There’s no easy fix

Dear Editor,

As a former Head of Public Health, I have some sympathy for Health Minister Cook in his handling of the current health crisis. Many of the circumstances are historical and well beyond his control. 

The first is the Federal Government’s unsustainable scheme for a big Australia and GST growth by immigration of over 300,000 per year. Every new immigrant needs housing, health, roads and infrastructure; a cost that is passed to the states.

The mental health crisis can’t be solved just by money. What is desperately needed is a properly trained medical, clinical psychological and nursing workforce. After years of lobbying, I started in 1995, we will finally graduate our first new doctors from Curtin this year. It will take another five years to get our first qualified psychiatrist, that is if any choose psychiatry which is one of the lowest paid specialties. 

Why choose mental health when surgical specialists take over $1 millon a year from the health system and no wonder when our Federal Government has raised the cost of university to $100,000 degrees.

The hospital system is the squeaking wheel and demands resources yet value for dollar is in preventive health. 

Poverty is the biggest cause of mental health where children living in poverty are 30% more likely to have mental health problems. Then add the physical and mental health problems of those in housing stress. Those who can afford private care are well off but why do we give billions of dollars to the private health industry and not to properly resource Medicare?

People are bypassing GPs with out-of-pocket expenses of $70 per consultation to go to public hospital EDs. 

State governments have their own structural problems. If WA charged the same royalties as Queensland over the last 10 years WA would have an extra $47 billion to spend on mental health, hospitals and public housing as well as offering scholarships to young West Australians who don’t have rich parents to study health-related degrees. Like the start I got when I graduated in 1973 after free university due to a Commonwealth scholarship.

Dr Colin Hughes
Former head Public Health East Metro Perth and former chair Royal Australian College of GPs WA.

Accumulation of neglect

Dear Editor,

Re: ‘Fear, resilience and our mental health’, Medical Forum, June 2021, p 43.

Yes, it may well be that we are less ‘resilient’ than previous generations. Unfortunately, the concept of resilience is too wishy-washy. 

Current generations probably do have it ‘easier’ in some regards than previous generations. I believe it is important to figure out the potential causes for this and not ignore the actual underlying issue. One can drown in a bath and in an ocean.

I propose that one cause may be that previous generations failed to explicitly teach us what they were doing to cope. Our grandparents learnt to survive and swim in their oceans of trauma and omitted to recognise what they were actually doing to cope and thrive. So, they never actually taught us the skills they were using.

What they were doing that looked like ‘resilience’ was radically accepting their situations and responding effectively to them – i.e. doing exactly what was needed. However, they often pushed away emotions because they were busy rebuilding. 

Pushing away (and pathologising) emotions as the only strategy used for regulation of emotions doesn’t work – they eventually catch up with us. I believe that current generations are paying the price because they lack the requisite acceptance, distress tolerance and emotion regulation strategies.

We have all these new-fangled treatments being explored for when the problems get entrenched. And yet we are still not focusing on universal teaching of a broad range of psychological fitness and mental health maintenance skills in schools. This needs to be a compulsory subject that is given the appropriate weight amidst the academic curriculum.

Reminding our children that they have it ‘easier’ than previous generations invalidates the fact that they are drowning in a bathtub. 

Teaching a rich repertoire of skills and helping our young people change in ways that help them get out of their place of drowning is what’s needed.

Dr Pauline Cole
Marian Centre