‘She’ll be right’

There is no doubt that in the past, the perception of mental health in Australia has not been positive.

For too long, Australians have often approached their mental health as something that could fix itself, or perhaps was not a problem at all. The ‘she’ll be right’ attitude was a way to brush off an enormous problem, reducing it to a trivial notion, rather than a health problem that has serious implications on an individual’s life.

It is this perception that the RACGP Foundation is challenging - from a disease, hidden behind closed doors, to being recognised as a health priority.

These perception changes in society lead to huge benefits to the health of all Australians.

Around 45% of Australians aged 16-85 will experience a common mental disorder such as depression, anxiety or a substance use disorder in their lifetime1.

The internalisation of mental health often leads people to substance abuse - use that spirals into secretive patterns that are hidden from those closest to them.

The connection between mental health and substance abuse is often a burden that an individual has carried by themselves for so long that, for the loved ones around them, even the thought of broaching the subject is weighted with feelings of nervousness, apprehension, caution and fear.  

Because of this, opportunities to approach potential life saving conversations are often missed. 

These missed opportunities can have huge repercussions - and therefore the role of the GP in nurturing the conversations can be life changing. 

1.8% of the Australian population received specialised state/territory community mental health care in 2015-162.

RACGP Foundation researcher Dr Michael Tam, from the University of Sydney, has focussed on enabling GPs to find tactical ways to approach the conversation of mental health and substance abuse early on, so that options of interventions are introduced earlier to the patients.                       

Risky alcohol use is a major contributor to ill health in the community, and it is frequently co-occurring with mental illness. My research has largely been looking at the beliefs and attitudes, of both GPs and patients, about having discussions about alcohol in the GP consulting room.

With $9 billion spent on mental health-related expenditure in 2015-162 and 4 million people estimated to have experienced a common mental disorder in 20152, it is in our nation’s best interest to find solutions as to how we can improve our mental health services. 

Early detection, alongside advice and monitoring of mental health, plays a key role in benefitting the patient - and we’re coming to understand that it should be done in a way that the patient feels is non-threatening. 

However, the context of the assessment, and how it is asked, can potentially be seen as threatening. The reason for presenting seems to have an impact on patient acceptance to receiving alcohol assessment. Specifically, our data would suggest that alcohol assessment in consultations for mental health issues is particularly acceptable.

This research is vital in understanding how best to service patients with substance abuse. 

According to the BEACH data2, it is estimated that just under 18.0 million GP encounters were mental health-related in 2015–16, equating to around 12.4% of all GP encounters3.

The research provides clear evidence that individuals suffering from mental health would feel comfortable addressing possible substance abuse with their GP - but relationship is key.          

There is broad agreement and acknowledgement that GPs play a central role in reducing the harms from alcohol at a population level - in screening and early detection, in providing advice and brief interventions, as well as working with specialised alcohol services for patients with more severe alcohol use problems.

My research into patient beliefs and attitudes confirms that patients and GPs are quite aligned in their perspectives on alcohol assessment. Most people acknowledge that it is important, and that this is a role for general practice.

It is in this research that we are coming to realise that not only can the GP be the first to recognise the mental health problems that patients may be suffering from, but the GP/patient relationship is integral to introducing health solutions in a nurturing way; a way that potentially close friends and family are too emotionally connected to, to address.  

It is known that a strong therapeutic relationship between the patient and their doctor is associated with good treatment outcomes, both for physical and mental health.

To encourage a loved one to seek help is often a burden that families feel that they must carry themselves, when in fact the answer could be found in their GP. 

The connection between mental health and substance abuse is quite clear. However, like all health concerns, each approach and path to a healthier patient needs to be provided individually.

By empowering GPs with the tools to nurture sensitive conversations with their patients, we in turn empower the Australian public to feel that they are supported in their mental health needs, rather than having to go it alone.

If alcohol or drugs are harming you, or someone you know, please contact Lifeline’s free counselling for drug use or drug use by a family member or friends. Call 13 11 14 or use Lifeline’s online crisis support service.
In the event of  severe alcohol or substance abuse crisis, please call 000, emergency services.

1. Australian Institute of Health and Welfare. Australia’s health 2016 - in brief. Canberra, 13 September 2016

2. Australian Institute of Health and Welfare. Mental health services in Australia. Canberra, 02 February 2018

3. Australian Institute of Health and Welfare. Mental health services in Australia - General Practice. Canberra, 02 February 2018

We're always looking for partners who want to create a healthier Australia. To find out more about the RACGP Foundation's work, or how you can partner with us to create a healthier Australia, visit www.racgp.org.au/foundation/foundation

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