The depressing state of mental health
Today is mental health day, and I’m here to tell you; depression sucks.
I’ve often thought that depression is like slowly walking into a lake of honey. At the start, you barely even notice the extra weight, it’s just a bit odd that suddenly lifting your legs takes a little bit more effort than the step before. A few meters in, and the honey is starting to creep over your thighs, and suddenly you start wondering “what’s the point of pushing so hard? I might as well just take my time”. You get to the point where the honey is up to your chest, and you can barely breathe, and it’s just easier to lie down and stare up at the suddenly-dark sky wondering why it’s now so hard to even lift your head, even though just a few steps before you could lift your arms and run.
My personal experience of the mental health system was smooth, fortunately. I was lucky to have the support of my family, and overall I am amazed at how much difference it has made in my life. This is true for a vanishingly small proportion of the population; I am incredibly privileged to have had the treatment that I did.
Mental Health Matters
It’s amazing how far we’ve come with treating and managing depression, and indeed all mental health problems. We’ve gone from the point 100 years ago where most treatments for mental health conditions were a barbaric amalgam of religion and superstition, to the 70s where the horrors of psychiatric hospitals came to light, to today where mental healthcare is central to the agenda and patient-centered care is the key item.
We are now actually (sometimes) asking people how they would like to be treated. Aren’t we amazing?*
There may still be a huge amount of discrimination against sufferers of mental health conditions, and it’s possible there always will be, but in general the state of mental health care is looking up. Depression is becoming increasingly normalized, and in general mental health disorders are becoming more and more widely accepted across the board. That’s not to say that the labels are not still a lifelong burden, but we are slowly but surely getting better at not treating people with mental illness as subhuman monsters.
There’s also increasing recognition at all levels of government that mental health is important; it now occupies 8% of all government health spending. Of course, the burden of disease from mental disorders is more than 50% higher than that (>12%), but the point is we are getting better. We are also getting significantly better at providing options for community treatment, a significant step away from the old days where it was hospitalization or suffering by yourself.
So why am I still depressed about the state of mental health?
I’ve previously written about how we ignore the societal impacts and drivers of suicide. It’s amazing what happens when you go to talks on population health; people speak volumes about how where you live effects your heart health, your likelihood of smoking, the chances of you dying of cancer. But mental illness is rarely covered.
As with many things, your mental health is effected by the place where you live. There’s a certain genetic component (best estimates put it at somewhere around 5–10% of mental health problems), but realistically most mental health is caused by environment and lifestyle factors as opposed to inherited problems.
We know that people in rural and regional areas are more likely to experience mental illness. Depression is significantly more common the further away from cities you go, and suicide rates skyrocket in remote communities. Young men living in regional areas are more likely to die by their own hand than from any other cause. Young Indigenous men in remote areas have suicide almost 10 times higher than the national average (and arguably the highest rates in the world).
Your background affects your mental health as well. Lower educational rates are linked with an increased risk of mental health disorders. Not speaking English (in English-speaking countries), is linked with all sorts of increased risks, particularly anxiety and social disorders. This is not even factoring in the mental health burden caused by racism.
And of course, the poorer you are, the more stressful your job and financial situation, the more likely you are to suffer mental health problems. For anyone who has ever had to worry about bills, this will come as no surprise.
So it is disappointing that all of our increased efforts amount to the same old story when it comes to mental health; get yourself treatment, ask your friends if they are ok, it’s all up to you to get yourself better.
“Society is too hard to fix”, we say “but now you can see a psychologist for free! If you don’t get help, it’s not our fault”
We aren’t going to solve this problem overnight. I’ve barely scratched the surface of the factors that underlie mental health issues. They are all just as difficult as the problems above; there simply is no easy way to fix societal problems with mental health.
But that doesn’t mean that we don’t know things that we can do. Reducing mental health discrimination has been shown to improve mental wellbeing, because bullying people with depression doesn’t make them happier (it only took us 100 years to realize). Reducing racism, fighting sexism, decreasing isolation in rural and remote areas, these are all things that are linked with better mental health outcomes. More equity in exercise options, better legislation around workplace mental health, better laws to improve diet; these can all help too.
It’s time to stop looking at mental illness as an individual problem.
You are not alone.
If this article raises difficult issues for you, contact lifeline on 13 11 14, or call up your local MP and yell at them for failing you (it’s what I do).
*Sarcasm is hard to convey in text, but I try.