In 2016, 20-year-old Sarah* walked into a sparse, open-plan room peppered with a few bare tables and plastic chairs.
Fluorescent lights and the flicker of a TV that was never switched off cast everything into stark relief. Personal belongings including phones and laptops had had to be surrendered at the front door. A few benches were squeezed into an outside area enclosed by high fences.
To the left was a reception desk behind thick plate glass, with a gap to talk through, like a ticket window at a train station. Overwhelmed and alone, Sarah approached the desk on her first night, wanting to call her mum.
“I was waiting for 20 minutes and I got really upset,” says Sarah. “Eventually I just said, ‘Can’t I just call my mum? Please?’ And the nurse goes, ‘No, you don’t have phone rights.’”
Sarah hadn’t been incarcerated in a state prison. She was one of an estimated 65,300 Australians who attempt suicide every year, according to Lifeline. Following that attempt, she was in the mental health ward in a Sydney hospital.
“The care I got there was shocking; it was really bad,” she says.
“It’s really humiliating because you’re treated as mentally inferior.”
Annemarie Lewis was 19 when she was first hospitalised following a suicide attempt. The trauma of reaching crisis point was only compounded by her stay. She spent her first night on the floor of her shower, locked in a panic attack.
“Here I think I had the most traumatic time of my life,” she says. “The nurses were meant to be checking on me every 30 minutes, except no one came to find me.”
Sarah’s and Annemarie’s stories are not uncommon. Latest data from the ABS shows that suicide is the leading cause of death for people aged 15 to 44, and accounts for more than one-third of deaths among the 15-24 age bracket.
A recent survey of GPs by the Royal Australian College of General Practitioners found mental health is the most common reason for visiting a doctor, and the issue of most concern to GPs.
The public health system has only two options for treatment: six to 10 free sessions of psychological therapy for patients with early mental health issues and hospitalisation for those in crisis. So it’s not hard to see why patients are struggling and GPs and mental health wards are overrun.
While last year’s federal Budget made extra funds available for follow-up care for people who have attempted suicide, and for rural and aged services, when it comes to prevention little has changed.
Dr Sebastian Rosenberg, a Senior Lecturer in Mental Health Policy at the University of Sydney who has previously worked with the Mental Health Council of Australia, says the extra money was positive.
However, he adds, it was just a “baby step” in terms of tackling prevention – an issue he feels was not addressed by the Fifth National Mental Health and Suicide Prevention Plan released by the COAG (Council of Australian Governments) Health Council in 2017.
“People need to own the issue of hospital avoidance and of prevention and early intervention, and nobody does.
“If you [search for] … ‘hospital avoidance’ in the Fifth Mental Health Plan, you won’t find it.”
Dr Rosenberg says: “We never invest in connected community mental health, which has meant that if you have a problem that is too complicated for your GP, and does not respond to six or 10 sessions of Cognitive Behaviour Therapy [one of six approved therapies under the Mental Health Plan], then there’s really no place for you to go other than to hospital.”
On being discharged from the mental health ward, Sarah was not suffering psychosis and was therefore ineligible for EPIS, the Early Psychosis Intervention Service offered by the hospital as follow-up care. Instead, she visited her GP.
“I said I needed a bulk-billing service … so he referred me to Headspace [the federal government-funded mental health organisation for young people],” she says.
“So I went there and I had one session and they told me that I actually couldn’t come back because they could only give me 10 sessions and my issues were far too complex.”
Despite her suicide attempt two weeks earlier, Sarah was one of many people who didn’t fit either the hospital program or the Medicare psychologists. Her other public options? None.
“In my mind, hospitals should be the backstop, the ‘when all else fails’ option,” says Dr Rosenberg. “And at the moment we don’t have ‘all else’.”
Dr Helen Elliot is a clinical psychologist in Brisbane who had her own experience with the public health system when she was admitted to the Royal Brisbane Hospital with acute depression.
She describes mental health in Australia as “an epidemic”, and agrees that public hospitals, as they now stand, are not the answer.“It was terrible,” she said.
“For me it was like a jail sentence, and there was sort of that sense that you’d done something wrong. I wouldn’t wish it on anyone.”
Dr Rosenberg believes the emphasis on hospitalisation has set the bar for admittance unacceptably high.
“It’s a bit like in cancer terms only providing care once your lump is really big. We make people as acutely unwell as possible – floridly unwell – before they qualify for care.”
Private services, meanwhile, can cost thousands of dollars.
“I was looking for extra support from the public system. But they really don’t seem to care unless you’re waving a knife around,” says 25-year-old Lisa*, who suffers from depression.
The NSW Minister for Mental Health, Tanya Davies, was unavailable for comment on this story, as was Headspace.
Dr Rosenberg says of Australia’s mental health system: “It is bad medicine, bad healthcare, bad service to consumers and their families, and bad economics.”
*Names have been changed
If you or someone you know needs help, contact Beyond Blue on 1300 224 636; Headspace on 1800 650 890; or Lifeline on 13 11 14