19 March 2018

When it comes to women’s health, talk is cheap …

Clinical Women

Mental illness is a leading cause of disability for women in Australia, and yet after years of attention and multiple policy documents it feels like a cohesive and comprehensive approach evades us.

Now, in the wake of another International Women’s Day, we have another concerted push to put women’s health at the top of the agenda. But where do we start?

Recently, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) launched their National Women’s Health Summit with the aim of identifying the most pressing questions and proposed solutions and have them discussed by people with influence.

Around 100 leaders in women’s health were invited to attend, and speakers included health minister Greg Hunt, shadow health minister Catherine King, Greens senator Janet Rice and former NSW health minister Carmel Tebbutt.

In his talk, Mr Hunt announced that the government was going to renew the national women’s health strategy, for 2020 to 2030, spurred on by the summit.

While multiple facets of women’s health were on the program, from ageing and disability, to issues related to migrant and rural women, a major spotlight was shone on mental health.

Almost one in two women will experience mental illness at some point in their lives, and women are more likely to experience both physical and mental illness simultaneously.

Multimorbidities tend to go hand in hand with a greater severity of mental and physical health problems.

In fact, the burden of mental illness is huge, accounting for an estimated loss of $22 billion to the Australian economy each year, in part due to the carer role that women often have as mothers and partners.

Yet despite the different roles women play in society and the different factors leading to their mental health problems, Australia has typically had a gender-blind approach to policy.

A consequence of this is a failure to identify and address gender-specific triggers to many mental illnesses, which include hormonal changes such as those that occur at puberty or pregnancy for example, as well commonly female role demands such as child-rearing.

Another consequence is that the approach stymies funding and research to gender-specific strategies.

Without research and clear metrics, it becomes difficult to make an economic case for change, or to evaluate the benefit of interventions.

In the session dedicated to identifying what was currently working, what wasn’t and what could be done better, experts expressed frustration at the fragmentation of care that women currently experience, and called for initiatives to improve continuity of care and address women’s mental health in a holistic way.

Participants heard about women refusing to enter buildings solely dedicated to mental illness due to stigma, of cuts to culturally and linguistically diverse services severing one of the only avenues women have to seek help for domestic violence, and of clinicians too reluctant to bring up questions of mental health and violence because of a lack of resources and clear pathways should the patient screen positive.

GPs were, of course, pinpointed as one of the most useful first lines of defence, given they see around 90% of women each year.

However, a common refrain from participants in the session, which included GPs, obstetricians and gynaecologists, social workers, police, psychologists and other mental health experts, was that amid the growing demand to adequately address mental health, very little funding was being allocated to help.

In fact, rather than resources increasing in response to demand, resources were often being cut.

It was important to stop practitioner blaming, RANZCOG vice president Dr Vijay Roach said.

The reality was that professionals in this field felt no shortage of anxiety and self-blame when they thought they had let a patient down, he said.

The burden of fixing this problem shouldn’t fall on the shoulders of individual clinicians or even organisations alone.

Raising awareness and creating more policy documents to try to get each sector of the community on the same page was all well and good, but if policy documents were not backed by real funding, and if services and recommendations were not coordinated, then the consensus of expert opinion was that we would be likely to see the same piecemeal and inefficient approach continue.

Speaking at the summit, public health expert and director of the Southgate Institute of Health, Society and Equity at Flinders University Professor Fran Baum said that social determinants were important in understanding and addressing women’s health problems.

Using the metaphor of an iceberg, she explained how the physical and mental manifestations of poor health were commonly underpinned by psycho-socio-cultural factors such as ethnicity, education, income, food security, violence, discrimination, social connection, access to health and social services and early life.

“If you want to improve health, you need to improve daily living conditions such as food supply, housing, education and social protection,” Professor Baum said.