporting of the Royal Commission’s examination of the forensic mental health system, which is planned for next year (Ross et al., 2019).

While the Victorian government has agreed to implement the recommendations of the Royal Commission, this is likely to take years and to need substantial funding increases in order to bring about real change. In the short term, we risk deterring people from seeking the help they need and further stigmatising people who live with mental health problems. Careful consideration of these risks is needed to avoid this.