Assumptions - Fuck you, fuck the lot of you!

There are a hell of a lot of assumptions that go on in mental health care and policy.  I've been thinking about it a bit lately, and what keeps coming up in my mind is Adam Hills... see below...

Fuck you.  Fuck the lot of you.

Fuck politicians that say, in regards to Better Access - "If you think you will need to access more sessions, I encourage you to speak to the GP who refers you to mental health services and professionals. GPs liaise with mental health professionals and counsellors so that patients can achieve the best possible services and outcomes. There is a lot of information out there and it can be confusing, but I really recommend discussing your whole Mental Health Treatment Plan with your GP." (Tania Plibersek).

Fuck you for speaking to mental health consumers as though they are intelligently impaired.  Fuck you for thinking that it's OK to speak to anyone in that patronising manner, and fuck anyone who thinks that the manner isn't patronising.  Yes, sometimes the crap the government puts out is confusing - but what the fuck kind of chance do you think a GP has of figuring it out, when they also have every other aspect of health to keep on top of, if someone who can devote larger parts of time to research can't work it out?  You are assuming that we're a bunch of fucking idiots, and I don't fucking appreciate it.

I'm crass.  I lack fashion sense.  I have teenage taste in music.  I'm not a fucking idiot.

The problem is that the system is fucked up.  It's got nothing to do with individuals being confused.

Fuck the ATAPS system.  The entire fucking system.  Fuck the lot of it.  What a waste of fucking time, resources, and money.  There are so many assumptions that come into play when it comes to this system that it defies fucking belief that anyone with more than two brain cells could actually think it would ever work, but here's some that piss me off the most:

1) The idea that ATAPS will reach more disadvantaged communities than Better Access can, or will.  If only the fuckwits that decide these things had ever fucking lived in a disadvantaged community...  Seriously - how the hell is an entire system of people going to reach disadvantaged people more than one single practitioner?  It defies basic fucking physics for a start.  It also costs a shitload more.  If you want to reach disadvantaged communities, you don't take their care away while you fart arse around with some scheme that a fifth grader can see won't logically (or physically) work.  You find out what the barriers are, and you fix them.  Is it money?  Then up the rebate for anyone living in those communities.  Is it public transport or physical access?  Then fix the fucking problem at hand.

2) The idea that ATAPS will work better for people with severe issues.  For starters - how the fuck do you define a severe issue?  At the moment, we seem to be going on diagnosis alone, with some fuckwits calling depression and anxiety "garden variety" illnesses.  I bet that particular arse would lack the balls to go up to the family who has lost someone to suicide due to depression or anxiety and tell them that it wasn't "severe".  A diagnosis alone doesn't indicate the severity of the condition.  It also doesn't take into account that there may be diagnosis's that we haven't named yet, nor that some may be redundant.  Like or hate the DSM, I think it's pretty obvious that it exists purely for insurance purposes, and as a general guide, and not out of any deep insight into the how's and why's of mental illnesses.  We need to get a system up and running that takes each persons case as an individual case - not square them into a round hole.  That sort of pushing people out of shape ends up with deaths.

Fuck government departments that listen to arseholes that lie about shit.  And fuck people who pretend to give a shit about people when the only people they give a shit about are themselves.

Fuck anyone who contributes to stigma.  I try to keep up with current developments in ASD theory and programs, and the best way to do that is by social media.  Nobody researches better than a mother worried for her child.  Some of these women are fantastic.  Some of them need a bitch slap.  I am sick and fucking tired of hearing "my kid doesn't have a mental illness - they have a neurological problem.  There is nothing "wrong" with them."  There's nothing "wrong" with people who have a mental illness either sweetheart - not in the way that you obviously mean.  Yes, your child doesn't have a mental illness, and it can be frustrating to constantly distinguish, especially when you need to put forth with force the idea that it is not something that can be "fixed".  However you can take your stigma, your patronising fucking attitude and shove it up your arse.

And while I'm at it - fuck anyone with a mental illness who does the same to people with a drug and alcohol problem.  And that, sadly, includes me.  I have done it from time to time.  "I have a mental illness, I'm not a fucking druggie".  It's the tone - the idea that one is OK, and the other isn't.  The fucking superiority complex.  It pisses me off when mental health professionals ask me when I last took drugs.  I've done pot twice, to see what it was like.  That's it.  I don't have a fucking drug problem. But...

The way I look at it now - people who do drugs and alcohol are either in some desperate need of help, and the only help they could find was substance abuse, in which case they need our compassion, not our disdain; or they are just fuckwits (and allow me to point out that it's not like we're lacking in fuckwits in any type of demographic).  Who also probably need our compassion and not our disdain.  In any event, I don't think that "just because" someone goes down that path, that they are any "worse" than someone who doesn't.  Just like I don't think that having a neurological disorder is any "better" than having a mental illness.

We're all fucking human for fucks sake.  When the fuck did compassion become a commodity???  When the fuck did it become OK to judge someone based on the name and cause of their suffering?  A football player goes out and gets banged up in the name of fucking sport, and I'd bet my arse we would all feel bad for them.  But fuck that 19 year old who was raped as a six year old and has turned to drugs to numb the pain and take away the nightmares - that girl should know better!!!  There will be no compassion for her today!

Yeah - fuck that shit!!!

And speaking of stigma, fuck this idea that more education is going to work.  How many studies do we need to say that it doesn't before we'll listen?  Do you know what will work?  Proper health care.  A choice in health care options that suit the person, not the demographic.  We do this for kids under six with Autistic Spectrum Disorders - so it CAN be done.  And health care that takes into account intentions, and not just acts.  I've heard WAY too many times of people self-injuring just to get someone to help them.  Because until they self-injure, they are ignored.  If we want to combat stigma, we need to start treating people with a mental illness as intelligent until individually proven otherwise.  We need to start giving people options that work for them.  We need to get people back on their feet, so that having a mental illness isn't a fucking life sentence of social exclusion.  We need society to be able to point at Johnny and say "hey, he has a mental illness, and he's OK" instead of pointing to people like me and saying "she has a mental illness and look at how fucked up she is - I don't want anything to do with THAT".  You can educate all you fucking want, but until such time as people with a mental illness are treated as people first, you've got fucking buckley's of changing how people see us.  And as for the rest who will believe that mental illness is something humanly inferior even when it slaps them in the face that it's not - you're never going to change their minds anyway.  So fuck 'em.

Fuck public mental health.  I am yet to meet someone who has been truly helped through the public system.  I assume they are out there.  Somewhere.  I do know about the countless fucking people who have been abused.  Who have been given the wrong medication or the wrong dose - and I mean life-threatening wrong here, not just the stock standard "this shit doesn't work" or "I'm having an abnormal reaction".  Then there's the countless more who have begged for help, only to be turned away, who have then turned on themselves.  Our public mental health system is a fucking disgrace, and not all of it is to do with being under-staffed and overwhelmed.  The public mental health system is over fucking regulated when it comes to paperwork and strategies, and under fucking regulated when it comes to the hiring of fuckwits.

I've been reading up on a variety of Mental Health Commissions lately, and it is really starting to piss me off.  In general really, though some of it does actually read well.  Unfortunately, it's the same old shit that I see everywhere.  It's the same old shit, given a new name, with some new players.  Somewhere, there's a database of documents that just get copied and paste with a few words changed so that we don't plagiarise. It's hard to read without wanting to cut my fucking wrists - again.  It's hard to imagine that THIS time is going to be any fucking different.

"We have a brand new mental health plan.  We are investing in the future of mental health!"

No, you have the same fucking plan you had last time, just with different signatures at the bottom.  You have had the same plan for quite a while now, and done jack shit about any of it.  You are good at making fucking plans, and completely fucking crap at implementing them.  Perhaps if you pulled your fingers out of your arse, you could get something done, other than make up pretty posters to stick behind the Premier when she gives a speech.  Perhaps if you didn't crap on about "accountability" so fucking much and just let people get on with their jobs, they could actually have the time to do their fucking jobs.  I wouldn't worry about accountability at all - we've had accountability for some fucking time now and it's fucking useless.  People are still abused, they are still neglected, they are still treated like crap.  People are still people.  Instead of self regulating shit - how about we just make it fucking easier for people to complain?  Make it so that people don't have to be scared to complain.

The shit we've had doesn't work.  And yet, we seem to be pushing forward with plans to do the same shit again.  The same systems.  The same ideas.  The same consultations.  Someone once told me that there's a reason that people listen to Hickie, and not me.  Yeah, you're right.  People listen to people like Hickie because it's EASY.  It's easy to make small changes and pretend you're being revolutionary.

Pity it fucks us over.  This complacency.

We need to start remembering where we come from.  We didn't invent the wheel by slightly changing shapes every few years until we got it right.  No, some fucker decided "let's try this shit out", and let it rip.

Psychological therapies are getting there.  Getting rid of any sort of respect for Freud was a great start.  We have a ways to go, but once people start accepting that everyone is different, and is going to need an individual therapy, rather than the tick-a-box each week therapies, we'll get there.  Psychiatry needs a good kick up the arse, but that has more to do with corrupt fuckers than it does with science.

Policy however - the politics of mental illness - this shit needs to be thrown out so that we can start again.  Get all the departments, and sub-departments and get rid of them.  Find the people who work there new jobs in other areas.  Start fresh.  Brainstorm.  No idea is too fucked up until it is.  Look at the actual problems that we face, instead of the perceived problems.  Look beyond the information collected, and find out how it is collected.  Pick every little thing apart, and question it.

Because this shit isn't working.  And we desperately need something that does.  Something completely different.  Not just the same old shit with different branding.

The government always assumes that it's been on the right track and that only minor changes are needed.  Fuck that shit!  Fuck assumptions.

Assume NOTHING!!!

Stigma - how much coming out is too much?

In an article today, on stigma in relation to mental illness, Glenn Mitchell writes that:

"I do think provision of mental health services is a big problem in regional Australia but in small communities I think some people just feel that there's a bit of a stigma that if I let my best friend or my girl friend know about it that everyone is going to find out about it, but I still have the thought process that so what if everyone finds out," he said.

So what if everyone finds out?

Here's what...

* Teenagers are bullied to the point that they attempt suicide.
* People of all ages find that family and friends stop talking to them, bitch about them, and sometimes openly ridicule them.
* People lose their jobs.
* People have their property vandalised.
* People in small communities find that complete strangers know who they are.  They know this, because the complete strangers look scared when they meet in the street.  This particular example is that of a fifteen year old boy whose own mother refused to talk to him.
* Physical abuse.
* Sexual abuse.
* Emotional abuse.

I've talked to a lot of people that have a mental illness, and I've talked to them in places that most don't want to admit exist - this shit happens to people when people find out.

That's what Glenn.  That's what.

Look - I get that we need to break down stigma.  That has to be one of our top priorities.  However, not everyone has the open family and the understanding friends - and encouraging those that don't to speak out to their family and friends is irresponsible.  Because some kid is going to read that story and believe you because they desperately want to believe it's true, even if in their heart they know it's not.  They are going to want to believe it's true, and they are going to speak up, and they are going to suffer the consequences, and we are going to lose them!

So how about this, for now...  How about, for now, we encourage people to speak to someone they trust.  Let's not pretend that everyone is going to be understanding.  My family isn't.  They don't want to speak to me.  And quite frankly, I don't care.  For me, this article is correct - so what if I lose a family that was never there in the first place?  But I'm not a fifteen year old kid about to get the crap beaten out of him to "toughen him up".  So can we please assume that fifteen year old kids with deadbeat family are going to read this, and tell them to speak to someone they trust.  Maybe it's a family member.  Maybe it's a teacher.  Maybe it's their doctor.  Maybe it's a friend.  And then they can make a judgement call on whether or not to tell people in general.

I would love to live in some Utopia where we can all just be fucking honest about who we are.  We don't.  We live in a world that will kick us when we're down, and being honest and finding out your family and friends are the ones who will do the kicking - that's a fucking shitty way to learn that particular life lesson.

There are people who can speak out without severe repercussions - and they should.  That is why I do.  I can now.  Let's not forget our brothers and sisters who can't speak out.  Let's not tell them that it's safe to do so until it fucking well IS safe to do so.

So in closing - my advice on "coming out"...

Do what you think is best for you.  Look after yourself first.  If you can, find someone you trust.  If you can, get some help.  Talking about it IS important and I'm not trying to say it's not.  I'm just saying - only speak up if it's safe to do so.

Glenn was right - the more people that help, the better chance you have of recovery.  That is dead set true.  We just need to lose the assumption that the people around us are the ones that will provide that.

Once Upon A Time... (SBS)

I missed "Once Upon A Time In Cabramatta" last week (a three part series shown on the SBS - the first episode can be found here for a limited time).  It is about the "drug war" in Cabramatta - and of course, the Vietnamese Australians who live there.

As I was looking at Twitter during the advertising, I noticed one unremarkable twit's comment which had been retweeted by another:

"I don't feel sorry for the parents when couldn't be bothered to learn English in 30 yrs they lived here"

OK - to be fair - I was brought up with this attitude.  Then for a while, I decided that it was racist, but as I didn't know why I thought it was racist, I just tried not to have an attitude at all.

Then I moved to a country where I knew not one word of their language, and I lived there for eighteen months.  And I can tell you a few things about that.

For starters - I doubt these parents do not know "any" English, but for sure I don't blame them one iota for not wanting to speak in English on television.  I know that if I had continued to live in Japan, there would never ever come a day when I would feel comfortable speaking in public in a language that was not my first.  It would just never happen.  Thus, I don't presume to know whether or not they speak English.  It's entirely possible they do.

In keeping with this twit's comment however, I'll move on as though they don't.

Language acquisition is a funny thing.  Most people do not understand that language is not learned by memory.  Language is learned in the first ten years of life, mostly in the first few years.  After THAT, language acquisition is memory.  Feel free to Google it to look up the specifics if you're interested.

This means that while it takes children a few years to learn a new language - they are essentially cheating.  Learning a new language is much harder for adults as we have to rely on memory to do so (at least, until we've practised enough to form new synapses from what I understand).  Each and every adult has a different memory capability.  My own memory can be clinically described as "up the fucking shit".  Which explains why in 18 months, despite buying a tonne of books and practising whenever I could, I learned no more Japanese than it took to get the very basic of basics (and not be swatted by taxi drivers intent on proper formalities - never again shall I say the shortened form of "thank you" to someone I am not familiar with).

And all that is without the added drama of wrapping your head around the fact that it's not just the different words - it's the different grammar!!!  It's not just replacing one word with a different word, but learning how to speak from scratch.

In other words - it's fucking hard if you are not that way inclined.

Thus, one issue with learning English once migrants arrive in Australia is one of technical capability - it is possible that no matter how hard they try, they will simply never acquire conversational English, let alone enough English to feel comfortable speaking in public in the language.

The other issue is one of morality.  I have been finding that white Australians bleat on about "multiculturalism" when in fact, what they want is "white culturalism, but I don't care if your skin is a different colour".

See, I see multiculturalism as being - you live the way you want to and I'll live the way I want to, and we'll visit each other and have fun learning about each other.  Perhaps I'll take some part of your culture into mine and perhaps you'll take some part of mine into yours, but what-the-fuck-ever-works.  In this definition, what language each person is speaking is not important.  Trust me - so long as you've got please and thank-you down pat - you can get by on the universal sign language of facial expressions and general gesture.

This twit has never met these people - so who the fuck cares what language they speak?  What is it to her?  For fucks sake, is compassion and empathy such a limited commodity, that regardless of what language they speak, a little can't be spared for parents whose son turned to drugs and dealing in order to escape a gut-wrenching poverty?

That, my dear, is racist.  Pure, simple, right down the line.  And THAT is at the heart, I imagine, of why such sad stories exist in this country.  It's not a drug problem - that is just the consequence.  It's a fucking racist problem.

Calling a spade a fuckwit

Credit: No idea - it did the FaceBook rounds...

Given good quality and regular psychological care is now only within the realms of the rich, I have decided to try screaming obscenities.

Brace yourself.

I have been e-mailing politicians in order to enlighten them of my concerns to the cutting of the Better Access Initiative.  Over the last couple of days, I have received mostly automatic replies, with a few "I've told my assistant to tell you I'll look into it"'s, and a couple of "you do not live in my electorate therefore bite me"'s.  Fair enough - they are (god I hope) busy running the country and thus this was to be expected.

One reply however, pissed me off in a rather spectacular way, and not simply because it was a cut-and-paste disguised as an actual reply (I can Google people).  What pissed me off was the content of the information itself, as well as the fact that it is being used in a formal capacity as the justification to screw the average person with a mental illness over.

I have included the e-mail, and addressed it, below:

Dear Ms Wemyss,

Senator Cameron has asked that I acknowledge your email of 25 October 2011 and thank you for raising your concerns regarding the Better Access initiative.

While I'm sure Senator Cameron did not actually ask that Jessica reply to Linda's e-mail, but rather said something along the lines of "get onto those fucking e-mails too will ya - my inbox is getting full" - it is a nice personal touch.

The 2011-12 Budget provided a record investment of $2.2 billion over five years in new and expanded mental health services.  Included in this investment were some changes to the Better Access initiative.

The government says "changes" - I say we got our fucking arses handed to us.

The Australian Government is concerned that while Better Access is a good program for those it is reaching, it is still not servicing hard to reach groups like young people, men, people living in rural and remote regions, Indigenous Australians and people living in areas of high socio‑economic disadvantage.  In fact the evaluation showed that people on lower incomes received both significantly less services and funding under Better Access than those on higher incomes.

I'm on a low income (DSP).  I live in a rural area.  And to whoever thought to come up with this particular argument for taking away the one support I have - go fuck yourself.

If the system is working, but not reaching the "right" people (and I don't accept the premise that this is the case), then change the system to make it better - don't throw it away.

From 1 November 2011, the cap on Medicare rebates for eligible people with a diagnosed mental disorder will be changed from 12 sessions per year to ten.  Following the initial course of treatment (a maximum of six sessions) consumers will be able to access more sessions of up to ten.  Consumers are also eligible for ten group sessions per calendar year in addition to their individual sessions. 

Bullshit.  It is being cut from 18 to 10 sessions.  My two year old is pretty good with his numbers, if the government would like some tutoring.

In making these changes the Government has listened to mental health experts and examined the available evidence, including the independent evaluation of Better Access.  After more than four years of operation, the Government has a clear sense of how the program is being used by providers and consumers.

Actually - in making these changes, the Government has listened only to those it has deemed "worthy".  Many mental health experts have challenged the cuts.

Providers and consumers, in general, are pissed off at the cuts.  I suggest to the government that given providers and consumers are the ones providing and consuming, we have a pretty good fucking sense of "how the program is being used".   At this point, I really wouldn't assume that the Government has a "clear sense" of where to find it's dick, except that we're all being royally screwed.

The findings of the Better Access evaluation showed that almost three-quarters of people who access services used between one and six sessions a year.  The majority (87 per cent) of current Better Access users received between one and ten sessions and will therefore be unaffected by this change.

Yes.  Fuck the 13%.  The 13% are I'm guessing, more likely to have complex needs and more likely to be suicidal.  A fair whack of cancer patients don't go on to have chemotherapy - should we stop funding that too?  And if the government thinks we're talking about talk-therapy vs. death, then I'd invite the government to go and meet the families and friends of the approx. 65000 Australians who try to kill themselves each year, and tell them that their loved ones aren't worthy of treatment.  I don't suggest the government tell it to people trying to kill themselves.  I think the government has given them enough to deal with for now.

People currently receiving services under Better Access will be able to access up to 12 individual and/or up to 12 group sessions prior to 30 October 2011.  In exceptional circumstances, and where there is a clinical need, they can access an additional six individual services prior to 30 October 2011.

From 1 November 2011, the new arrangements will apply. Individuals who have already accessed ten or more individual and ten or more group services by 1 November 2011 will not be eligible for additional services until 1 January 2012.

So they are left with nothing.  Over Christmas of all fucking times of the year.  Bravo.

The Department of Health and Ageing is working on implementation arrangements and further information will be made available to consumers and providers in the near future.

What near future is that?  I received this e-mail on the 27th October for fuck's sake - the cuts kick in this Tuesday.  I'm guessing Jessica didn't proofread before she sent this e-mail.  There has hardly been a mass advertising campaign - certainly NOTHING to the general public.  Not surprising obviously.

The Better Access initiative was introduced to address low treatment rates for high prevalence mental disorders such as depression and anxiety – particularly presentations of mild to moderate severity where short term evidence based support is most likely to be useful.

Short term evidence based support is MORE than 10 sessions.

While some people with more complex or intensive care needs may benefit from psychological interventions under Better Access, the initiative was not designed to provide intensive, ongoing therapy for people with severe, ongoing illness. 

And yet, it is working for that anyway.  In any other area of medicine, this would be seen by all as a GOOD thing.

It is important that people get the right care for their needs.  People who currently receive more than ten allied mental health services under Better Access are likely to be patients with more complex needs and would be better suited for referral to more appropriate mental health services. GPs can continue to refer those people with more severe ongoing mental disorders to Medicare subsidised consultant psychiatrist services, where 50 sessions can be provided per year, or state/territory specialised mental health services. 

Many people ARE getting the right care for their needs.  Or they were at least.

If people wanted to see a psychiatrist - if they thought that would work for them - they would be doing it already.  And probably are.  Thus, the government is forcing people to see a specialist they do not want, or do not need - or just forcing them to go without altogether if they figure it's not worth their time to see someone they do not want or do not need.  People with "complex needs" are still capable of deciding for themselves what works for them.  For the very very few who are not, I'm sure their GP isn't sitting there going "well, I could refer to a psychiatrist because I think that would be more appropriate, but fuck it, I'll refer to a psychologist instead, just for shits and giggles".

The Government is also investing through this year’s Budget, $549.8 million to provide coordinated and flexible funding for people with severe mental illness and complex multi‑agency needs.  This will provide eligible individuals with a single point of contact, a care facilitator, and will assist about 24,000 people and their families.

Again with the telling people what they need.  That aside - where is this funding?  Where are these services?  Who is this single point of contact that I might call this Tuesday?  Might it not have been a good idea to set this shit up BEFORE taking away current services?

To help make psychiatrist services available in more areas, from 1 July 2011 the Government is providing new Medicare rebates for video psychiatrist consultations for patients living in regional, remote and outer metropolitan areas.  GPs, specialists and other health professionals will be provided with financial incentives to help deliver these online services and funding will also be provided to support training and supervision for health professionals.

ROFL.  Has the government ever tried to access the internet rurally?  It's provided by satellite and coverage depends on the weather, the satellites, and I imagine some higher power's general mood at any given time.  I can just imagine the conversations now... "Hello Dr. Quack, I'm feeling suicid... beep beep beep".  Not to mention added complications such as ensuring privacy ("Yes you can talk to your doctor about how I'm beating the crap out of you, but I'll be standing behind the desk here where he can't see me" - it's every abusers wet dream), whether or not the person is computer literate (or literate in general), or even whether someone has access to a bloody computer at home (because doing therapy in a public library is really what we all wish for *rolleyes*).

Hey, it's a great idea to offer it as an option.  But to take from a program that works in order to do so?  Is the government fucking kidding me?

Also - taking money from psychologists and giving it to psychiatrists is like taking money from therapy and giving it to medication.  Oh wait... that is exactly what it is doing.  If only all mental illnesses could be cured with a few pills...

Credit: Picture - Steve Sneider (2011); Text - Ania Krysztofiak

Every cent generated from the changes to Better Access is being redirected to double the number of services targeted at vulnerable and hard to reach groups through the Access to Allied Psychological Services (ATAPS) program, as well as investing in additional services for early intervention youth services and improving the coordination and accessibility of services for individuals with severe mental illness.

ATAPS in my area gives you a maximum of 8 sessions per year.  No choice of practitioner - not even a guarantee of seeing the same practitioner for each visit. I have done "see whoever is on shift at the time" and it nearly fucking killed me.

If a private psychologist gets a little mouthy, you can tell them to fuck off and find another one before it gets too bad - if a psychologist at ATAPS gets a little mouthy - you've got nothing.  And if the government thinks for a moment that there are "complaint systems" in place - then I'd like to shove their arse into a public psych ward, and a week later tell me how well those work in real life.

I don't think ATAPS is working as well as the government thinks it is and/or they simply don't give a fuck.

The Government does not take the decision to make changes to Medicare services lightly, but given the tight fiscal environment it has a responsibility to ensure that its investments are appropriately targeted to ensure maximum value.

Maximum value?  My psychologist is not a fucking commodity.  Last night, she was the person who took me from "I've just lined up all the medication I have and was about to down it with a bottle of Jack Daniels except my husband came home earlier than expected" to "Fuck it, let's die another day".  Next week, my only option is hospital.  Let me tell the government about hospital.

A few years ago, the police picked me up at a park and took me to hospital.  I was suicidal.  There were no beds, so despite the fact that I just been made homeless earlier that evening, they let me go at 2am in the morning.  The next day, my best friend, who had travelled three hours to come and get me, called the hospital to tell them I was still suicidal and should he bring me in?  He was told "Call back when she's done something".  When I've done something.  I have to actually cut my wrists or swallow a bunch of pills before they'll even consider a pre-admission meeting.  Now granted, experience has revealed that I'm bad at most things, and I can add trying to kill myself to that list, given I've tried and failed twice (three times if you count the first one, which was pretty doomed from the start).  Next time, I'm not going to fail.  Mainly because some emergency department doctors have given me such great advice on how to succeed next time.  Seriously.  "Next time go up, not across" was said to me as my wrists were being stitched.  I took note for future reference.

THAT is my other option.  And if the government thinks that is acceptable for me - let alone a child, teenager or young adult - then they are cunt of the fucking millennium.  McGorry and Hickie, stand aside...

The Government is also investing in a range of expanded mental health services, including:

·     doubling funding to the ATAPS program delivered through Divisions of General Practice and Medicare Locals into the future;

·         30 more youth friendly headspace services;

·         16 new Early Psychosis Prevention Intervention Centres; and

·         a doubling in the number of Family Mental Health Services.

Wank, fucking wank.

More information about these and a range of other initiatives can be found at www.health.gov.au/mentalhealth

I trust that this information is of assistance.

Well, it did give me something to do today...

Yours sincerely

Jessica Xxx (because the poor woman is just doing her job)

On Behalf of

Senator Doug Cameron

Senator for New South Wales

And not one of these arguments addresses the fact that I've been seeing my psychologist for three years, AND I FUCKING WELL LIKE HER.  After fifteen years or thereabouts, of seeing every quack under the sun, I found someone who knows what she is talking about, and is prepared to do more than just listen to me bitch about my previous fortnight.  I trust her.  And sometimes I may blush and do some deep breathing first, but I can tell her anything.  I don't want or need a "team".  I don't want or need a psychiatrist.  I sure as shit don't want to do therapy online any more than I want to do pap smears online.  ATAPS is simply Better Access without choice or continuity of care, so I don't want or need that either.

I would have had a hell of a lot more respect for the government if they had just stood up and said, "OK, we're in bed with McGorry and Hickie and have decided to fund their pet projects and have decided the rest of you can go and get fucked in order to fund it".  It would have been clean.  It would have been honest.  Instead, on top of having therapy cut, we're continually trying to determine whether the government is truly deluded, or just plain evil.

At this point, I think I'll assume both, and henceforth refer to them as a collective bunch of fuckwits.

Further Blogs to read:

Pretty sure none of them swear ;-)

If I haven't listed your blog on Better Access, and you think that negligent of me, feel free to e-mail me at lindamadhatter@gmail.com and I'll add it for you.

Talking Fairleigh: The Personal Face of Cuts to Better Access

Talking Fairleigh: Impact on Rural Australia

Clem Bastow: The Problem with Health Advocates is When They Don't

Thembi: Better Access Blog

John Alchin: Ian Hickie Rejects Better Access in Mental Health Reform Debate

John Alchin: Prescient Remarks About Mental Health Funding

Mike Stuchbery: Cutting Better Access Hurts Us All

Precocious Lotus: Cuts to Medicare Psychology Sessions: Please Mr Butler Are You Serious?

Left Flank: The McGorry/Hickie Reform Controversy: Why Has Mental Health Become So Political?

If this article, or my general being, has distressed you, please feel free to call Lifeline on 13 11 14.

Sebastian Rosenberg

Sebastian Rosenberg, a senior lecturer at the Brain and Mind Institute (for those playing at home, the same Institute that Ian Hickie heads), has written a piece for the Canberra Times.  It would be sweet to see friends sticking together as such, if it weren't reministant of playground bullies gathering together in order to take our lunches away.  For our own good of course *insert sarcasm*.

As part of his piece, Rosenberg writes "Mark Butler has travelled widely and has proven himself a willing listener. There is never a shortage of complaints in mental health so this is no small thing. Butler is now, as I understand it, formally the Minister Assisting the Prime Minister for Mental Health. This moves him and his portfolio responsibilities clearly out of the realm of health and gives him licence, indeed obligation, to work with Jenny Macklin's Department of Family and Community Services, Tanya Plibersek and Mark Arbib in Housing, and Chris Evans and Kate Ellis in Employment and Education in relation to mental health."

So let me clear this up for people who may not have had the pleasure of attending the two online "forums" I have; and that Mark Butler has "attended" in order to provide a QandA session...  The term ButlerBot has come about for very good reason.  Mark Butler has answered very few questions, and only those that could be answered with what has been an obviously predetermined response that puts forth the usual government spin.  Both times there were photo's of him sitting at his computer - while I didn't bother wasting my download limit, I suspect they were probably very similar.  Indeed the description both times of him being in his PJ's seemed to put forth the idea that the photo's were just for show.  Who knows?

I have talked to many people after both events, and am yet to hear anything positive about their experiences.  Not surprising really, given how obvious it was to all that Mark Butler couldn't have given a rats arse about anyone there, or anything that was discussed.  He had an agenda of selling the latest budget and he stuck to it like glue.

Not impressed.  Tell us what we don't want to hear - but don't just ignore us while pretending to give a shit.

While I'm sure that Mark Butler has been making good use of some frequent flier miles (or at least acquiring them), I doubt very much that he's listening to anyone who isn't singing his praises.

As for how well he'll do with his new title of Minister Assisting the Prime Minister for Mental Health - I'm hardly sitting by waiting on the wings of anticipation.

"Butler has stated that the Government's support for a commission is based heavily on community support for such an entity. In my view, such support reflects fatigue with the same old debates and the same old voices and interests."
Based heavily on community support hey?  Well, you know what?  I think that one of the few things the government and McGorry Crew have done well is unite the country around the issue of mental health.  They've done this so well, that few are asking the pertinent question of "Show Me The Money".  All the community knows is that there is some, and they're happy as.  And who can blame them?  Mental health has had a bad rap for - well, ever.

We may have new voices and interests - and yes - wait - we have new interests.  The new voices are not the welcome change we've all been hoping for - indeed instead of the apathy of old, what we're finding is greed and conflicts of interest.  Lack of full disclosure.  And lies that on the one hand are working really well, and on the other hand, to anyone who is actually looking for the money trail, makes my two year old look like a professional.

We may have new voices, but we have the same shit behind them - money and power.

"Consumers and carers are used to being ignored as government departments and many service providers make arrangements to suit themselves rather than their clients."
This. Is. Fucking. Rich.

Consumer and carers are STILL being ignored.  And a couple of service providers have done well to screw over a majority of mental health consumers this year, suiting themselves nicely, not to mention suiting their bottom line, their current projects, and their end-game.

"Poor services retain their funding while effective services miraculously lose their funding. New service options struggle to emerge and when they do, ugly and ill-founded public controversy often arises. Witness the public vitriol associated with the emergence of a national roll-out of the Orygen model of early intervention for youth psychosis. Commentators like Janet Albrechtsen criticise McGorry for his role in ''politicising'' mental health. From its base in a series of demountable dongas in Carlton, Melbourne, Pat McGorry's service has led the world in demonstrating the benefit of early intervention in psychosis in young people. Supporting this new service does not mean we ignore the mental health of children, adults or the elderly. It simply means that piece by piece, Australian governments are being poked, prodded and persuaded into developing a range of mental health services designed to cover all ages. If this is political then so be it."
We're still talking about mental health right?  What effective services?  Oh, do you mean Better Access, which just had it's arse handed to it?  That one?

McGorry has led the world in jack shit.  The Orygen model of early intervention is a joke. It's that much of a joke, that prominent psychiatrists overseas are scratching their heads.

And when you cut programs like Better Access (cuts which affect a hell of a lot of kids with psychosis too, given the very few EPPIC centres around) - you ARE "ignoring the mental health of children, adults and the elderly".  Whether it is political or not is up for debate.  What isn't up for debate is the fact that it very fucking sad to watch.

"It follows that a key role for the new National Mental Health Commission must be as an independent arbiter of what works, what should be funded and, importantly, what should be de-funded."

True that.  What a shame it's never going to happen, when the likes of McGorry and Hickie have their claws in everything and our Hon Mark Butler lacks the balls to tell them both to piss off.

"Mental health needs not only more funding but also to make sure it is spent in accordance with the evidence."
Then why aren't you?  Better Access was working well and some bastards convinced the government to cut it in favour of something that may or may not work (and if it doesn't - could do a hell of a lot of long-term harm).  And even if EPPIC and headspace DO work - they reach such a small number of people it's ridiculous.  One senate inquiry submission put the number of clients seen at a headspace centre to be 17 in a month (Number 483, p. 17).  Not one particular month, but as an average.  Put that money into Better Access and how many could have been helped?

(Edited 5th October 2011 - I had mistakenly put 17 clients at an EPPIC centre, whereas I should have written "headspace centre".  My apologies to all, and thanks to the person who pointed out my error :) ).

"The Government has already committed itself to the task of developing a 10-year road map for mental health, though it is yet to make clear what if any role the new commission will play in this. A simple re-hash of the fourth National Mental Health Plan will leave an expectant mental health sector feeling very let down. This plan has no goals, no targets and commits no one to anything."
Quite frankly, I'd prefer a plan that has no backbone, to the severe fucking over mental health consumers are seeing at the moment.  At least it leaves things open for discussion and debate.  Something I'm sure is a new concept to some of our current players.

"The Government has appointed Robyn Kruk as chief executive to the commission. An experienced and able health administrator, she will have her work cut out to bring these various threads together but in this, she will have the strong backing of a mental health sector keen to ensure that the next 20 years of plans deliver more than the past 20 years. "

I don't know much about Robyn Kruk - however a quick Google search finds that she's been doing a fair bit for the environment lately - not health. 

"The capacity of the commission to build strong partnerships with key organisations in the sector will also be critical. The recent resignation of Dawn O'Neil as chief executive of Beyond Blue is a significant blow in this regard. The ex-chief executive of Lifeline and Deputy Chair of the Mental Health Council of Australia, Dawn had demonstrated commitment to reform and innovation in mental health over many years. In an environment characterised by a lack of resources, Beyond Blue is the largest non-government organisation operating in the area of mental health promotion and awareness.
Under Dawn's leadership, it had begun to show a willingness to support a range of new services and research and from such a huge and influential organisation, this was both very significant and welcome."

Jeff Kennett shows his bigotry against the LBGTI community, there's some scuffling behind closed doors and Dawn O'Neil quits.  My first question was - did she try to out him (and for good bloody reason) and he and  his buddies kicked her out?

"In an environment characterised by a lack of resources..."  WTF?  Beyond Blue is making a profit - quite substantial profits - each year.  2009 - $7 278 315, and 2010 - $1 258 758 (2009/2010 Annual Report, p. 76).

Not that we can be that surprised by anything Beyond Blue does.  In the above report, they state:

"During the 2009-10 financial year, more than 4.2 million Better Access Medicare-subsidised mental health services were accessed by Australians living with mental illness... The number of people who have received primary mental health services clearly demonstrates the need for such subsidies" (p. 57).

Yet, in their submission to the Senate Inquiry, they state:

"The rationalisation of GP and allied health services through the Better Access program is justified. It enables the redirection of funds to other mental health programs and services, which focus on prevention, early intervention, and increasing access to services...The majority of people with depression and anxiety seeking treatment through the Better Access program will not be impacted by the reduction to the number of allied health services" (p. 4).
Clearly their opinion is driven by the given mood of whoever is in charge on the day.  Either that or they just put forth whatever bullshit they've decided to swallow in order to... well, what exactly I don't know.  Not sure about their end-game yet.  I'll find out eventually.  I suspect it's nothing more than an easy pay cheque.

Sebastian - I hope for damn sure you're getting paid well for your soul.

A few Bupa shares perhaps?

Dear Mr Hickie

I am what you might have thought of when you referred to "armchair critics" in your opinion piece in Fairfax Media on the 23rd September.  I am a mother of two, and a mental health consumer.  I am also a "critic" of the new mental health reforms.

First of all, you speak of "$2.2 billion to new programs".  Let's be honest shall we?  It is NOT for new programs, it is for the total mental health budget.  And it is the total mental health budget for the next five years - a point that seems lost on some.  It is not even the correct figure.

The total spend over the next five years is $1 463 300 000.  $316 200 200 was already earmarked from previous budgets, so only $1 147 100 000 is actually new money.  $1.1 billion is a far cry from $2.2 billion.  I'm not even totally sure where the $2.2 billion figure comes from, other than political spin, because I can't find it anywhere.  Even the government here, says the budget spend over the next five years is $1.5 billion.  For now, I'll assume that they mean their Ten Year Road Map for mental health or something.

Aside from all this however, is the $580 500 000 that has been cut from Better Access.  $580 million CUT from the budget.  $580 million that people such as myself will now have to find.

Your article points out that the changes "will greatly increase the number of services provided and, most importantly, access for those with the least capacity to pay privately".  I am on the Disability Support Pension, and as my carer, my husband is on the Carer's Payment.  I consider us to be about the least capable of paying as you can get.  Ideally, I need to see my psychologist every fortnight.  Every week would be great, but I don't mind keeping it real.  The current eighteen session cut off leaves me with eight fortnights to find the full fee myself.  After the changes go through, I will have to find the money for sixteen full fees.  Possibly twenty, depending on what the criteria is for the additional four sessions.

I have heard of all manner of other alternatives, and I can assure you that I have either tried them to no avail (medication, inpatient services), or been turned away (public mental health outpatient services).  ATAPS is not an option as I don't know a GP who is eligible to refer, and other GP's here have totally closed their books to new patients.

Seeing my current psychologist is the first time I have felt "better".  And that is about to be ripped away from me because I can't afford to pay the full fee privately.  Your argument on behalf of those least able to pay makes no sense at all to the people who are actually living it.

In addition to this, I will have to come up with the same fees for my son, who has Asperger's and needs psychological appointments to help him learn how to regulate his emotions.  As he was diagnosed after his sixth birthday, we are not eligible for funding from the Helping Children With Autism Package.  This is on top of his speech therapy and occupational therapy - a total out of pocket of $285 a fortnight.  We live rurally - there is no other alternative for him here and we are not in a position to move.

Let us step back for a moment, and suppose that these new services WILL cater to our needs.  Our sessions run out on November 1st of this year.  This mental health reform is a five year plan.  At what stage in that five years is our local area going to see some new services that we can utilise?  What are we to do in the meantime?

And let us not forget the issue of continuity of care shall we?  I've been seeing my psychologist for three years.  In that time, I've developed a physical disability.  Most of our sessions to date have been dealing with issues that have arisen from that, thus, even after three years, my psychologist is still acquiring my history given I've led quite the eventful life.  To change over to another service will mean all that time is lost - wasted - as I will have to start over with someone new.

The second point you raised was the issue of attacks on the evidence of the new approaches, and indeed, exactly what these new approaches consist of.  Given that I am not a health care professional, I can not in good conscious debate that point in detail here.  I will say however, that I have done enough tertiary study in statistical analysis to be highly sceptical of the studies I have read.  The outright lies (such as $2.2 billion of new money), do not help your credibility either. Nor does the fact that yourself, and many of your cohorts, fail to disclose any potential conflicts of interest.

Your third point that "academic voices have expressed concern that expanding services to include early intervention will come at the expense of desperately under-developed services for those with chronic or persistent illness" and that "no such debate characterises similar advances in cancer or heart care" can be rebutted with a simple - in other areas of medicine, early intervention is added to advanced treatment.  In the case of the last budget, funding was taken away from the only advanced treatment that some of us have available to us (Better Access).

The fourth and final argument you stated is that "a very peculiar commentary proposes that mental health academics should not engage with the broader public debate".  From what I've seen, there seems to be more of a concern that some of those academics have their own agenda's to push at the detriment of consumers; and that consumers themselves need to consulted as well (which is not happening effectively), as they know best what works for them.  And usually what works best for us is choice, because we are all individuals and we all need different things, even if our "diagnoses" are the same.

Your final statement that "those governments (including NSW) that are making genuine attempts to develop a mental health system of which we can all be proud need the public's support" is truly a laugh.  If the current developments were indeed "genuine", I imagine there wouldn't be such opposition to them.

And so Mr Hickie - your arguments may work at your dinner parties with friends - but down here in the dirt where we struggle every day living this nightmare - your arguments simply smell like bullshit.



Note: In order to keep this blog relatively small enough to read in one sitting, I have left out quite a few finer points - and there are many many finer points.  Please don't think that they have escaped me.  I simply wanted to keep this as an overview rebuttal of the article Mr Hickie wrote.


Figures from the 2011-2012 budget.
Budget
Delivering National Mental Health Reform

	Total funding	Old funding	New funding
Leadership in mental health reform	$64,100,000.00	$64,100,000.00
Coordinated care and flexible funding for people with severe and persistant mental illness	$549,900,000.00	$206,100,000.00	$343,800,000.00
National Mental Health Commission	$32,000,000.00	$19,800,000.00	$12,200,000.00
Mental Health Online Portal	$14,400,000.00		$14,400,000.00
ATAPS	$205,900,000.00		$205,900,000.00
Support for day to day living in the community program	$19,300,000.00		$19,300,000.00
Expansion youth mental health - headspace	$197,300,000.00		$197,300,000.00
Health and well being checks for three year olds	$11,000,000.00		$11,000,000.00
National partnership agreement on mental health	$201,300,000.00		$201,300,000.00
Research funding	$26,200,000.00	$26,200,000.00
Family mental health support services	$61,000,000.00		$61,000,000.00
Employment services	$2,400,000.00		$2,400,000.00
Four mental health infrastructure projects	$78,500,000.00		$78,500,000.00
	$1,463,300,000.00	$316,200,000.00	$1,147,100,000.00
Better Access Initiative - rationalisation of allied health treatment sessions	-$174,600,000.00
Better Access Initiative - rationalisation of GP mental health services	-$405,900,000.00
	-$580,500,000.00