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By Glen Davis - posted Tuesday, 27 November 2018

Anxiety is the most common mental health problem in Australia. It's estimated over two million Australians, or 14.4%, of us suffer from anxiety, highlighting its prevalence. In 2017 it was estimated 260 million people worldwide experience anxiety. In America 18.1% of the population, or 42 million people, experience anxiety. In our modern world where so much is about choosing, does this contribute to anxiety?

Life now is like a trip to the supermarket. Scan the shelves, real or metaphorical, what /which product do I choose to meet my needs? Have I made the right choice? What happens if I haven't?

With the corporatisation, privatisation of so many services previously the domain of the state a substantial change has taken place. It's not seen as a right or a need to access these services, more so it's portrayed as a transaction. Transactions involve choice(s) where one is supposed to make an informed/rational choice. It sounds easy.


I've been around long enough to recall the introduction of the Purchaser-Provider split under the Kirner ALP Government in Victoria back in the 1990's. This market based approach to the provision of health care sped along significant changes in the field, including how health care is perceived as being delivered. This was all part of an accentuated commodifying of all around us.

In the health field workers no longer support/assist, patients, let alone people. The term patient originated from the Latin term Patior meaning I am suffering. Nowadays it seem those who attend health providers no longer attend because they are suffering, more so it seems to be about making an informed choice of which health care product you purchase.

The resultantlanguage has changed substantially. Over the last two decades those presenting for health care, especially non –inpatient services, are deemed as clients. Clients used to indicate a person buying a service; it pertained to a commercial transaction. Clients were those who went to prostitutes, lawyers or accountants. It reflects the nexus of cash exchange for a service.

However we're actually moving beyond calling health care recipients clients. Increasingly they're called consumers, with the term customers also becoming more prevalent. It reflects health care in all its aspects is little more than a product they purchase. With changes in areas like aged care and mental health, people, no, wrong word, consumers, are informed they now have more choice of which service they go to. They are not advised of who has the best trained staff, which service is best resourced, but hey, they still have choice.

Recent changes in how Aged Care services are funded are a further 'deform', to healthcare changes. Instead of older people accessing their supports through established health networks they're now informed they have choices of who can deliver their care. Bureaucrats under both the ALP and LNP governments sing the same tune re choice. Tweedle Dee, Tweedle Dum.

With the roll out of the much vaunted National Disability Insurance Scheme, (NDIS), its proponents trumpet the choice mantra. Those eligible for NDIS funding and supports are informed/ encouraged by the advertising about the NDIS givingthem more choice, & control, to get the supports they require, as well as accessing these supports. What does it mean in practice re having their goals, and needs, met?


Despite all the hyperbole about choice the beginnings of the scheme have not seen it without problems. There may be lots of rhetoric about choice but the implementation hasn't been all smooth sailing. Concerns around the level of funding, delays in rolling out the scheme in many areas, a tawdry process of reviewing/updating people's plans, all of these have had more impact than the choice mantra. Though the NDIS is working well in many aspects, around 20% of those receiving NDIS supports feel worse off, with a similar number feeling their situation hasn't changed. Has choice delivered the outcome these people wanted?

It's not just in the health field. When you're on the railway station the announcements made over the loud speakers address you as customers, no longer passengers. You don't travel on these vehicles, you choose to pay to use their product. Of course you may choose not to, but would that be the best choice?

With sporting events spectators are still, at this point of time, called spectators. But the engagement of spectators now has changed. In the days of yore people supported a team, or a few different sports: one summer, one winter. You watched YOUR team, wanting it to win. Your team was often based on where you lived, with its culture and identifiable traits and supports. You could pick another team for whatever reason; maybe you liked their mascot, or colours. Concepts like choice played little role in who you supported/watched. Now with changes in technology, and the directions of our world, that approach seems outmoded. Some people are making lots of money from our choice(s).

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About the Author

Glen Davis has post graduate qualifications in Humanities and Health Sciences and is a freelance, writer, blogger and broadcaster.

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