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The great truths around mental health

6 May 2021

Niels Bohr said the thing about great truths is that the opposite is also true. Isn't that the very definition of counter-intuitive and fantastically thought provoking because of that? Below I lay out a great truth about mental health, and then sort of its opposite. We have to hold these twin truths (or something like them) in our minds if we want to overcome stigma and make best use of this incredible reform opportunity in mental health that sits before us (post Royal Commission into Victoria's Mental Health System).

Truth #1: The combination of mental ill-health and substance use (alcohol or other drugs) can happen to just about anyone.

You, me, your parents, your friends. It is really important that as a society we get our heads around this. Just like with physical health, we are seldom in perfect nick and we have our ups and downs. Just like with physical health, sometimes it’s serious enough to require professional intervention. Even those who don't drink or take drugs in today's insane world are at risk of addictions, perhaps to work, or sex or screens.

All of us. Any of us.

Truth #2: Chronic substance use and mental illness are concentrated in areas of great disadvantage and poverty.

It’s kind of obvious that absolute poverty is a cause of ill-health – think perhaps of a developing country with insufficient food supply. But relative poverty (being poorer than those around you, suffering the disadvantage and stigma) is also a source of ill-health. Australia is growing ever more unequal, and poverty is the ‘cause of the causes’ of chronic mental ill-health.

We all experience pain and loss as children and adults. However, we need to appreciate that there is a tangible difference in expected life outcomes between those of us who had a relatively stable upbringing (often characterised by having at least one constant, caring parent) and those who did not. This is about acknowledging that there are things we all need, the absence of which creates vulnerability, sows the seeds of neglect and abuse and leaves trauma in its wake.

Connection vs isolation. Support vs neglect. Financial resources vs poverty. Encouragement vs silence. Love vs nothing. Any human being sliding to the right on some of those scales will need to summon extraordinary resilience and ingenuity just to survive.

What do we do with this information? We apply our compassionate minds to the project of understanding. We need to see our own vulnerability as we imagine the child that lacks what we all know are essential elements for the daily experience of happiness. See our own vulnerability and remember our own struggles as we imagine the teenager who never had anything close to the basics (and I don't mean material possessions). Picture the young person who made it to 18 years of age without once being told or showed that they were loved, perhaps recently moved to their 30th group home or foster family. The likelihood of early school leaving, pre-teen alcohol and drug use, periods of homelessness and interaction with the law are exponentially more likely for any human being suffering ‘adverse childhood events.’ And the adult? Yes, I think we'd better maintain our compassion for them too.

So, what do we do about this injustice, this inequality, this suffering? We look after ourselves and our own mental health, we look after our friends and family, and we seek to contribute in some way to a society where people get all the help they need. Mental health. Addiction. Cancer. The approach should be the same. Integrated, state of the art support to alleviate pain and suffering, and quite possibly save a life. Delivered wherever possible from one team in one place. To do less is unacceptable.

And what is the fundamental difference between cancer and addiction or mental illness? Simply stigma.

Do we deny cancer care to my aunty Lorna who smoked her whole adult life? Do we write-off her illness as self-inflicted and her care as doomed to fail? Hell no! We fight the good fight. We allocate resources, we build the Peter McCallum Cancer Centre, we research, we give a damn. We reduce harm as a matter of principle. Let’s get over the stigma and do a bit more of that in the field of addiction. Mental health is responsible for 20% of Australia's burden of disease and receives (historically) about 7.5% of health funding.

We are in a period of extraordinary reform in the mental health sector. Don't let addiction be an afterthought.

First Step is running an awareness and stigma busting campaign for International Harm Reduction Day (May 7th). Please click here to see the amazing video contributions of government ministers, workers, doctors, magistrates, campaigners and others:

And to contribute to First Step's fundraising campaign:

Patrick Lawrence
Chief Executive Officer