When governments get mental health policy wrong, people die.
For over half a century, governments in all jurisdictions have been funnelling money out of mental health services.The old psychiatric hospitals were expensive, electorally unpopular and outdated. But the new model – light-touch intervention – is clearly not enough. Not everyone can be treated in the community.
Deaths by suicide – the clearest measure of catastrophic policy failure – have gone from 2,393 in 2011 to 3,139 in 2020 – an increase of 31 per cent in a decade. The toll is not evenly shared. The indigenous suicide rate is more than double that of the rest of the population. And across the board, men are more than three times as likely to kill themselves as women.
A clue to why prevention efforts are failing can also be found in the statistics – in the well-known background causes of suicide. Depression, predictably, is a factor in over 40 per cent of cases. Almost a quarter have a history of suicide attempts. Relationship problems are found in more than a quarter.
But the origin of these problems lies, most often, in family backgrounds, often in early childhood and reflecting difficulties that can span generations.
The story of Ben Wildman, who died aged 37, two days before the end of 2020, is a story of how failures in care can destroy the lives of generations.
But it begins more than half a century ago, at Tasmania’s notorious Wybra Hall state reformatory near Hobart. Here, boys endured repeated bashings, sexual and emotional abuse, and denial of education. The boy who would become Ben Wildman’s father was one of them. The cruelty that occurred there shaped both the father and the son.
A government report on the abuse of children in state care included a long list of effects the emotional, physical and sexual abuse had on the powerless kids who were subjected to it. Later, as parents, they were often unable to provide a calm, stable and loving environment for their children – so the trauma cascades down the generations.
|A child's Christmas|
Ben Wildman and his sisters grew up in just such a household. Their father, who never recovered from the childhood he had endured, lived in a vortex of alcoholism, drug use, sudden anger and violent outbursts. There was never enough money.
Children do not thrive in such an environment. Ben left school at 16, directionless, without role models and with an increasingly troublesome depressive illness that he could not identify or counter. By his early 20s, his employer required him to attend counselling sessions. In 2011, at 28, a GP diagnosed major depression and prescribed an antidepressant but he soon stopped taking the pills, saying they made him feel worse. There was no follow-up.
After a determined suicide attempt a few months later he was flown, near death, to the Royal Hobart Hospital for emergency surgery. Family members were anxious for him to be admitted to involuntary psychiatric crisis treatment. Instead, he was released “into the care of his GP”. But he did not have a regular GP. Consultations with a psychologist followed soon after, but treatment did not continue past the ten sessions funded by Medicare.
According to his sister, Kylie Eastley, Ben had a fundamental aversion to authority figures, which is how he saw mental health practitioners. He was expert at convincing them that his problems did not exist, were well-controlled or had passed.
|Ben as a schoolboy|
As his condition worsened, and his life became more disordered, more suicide attempts occurred. After he survived one dangerous attempt, Kylie tried fruitlessly to find appropriate mental health care for her brother. When, after four months, a GP appointment became available, Ben – by now highly anxious and distressed – did not go.
Events spiralled. In June 2020 he was charged with domestic violence, saw a psychologist, was twice arrested for breaching bail and tried to kill himself in the back of a police van.
Two days before New Year’s Eve, he was pulled over by police for driving while using a mobile phone. By the time the shocked police could intervene, Ben had killed himself.
Kylie Eastman remains angry at what she sees as a failure of mental health care staff – and the entire system – to engage effectively with those in desperate need. “At no point,” she tells me, “did I feel we were listened to – which is why I was constantly writing to get people to look at the whole situation. At no point did I feel anybody took proper notice.”
|Just before his death|
Childhood trauma is seldom the result of a single event. More often it develops in an environment of problematic relationships, abuse and – above all – continual emotional stress. And, as in this case, it can cascade down the generations.
Persistent stress causes changes to the structure of the developing brain, particularly in the areas involved in emotion, memory and impulse control. And the earlier in life the stress occurs, the more serious the damage is likely to be.
In her chapter of a recent book, Humanising Mental Health Care in Australia, Associate Professor Sandra L Bloom, a leading proponent of trauma-informed care, explained the mechanism.
“People under severe stress also secrete neurohormones that affect the way those memories are stored,” she wrote. “In animals and humans, high levels of glucocorticoids secreted during stress impair the functioning of the hippocampus.”
The hippocampus, located in the middle of the brain, has a key role in memory and emotions.
Various studies have revealed how toxic stress in childhood leads to physical and mental problems – depression, heart disease, cancer, chronic lung disease, suppressed immunity and early death. Toxic stress is closely associated with serious risk-taking, including smoking, alcohol and drug abuse, obesity and self-harm.
Many of the problems that began with Ben Wildman’s father were the result of his neglect and abuse while in state care. But it didn’t end there. It seldom does.
Fifty years ago, the system that purported to care for vulnerable children, and protect them from harm, did the opposite. But the failures of that era were echoed through to the next generation, in a fragmented, chaotic and incompetent mental health system that extended and compounded the damage of the past.
I ask Kylie: are you angry?
“Yes. I have been all along, because each time it’s been so hard to get people to listen. And every single time getting nowhere.”
Nobody can be sure whether appropriate care would have saved Ben Wildman, but it would have given him a chance. Like too many, he was denied that chance.
If this story raises issues, contact Lifeline (13 11 14) or Beyond Blue (1300 224 636).