SWN005

Mental Health
Landscape and Social
Work Practice
Dr Niki Edwards

1
1
 AIMS
• QUIZ : appreciate the role that stigma and
discrimination play in the management of
mental illness and mental health problems (self
reflection).
• Awareness of key definitions of mental illness,
mental disorders and mental health problems.

2
 Quiz
• Please write down TRUE or FALSE to
following questions.

• We will come back to these at the end of the

presentation.

• This presentation will address many of the

issues raised.

3
 True or False #1

Mental health is a life

long process. It
involves a sense of
harmony and balance
for the individual,
family, friends, their
community and more
broadly society.

4
True or False #2
Mental illness is a
single rare disorder that
is uncommon. It only
affects a small number
of people.

5
 True or False #3

Being treated for a

mental illness means
an individual has in
some way "failed" or is
“weak”.

6
 True or False #4
People with mental illness are violent and
dangerous so should be approached with
caution, and fear.

7
True or False #5

People with mental illness

have childlike perceptions of
the world (they lack
intelligence) and will always
need to be taken care of.

8
 True or False #6
Mental illness is not a “true” medical diagnosis
eg. people with depression should (and could)
really just “snap” out of it, get a job, and get on
with life.

9
 True or False #7
Depression and other illnesses, such as anxiety
disorders, do not affect children or adolescents.
Any emotional problems they have are just a
part of growing up ie. they just grow out of it.

10
 True or False #8
People with severe mental illness should
really be cared for in hospital. (They are
best cared for in hospital)

11
True or False #9

Mental illness is NOT a life

sentence ie. recovery IS
possible for people with
mental illness.

12
 True or False #10
No individual or
cultural group is
immune from
mental illness.
It is a global
phenomenon.

13
True or False #11
People living with mental
illness expect to be rejected
by the community and are
therefore reluctant to engage
with others.

14
 True or False #12
The effects of stigma and
discrimination may have a greater
impact on an individual than the
actual mental illness.

15
 Introduction

Mental Health & Social Work

SWN005

16
16
 Introduction
• Mental illness is common, effects 1:5 people
during their lifetime.
• Universal: mental health problems and mental
illness is experienced by people of all countries,
by women and men of any age and
socioeconomic status, and in urban and rural
environments.
• Global phenomenon and global health priority
eg. not just in developed countries.

17
 Introduction
"Mental illness is Australia's great invisible
epidemic. Of all the diseases in our
community, it exhibits the grossest mismatch
between the cost of the disease, the disease
burden, and the amount that is spent
collectively by the community to address that
cost."

Commonwealth of Australia (2006) A national approach to

mental health – from crisis to community.
www.aph.gov.au/Senate/committee/mentalhealth_ctte/report/
index.htm

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 Introduction
• As with many diseases, mental
illness can be severe for some
people and mild in others.
• People with a mental illness don’t
necessarily look like they are
“sick”, particularly if their illness
is mild.

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Introduction
• No objective tests – only
subjective assessment.
• Other individuals may show more
explicit symptoms such as
confusion, agitation, or
withdrawal.
• Often “others” first notice
something is wrong, rather than
the person.
• Cascade effect: individual, those
around them and society.
20
 Introduction
• Social workers have a key role to
play in working with people living
with mental illness.
• Work at micro, mezzo and macro
levels.
• Roles in assessment, diagnosis,
treatment and interventions.
• Roles in advocacy (individual and
systemic) and policy and
program review and
development (local through to
national/international).
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Legislation and Service
Delivery Guidance
Policy and Services

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22
 Mental health system

OK…it’s a BIG problem

• How does society respond?
• How do Australian governments rise to
the challenge of providing appropriate
services to people living with mental
illness?...or carers supporting people
with psychosocial disability?

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 Queensland mental health
system
o Far more than acute inpatient mental health beds or
community mental health services (clinics and outreach
assessment teams) provided by Queensland Health.
o NB role for general practitioners
(gatekeepers/ usually first
point of call).
o Psychiatrists, social workers,
o psychologists & other clinicians in private practice
(Medicare Better Outcomes initiative).
o Non-clinical mental health services/psychosocial
disability support provided by non-government
organisations (NGOs).

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 Queensland mental health
system
Public and private, government and non-
government, and hospital and community services
comprise the Queensland mental health system.
o Cross-sectoral responsibility “everyone’s
business”.
o Queensland Government (Queensland Health) is the
major provider of acute services for people with
serious mental illness.
oHospital and Health Services provide
based community mental health services
and hospital based beds.
oQH oversees the provision of authorised
mental health services, as per the Mental
Health Act (Qld) 2016.
25 25
Queensland mental health
system
o Most common way of seeing a private
psychiatrist is through a referral from a
GP, which allows the Medicare rebate to
be claimed.
o Notably in rural areas, private
psychiatrists may not be available.
o Private psychiatrists mainly provide
outpatient services from their consulting
rooms or inpatient services to private
hospitals.
o Some may have specialist interests (eg.
working with particular age groups or
disorders, and specific therapies).

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 Queensland mental health
system
Psychiatric Disability and
Psychosocial Rehabilitation Support
Services (non-clinical mental health
services)
o A range of services provides
employment placement, support,
information, day and residential
programs and family respite.
o Many are NGOs with government
funding.
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 Non-government sector
Non-government service providers in
Queensland deliver/implement a range Queensland Alliance
of programs including: for Mental Health is a
o community awareness and NGO that supports over
education
240 community
o early intervention
organisations working in
o family and peer support
mental health in
o independent living and support
Queensland
o non-clinical counselling services
www.qldalliance.org.au/
o building sector capacity through
training and organisational
development activities.

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 National Mental Health Strategy
• Mental Health Statement of Rights and
Responsibilities 1991
• National Mental Health Policy 1992

• National Mental Health Plan, 1992–98

• Second National Mental Health Plan,1998–
03
• National Mental Health Plan 2003–08

• COAG National Action Plan for Mental

Health 2006-11

• National Mental Health Policy 2008

• Fourth National Mental Health Plan 2009-14
• Fifth National Mental Health Plan

• States and Territory mental health policies,

plans and strategies
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 National Mental Health Policy
(2008)
Principles underpinning future mental health reform:
o To promote the mental health and wellbeing of the
Australian community and, where possible, prevent the
development of mental health problems and mental
illness;
o To reduce the impact of mental health problems and
mental illness, including the effects of stigma on
individuals, families and the community;
o To promote recovery from mental health problems and
mental illness; and
o To assure the rights of people with mental health
problems and mental illness, and to enable them to
participate meaningfully in society.

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National Standards for Mental
Health Services (2010)
o The first National Standards for Mental
Health Services were developed in 1996,
focused on raising the quality of acute
mental health services.
o The key changes to the 2010 Standards
are:
o Addition of a Recovery Standard; and
o Expansion of the applicability of the
2010 Standards.
o The 2010 Standards are now applicable
to:
o The public health system (inpatient,
rehabilitation and community) and
private hospitals;
o Private office based providers; and
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o NGOs.
Fourth National Mental Health
Plan 2009-2014
Set an agenda for collaborative
government action in mental
health for five years from 2009,
offers a framework to develop a
system of care that is able to
intervene early and provide
integrated services across
health and social domains,
and provides guidance to
governments in considering
future funding priorities for
mental health.

32
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Fourth National Mental Health
Plan 2009-2014
5 priority areas for government action in mental health:
1. Social inclusion and recovery
2. Prevention and early intervention
3. Service access, coordination and continuity of care
4. Quality improvement and innovation and
5. Accountability - measuring and reporting progress.
o Robust accountability framework and governments must
report annual progress to the Council of Australian
Governments.
o Includes indicators for monitoring change in the way the
mental health system is working for people living with
mental illness as well as their families and carers.

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 Fifth National Mental Health and
Suicide Prevention Plan?
http://www.health.gov.au/internet/main/publishing.nsf/content/mental-fifth-national-mental-health-plan

Seeks to establish a national approach for collaborative government effort

from 2017 to 2022 across eight targeted priority areas:
1.Achieving integrated regional planning and service delivery.
2.Effective suicide prevention.
3.Coordinated treatment and supports for people with severe and complex
mental illness.
4.Improving Aboriginal and Torres Strait Islander mental health and suicide
prevention.
5.Improving the physical health of people living with mental illness and
reducing early mortality.
6.Reducing stigma and discrimination.
7.Making safety and quality central to mental health service delivery.
8.Ensuring that the enablers of effective system performance and system
improvement are in place.
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 Critique
https://croakey.org/magical-realism-and-
the-draft-fifth-national-mental-health-plan/

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Roadmap for National Mental
Health Reform 2012-2022
• COAG initiative that outlines directions
for all governments over next 10 years -
$2.2 b investment.
• “Our long term aspiration is for a society
that: values and promotes the
importance of good mental health and
wellbeing; maximises opportunities to
prevent and reduce the impact of mental
health issues and mental illness; and
supports people with mental health
issues and mental illness, their families
and carers to live contributing lives”.
• Indicators and accountability.
• Mixed responses – consider looking at
http://theconversation.com/five-views-of-
the-roadmap-for-national-mental-health- 36
reform-11216
 Roadmap for National Mental
Health Reform 2012-2022
o Priority 1: Promote person-centred approaches.
o Priority 2: Improve the mental health and social
and emotional wellbeing of all Australians.
o Priority 3: Prevent mental illness.
o Priority 4: Focus on early detection and
intervention.
o Priority 5: Improve access to high quality
services and supports.
o Priority 6: Improve the social and economic
participation of people with mental illness.
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 http://www.mentalhealthcommission.gov.au/our-reports/our-
national-report-cards.aspx

• The National Mental Health Commission’s 2017 National Report on

Mental Health and Suicide Prevention.
• Reporting on the outcomes of engagement with stakeholders and the
work of the Commission to help shape a mental health system that
can respond to peoples’ needs more effectively.
• In the process of developing a new monitoring and reporting
framework which will guide future reports.
• This framework will also assist national reform in mental health and
suicide prevention through the lens of consumers and carers, and
their experiences.
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39
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41
Queensland
Mental Health
Commission

http://www.qmhc.qld.gov.au/w
ork/queensland-mental-
health-and-drug-strategic-
plan/

https://www.qmhc.qld.gov.au/wp-
content/uploads/2017/02/Discussion-
Paper_A-renewed-plan-for-
Queensland_Feb-2017.pdf

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43
 Challenges
o Positive mental health outcomes for
people living with mental illness
depends on much more than mental
health policy.
o Good mental health and wellbeing
depends as much on things like
housing, employment, education,
personal and family support (cross-
sectors) ie. people are primarily “social”
relational beings.
o Need to adopt a life course approach
It’s not an individual problem – everyone is
(needs change over time).
responsible and has an NB role to play. 44
 Challenges
o Tension between funding for mental health hospital
beds and community options (eg. step down/step
up services).
o BUT funding allocated to mental health still does
not reflect the prevalence of mental health
problems and associated psychiatric disability in
the community.
o No national infrastructure for mental health
promotion, prevention and early intervention.
o Contemporary services continue to focus on
chronic illness.
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 Challenges
o Health system still focuses on low
prevalence disorders and high
prevalence disorders left to GPs and
private sector.
o Specialised mental health services
cluster around hospitals, acute mental
health services, jails.
o Growth in the non-government sector
(outsourcing by government to save)
and allegations of de-professionalisation
of mental health.
o Mental health needs of minority groups
“neglected” eg. dual disability, refugees,
people with mental illness in rural
communities etc.
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 Conclusion
o Shift over time from institutionalisation to
community care, noting resourcing issues for a
“good” life in the community.
o Mental health is a now a major focus of
Government policy and increased funding.
o Evidence that mental health and wellbeing is
closely linked to social determinants of health
including low income, unemployment, poor
housing.
o Promotion, prevention and early intervention in
mental health and wellbeing is acknowledged.
o Emphasis in policy and programs on: equity,
access, equality and participation .
o Increasing focus on recovery and consumer and
care involvement.

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 Key references
o Australian Bureau of Statistics (2007). National Survey of Mental Health and
Wellbeing: Summary of Results. ABS Cat No. 4326.0. Canberra: ABS.
o Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD, 2007. The
burden of disease and injury in Australia 2003. PHE 82. Canberra: AIHW
www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459747
o Forbes, M., Barker, A. and Turner, S., 2010, The Effects of Education and
Health on Wages and Productivity, Productivity Commission Staff Working
Paper, Melbourne.
o Fourth National Mental Health Plan 2009-2014
www.health.gov.au/internet/main/publishing.nsf/content/mental-pubs-f-plan09
o Mental Health Council of Australia Mental Health Fact Sheet Definitions of
Mental Illness www.mhca.org.au/documents/Definitionsofmentalhealth.pdf
http://www.mentalhealthcommission.gov.au/our-report-card.aspx
o Queensland Health. The Health of Queenslanders 2010. Third Report of the
Chief Health Officer Queensland. Brisbane 2010
http://www.health.qld.gov.au/cho_report/
o Roadmap for National Mental Health Reform 2012-2022
https://www.coag.gov.au/sites/default/files/The%20Roadmap%20for%20Natio
nal%20Mental%20Health%20Reform%202012-2022.pdf.pdf

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 Resources
National help lines
• Lifeline – 24 hour counselling and referral 13 11 14
• Kids helpline – counselling for people under 18 years 1800 55 18 10
• Just Ask – rural mental health info 1300 13 11 14
• Mens Line Australia – 24 hour counselling for men 1300 78 99 78
National web sites
• BeyondBlue – www.beyondblue.org.au
• Black Dog Institute – www.blackdog.org.au
• depressioNet – www.depressionet.com.au
• Mental Health Council – www.mhca.org.au
• SANE Australia – www.sane.org
Government
• Federal Government Mental Health – www.mentalhealth.gov.au
• Queensland Health – www.health.qld.gov.au

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Mental health landscape

ANSWERS TO THE QUIZ

50
50
 True or False #1
Mental health is a life long process. It involves a
sense of harmony and balance for the individual,
family, friends, their community and more
broadly society.
TRUE but everyone is potentially vulnerable to
mental health problems and mental illness. Risk
factors for mental illness include recreational drug use,
smoking, alcohol misuse and dependence,
socioeconomic disadvantage and life events such as
trauma, stress, bereavement, and unemployment etc.

51
 True or False #2
Mental illness is a single rare disorder that is
uncommon. It only affects a small number of
people.

FALSE There are multiple types of mental illness,

each with its own features and underlying causes.
Some symptoms are shared across different
diagnoses. Saying mental illnesses are all the same is
just like saying that all cancers are the same. Just like
cancer, causes and treatments all differ. Mental Illness
is common, with over a one year period, 1:5 of
Australians experiencing mental illness.

52
 True or False #3
Being treated for a mental illness means
an individual has in some way "failed" or
is “weak”.
FALSE A mental illness is not a character flaw. It is
a diagnosable medical illness, and it has nothing to
do with being weak or failing in some way. It has
been suggested that society is “failing” people with
mental illness and that the best way of judging a society
is how it treats it’s most vulnerable people.

53
 True or False #4
People with mental illness are violent and
dangerous so should be approached with
caution and feared.
FALSE Most violent people have no history of mental disorder and
most people with mental illness have no history of violent
behaviour. Research indicates that people receiving treatment for a
mental illness are no more violent or dangerous than the general
population. The use of drugs or alcohol has a stronger association with
violence than does mental illness. People living with a mental illness are
more likely to be victims of violence, especially self-harm. When it does
occur, violent behaviour usually happens in the context of distressing
hallucinations or treatment that has not been effective.

54
 True or False #5
People with mental illness have childlike
perceptions of the world, lack intelligence and
will always need to be taken care of.

FALSE Many studies show that most people with

mental illness have average or above-average
intelligence. Mental illness, like physical illness, can
affect anyone regardless of intelligence, social class
or income level. What support is required will differ
significantly between individuals and depend upon their
unique circumstances and experiences.

55
 True or False #6
Mental illness is not a “true” medical diagnosis
eg. people with depression should (and could)
really just “snap” out of it, get a job, and get on
with life.

FALSE Although people with mental illness can play a

big part in their own recovery, they did not choose to
become ill, and they are not lazy because they cannot
just "snap out of it." Mental illness cannot be willed away.
Ignoring the problem does not make it go away, either. It
takes courage to seek professional help.

56
 True or False #7
Depression and other illnesses, such as anxiety
disorders, do not affect children or adolescents.
Any emotional problems they have are just a
part of growing up eg. they just grow out of it.
FALSE Children and adolescents can develop mental illness, including
severe mental illness. Since World War 2 there has been a substantial
increase in psychosocial disorders among young people. The incidence of
mental illness in young people is now well documented and shown to be the
highest of any age group. In Australia, the prevalence is approximately 14%
in children aged 4-12 years; 19% 13-17; and up to 27% for 18-24 years . Many
young people do not access services. Left untreated, these problems can
get worse. Talk about suicide should be taken very seriously.

57
 True or False #8
People with severe mental illness should really
be cared for in hospital.
FALSE Most people can recover from mental illness, especially if
they receive help early. Some people will only experience one episode
of mental illness and recover fully, others may be well for long periods
with occasional episodes, and a minority of people will experience
ongoing psychiatric disability. Most people with mental illness will be
treated while living in the community. Some people may require
admission to hospital but will return to supported community
accommodation. There is overwhelming advice from people with
mental illness and their families and friends that living in the
community with appropriate support and assistance, is the
preferred option.

58
 True or False #9
Mental illness is a life sentence ie. recovery is
not possible for people with mental illness.

FALSE Most people can and do recover from mental illness

although early treatment is key. Recovery is “described as a
deeply personal, unique process of changing one’s attitudes,
values, feelings, goals, skills, and/or roles. It is a way of living a
satisfying, hopeful, and contributing life even with limitations
caused by illness. Recovery involves the development of new
meaning and purpose in one’s life as one grows beyond the
catastrophic effects of mental illness” (Anthony, 1993) Recovery-
oriented services are essential to mental health treatment and
community care.

59
 True or False #10
No individual or cultural group is immune from
mental illness. It is a global phenomenon.

TRUE People from any background can develop mental illness.

Cultural background affects how people experience mental
illness and how they understand and interpret the symptoms of
mental illness. Many Aboriginal and Torres Strait Islander peoples
carry a significant burden of grief and loss from an early age, due in
part to the high rates of mortality, illness, incarceration, and deaths in
custody. Pre-migration experiences and the process of resettlement
in a foreign land can impact on the mental health of people from
culturally and linguistically diverse backgrounds and their children.

60
 True or False #11
People living with mental illness expect to be
rejected by the community and are therefore
reluctant to engage with others.
TRUE Stigma has 2 major components: public (reaction of
general public to people with mental illness) and self-stigma
(prejudice that people with mental illness tend to turn towards
themselves (Goffman, 1963). The more visible the stigmatizing
mark or condition, the more society believes the individual should
be able to control it and the greater the negative impact of not
being able to do so. Stigma creates a culture of “us” and
“them”. Stigma hinders help-seeking behaviours.

61
 True or False #12
The effects of stigma and discrimination may
have a greater impact on an individual than the
actual mental illness.
TRUE It is human nature to fear what is not understood.
Therefore mental illness is feared by many people and,
unfortunately, still carries a stigma (defined as a mark or sign of
disgrace) which results in negative discrimination – at school, at
work, in relationships etc. Because of stigma and discrimination,
many people hesitate to get help for a mental health problem for fear
of being looked down upon. It is unfortunate that this happens
because effective treatment exists for almost all mental illnesses.
Worse, the stigma experienced by people with a mental illness
can be more destructive than the illness itself.

62
 Resources
National help lines
• Lifeline – 24 hour counselling and referral 13 11 14
• Kids helpline – counselling for people under 18 years 1800 55 18 10
• Just Ask – rural mental health info 1300 13 11 14
• Mens Line Australia – 24 hour counselling for men 1300 78 99 78
National web sites
• BeyondBlue – www.beyondblue.org.au
• Black Dog Institute – www.blackdog.org.au
• depressioNet – www.depressionet.com.au
• Mental Health Council – www.mhca.org.au
• SANE Australia – www.sane.org
Government
• Federal Government Mental Health – www.mentalhealth.gov.au
• Queensland Health – www.health.qld.gov.au

63
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