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A parallel Australia - tackling mental health

By Rob Moodie - posted Monday, 24 October 2005


Recently I made quite an unusual journey. It was in a time machine - but one with a bit of difference. Instead of moving forwards or backwards in time it moved sideways - into a parallel universe - into a parallel Australia. And I’m dying to tell you what I found. I couldn’t believe it.

I was there for several months - observing intently. I lived with a reasonably well off family, I read their papers, watched their TV, used their Internet and listened to their talk back radio. I travelled widely across the whole state, and I walked hundreds of kilometres, just so I could see and understand as much of their life as I could.

The strongest impressions I got were those of vibrancy, involvement and participation. They seemed less stressed and they acted as if they had real control over what they were doing. They even seemed to laugh more than we do. Amazingly everyone seemed to be included. Children were obviously special. Not spoilt but special.

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Their media didn’t seem any less interesting than ours - a lot of tension and disagreement but they seemed to handle it differently from the way we do. And I watched their parliament, live and on TV - and this bit I just could not believe. They were really debating the issues. Some of the parliamentarians turned puce with passion in their speeches, but they didn’t seem to be hurling insults at each other or constantly trying to put each other down.

So I asked my hosts about bullying in school and in workplaces - they said it exists, but they had taken it really seriously and it become much less of a problem.

I asked about domestic violence and they said it’s a major cause of anxiety and depression in women but it had reduced a lot over the past 20 years, and this had had enormous positive benefits for children.

They said that overall they had very low levels of depression and anxiety. And they had the data to show me. Their annual surveys conducted in each local government area across the country showed impressive declines of self-reported anxiety and depression, in addition to increases in those seeking treatment. They still had significant levels of other mental illness.

They gave me reports to look at - one of which showed that mental health was worse in those who were socially and economically worse off. But at the same time they showed that these disparities had decreased through their progressive tax and social policy. And in my travels it did appear that there were fewer “depressed” suburbs in this parallel Australia.

Is this parallel Australia credible? What does the science tell us and what might have just been my fanciful imagination?

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It seems that anyway you look at it, discrimination and violence for any reason makes people miserable. Let’s start with the common or garden variety of discrimination that happens in our school and workplaces, even on our sporting fields - bullying. A study in Melbourne has shown that up to 30 per cent of depressive symptoms in high school children is due to victimisation or bullying at school. Studies in Australia and elsewhere show a very common link between bullying and depression, fatigue, and sleep disorders. In one study over half also said their relationship with partner or family had worsened because of the bullying.

Discrimination on the grounds of race, religion, ethnicity, gender, sexuality, body shape, age and social class is consistently associated with lower levels of well being, self esteem, control and mastery and higher levels of depression, anxiety and other mental disorders.

Physical, verbal, psychological or sexual violence against women has shown in landmark study to be the greatest cause of preventable physical and mental ill health in 15-45-year-old women. And it might not being doing the mental health of the male perpetrators much good either.To marginalise, alienate and isolate people are other very effective methods of making them mentally unhealthy, let alone physically unhealthy. Studies consistently show that those who are socially isolated are two to five times the risk of dying from all causes compared to those who maintain strong ties with family, friends and community.

If you have few social supports or connections then you are more likely to be depressed or anxious - this has been shown in Aussie schoolchildren, US college students, and Finnish adults, just to name a few of the groups.

Similarly in studies in Canada, the US, Australia, UK and Netherlands show that if you are poor, unemployed and underprivileged then anxiety, depression and substance abuse is more likely.

So if they had managed to get things right then perhaps this parallel Australia could actually exist. Our own Australian data, as well as international data suggest that if we had lower levels of social isolation, lower levels of discrimination and less poverty then we’d be considerably less anxious and less depressed as a nation.

And it seems we would be even more productive, because according to the World Health Organisation’s seminal report in 2003 Investing in Mental Health, up to 45 per cent of absenteeism is due to mental health problems.

As I said before, during my recent visit I felt a very strong sense of vibrancy and productivity. You could tell that by the way everything was organised and carefully looked after.

I also noticed two other things - people were outside much more. All across the places I visited and they seemed to walk and cycle, so much so that I thought I was in Europe. They reported that 80 per cent of the school children in years 1-4 walked to and from school. Come to think of it, they even looked a bit thinner.

I asked about crime rates and perceived levels of fear of crime. Their crime rates were lower than ours, but not greatly. The big difference was their levels of fear were so much lower than ours. I could only think of two reasons.

One reason was the fact there seemed such a strong and direct participation in local neighbourhoods - people were out in them - not just hidden in cars or houses, and we know that used spaces tend to be safer.

The second reason came to me by reading their papers, listening to the radio and watching TV - all directly or via the net. Their media didn’t seem to be as hysterical as ours sometimes get. They had a few tabloid and broadsheet ranters but overall they didn’t seem as determined to pit different parts of the community against each other, nor were they intent on scaring the community either.

They showed the same level of concern about things like global terrorism and avian flu, but the level of fear seemed to be less than it is here - but this is wholly subjective - they didn’t have measures for it and neither do we. On the other hand it does make some sense given that it’s been proposed that social networks improve the well being of individuals under stress by acting as a buffer or moderator of that stress - perhaps they also act in the same way at a population level.

They were as multi-cultural as we are, if not more so. But they reported a high level of cross-cultural harmony. They had developed purposeful projects, then systems, based on the contact hypothesis to ensure different ethnic, racial and cultural groups could work, learn and play together in mutually respectful and equal ways.

I also asked them about the general level of understanding about depression, anxiety and psychiatric disorders. They said the stigma of mental illness had declined and that empathy was high. They had been working on teaching MHFA (mental health first aid) across the country for many years. It had become just as accepted as physical first aid like cardio-pulmonary resuscitation (CPR). They also showed me figures on the huge increase in support for people at (mental health) risk, and their families and friends through Internet-based support and counselling services, operating 24 hours a day, 7 days a week.

They not only took this whole process of early intervention and treatment seriously, but they seemed to talk a lot more than we do about looking after their own mental health. They constantly talked of prevention, and of promoting good mental health and well-being. Spirituality seemed to be very high on the agenda - in the press, in daily workplace and in social conversations. Most workplaces I came across had their own programs for staff - yoga, meditation, prayer.

And the CEOs and managers I talked with in private, public, non-government sector workplaces seemed to walk their own talk. One told me it was no use doing yoga and meditation if you threw the employees back into a bullying bear pit on the workplace floor. Many told me not only did they actively looked after their own mental health, their own spirit every day, but that this was greatly beneficial to their roles in leadership and management of people, and profits.

They aimed for flexibility and acknowledged that all employees had families for whom they often needed to provide care. In particular, there was a common thread among those I spoke with that looking after the children of employees had become, metaphorically at least, a collective responsibility of their companies.

I keep reflecting on the difference. They were indeed a civil society. More than just civil though, they were amazingly friendly. And they were a lucky country, but then again they were more than lucky. They have worked out the big picture (equality, productivity, respect) as well as ensuring individuals had better skills and understanding of how to cope with mental disorders and to promote their own mental health. They had worked out (by intuition and then by verifiable, replicable studies) that treating each other well had a lot more than being just a religious teaching - it made good sense from a perspective of mental and physical health, safety and productivity.

And a last point. When I got back from my journey, lots of people asked who these people were and what they were like. I said that they were us.

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About the Author

Rob Moodie is Professor of Global Health at the Nossal Institute for Global Health at the University of Melbourne. Between 1998 and 2007 he was the CEO of VicHealth. He is co-editor of three books, including Hands on Health Promotion. He is currently writing a book called Recipes for a Great Life with Gabriel Gate.

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