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Mental illnesses continue to affect thousands of lives and communities globally but access and equity are the compromise. Australia’s access and equity policies were implemented to enable all Australians to access affordable, quality, and appropriate medical care. Equitable health is a fundamental human right; therefore, it should be available to all. Cumulative realization of healthcare inequity enables the elimination of unfair allocation of resources often resulting from disease and disability variations that hinder the course of planning and well-being (Breslow, 1972). This study focuses on the inequality that is prevalent in accessing standard healthcare, particularly among those living with mental illnesses.
Numerous media reports indicate a belief that inadequate physician access and equity are mainly affecting Australians living in regional and rural areas. The distribution of healthcare resources in remote areas is affected by poor infrastructure, specifically, distance and transportation which limits the receipt of healthcare(Branche, 1991). The fact is not surprising as Australia continues to rely on postcodes as a determinant of patient’s wait to receive medical attention(Australian Institute of Health and Welfare,2016). Nevertheless, according to Corscadden et al. (2016), the most contributing matter of causation originates from the general cost-efficacy and equity of mental healthcare systems and mental health sequels.
Australia has one of the best healthcare systems in the world with the Medicare Benefits Scheme providing subsidized costs for mental healthcare treatments, which allows patients who have obtained a treatment plan to receive free healthcare, at least up to ten sessions a year(Gorman & Brooks,2009). However, the extended long queues to obtain a mental health plan to receive free treatment become less of a priority for patients due to frustration and loss of hope, which is worsened by the scarcity of rural medical professionals(Department of Human Services, 2019).
Nevertheless, the shortage of mental health practitioners in areas of need is not only unique to Australia. The World Health Organisation[WHO] reported a healthcare shortage estimate of over 4 million globally(Gorman & Brooks,2009). Australia continues to recruit foreign doctors who are paid competitive pay packages to fill the medical shortage in rural areas. However, there are not enough doctors specializing in mental health in addition doctors do not prefer to practice in economically deprived regions. Yet, nearly 90% of the world’s population including Australia is still reported to reside in poverty-stricken areas where education is inaccessible, feeding is a problem and infrastructure is alarming( Chen & Ravallion, 2007). With a multitude of evidence-based literature linking poverty to worsened mental health, it would then be convinced that there remains a barrier for people living in socioeconomically deprived regions to access healthcare services and resources, thus contributing to healthcare inequity.
Furthermore, the lack of mental health education and awareness, as well as the poor mental health structure, are factors that also explain why there is compromised healthcare access and service inequity. People living with mental health illnesses are still streamlined. Many lack education and are not in employment either. This group accounts for more than half of homes in rural settlements and is in the very low-income quintiles (AIHW,2006). If food costs and necessary costs are about 10% higher than those in urban and regional areas, then this would suggest that patients are inclined to choose to spend on basic needs over health care.
Also, a significant proportion of the population avoids seeking treatment for mental illnesses due to the associated social stigma, and discrimination, which increases treatment avoidance, restricts health self-disclosure, worsens mental illnesses, and imposes a burden on the healthcare sector( Rouufiel & Lipzker, 2007). Poor mental health stigma and false stereotyping of people living in regional and rural areas are the main disincentives to healthcare access. Everyone seems to know everyone in smaller communities which causes people to hold on to information in fear of confidentiality breach. It is this shared belief that causes people to decide against seeing support, thereby missing out on available services and resources(Australian Psychology Society, 2019)
To conclude access and equity, the combination of factors already discussed, are what contribute to healthcare exclusion in the healthcare system, thus empowering healthcare inequity. However, a clear understanding of the presenting problems can enable preventative measures to reduce care exclusion (Currie et al. 2014).
Besides healthcare access, other factors such as psychiatry medications are medically reported as the leading cause of poor diet and nutrition which will be discussed herein, and the development of other biological illnesses. This interrelation is one that severely contributes to poor physical health in patients living with psychiatric illnesses(Jahoda, 1958).
Many patients diagnosed with mental disorders are prescribed antipsychotics, antidepressants, and anticonvulsants for extended periods of time. Intake of antipsychotics particularly triggers physical illnesses such as parkinsonism, elevated diastolic blood pressure, and diabetes. Worse still, antipsychotics affect gut bacteria thereby causing eating disorders, obesity, and in some cases behavioral concerns( de Kuijper et al, 2013). Often these individuals end up in supported accommodations, have restricted movements, and do not function instrumentally as they once did. No doubt, the long-term side effects of antipsychotics are detrimental to well-being.
On another hand, abuse and neglect is a determinant of poor biological health. A good percentage of mental health patients are physically, sexually, and financially abused by members of the public and their families. There remains a potential for victims to acquire sexually transmitted diseases, live a life of grief and trauma, divorce and separation, and poverty among other effects. In the absence of psychosocial support, patients’ mental and physical health is set to worsen due to the choice of unhealthy coping mechanisms such as self-harm, substance use, gambling, and prostitution(Currie et al. 2014).
Preventative medicine can not stress enough about the benefits of staying active on mental health. Depression, anxiety, and stress all left untreated can impact physical health, therefore, it is vital to take care of mental health as one would take of their physical health. Studies have reported exercises to improve general patient mood thus reducing symptoms such as depression and anxiety. Physical activity acts by increasing energy levels, improving the quality of sleep, and reducing stress (Kovandžić et al. 2011). Furthermore, according to Anderson, Danziger & Kalil (2000), patients who are undergoing psychiatric treatments have registered an improvement in memory, concentration, and general cognitive function. Others reported improved self-esteem and reduced social withdrawal by engaging in physical therapy.
Secondly, food and nutrition are equally central to a healthy body and mind as they are related to metabolism, appetite, culture, and behaviors which are factors, which control our physical and mental well-being. Through various studies into the complex nature of diet and mental health, researchers have suggested that nutrition could potentially treat mental health, hence the introduction of nutritional psychiatry ( Rucklidge & Kaplan, 2016).
Diagnoses for depression, anxiety, attention deficit-hyperactivity disorders, and obesity are increasing and have all been associated with poor nutrition. Studies have in fact shown that a higher intake of foods such as fruits, fish, and whole grain, for example, reduces the risk of developing depression, while other researchers have attached food to growth, increase in energy levels, hormonal regulation, stress management and improved sleep and general mood ( Treasure & Williams, 2004). However, it should be noted that to benefit from diet and nutrition, patients need to adhere to set dietary and nutritional requirements.
Pharmaceutical treatments for the mentally ill play a vital role in the treatment of recurring disorders. The main indication of antipsychotics is to reduce symptoms and prevent relapses associated with psychiatric disorders. However, these should be prescribed by licensed medical practitioners if there are no other alternative solutions for treatment (Currie et al. 2014).
Patients with mental illnesses are at risk of reduced life expectancy as well as poor physical health when compared to other people. Mental illnesses are often associated with a variety of inequalities. They are usually a result of demographic changes, social and economic differences, and geological factors. As evidence, health inequalities lead to reduced life quality, deprived health outcomes, and early mortality rates in patients, consequently, lack of equity in the distribution of health’s social determinants which affects the equity of mental healthcare (Kovandžić et al. 2011).
Statistics show that there is an increase in psychosis in the homeless and low-income households as compared to the general population. Stable employment with good earnings is vital for the recovery from mental illness, but the patients face challenges in gaining and maintaining employment, which is often associated with stigma and a negative attitude from colleagues and society.
Mentally ill patients also suffer from physical health inequalities. According to estimates, two in three deaths of severely mentally ill patients result from preventable physical illnesses like cardiovascular disease. A high rate of suicide in mentally ill patients is standard, at is a leading cause of death for psychosis. Therefore, factors related to psychotic symptoms include lifestyle factors, physical inactivity, underweight, and alcohol intake (Deans, 2017).
Mentally ill patients suffer from compromised physical health. They are vulnerable to physical health problems due to a lack of accessibility to appropriate healthcare due to overlooking their needs and wants. Behavioral factors including but not limited to drug and substance abuse (alcohol and smoking), poor dietary concerns, inadequate living situations, and poor self-care also affect people’s mental health. Social factors linked to mental health vary from social class and poverty (lower class members in the society and the unemployed are likely to suffer from mental illnesses). Other factors include social inclusion and exclusion and inequality in healthcare provision (Langley‐Evans, 2015). Physical factors affecting mental health are friendships and associations with family, friends, and co-workers, state of the environment, income and educational levels, as well as genetics and access to and the use of affordable and quality healthcare. Poor physical health increases the development of mental health problems and vice versa. Studies show that severe mental illness is associated with health diseases like cardiovascular disease; depression and anxiety go hand-in-hand with cancer mortality rates (Langley‐Evans, 2015). There is a connection between diabetes and depression as patients with both illnesses experience severe symptoms than those who have diabetes. These studies show the inter-relationship between mental and physical diseases and the need for the integration of mental health in the treatment of other medical conditions. Statistics show that mentally ill patients are prone to problems like high blood pressure, high levels of cholesterol, high levels of glucose, and weight gain, especially around the midriff, which mostly leads to heart diseases and diabetes. Therefore, it is crucial to have a regular health check when visiting a doctor or psychiatrist to rule out any illnesses and before starting any medication (Reyes et al. 2018).
For positive mental health, physical activity is essential as it helps with the management of stress and anxiety alongside the control of intrusive and racing thoughts. Physical activity is a positive strategy for coping with difficult times. After physical activity, the body releases feel-good hormones that trigger happier moods, which make one feel better as well as have a robust bout of energy (De Hert et al. 2011). One feels tired after a physical session, which translates to better sleep. Therefore physical activity pushes away lethargic feelings, and depression and promotes the feeling of being content with oneself. Previous studies show that there is a link between diet and mental wellness. An improved diet based on fresh and whole foods (enriched with nutrients) improves symptoms of mental illness and helps in the reduction of depression and anxiety.
Lastly, there is no overstating of the importance of mental health. Concerns for mental health lead to mental illnesses when they affect one’s ability to function correctly and cause stress. Mental illnesses make patients miserable and affect their ability to have healthy relationships with other people. Psychotherapy, medication, nutritional therapy, and regular exercise help manage the symptoms of mental illness. Psychosis is the leading cause of disability. Lack of treatment affects the emotional, physical, and behavioral health of patients, which may be fatal in the long run (Reyes et al. 2018). It is also significant to point out that equity in healthcare is imperative to everyone since it is a fundamental human right.
On the other hand, a spectrum of individuals and patients do not have adequate financial resources that can help them to seek the necessary support and help which leads to inconsistent and inadequate mental healthcare and other essential services. Besides, the value of medical expenses typically occurs due to the need for regular therapy, complicated medication management, and intensive treatment plans. In this regard, the insufficiency scenarios lead to mental health professionals that in the long run, facilitate to lack of healthcare equity of access to quality healthcare as anticipated by the industry.
References
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- Chen S., Ravallion M. (2007) Proceedings of the National Academy of Sciences of the United States of America, 104 (43), pp. 16757-16762.
- Currie, L. B., Patterson, M. L., Moniruzzaman, A., McCandless, L. C., & Somers, J. M. (2014). Examining the relationship between health-related needs and the receipt of care by participants experiencing homelessness and mental illness. BMC health services research, 14(1), 404.
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- Deans, E. (2017). Microbiome and mental health in the modern environment.
- De Kuijper, G., Mulder, H., Evenhuis, H., Scholte, F., Visser, F., & Hoekstra, P. (2013). Determinants of physical health parameters in individuals with intellectual disability who use long-term antipsychotics. Research in Developmental Disabilities, 34(9), 2799–2809. https://doi.org/10.1016/j.ridd.2013.05.016
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- Gorman, D., & Brooks, P. (2009). On solutions to the shortage of doctors in Australia and New Zealand. Medical Journal of Australia, 190(3), 152–156. https://doi.org/10.5694/j.1326-5377.2009.tb02320.x
- Jahoda, M. (1958). Current concepts of positive mental health.
- Kovandžić, M., Chew-Graham, C., Reeve, J., Edwards, S., Peters, S., Edge, D., & Dowrick, C. (2011). Access to primary mental health care for hard-to-reach groups: from ‘silent suffering’ to ‘making it work’. Social science & medicine, 72(5), 763-772.
- Langley‐Evans, S. C. (2015). Nutrition in early life and the programming of adult disease: a review. Journal of Human Nutrition and Dietetics, 28, 1-14.
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- Rucklidge, J. J., & Kaplan, B. J. (2016). Nutrition and Mental Health. Clinical Psychological Science, 4(6), 1082–1084. https://doi.org/10.1177/2167702616641050
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- Corscadden, L., Levesque, J., Lewis, V., Breton, M., Sutherland, K., Weenink, J., Haggerty J & Russell Grant. (2016). Barriers to accessing primary health care: comparing Australian experiences internationally. Australian Journal of Primary Health 23, 223-228. Retrieved from https://doi.org/10.1071/PY16093
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