On a recent trip to Australia, I kept finding myself talking about Ireland. My visit, planned before the recent general election, which anyone who still believed in polls expected the Labor Party to win comfortably, was to campaign on mental health. I would go out and join Aussie campaigners in pressing the new government to make mental health their big thing. As with Brexit, as with Trump, the unexpected happened.
Scott Morrison’s Liberal Party won, and so it was a very different political mood I found when I arrived: Labor close to despair, and the right-wing Liberal Party happy to have won but unsure of its agenda.
Ireland kept coming up because of the leadership role it had played tackling smoking. I can remember, as a heavy-smoking journalist on The Daily Mirror in the 80s, peddling stories designed to portray ASH – Action on Smoking and Health – as a bunch of fun-hating weirdos. ASH is largely forgotten. Yet its role in the campaign for change was enormous. History, and our health, owe ASH.
Major change almost always requires government action though, and if I had to single out one government that helped change not just one country but the whole world in its attitudes to smoking, it would be Ireland. Tony Blair was not averse to bold policy, yet even he thought we were pushing our luck banning smoking in the workplace. The word went out: let’s wait and see how the Irish get on.
The Irish got on fine. The Irish became healthier. The Brits followed their lead, as did many other countries, like a health virus spreading, saving lives, saving money. So at every public and private meeting I attended in Australia, nobody thought of lighting up. On the long flights there, there was none of that tobacco smell that used to greet you on the plane. How did we ever tolerate it? (I speak as someone who always tried to get a seat near the back, so I could smoke between meals. )
So what do Ireland and smoking have to do with Australia and mental health? I want Australia to become in mental health what Ireland became in smoking: a trailblazer, a pioneer, a leader by example.
Three things were happening there that led me to believe this is possible. First, the Premier of Victoria, Dan Andrews, has recognised a mental health crisis in his state of seven million people, and ordered a Royal Commission into services there. Second, the Productivity Commission, a federal standing body constantly looking to improve the Australian economy, is undertaking a huge inquiry into mental health. We all know about the human costs. They are looking into the cost to the economy. Third, Morrison announced a goal of “zero suicide in Australia”. A bold pledge, but it is now in black and white, and the mental health sector will press to make it mean something.
On one level it is an impossible goal. But it is nonetheless a good one to set, to get government policy focused on the understanding that most suicides are avoidable. Eight people a day kill themselves in Australia. The real figure may be higher. After one speech I gave, an official who works for the roads network, told me he believed a considerable number of road deaths, recorded as accidents, were actually suicides.
The economic cost is enormous, the human cost incalculable. When I was a panellist on ABC’s Q&A, the equivalent of the BBC’s Question Time, a woman in the front row, Krissi Grant, told of her brother Paul’s suicide. She spoke of the family’s desperation as he got sicker, services that failed to help, the feeling that the support he needed simply was not there. She spoke through tears and I was not alone in fighting back mine as she did so.
“The suicide rate continues to rise,” she said. “I am pleading with Scott Morrison to do more. I have taken it on myself with others to start up a mental health and suicide prevention action group, because if not me, then who? I am disgusted at the lack of support. I am disgusted at the lack of facilities…. My brother was a beautiful, kind soul, who was lost in the system.”
At an event where I appeared as an ambassador for Australians for Mental Health, a woman called Connie Boglis spoke eloquently of her partner, Jesse Bird, who ended his life on 27 June 2016. It was the same story – heartbreaking loss to those left behind, a human being let down by the system. “He joined the Army as a rifleman in 2007, deployed to Afghanistan in June 2009, returned a different person in February 2010,” she told me. “Ended his life six years later.’”
Darryl Wade, a clinical psychologist who works with veterans, told me this: “Forty seven Australians lost their lives in combat in Iraq and Afghanistan; 350 have ended their own lives through suicide since coming home. Think how many others are struggling if that is the suicide rate.” Connie and Jesse Bird’s family now campaign non-stop, not just for better services but also to have victims of suicide recognised at the National War Memorial at Canberra. “I don’t want to glorify suicide but we need to educate people about the truth, and give survivors a place to remember, to grieve, just be,” Connie said.
Next to Connie was Annette Baker, a mother who lost her daughter, Mary, to suicide. Mary, aged just 15, who had an eating disorder, died eight years ago. Annette sat through the entire event, from start to finish, crying without stopping. “The pain never goes. It never will,” she said.
I met Dan Andrews in his Melbourne office after a meeting with commissioners at the Federal Productivity Commission, currently undertaking an inquiry into how mental health can support economic participation and enhance productivity and growth. Andrews and I were on the same page. As I had said in a speech in Sydney the night before: “For old lefties like me, it is obvious why we would get involved in campaigning on this – we are the nice guys, with the touchy-feely values, and we want to look after the most vulnerable, and the State has a role in that. But for the most hard-headed Aussie Liberal, British Tory, American Republican, there is a great deal of money to be saved and made for the economy.” Andrews put it like this: “The social justice argument – no-brainer. But the driest of the dry on economics should see it is a no-brainer for them too.”
If Morrison has set a bold goal with his zero-suicide pledge, Andrews has done something even bolder. He has announced, in advance even of seeing the Royal Commission first draft, that he will implement whatever they recommend.
“Hey, if we are going to do it, we have to do it. The Commission is full of sensible people. They will come up with sensible stuff. And as you know, this is an issue whose time has come. Incremental won’t do it.”
So why not Britain? Why can’t the UK be to mental health what Ireland was to smoking, or the Scandinavians were to welfare and education?
When Theresa May spoke for the first time as Prime Minister, promising to address burning injustices, she said mental illness was one of them, and dealing with it would be a priority. I suggest she looks up “priority” in the dictionary. The injustices still burn. Many services have gone backwards. Child and adolescent mental health services, in many parts of the country, are in crisis.
For her predecessor David Cameron it was a “priority” too. He made a series of “historic pledges”. One was that if you had psychosis you would see a psychiatrist within a maximum of two weeks. I have had psychosis. The physical health equivalent would be smashing through a car windscreen and breaking a dozen bones as you bounce down the highway. No parity between mental and physical health there. “Don’t worry,” the ambulance driver tells the car crash victim lying in the road. “We will have someone here for you in two weeks.”
I don’t underestimate the difficulties. There are many demands on the public purse and politicians’ time. Also, centuries of stigma impact them too. How else to explain that only half a dozen of our Parliamentarians have openly talked of their own mental health challenges, given the demands of political life?
So it is hard. But every time I hear a politician say “isn’t it great we are talking about this more?” I want to scream. Yes, breaking down the stigma is important. But it is not nearly as important as dealing with the problem itself: suicide, the biggest killer of young men; an epidemic of anxiety and self-harm among young women; a boom in anti-depressants. Indeed, my worry is that as the stigma fades and my kids’ generation become more open, we simply will not be able to meet the growing demand.
What would a good mental health system look like? It would be exactly that, a mental health system. That means encouraging knowledge and awareness from the early years. It means sport. It means diet. It means alcohol and drugs policy. It means proper support in schools and colleges so that signs are spotted early, and it means having expert multi-disciplinary care to deal with problems as they arise. It means care being available close to home. It means support in the home. It means special focus, not least in research, on the serious illnesses like that whose medication helped take 20 years off my brother Donald’s life, schizophrenia. It means making real the promise, written into the NHS Constitution, of parity of esteem between physical and mental health.
Words are easy. Delivery harder.
I said the focus must be on a proper mental health policy as opposed to mental illness crisis policy which is what most countries have now. Dan Andrews said the current system was “an incentive to relapse …” A young man at my talk, in Sydney’s City Recital Hall, confirmed this. “I was turned away from hospital because I ‘wasn’t suicidal enough’,” he said. Even at Orygen in Melbourne, one of the best, most welcoming, well designed, well equipped and innovative youth mental health services I have witnessed, they agonised about turning away sick people, because they had minimal resources and tougher cases to deal with.
None of us will be able to prove in years to come, that when Teenager A self-harmed, Drug Addict B became a thief to feed his habit, Desperate Case C took her own life, early intervention would have changed the course of their lives. But it might. The cost would have been minimal compared with the cost of addressing the problems they present and create when things go wrong. Invest in the well-being of the young and you invest in the future.
These days, in most towns and cities, you see the mentally ill on the streets, begging, sleeping. There are so many now that ministers and policymakers looking out of the back seat window probably think it is too hard a nut to crack. Also, as most people just walk on by, the political demand to address the problem seems weak, so they shrug and move on.
The NHS Constitution aims for parity between physical and mental health. We are a million miles away from it. If we saw a man collapse with a heart attack, or a woman fall and break her leg, we would rush to help, give first aid and support, call an ambulance. Yet we walk past the mental equivalent of broken hearts and broken limbs every time we walk through town.
No country has got this right yet. As Orygen’s Executive Director Pat McGorry put it: “I have not met a single politician anywhere in the world who truly gets the scale of the problem.” It is politics and campaigns we need now.
Day after day I had banged the drum for little old Ireland, urging that where they had led on smoking, Australia can lead on mental health. For all the evidence I saw of failing services and disjointed delivery, the Commissions and the bold goal on suicide prevention made me leave Australia with hope.
So come on ScoMo. Show BoJo how it’s done. Show Leo Varadkar the way his predecessors showed everyone else on smoking. Lead the world.
Alastair Campbell is an Ambassador for Time to Change, Mind, Rethink Mental Illness and Alcohol Concern, patron of the Maytree Suicide Sanctuary in London, and now Global Ambassador for Australians for Mental Health.