Why the 'outlook is good' for mental illness

With 80 years of experience between them in the mental health space, Gavin Andrews and Janne McMahon have been privy to significant changes in both understanding and approach.

On Friday evening, at the University of New South Wales, they were announced as the dual winners of the 2018 Australian Mental Health Award.

Janne McMahon.

Janne McMahon.

Two decades ago, having been admitted to Adelaide’s psychiatric clinic eight times and on a disability support pension for Borderline Personality Disorder (BPD), Ms McMahon could barely get out of bed each day.

Asked to provide a patient voice as part of a trial to deinstitutionalise care in South Australia and provide more community support, Ms McMahon found her voice.

In her experience, talk about “patient-centred care” was often lip service that didn’t involve patients at all.

“What we see too often someone sits in an office somewhere and goes 'we are going to put money into this service' and it may not the right sort of service,” she said. “People were being treated appallingly and still are. They're considered to be emotional nuisances and they're not, they have a mental illness.”

Having found a sense of passion and purpose she fought, and continues to fight, for the rights of patients and their carers.

“Mental illness was no longer going to define me. I would get on with things and try and turn my experiences into helping others who didn't have a voice,” says Ms McMahon, who has been central to the development of the Practical Guide for Working with Carers of People with a Mental Illness, the development of the NHMRC Clinical Practice Guidelines for BPD and the BPD National Training Strategy. “You don't do this work for personal recognition you do it because you've got a passion for it.”

Professor Gavin Andrews.

Professor Gavin Andrews.Credit:James Brickwood

In his 60 years in the profession, psychiatrist Gavin Andrews has also witnessed and driven significant change.

Professor Andrews was largely responsible for the introduction of cognitive behaviour therapy in Australia, wrote the the first set of clinical practice guidelines in psychiatry, and established the National Survey of Mental Health to understand the prevalence of mental illness in the country. He also developed online treatment programs and has pushed for deinstitutionalisation of care.

“It's changed … from a focused almost ‘lock 'em up and throw away the key’ [approach] to a 'let's treat people in the community and expect them to get better',” he says.

And Professor Andrews expects people to get better, thanks to a combination of improved medications, new clinical guidelines for and better access to treatment.

“People developing a mental disorder today, more than half of them will be cured by treatment and cured means a couple of years down the track, they’re not on treatment, they’re not taking medication. When you ring them and say, ‘How are you?’, they say, ‘It’s not part of my life’,” he says. “And that means getting better within 60 days and certainly improving within 30 days and otherwise the doctor should ask why and so should the patient.”

Professor Andrews says up to 30,000 people around Australia last year were treated using web-based programs. “That’s a real change and we had no concept that was practical,” he says.

After looking at the results of the second National Survey of Mental Health recently, he believes the recovery statistics may be even higher than he first thought.

“It established how many people had ever met criteria for a mental disorder and how many of those people still had it and it turned out that 80 per cent of people who had ever had a disorder, an average of 15 years later, no longer had it,” Professor Andrews explains. “It had gone away. Some people had treatment but, in this particular survey, there are countries that have used it and have the same answer and they have virtually no treatment options.

“So it seems that is the natural history of the common mental disorders – for people to recover. It may take six months to recover and that will feel like forever but the outlooks are good; in the short term with treatment and in the long term even without treatment.”

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