EVALUATION OF THE CURRENT MENTAL HEALTH SYSTEM IN AUSTRALIA AND THE ROLE COUNSELLORS AND PSYCHOTHERAPISTS PLAY: ANY LESSONS FOR NIGERIAN HEALTHCARE PROFESSIONALS?

Introduction
Whenever ‘mental health’ is mentioned or issues bordering on it are being discussed, two things are usually evident. One is that it invokes a great deal of attention, apprehension and concern from the general public, and two is that these concerns often sprout from varied perspectives and understandings of people in society. Based on this backdrop, Aneshensel and Phelan (1999) admit that mental health, and by extension mental illness is a multifaceted idea whose understanding demands the interpretations of a lot of disciplines such as psychiatry, anthropology, sociology, with each presenting its position on the premise of empirical research.
Asides the fact that the above-named disciplines represent the thoughts, logic and conclusions of medical and non-medical experts, it should also be noted that there are variations on peoples understanding of the concept in different cultures and societies across the globe. For instance, to some people, mental illness refers to the plight of an individual who: talks to himself alone or people that sit quietly alone; contemplates death; is engulfed with anxiety for reasons unknown, consumes intoxicating quantity of alcohol, not minding its implications on him and the people around him; becomes ill with no traceable physiological disease; and cares less of the dampening consequences of his actions on people; (American Psychiatric Association, 1987); while to others, it is just a social construction invented by psychiatrists (Scheff, 1966).
Another interesting point to note is that these viewpoints determine a peoples’ behaviour towards mental health, especially, how the government and health practitioners tackle issues related to it. Based on this background, the thrust of this report is to critically examine the current attitudes and understanding of mental health in Australia. The report also seeks to unravel how counsellors and psychotherapists contribute to the wellbeing of people with mental health issues.
Mental Heal in Australia
In this section of the report, we will focus our attention on examining the overall perceptions of mental health and mental health issue. Relying on Australia and its health system as case study, the report will capture the attitude of the general public and psychiatrists on mental health. It will also look at the culture differences inherent in these perception, as well as how it informs the reactions of Australians towards mental health. Beginning from a global outlook, the World Health Organization (2003) submits that mental health is not just about the absence of mental disorders in individuals but rather, it is a state of mental wellbeing and perceived self-wellness, independence, as well as the recognition of the ability to realize one’s emotional and intellectual potential. Furthermore, the body identifies mental health as a condition whereby people recognise their abilities, and have the capability to absorb stress, work productively and add value to the society.
Furthermore, the global health body explains that although mental health challenges are serious problems to not just the human society as a whole, but also to people living in poverty, the homeless, unemployed, victims of violence, persons with disability, refugees and migrants, indigenous populations, women and children (people who make up a higher percentage of the world population), mental health remains essential to the general well-being of people and societies all over the world. In another event, WHO (2023) defines mental health, an integral part of health and wellness as a fundamental human right that exists on a continuum, that is viewed differently by people, with varying levels of difficulty and results.
In Australia, the Australia Bureau of Statistics (2022) documented that between August 2022 and June 2021, 20% of Australians declared that they had a mental condition. While the mental condition in men was 17%, that of women was 23%. Overall, the survey conducted by the bureau revealed that 9% of Australians reported that they have been diagnosed with one or more mental health condition (ABS, 2022), In the same, the survey of the National Study of Mental Health and Wellbeing (NSMHWB) 2021revealed that 44% of Australians between the ages of 16 and 85 have had experiences of mental disorders during their lifetime; 31% of these people experienced symptoms some twelve months before the survey, with anxiety disorder as the most prevalent, followed by Affective disorders and substance use disorder while 45% of them were female compared to 43% who were men (ABS, 2022).
The National survey of people living with a Psychotic illness also produced a report which presents that there are sixty-four thousand people with a psychotic illness in Australia between the ages of 18 and 64 (Morgan et al., 2011). The survey further states that the prevalence of the illness is higher for men than for women, while the age group with the most prevalent rate is from 25 to 34, and 35 to 44.
As a health condition that is not restricted to a particular age group, mental health also encompasses the well-being of children and adolescents who are also liable to suffer the implications of mental health disorders. This is evident as the Australian child and Adolescent survey of Mental Health and well-being 2013/2014 records that twelve months prior to the survey, about five hundred and sixty thousand children and adolescents, between the ages of four and seventeen had mental disorder, with the prevalence of the condition higher in men (16%) than in women (12%). Furthermore, the following mental disorders were the most prevalent in them: Anxiety disorders (7%) Attention deficit Hyperactivity Disorder (ADHD) (7%), Major Depressive Disorder (3%) and conduct Disorder (2%) (Lawrence et al., 2015).
From the above-mentioned, one may not be wrong to conclude that the Australian society is embattling a serious mental health crisis that is devoid of age, and diversity. This is even more evident as fifty percent of the Australian population, especially adults experience mental illnesses during their lifetime, while other individuals between fifteen and fourty-nine years committed suicide as a result of the condition in 2019 (Commonwealth of Australia n.d). By and large, what is more important at this point is the attitude and understanding of Australians towards this health crisis that has continued to critically affect the social and development of the country.
The Attitudes of the General Public
Issues bordering on mental health especially as it relates to young people in Australia have become so intense that an election pollcommissioned by oxygen-the National centre of Excellence in Youth Mental Health was organised to ascertain the opinions of 1,869 Australians on the nature, cause(s) and consequences of mental health. At the end of the poll, it was uncovered that 88% of Australians who voted agrees to the fact that there was need for early intervention rather than waiting until a young person was critically ill before seeking treatment; 87% agreed that Australian youths should have access to community-based mental health care; while 80% voted that young people should be able to access constant treatment in their local communities instead of waiting until their condition calls for an emergency (Oxygen the National Centre of Excellence in Youth Mental Health, 2019).
Furthermore, 88% of voters also believed that if mental illness is left untreated in young people, it could result in lifelong challenges. The poll also revealed that not more than one-third of Australians agree that youths with mental illness had good access to treatment, and that one in every ten Australian voters agree that young persons with mental illness would be able to get help before their condition becomes severe (Orygen, 2023).
In another event, Reavely, (2019) discussed the attitude of Australians towards mental health illness. The author noted that there are many dimensions of stigmatizing behaviour toward people with mental illness in Australia. These include: personal stigma, perceived stigma and self-stigma. All dimensions of the above-named dimensions of stigma point to the fact that: people living with mental illness are very unpredictable and dangerous; mental illness represents personal weakness; Australians lack the willingness to communicate and socially interact with mentally ill patients; and people will mental illness are more likely to become victims of violence, hence the need for social distancing.
Reavely (2019) continued that according to the National Survey of Mental Health Literacy and stigma 2011, the number of Australians who believe in the violent and unpredictable nature of mentally ill people especially those that suffer schizophrenia is higher. This is evident as 37% of participants agree that a person with schizophrenia is very dangerous while 22% agree that a person with depression can act in the same manner. Furthermore, the survey reveals that 40% for participants are less likely to give employment or vote for people with chronic schizophrenia; Males are more likely to be considered dangerous, and this results in the desire for social distancing; general belief that mental disorders are a sign of human weakness are very high for illnesses like social phobia than for other illnesses like schizophrenia; and individuals are likely to divulge mental illnesses such as Post-Traumatic Stress Disorder (PTSD) than they would do when it comes to chronic schizophrenia (Reavley & Jorm, 2011).
The Attitude of the Psychiatrist
It is interesting to note that the issue of the stigmatisation of mentally ill people in Australia is not only applicable to the general public as it also concerns health professionals, specifically psychiatrists. This means that some health professionals are also involved in the discrimination of people with mental illness. It was in a bid to capture the validity of this claim that the Commonwealth Government funded a project on behaviours of health professional towards the concerns of mentally ill patients their carers or even representatives. The outcome of the project revealed areas where the behaviours of health professionals are different from those of carers, as well as professionals (Rosen, 1997). By and large, in buttressing the idea that the beliefs of the public and health professionals on the treatment of mentally ill patients, Jorm et al., (1998) explain that in Australia, health professionals discriminate mentally ill patients as they often rate long-term mental conditions inadequate than the general public.
Viewing this from a more realistic angle, one may think that such action could be because psychiatrists deal directly with people who are mentally ill and as such, are realistic in their assessment. In the study, Jorm et al., (1998) also noted that clinical psychologists had more favourable attitudes than psychiatrists, especially towards depressed patients. On why this is so, they explained that it could be because clinical psychologists do not have much physical contact with severely affected patients (Jorm et al., 1998, 82). On the other hand, the authors also found that psychiatrists in good remunerated positions had more favourable attitude towards a depressed patient. However, whether this is as a result of workplace culture i.e. staff treatment or because they are used to having encounter with more severe patients remains a question to answer.
In the same vein, a research carried out by Rose et al., (2018) on a comparison between the attitudes of people who work in mental health non-governmental organisations in Australia with other mental health professionals show that mental health NGO employees have generally more positive attitudes towards people with mental illness than other health professionals, including psychiatrists. This makes NGOs more accessible as they encourage people to engage with care. Nonetheless, NGO workers liaise with other public and private health systems to support the mental and physical health of their clients. As such they act as an intermediary for referrals and support for the health of people that are mentally ill (Rose et al., 2018, 5).
As it is known, there is no smoke without fire. This means that there must be a reason behind the negative perceptions of psychiatrists towards mentally ill patients in Australia. Some of these reasons will be highlighted below. First, there is limited training opportunities especially for psychiatrists. Given the fact that a lot of psychiatrists and psychiatric nurses approach their retirement age, and there are very few trainees to replace them, there is bound to be shortage of staff, and even the staff available would be overburdened with work. Furthermore, considering that the training opportunities for elaborate training experience for psychiatrists are limited, one may wonder how well psychiatrists are expected to handle cases of mental illness professionally. Second, as a result of the rationing of mental health services because of scarce resources, patients who need to be admitted into the hospital for care do not get it, those who need longer stay in the hospital tend to be discharged quickly, and those who need serious community case management and follow-up may not get it. As a result of this, there has been an increase in high-risk patients, and this affects psychiatrists, who continue to complain of the lack of acute psychiatric beds, which make the admission of mentally ill patients difficult (Morris, 2022).
The Culture Difference
In this section, the treatment of mentally ill patients, with more concentration on their cultural identity as a way of ensuring a clearer understanding of their take on the treatment they are expected to receive will be discussed. But before that, it is important to note that with the changes in the cultural diversities of groups in the Australian population, there is a dire need for health practitioners to learn about the different beliefs and attitudes of their clients that can influence their thought process. For instance, Westerman (2010) explains that the Aboriginal people in Australia do not access mental health services that are consistent with their medical needs as a result of their cultural inclination. Also, in the course of evaluating a patient that communicates in French and also has a different social and religious beliefs, health practitioners like psychiatrists have to be very much aware of the complex processes that facilitate conflict management among people of the French society. This is because every cultural group has what is defines as normal behaviours within their group. They also have behaviours they tolerate and those they do not. For instance, attitudes that may be intolerable in the French society can result in diagnosis of a psychiatric disorder for a clinician who is trained in the same society.
By and large, the same behaviour in other cultures e.g. English or Spanish can be indicative of an adaptive response to a stressful situation. It is on this note that Fogel et al., (2022) submit that in order to gain an understanding of a patient’s cultural identity, the psychiatrist will have to take note of the patient’s ethnicity, orientation, socio-economic status and religious belief. This will help him address cultural concerns that are relevant to the patient’s mental health diagnosis and treatment.
How counsellors and psychotherapists contribute to the well-being of people with mental health issues
Counsellors are mental health professionals that help patients scale through their difficulties by developing problems. They do not diagnose mental health cases but rather work with their clients to improve their mental health and develop new ideas on how to build resilience and regain sanity. Counsellors contribute to the well-being of mentally ill patients by helping them to: develop a positive identity, self-manage their condition develop valued social roles (Slade, 2009); be actively involved in making decisions that concerns them and their condition (Tomes, 200); change their former behaviours which probably have been unhealthy for them, thus deteriorating their mental health; take on challenges without fear and in a healthy manner such that it will improve their confidence and boost their morale and productivity level; get acquainted to their mental condition, the reason(s) behind them and possible solutions and accommodate their condition in order to give room for healing; and get rid of stress in order to feel better and understand how to cope with the condition 9Vision, Counselling and Psychology, 2023).
On the other hand, psychotherapists also contribute to the well-being of mentally ill patients by helping them to: be aware of wrong ways of thinking and their implications on their mental health; identifying strategies to manage stress and apply consciousness and relaxing techniques like sober reflection, mediation and even breathing excises; embrace their condition by understanding the symptoms, history and patterns of their mental illness (Philbrick et al., 2012). Psychotherapists also help their clients by: monitoring their emotional responses in order to raise awareness of their impact, creating a safety plan to assist clients who habour suicidal thoughts, and utilise coping mechanisms like contacting friends, relatives or family and different types of therapies e.g. Cognitive Behavioural Therapy (CBT) to help their clients become well.
Conclusion
This report is based on an evaluation of the current mental health system in Australia and the role counsellors and psychotherapists play. The report exhaustively discussed mental health in Australia, analyzing statistical reports on the views of Australians regarding mental health issues, the number of people that are affected. Overall, the report assessed the attitudes of the Australian population, specifically the general public and psychiatrists towards mental health challenges.

Reference List
American Psychiatric Association. (1987). Diagnostic and Statistical Manual of mental disorder (3rd Edition). American Psychiatric Press.
Aneshensel, C.S. & Phlan, J.E. (1999). The Sociology of Mental Health: Surveying the field. In C.S. Aneshensel & J.E. Phlan (Eds.). Handbook of Sociology of Mental Health. Kluwer Academic Publishers.
Australian Bureau of Statistics. (2022). National Study of Mental Health and Wellbeing. https://www.abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/latest-release
Australian Bureau of Statistics. (2022). Health Conditions Prevalence. https://www.abs.gov.au/statistics/health/health-conditions-and-risks/health-conditions-prevalence/latest-release
Australian Bureau of Statistics. (2022). Long-term Health Conditions. https://www.abs.gov.au/articles/long-term-health-conditions.
Fogel, A., Nazir, S., Hirapara, K. & Ray, S. (2012). Cultural Assessment and Treatment of Psychiatric Patients. https://www.ncbi.nim.nih.gov/books/NBK482311/
Jorm, A.F., Korten, A.E., Jacob, P.A., Christensen, H. & Hendersen, S. (1998). Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals. Australian National University.
Lawrence, D., Johnson, S., Hafekost, J., Boterhoven de haan, K., Sawyer, M., Ainsley, J. & Zubrick, S.R. (2015). The mental health of children and adolescents report on the second Australian Child and Adolescent survey of mental health and wellbeing. https://www.research.acer.edu.au
Morgan, V.A., Waterreus, A., Janlensky, A., Mackinnan, A., McGrath, J.J., Carr, V., Bush, R., Castle, D., Cohen, M., Harvey, C., Galletly, C., Stain, H.J., Neil, A.L., McGorry, P., Hocking, B., Shah, S. & Saw, S. (2012). People living with Psychotic Illness 2010: Report of the second Australian National Survey. Australia New Zealand Journal of Psychiatry, 46(8), 735-752.
Morris, P. (2021). The Australian Mental Health Crisis: A System Failure in need of treatment. https://napp.org.au/2021/04/the-australian-mental-health-crisis-a-system-failure-in-need-of-treatment/
Reavley, N.J. & Jorm, A.F. (2011). Stigmatizing Attitudes towards people with mental disorders: findings from an Australian national survey of mental health literacy and stigma. Australian New Zealand Journal of psychiatry, 45(12), 1086-1093.
Reavley, N. (2019). Spotlight on Mental Health: Nicola Reavley on Stigma. https://mspgh.unimelb.edu.au/news-and-events/spotlight-on-mental-health-nicola-reavley-on-stigma
Scheff, T.J. (1966). Being Mentally Ill III: A Sociological Theory. Aldine.
Slade, M. (2009). Rethink. 100 Ways to support recovery. A guide for mental health professionals. https://health sciences.unimelb.edu.au/…data/assets/pdf_file
Orygen. The National Centre of Excellence in Youth Mental Health. (2023). Australians ‘ Attitude to Youth Mental Health. https://www.orygen.org.au/About/Federal -Election-2019/
Orygen. The National Centre of Excellence in Youth Mental Health. (2019). Australians’ attitudes to Youth Mental Health. https://www.orygen.org.au/getattachment/About/Federal-Election-2019/Australians-attitudes-to-youth-mental-health/orygen
Philbrick, K.L., Rundell, J.R., Netzel, P.J. & Levenson, J.L. (2012). Clinical Manual of Psychosomatic Medicine: A Guide to consultation – Liaison psychiatry (3rd Edition). American Psychiatric Publishing.
Rose, G., Hippel, C.V., Brener, L. & Hippel, B.V. (2018). Attitudes of people working in mental health non-governmental organizations in Australia: A comparison with other mental health professionals. Health Psychology Open, 5(1), 1-7. doi:10.1177/2055/1029/8765413.
Times, N. (2006). The Patient as a policy factor: A Historical Case Study of the consumer/survivor movement in mental health. Health Affairs, 25(3), 720-729.
Vision Counselling and Psychology. (2023). Counselling for mental health. The importance of counselling for your overall mental health. https://www.visioncounselling.com.au/
Walter, G. & Risen, A. (1997). Psychiatric Stigma and the role of the psychiatrist. Australian Psychiatry, 5, 72-74.
World Health Organization. (2003). Investing in Mental Health. Nove Impression.
Westernan, T.G. (2010). Engaging Australian Aboriginal Youth in Mental Health Services. Australian psychologist, 45(3), 212-222.