This article is a special submission by Best Selling Author – Naomi Fryers. She has recently launched her book – A Very Long Way which is based on her personal struggles with mental health. Naomi Fryers is a #writer, mental health survivor and #advocate, #TedX Speaker and #author of A Very Long Way which will be #released on World Mental Health day. The book is a story of surviving and thriving with a mental illness, sometimes funny, heartbreaking and hopeful. Naomi has been a mental health patient in the system, but has also worked for many years as a professional in the mental health industry in both not for profit, government organization’s, advocating for progressive and systemic changes to the sector.
Naomi’s TedX speech on her mental health journey will go live in September. Her writing has been featured in Australia and the US including; The #Huffington Post, The Elephant Journal and The Good Men’s Project where she was an editor.
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Many current public mental health services are failing to address basic
human rights, particularly so for women.
My experience of the public mental health system is multi-faceted. I have
some time ago, been a patient. I was a consumer on a locked ward during
my mid-twenties after suffering a severe nervous breakdown. Some years
subsequent I was also employed professionally to enhance systemic and
practical patient advocacy, education, and support during care.
These positions have allowed me great insight into how our navigating
current systems can be overwhelming, intimidating and riddled with current
complexities and failings that continue to go unaddressed. Drastic reform
is required to address current inequalities that inevitably culminate in poor
patient outcomes for some of our most vulnerable.
One of the greatest barriers facing women accessing services is safety.
Inpatient settings can be volatile. A recent Royal Mental Health
Commission exposed the fact that gendered violence is still par for the
course in some of these settings. As a tokenistic nod to address these
issues some gender sensitive spaces have been allocated to consumers
feeling unsafe.
The answer to keeping women safe from male violence will never be to
confine women to locked rooms. Particularly those feeling vulnerable
already trying to recover in restricted environments. That is not a solution
that will come with therapeutic outcomes. These facts do stop some
consumers presenting out of fear. Many psychiatric presentations stem
from trauma, and the risk of compounding that trauma for many is too
great. A lack of bed availability in forensic facilities often heightens this
crisis.
Which brings me to the need for greater education by governments,
facilities, management, educators, and staff in receiving thorough
educations on trauma informed care and what that may look like for
individual consumers. I have seen first-hand, fellow consumers enter a
clinical patient setting, only to be discharged in a worse state than they
entered due to lack of communication, understanding, basic care and what
largely amounts to the systemic neglect of not having staff members
properly educated and aware of varying their approach with prior
experiences in mind.
Factually or conceptually, there is still a hierarchical power dynamic that
exists in many public mental health services. Intentional or not, the doctor
is often viewed as the superior due to their authority status. This ongoing
inequality fails to recognise the autonomy of clients regarding driving their
own recovery journey. The strength of a therapeutic alliance can and does
often dictate clinical outcomes, so patients feeling subordinate to their
treating team may not achieve optimal levels of self-actualisation in their
recovery. Perceptions need to change to empower individuals to realise
that while guidance may be required, they are the indeed the experts in
mastering their own recovery. This would go a long way to promoting self-
determination.
Additional funding needs to be made available to women who require
perinatal care. Often in the public system there are lengthy waits for stays
in a perinatal facility for mothers and their babies to receive adequate care
and treatment for things like postnatal depression, postnatal anxiety, and
postpartum psychosis.
Any delays in treatment, pose obvious risks to women and the wellbeing
and general safety of their newborn and children. Periods between
episodes of cyclical mental illness demonstrate that early intervention and
greater periods more often host better holistic outcomes. Making women
wait for essential services during that can be the most challenging days of
their lives, is inhumane. Resourcing needs to prioritise the health of
mothers and newborns so that optimal outcomes can be demonstrated.
Governments periodically promote the needs for an increase in birth rate so
it’s hard to swallow that they are then not directly responsible for ensuring
the safe and immediate accessibility of crisis support services including
inpatient units.
On top of that many of our current service delivery models lacks agility. Too
often this means services are stretched by over-servicing those who are
deemed most ‘at risk’. That is the case simply because bureaucratic
parameters exist around which providers can deliver which essential
services with which training. This means that those who aren’t in
immediate crisis can face lengthy waits and further delays, be shuffled
between services and some even require re-referral by the time someone
becomes available to take up their case.
Obvious gaps still allow vulnerable people to fall through the cracks. But
also require them to undertake their own advocacy with ‘support services’
which is a challenge than those who are most unwell, may never be able to
meet. A one size fits all approach denies diversity of experience, culture,
education, cognitive challenges, neurodiversity, and varied abilities. This
approach will fail to meet patients where they are at. For example, clear
guidelines and contractual agreements regarding client / service
commitments and conduct may benefit some. But for those who can’t
speak English, are struggling with comprehension, or lack literacy skills-
they will likely prove quite useless.
Lived experience workforces understand these issues, having experienced
them firsthand. They are acutely aware that when clinicians refer to
medical jargon, presume knowledge, fail to educate, and use clinical
acronyms –patients can tend to become alienated from their own
treatment. Instead, mental health services should foster a culture that puts
the clients holistic care at the centrepiece of their model.
Clinical services should learn to make adaptions according to specific
patient requirements, with ongoing evaluation. This should have been a
reality a long time ago. It is the job of everyone moving forward to ensure
that women are not treated as subordinates and tended to like a tokenistic
afterthought. Women should not have to fight for basic human rights to
dignity and health, as though they are blessed privilege. Governments
around the globe owe it to women to ensure that basic support services
will stop leaving us in the dark.
