A Response to Running for Resilience’s Open Source Thinking #2

Matt Breen of Running For Resilience has started a powerful series on his Substack, titled Open Source Thinking. As explained by Matt, the purpose of this series is “Where I’ll be sharing my thoughts on how I think we could pursue a suicide-free society. I might be wrong, I’m most likely misguided, but I need to start the conversation, and if you’ve got something to say, I need you to continue it.”

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We're doing well. We can do better.

Below I share my thoughts to the second instalment of this series, herein referred to as OST #2, with the same sentiment as Matt “I might be wrong, I’m most likely misguided, but I need to start continue the conversation, and if you’ve got something to say, I need you to continue it.”

Barriers

Something I have taken from this second instalment is the importance of reducing the barriers to support and treatment. Before discussing this, I must first acknowledge my limitations - to both my understanding of the complexities of the total system and that my opinion can only reflect that of my experience as patient.

In OST #2 Matt has identified two significant barriers that I agree need to be addressed - time from presentation to starting treatment and economic sustainability. These barriers are close to my heart as they are the same barriers that many people living with rare diseases also face.

As highlighted in OST #2, the mental-health system is overwhelmed. As a consequence, the time from presentation to treatment can be several months, if not longer. This time delay further compounds the emergency state we’re operating in. Firstly, it may result in further deterioration of the individual’s mental state while waiting to start therapy; resulting in the need for longer and more intensive treatment in the long run. Secondly, it can result in individuals, who need support, dropping out of the system entirely.

So, in light of this, I dedicate the remainder of this article to the question how do you stabilise a system in an emergency state?

Factor 1 — in an emergency state you need to increase capacity

As we’ve all seen during the COVID pandemic one of the first tasks for communities around the world was to increase capacity of skilled personnel, resources, specialised equipment and rooms.

Likewise, the state of the mental-health crisis should prompt us similarly to the need for more practicing therapists, resources and available time-slots. This is obviously easier said than done, and my intentions are not to trivialise a complex system with simple ideas. Rather my hope is to prompt further discussion and thought about how this can be achieved.

As a start, I think there are two general factors that should be considered — the entry and exiting of mental-health professionals.

Entry

The topic of entry should be viewed through the lens of maintaining and retaining skill within the industry. To increase entry you may consider the need to remove barriers to education and job accruement (whilst obviously maintaining the quality of graduates). Maybe better marketing of these degrees and radical subsidies to students are needed as a start while we are in this crisis state. Additionally, the development of an employment plan for new professionals to provide job security, stability and growth in the early years of their careers may also be required. What other incentives could increase entry?

Exiting

Identify why professionals are exiting the system and look at ways of mitigating these points of friction. Are professionals reaching retirement age or are they overwhelmed, underpaid or under-utilised? Maybe something else entirely? If they no longer want to practice or work-fulltime, could they be provided clear pathways and opportunities to mentor and support students, graduates or young professionals?

Factor 2 — in an emergency you must reduce the volume

Going back to the familiar example of the pandemic, the other important factor is reducing the volume, or load, of the problem. The introduction of physical distancing, mask wearing and other hygiene measures were implemented to reduce the number of people requiring hospitalisation.

In the mental-health crisis, this translates to decreasing the number of people who need intensive therapy. For example, by studying the most at risk groups within a community you may identify opportunities to implement proactive support, like vaccines in the pandemic or Running for Resilience in the mental health space. These support mechanisms, such as the suggested group support or therapy discussed by Matt in OST #2, are often less intensive and expensive to implement and as such have the capacity for broader reach. Additionally, as outlined in OST #2 these support mechanisms are often amicable for both patients and the professional, and could possibly help reduce the number of professionals exiting the industry.

A Potential Barrier

To be sustainable and successful, I believe these types of support mechanisms require early adoption — before the individual enters a crisis state and subsequently requires intensive support.

By identifying at risk individuals early and providing proactive support we can help to normalise the entire system over time. However, to achieve this we must not turn our backs to the crisis we’re facing and we must adopt a position of maturity that ignores the adage ‘if it ain’t broke, don’t fix it’. When I hear this I ask myself ‘but how close is it to breaking?’ In this sentiment, we must be willing to invest in the strengthening and maintenance of the individual and the community. But why? Because the longer you leave a system in a state of emergency the more professionals and knowledge you’ll lose, the less professionals you’ll gain and the greater the problem becomes until the system collapses.

The Problem with Proactive Care

The difficulty of initiatives such as R4R is that we’ll never know how many individuals avoided, or prolonged entering, the mental-health system because of R4R’s positive intervention in their lives. Similarly, other proactive initiatives will face the same problem. Without short-term quantifiable metrics, it becomes increasingly challenging to validate the success of proactive treatment to policy makers, beyond anecdotal evidence.

Cost Prohibitive

Without significant investment into proactive support we are left with a system that is not only overwhelmed, but cost prohibitive to most Australians. There is a lot to consider here, but my fatigue levels are pretty high at the moment so this will need to wait for another day.

The Solution

There is no simple solution to the prevalence of suicide in our community, but I encourage you to join this conversation and share your thoughts on Running for Resiliences Substack.