Anxiety disorders are the most common mental health problem in Australia and are estimated to affect 1.3 million adults every year. Michelle Graeber has been CEO of the Anxiety Recovery Centre Victoria (ARCVic) for five years. ARCVic is a non-profit state-wide community mental health organisation that provides support, self-help, recovery and education for people and families living with anxiety disorders. They also provide education and training to primary care and mental health professionals. Claire Varley talked with her about women’s access to mental health service, mental healthcare reform and the gendering of the sector.
Right Now: Tell me about ARCVic.
Michelle Graeber: We’re a community organisation providing self-help services, and these play a really vital role in promoting the emotional, mental and social wellbeing of people living with an anxiety and [of] their carers. These services help consumers to rebuild a sense of worth and confidence and gain new knowledge and understanding which can assist them in moving forward in their journey and seeking treatment.
I’m really proud that we provide over 26 support groups in Victoria and we also run a helpline that operates from Monday to Friday providing people with information, support and referral. That gives people the chance to talk to someone who has that lived experience, who knows what it’s like to be living with an anxiety disorder.
We help anywhere from 5000 to 7000 people a year. We also have a regional presence running community education seminars and these have a very large audience. I’d say our service users would be 70 per cent female to 30 per cent male. Though the trend with our support groups is that most people attending are male, which is very unusual for a service.
Access to mental health is often called a human right. Tell me more about this.
We live in a society where unfortunately mental health is something that is still a little bit invisible. It’s something that you can’t actually see; it’s not like a broken leg…And there’s a lot of stigma and misconceptions surrounding mental health. I think sometimes there’s a danger of those people not being considered in the larger picture. And I think it’s a reminder that we need to see the individual and that they should have a right to basic mental health and have access to mental health [services]. For some of our people who are suffering from an anxiety disorder, it can be very debilitating and impacts on every aspect of their life. They could be housebound for quite some period of time, and they’re the sort of people who may not be able to just go down the street and access the Medicare local or access a psychologist or go into a health facility.
It comes down to everyone having the right to get the right kind of help and giving people options and having some diversity and choice.
The UN Convention on the Rights of Persons with Disabilities says that women with mental illness face multiple discriminations and are often disadvantaged. From your experience what challenges do women face accessing mental health supports and services?
It’s interesting because I think women are more open to seeking help than men. However I think they’re slightly disadvantaged sometimes, certainly in being able to financially access services because they’re always putting other people first, like their family or other things that might come up from time to time that prevents them from actually seeking help.
The other thing in terms of being disadvantaged is being truly heard in terms of what’s happening for them. Often their experiences are minimised, either by themselves or by other people.
From our experience women tend to always put other people first and it’s very hard for them to actually put themselves first. So we sometimes, in our community education sessions, will do a lot around self-care and allowing or giving people the permission to look after themselves or take steps to get some help in order to do their other life duties whether it be work or looking after the family home or looking after their child or even a carer role because sometimes people have many many roles. And I think there still needs to be a lot of education around that, particularly when you’re dealing with women from CALD backgrounds (culturally and linguistically diverse) in allowing them to look after themselves.
Who is responsible for mental health funding in Australia?
It really should be a national responsibility. My understanding is that the mental healthcare budget at the moment is like seven per cent of the actual health budget. So I think in terms of a flow of money that that needs to come from a national perspective and then that trickles down to a state perspective. I think there’s been a lot of inequity across the states in terms of disparity between the services delivered. We’re probably one of the largest funded services across Australia in terms of our type of service. South Australia has a very small service. Western Australia has none that I’m aware of. New South Wales has a service that is similar to ours but is under Mental Health NSW and I think that again that’s a relatively small service in terms of what we deliver. And Queensland has nothing. So I think there needs to be some sort of trend coming from a national perspective of having some similar type services that are happening across the states because there’s inconsistency and disparity in terms of what people can access.
Will the National Disability Insurance Scheme (NDIS) have any impact on your service?
Mental health and disability are funded separately so we’re not directly affected. But there’s been a lot of concern because of people not being sure of what changes are ahead… From a regional point of view we were told that there were going to be cuts of existing [community sector] services to accommodate the NDIS. I know somebody on the board of the NDIS who was then saying ‘No no no, that money needs to come from the Commonwealth’. And yet when they were looking at doing the pilots for the NDIS they were asking for state money to fund that. And initially Victoria was reluctant to put any money in there and then all of sudden they are putting money forward. I’m not too sure where that money has come from.
So the sector is concerned that in order to find the money to fund the NDIS, state Government will make cuts to the mental health sector?
Reviews are currently underway on how to reform the state-funded Psychiatric Disability Rehabilitation and Support Service (PDRS) in Victoria. Presently annual funding of more than $90 million provides support to more than 14,000 people through 105 separate service providers. Reforms aim to provide more accessible, flexible and individually-tailored support to people and their families. What do these reforms mean for your service and for the sector as a whole?
There are a number of concerns. There was a document – Community Managed Mental Health – that was put out by VICSERV that went to the Government [about] an agenda for future directions… There’s the message that they’re looking at having fewer funded services and creating larger services to deal with the issues of mental health.
The idea is to improve the existing system and in principle I don’t have a problem with that. But what is of concern is that they’re looking at perhaps larger services trying to provide all those services when some of those are very specialist or very individualised and I’ve got concerns that people will be lost in the system.
I think it’s about all of the organisations working more collectively and networking and providing partnerships. That’s important in terms of minimising the opportunity for people to slip through the system.
And it’s important that we don’t lose focus of providing consumer choice. So if somebody has a really bad experience with one particular service, there’s other services that they could potentially get that service from. I think there’s a danger of minimising that and there’s the potential of people giving up on the system and walking away. And I think that would be very sad.
What are some of the challenges of being one of the smaller mental health providers in the state?
One of the benefits of our type of service is that we’re almost [like] the training ground for future professionals. So for volunteers that come to our organisation, a lot of them want to get insight into what it might be like living with an anxiety disorder and then they take that information and knowledge and apply that to their professional career. And that’s something that is very undervalued and probably not recognised within the sector. And I think that’s one of the areas that isn’t recognised by the government and isn’t really seen as an outcome.
We have about 132 volunteers. Predominantly they’re female but we’re lucky in that we have a very good number of males coming through. It might be 75-25 or 70-30.
We’ve had volunteers here for twenty years. And it is very much about people wanting to make a difference and help others so they don’t have to go through the same journey that they did. Or wanting to be in a position where they can make that journey easier for others.
The community sector is often called a highly gendered sector, with a disproportionate number of women both accessing and providing the services. All five of ARCVic’s staff, for instance, are female. What implications does this have?
It’s predominantly a female workforce. I think that’s slightly changing in terms of more males coming in. But it’s disappointing that the Government don’t recognise the importance of this kind of work within the health sector and particularly the not-for-profit sector. I think it’s reflected certainly in poor pay and poor access to training. Organisations don’t have the money, even though they would like to, to provide professional development for the workers. And [there are] pay structures that don’t support a sustainable pathway – a career pathway. I think there’s a lot of barriers to people and I guess it is a challenge for the community sector because we’re so poorly funded. We’re not able to attract some workers to the sector because of the conditions of pay and work conditions… But – and I think there was some research recently in this – despite all of that, the morale in a lot of services is quite high. And it comes down to being bonded by our commitment and our passion about the work that we do and the fact that we feel like we’re making a difference.