It’s a great time to reflect on the mental health and wellbeing of people around us and consider what we are doing to support and promote good mental health.
Research shows young people Australia-wide are struggling with their mental wellbeing. Nearly one in five young Victorians show signs of depression, and one in four young Australians have experienced a mental health disorder in the past 12 months. Suicide is the leading cause of death among people aged 15 to 44. Worryingly, the suicide rate is higher in regional Victoria than in metropolitan Melbourne.
While this data is obviously concerning, young people are increasingly aware of how their mental health and wellbeing impacts them and their peers, and want to talk about how to stay well and access mental health supports. Working with Youth Affairs Council Victoria (YACVic), Victoria’s peak body for young people, I have been a part of a number of consultations with young people around our state who have raised mental health as one of the top issues they are concerned about, and have ideas to improve.
This month is the perfect time to ask young people what they need to support their wellbeing. And to ask yourself how your community can promote and support good mental health, especially so people know how to reach out for help in those times when things aren’t going so great.
Young people tell us that when it comes to addressing mental health and wellbeing, they not only need treatment services but support in lowering the hurdles in their way of accessing them. YACVic’s recent work with VicHealth, CSIRO, and the National Centre for Farmer Health on the Bright Futures: Spotlight on the wellbeing of young people living in rural and regional Victoria report, highlighted the negative impact a lack of accessible services is having.
Things such as distance, lack of transport, the potential cost of an appointment, the stigma associated with seeking help, and the lack of awareness of youth-friendly services can all present challenges to young people.
While some of these hurdles might be the same for young people across the state, young people in country Victoria tell us the hurdles for them are often a bit higher.
And so, they may require more assistance to get over.
Consider it from a young person’s perspective. They might have to travel a few hours to get to a mental health service. They may not have any way of getting to a service via public transport and cannot yet drive. They might not have friends or teachers in their life who understand the signs of ill mental health. They might not be able to afford an appointment. Their parents, family, of community members might not take them seriously, or not know how to help. Each time, the hurdle gets higher.
For some, a hurdle can be too hard to get over alone. This is where communities can work together and help reduce these hurdles, and in turn, some of those statistics.
An excellent example of a community initiative is Youth Live4Life. A recipient of the 2018 YACVic Rural Youth Award for Innovative Youth Project in Rural or Regional Victoria, the program takes place across three sites in country Victoria in Macedon Ranges, Glenelg Shire and Benalla. It brings together schools, support services, parents and the wider community to remove the stigma around mental health, increase supports and awareness, and reduce the hurdles for young people.
Key to the program’s success is its ability to continually engage young people in its design and delivery and create community partnership groups to drive it along. This means a lot of locals want to be involved and helps ensure the initiative will be something young people will engage in. YouthLive4Life trains school students, teachers, parents, and other adults in the community in youth mental health first aid. These courses reduce stigma around ill mental health, and ensure that people from throughout the community know how to respond when a person shows signs of mental health distress.
This type of prevention engages all of the community and normalises mental health help seeking. It takes minimal additional resources but can produce long-term results in lowering the hurdles for young people and generating positive conversations around mental health. Of course, increased investment in accessible mental health professionals in schools and the broader community will always be necessary, but we can’t just look to a single organisation or health professional to kick-start community action around mental health.
We need to start working today, with a co-ordinated approach, to look out for the young people around us, create positive spaces to discuss mental health, and support those who need help to get their mental health and wellbeing back on track.
Becc Brooker is rural policy and advocacy officer for Youth Affairs Council Victoria (YACVic).
F. K. Goodwin
A man known as Aretaeus of Cappadocia has the first records of analyzing the symptoms of depression and mania in the 1st century of Greece. There is documentation that explains how bath salts were used to calm those with manic symptoms and also help those who are dealing with depression. Centuries passed and very little was studied or discovered.
It wasn’t until the mid-19th century that a French psychiatrist by the name of Jean-Pierre Falret wrote an article describing “circular insanity” and this is believed to be the first recorded diagnosis of bipolar disorder. Years later, in the early 1900s, Emil Kraepelin, a German psychiatrist, analyzed the influence of biology on mental disorders, including bipolar disorder. His studies are still used as the basis of classification of mental disorders today.
The idea of a relationship between mania and melancholia can be traced back to at least the 2nd century AD. Soranus of Ephesus (98–177 AD) described mania and melancholia as distinct diseases with separate etiologies; however, he acknowledged that “many others consider melancholia a form of the disease of mania”.
The earliest written descriptions of a relationship between mania and melancholia are attributed to Aretaeus of Cappadocia. Aretaeus was an eclectic medical philosopher who lived in Alexandria somewhere between 30 and 150 AD. Aretaeus is recognized as having authored most of the surviving texts referring to a unified concept of manic-depressive illness, viewing both melancholia and mania as having a common origin in “black bile”.
A clear understanding of bipolar disorder as a mental illness was recognized by early Chinese authors. The encyclopedist Gao Lian (c. 1583) describes the malady in his Eight Treatises on the Nurturing of Life (Ts’un-sheng pa-chien).
The basis of the current conceptualisation of manic-depressive illness can be traced back to the 1850s; on January 31, 1854, Jules Baillarger described to the French Imperial Academy of Medicine a biphasic mental illness causing recurrent oscillations between mania and depression, which he termed folie à double forme (‘dual-form insanity’).
Two weeks later, on February 14, 1854, Jean-Pierre Falretpresented a description to the Academy on what was essentially the same disorder, and designated folie circulaire (‘circular insanity’) by him. The two bitterly disputed as to who had been the first to conceptualise the condition.
These concepts were developed by the German psychiatrist Emil Kraepelin (1856–1926), who, using Kahlbaum’s concept of cyclothymia, categorized and studied the natural course of untreated bipolar patients. He coined the term manic depressive psychosis, after noting that periods of acute illness, manic or depressive, were generally punctuated by relatively symptom-free intervals where the patient was able to function normally.
The first diagnostic distinction to be made between manic-depression involving psychotic states, and that which does not involve psychosis, came from Carl Gustav Jung in 1903. Jung’s distinction is today referred to in the DSM-IV as that between ‘bipolar I’ (mania involving possible psychotic episodes) and ‘bipolar II’ (hypomania without psychosis). In his paper Jung introduced the non-psychotic version of the illness with the introductory statement, “I would like to publish a number of cases whose peculiarity consists in chronic hypomanic behaviour” where “it is not a question of real mania at all but of a hypomanic state which cannot be regarded as psychotic”. Jung illustrated the non-psychotic variation with 5 case histories, each involving hypomanic behaviour, occasional bouts of depression, and mixed mood states, which involved personal and interpersonal upheaval for each patient.
After World War II, John Cade, an Australian psychiatrist, was investigating the effects of various compounds on veteran patients with manic depressive psychosis. In 1949, Cade discovered that lithium carbonate could be used as a successful treatment of manic depressive psychosis. Because there was a fear that table salt substitutes could lead to toxicity or death, Cade’s findings did not immediately lead to widespread treatments. In the 1950s, U.S. hospitals began experimenting with lithium on their patients. By the mid-60s, reports started appearing in the medical literature regarding lithium’s effectiveness.
The term “manic-depressive reaction” appeared in the first American Psychiatric Association Diagnostic Manual in 1952, influenced by the legacy of Adolf Meyer who had introduced the paradigm illness as a reaction of biogenetic factors to psychological and social influences.
Subclassification of bipolar disorder was first proposed by German psychiatrist Karl Leonhard in 1957; he was also the first to introduce the terms bipolar (for those with mania) and unipolar (for those with depressive episodes only).
In 1968, both the newly revised classification systems ICD-8 and DSM-II termed the condition “manic-depressive illness” as biological thinking came to the fore.
The current classification, bipolar disorder, became popular only recently, and some individuals prefer the older term because it provides a better description of a continually changing multi-dimensional illness.
Empirical and theoretical work on bipolar disorder has throughout history “seesawed” between psychological and biological ways of understanding. Despite the work of Kraepelin (1921) emphasizing the psychosocial context, conceptions of bipolar disorder as a genetically based illness dominated the 20th century. Since the 1990s, however, there has been a resurgence of interest and research into the role of psychosocial processes.
My name is Caitlin and I’m 34 years old. I was first diagnosed with depression and anxiety when I was 19, but I’ve probably been struggling with anxiety for my whole life. I am writing this today after seeing others share their stories of recovery from mental illness and feeling inspired to do the same.
At times, living with depression and anxiety feels overwhelming and life feels hopeless. I have tried 13 different psychiatric medications and currently take four. I’m on my fourth long-term individual therapist. These relationships have been immensely helpful, but having them come and go has been painful. Last year, things got particularly challenging and I spent three weeks in a hospital. Having to take time off from my daily responsibilities was something I never had to do before, and I’m still working to accept it.
My negative thoughts are telling me not to submit this because “who cares about my struggles,” “others have it way worse,” but I’m continuing to type this anyway because I want others who are struggling to know you are not alone. I also want to say that yes, I have a mental illness, but that is not all of who I am. I am a daughter, an aunt, a granddaughter, a friend.
This year has been one of my most challenging, but I still have hope. I am thankful to have a doctor who is willing to try new things. Currently, I am in my third week of TMS treatment for depression. All of this is still new, but I think things have slightly begun to shift. I notice it’s easier to get up in the morning—some days, the work day seems more manageable, some days that voice that says I’m not good enough is a little quieter. My friends have also said I seem calmer.
My story of recovery is not over, but hopefully with continued treatment things will continue to improve. I am writing this to say mental health is important, mental illnesses are real, and help is available.