The government’s latest budget shows that the Coalition has entered the election campaign with an agenda to improve mental health. The key announcements concern funding for eight new walk-in community mental health centres, the expansion of headspace – a mental health service for young people – as well as funding for workplace-based mental health programs and residential care centres for eating disorders.

Ian Hickie, the Co-Director of the Brain and Mind Institute, is lukewarm regarding these ‘less challenging but worthy targets’, noting that ‘the next federal government faces major structural challenges in mental health and suicide prevention’ while huge issues such as providing access to services, the uneven roll-out of the NDIS and the lack of accountability for system reform remain.

What we’re failing to see in Australian politics is a willingness to address mental health structurally, in places where government policies could have the most impact. Aside from Hickie’s suggestions, it’s also crucial to address social justice issues – things like equality, inclusion, and equitable access to resources.

Government policy has approached mental health as a personal issue that is addressed within the healthcare system. In this system, I’ve encountered a continual tug-of-war between understandings of distress as a problem with brain chemistry (perhaps, therefore requiring medication, or other interventions that target the brain such as light therapy or sleep hygiene) or as a result of environmental factors like stress, trauma, interpersonal issues, problems due to one’s upbringing, et cetera (which therapy may be best placed to address). Most clinicians will have a position on the nature/nurture debate, and these positions might be fluid, depending on the way a service user presents or what their diagnosis is. Most would also likely concede that this is a false dichotomy, that nature and nurture interact in complicated ways, and that many interventions, in tandem, might benefit individuals.

But thinking of mental health in terms of nature and nurture leads to another a false dichotomy: mental health is as much a social justice issue as it is a matter of individual health. Here are just a few examples:

• Australia is currently experiencing a crisis in the massive rate of suicide among Aboriginal children and young people. AS reported by the ABC, ‘Indigenous children make up less than 5 per cent of the youth population, but nationally account for 25 per cent of child suicides – in some states that number is upwards of 60 per cent.’ Inquiries over the deaths have concluded that social factors like intergenerational trauma, racism, and social disadvantage are major contributors to the crisis.
• Rates of suicide also increase in rural areas during times of economic and resource strain. w Academic China Mills writes that since 1997, over two hundred thousand Indian farmers have committed suicide, a fact linked with agricultural reforms that have resulted in farmers’ over-reliance on credit from private money lenders. Some farmers have deliberately politicised their deaths, leaving suicide notes that directly address the prime minister and declare that the state has betrayed them.
• Agricultural crises like drought and economic hardship – compounded with a lack of regional services – also increase the risk of suicide amongst Australian farmers. Currently, male farmers in Australia have double the risk of suicide compared to the average male population.
• In 2017, in the lead-up to the marriage equality survey, levels of depression, anxiety, and stress increased among LGBTIQ people who were exposed to the vitriolic and discriminatory attitudes of the ‘no’ campaign.
• Studies of premenstrual syndrome and premenstrual dysphoric disorder have found that both are less common in women in same-sex relationships and, when it is experienced, it’s perceived as less burdensome. The theory is that when the body goes through the changes associated with menstruation, these changes are less stressful when women have a supportive partner who eases the workload and who understands what it feels like. PMS and PMDD are more common in married women in heterosexual relationships, who are more likely to have the same over-responsibilities of caring for a household and working as usual, with the additional physiological stress that can go along with the start of menstruation.
• Entrenched racism, socio-economic strain, homophobia, sexism and the burden of household labour all contribute to distress. Likewise, policies that address discrimination, extreme stress, lack of services in regional areas, and poverty. Conversely, policies that support equality can relieve distress.

Ensuring equitable access to public spaces can also be a helpful way for governments to foster mental wellbeing. The amount of green spaces such as public parks someone has access to is proportional to their reported feelings of wellbeing because it ‘improves companionship, sense of identity and belonging’. Libraries play a similar role by allowing people to access books, computers, community events, and skills training, helping people feel included and connected.

Social factors also shape the experiences of those experiencing distress. Under neoliberal austerity measures, individuals are less likely to access adequate care from the state as a result of funding cuts to the health system or cuts to welfare payments. Yet, they also bear additional stress from increased economic insecurity as well as being vilified by governments as undeserving of support. In Australia, many welfare recipients have gotten terrifying notices to pay back debt to the government – that they often don’t even owe. Over two thousand people have died after receiving a ‘robo-debt’ notice from Centrelink. 429 of those who died were aged under thirty-five (a disproportionate death rate for this demographic), and 663 of those who died were classified as ‘vulnerable’ people. We don’t know what these people died of, but many who received erroneous debt notices have reported increased stress and anxiety. The family of one recipient of an incorrectly issued debt notice has said that it was a contributing factor to his suicide.

Depoliticising distress involves framing it as a problem of the individual. In the case of the agrarian crisis in India, Mills says that the government response was to increase access to medication in rural areas and to assess farmers’ genetic risk of suicide. These responses weren’t targeted to the farmers’ inherently distressing economic context.

We need to reframe the way we think of mental health – not just in terms of mutated genes, dysfunctional cells, misfiring neurons, and individual memories of an unhappy childhood – but also as an extension of public life. The mind is both a personal and politicised space.

‘Mental illness’ is the largest cause of disability in Australia, and both major parties have offered policies for dealing with it. The Coalition’s budget included some potentially helpful steps. But looking holistically at the budget and keeping in mind that any policy – not just health policy – can impact on mental health, nobody has come up with a strategy for structurally reducing distress.

One of the biggest ways the government has cut budget costs is from saving $1.6 billion from the NDIS because of a slower-than-expected uptake of the scheme, likely due to people having trouble accessing it. Plans under the NDIS ought to give people with disabilities the resources to participate in social life and to move through the world with greater comfort and independence. The scheme is meant to reduce their risk of coming to harm. The NDIS underspend is a policy implementation failure, and not congruent with the goal of improving mental wellbeing.

Indeed, in general, the Coalition – an alliance that hasn’t meaningfully addressed disadvantages faced by Aboriginal people, that enforced a national marriage equality survey and opened up LGBTIQ people to dehumanising rhetoric, that has issued stressful and erroneous debt notices to thousands of people, that has eroded welfare while managing to cut taxes for the rich – has not acted to uphold mental wellbeing.

The mental health policies listed in Labor’s 2018 National Platform document read as targets rather than specific measures. They focus primarily on broadening access to services, especially among vulnerable communities, boosting prevention and recovery-driven services, and increasing research funding. Labor also supports the formation of an independent agency ‘to ensure there is effective monitoring, assessment and reporting on the mental health system in a way that provides greater transparency and public accountability.’

These are good things, and it’s encouraging to see that both major parties have mental health on their agenda. However, it’s not enough to assess these platforms based on the mental health policies alone. It’s also crucial to look at all the ways they may be upholding (or failing to uphold) the principles of inclusion, equality, and social justice.

Image: The former Tarban Creek lunatic asylum (Frederick Manning).