The changes are part of a A$1.1 billion coronavirus health funding package, announced yesterday, which includes A$74 million for mental health support services, including Kids Helpline, Beyond Blue and Perinatal Anxiety & Depression Australia.
What steps can you take to improve your mental health?
The American College of Lifestyle Medicine highlights six areas for us to invest in to promote or improve our mental health: sleep, nutrition, social connectedness, physical activity/exercise, stress management and avoiding risky substance use.
Lack of sleep, or poor quality sleep, can contribute to poorer mental health.
Keeping to your usual sleep routine even when your daily life has been disrupted is helpful. Aim to get seven to nine hours of sleep a night.
You might need to find different ways of exercising, such as running, walking or tuning into an online class, but try to make physical activity an enjoyable and rewarding part of your daily routine while at home.
Scheduling physical activity at the end of your “work day” can help to separate work from your personal life when working from home.
Spending time outdoors has also been shown to reduce stress. So consider spending time in your backyard, on your balcony or deck, or if possible, take a greener route when accessing essential services.
Talking about your experiences and concerns with a trusted person can also protect your mental health.
If I told you that last night I built a blanket fort in the living room, crawled inside with my cat, a glass of wine and my just-arrived copy of the New Yorker, would you think less of me?
After all, we’re in the midst of a global coronavirus pandemic. Borders are closing, people are sick, dying, losing their jobs, and locked in isolation. And there was I, playing – as though I didn’t have a care in the world.
Meanwhile, you might be reading this holed up at home, screaming with fury at those bloody hoarders. Or perhaps you’re on a train valiantly trying to keep 1.5 metres away from the next person, shrinking back as they cough and splutter.
Wherever you are, whatever you’re doing, whatever you think about the pandemic, the economy, or your compatriots, a tiny part of you knows you could do with a bit of pleasure right now.
When we’re first exposed to something stressful, like a deadly new disease, our body reacts with a cascade of small changes such as releasing adrenaline and other chemicals, and activating brain regions related to fear and anger.
It may seem too simple to be true but shifting our attention toward the small, everyday pleasures in our lives can offset the consequences of stress or negative events.
US researchers reported last year that experiencing pleasurable emotions, for example having interesting things to do, serves as a buffer between chronic stress and depression. So, among people with sustained, high levels of stress, those who reported more pleasurable moments were likely to experience less severe depressive symptoms.
But to maximise the pleasure in every day, we should look more widely, to a multitude of sources.
If we’re too busy reading those alarming headlines to notice the beauty of the sun setting outside our window though, it’s a missed opportunity for a moment of delight.
When I recently asked people on Twitter to share the things bringing them delight in these challenging times, I received hundreds of replies within a couple of hours.
Each one was a small vignette conveying a personal moment of simple pleasure. Gardens and dogs and children and nature featured strongly, and many people reflected on the added pleasure of recalling such moments.
Indeed, recollection and anticipation – along with relishing pleasure in the moment – are effective ways to maximise the value of positive experiences or emotions. We call it “savouring”.
Luckily, we can get better at savouring with practice. And the more we savour, the less stressed we feel. And that’s why I’m here.
My message is not to avoid the facts or pretend nothing has changed. It’s to intentionally build in moments of reprieve and restoration. It’s to turn your attention to what is still good and rich and fun – to really focus on those things.
This is how we can harness the protective power of small pleasures, for the sake of delight itself and to build grit and resilience.
So, there may never have been a better time to build a blanket fort, or to bring out a game of Twister, or to lie on your back in the garden making fantasy creatures out of passing clouds. Find excuses to giggle.
In difficult, frightening times, no one is immune to worry; it’s a natural response. But what we can do is take steps to protect ourselves, as much as possible, from its physical and psychological ill-effects.
The challenge is to make this happen, to tear yourself away from analysing the COVID-19 curve and intentionally, systematically engineer more small delights into your day.
Do you like the sunshine? Then know when the sun falls on your balcony, in your garden or in the street near your place. Take a cup of tea or coffee with you and soak up the warmth.
Pets? Run, play, be silly with them. Eating a tomato? Plant the seeds and watch something grow, from nothing, because of you. Sing. Dance. Delight someone with an act of kindness.
Plan your opportunities for pleasure. Put them in your diary. Set your alarm for them. Commit to share them with others. Photograph them. Post them on social media or share them directly with friends and family. Anticipate them gleefully and reflect on them with delight. This is our time to be here. Savour.
Many firefighters will by now be exhausted, having been on the front line of Australia’s bushfire crisis for weeks or months.
This bushfire season has been unrelenting, and the hottest months of summer may still lie ahead.
In part, the toll is physical. The flames are high, they are intense, and they move fast. It’s hard to breathe because the air is so hot.
At the same time, first responders have witnessed widespread devastation. To land and livelihoods, to people and animals. Meanwhile, grief for the death of fellow firefighters feels raw, and the risk to their own lives very real.
We’re right to be concerned about firefighters’ mental health.
Emergency responders already have poorer mental health
Every 4.3 weeks, a firefighter, paramedic or police officer dies by suicide – and that’s when it’s “business as usual”.
Research shows our first responders are more likely to be diagnosed with a mental health condition than the overall Australian population. They are more than twice as likely to think about suicide, and three times as likely to have a suicide plan.
This paints a grim picture of the well-being of a population who dedicate their professional lives to helping others.
It’s likely responding to a disaster on the scale of the current bushfires could increase the risk of mental illness for some.
If firefighters are not coping, they may develop psychological disorders including post-traumatic stress disorder (PTSD), anxiety, depression, and substance abuse.
PTSD develops when a person isn’t able to recover after experiencing a traumatic event.
Some firefighters may develop symptoms while they’re still fighting the fires. They may feel on edge, but push down their fears to get on with the job. However, it’s more likely symptoms will only appear weeks, months, even years down the track.
PTSD is associated with significant impairment in day-to-day functioning socially and at work. For firefighters and others with PTSD, typical symptoms or behaviours will include:
reliving the traumatic event. People with PTSD describe vivid images and terrifying nightmares of their experience
avoiding reminders of what happened. They may become emotionally numb and isolate themselves to avoid any triggers
being constantly tense and jumpy, always looking out for signs of danger.
Volunteers in regional communities are particularly susceptible to trauma. They have often joined fire brigades to help protect their own communities, and then face trying to save their own homes or those of neighbours and friends.
We also need to be mindful of retired firefighters for whom these current bushfires will have triggered painful and disturbing memories. They may not currently be on the front lines, but they only need to turn on the television, open the newspaper, or look at social media to be taken straight back to Black Saturday or whatever particular event is distressing for them.
The increased prevalence of mental health issues among emergency responders suggests many existing emergency service well-being programs are failing those who need them the most.
In Australia, these programs are largely based on a what’s called a “resilience model” that focuses on people “reaching out” and seeking help when they need it.
First responders may be unlikely to take this initiative in the middle of a mental health crisis, when it’s often a struggle even to pick up the phone to a loved one, friend or colleague.
Instead, we need an approach to well-being that removes the onus on the individual. We need to shift our thinking from a model that requires the individual to “reach out”, to a model that also values others “reaching in” to identify those who may be struggling.
Ambulance Victoria’s Peer Support Dog Program, which allows staff to bring in accredited dogs to create social interactions and conversations, is a good example of how “reaching in” helps with first responder well-being. This kind of approach empowers people through social connections and the appreciation they are also supporting others.
While employers need to do more in to facilitate “reach in” programs, anyone can create informal support networks. Whether friendship groups, community groups, sporting groups, or something else, the underlying thread should be a committment to each other’s well-being.
As we continue to contend with this crisis, ensuring firefighters feel supported can make a difference to their well-being. If you see a responder in the street, say thank you. If you see one in a cafe, shout them a cuppa. If you have kids, get them to write a letter or draw a picture and drop it off to the local emergency services station.
We can’t eliminate the risk firefighters will suffer with mental health problems after what they’ve been through, but these little acts of kindness can make a difference.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
In other fire conditions, staying and defending requires accurately assessing the safety of your house and the surrounding environment, preparing your property in line with current best practice and understanding fire conditions.
It also requires a realistic assessment of not just your personal physical capacity to stay and defend but also your psychological capacity.
Why do people stay and defend?
Our survey of people who experienced the 2017 NSW bushfires asked what they would do next summer if there were catastrophic conditions. Some 27% would get ready to stay and defend, and 24% said they would wait to see if there was a fire before deciding whether to stay and defend or leave.
Animal ownership, a lack of insurance, and valuable assets such as agricultural sheds and equipment, are motivators for decisions to stay and defend.
change their plan at the last minute, including leaving late which is the most dangerous response to a fire
drive unsafely, especially speeding
forget to take important items (such as medication)
leave their animals behind
engage in unrelated tasks that took up precious time
ignore the threat (by going to sleep, for example).
This is one person’s account of how they responded as the fire approached:
[I] grabbed my son […] saw the smoke and […] went and got the boxes that I’d prepared which I packed when he was a baby. So I had stupid things in the boxes, like baby outfits. But I can’t freak him out […]
[I]n the back of my mind I’m thinking about what do I need to do […] I’ve quarter a tank of diesel, I’d better go get diesel. I also had a back seat full of books that I’d been tidying up [from] his room, so I thought op shop, better do that because I’ll clear the back seat. […]
Came in the house like a mad woman screaming for cats, nowhere in sight. I’ve got four cats and not one of them [is there]. Grabbed a bag and then started putting stupid amounts of clothes in like 20 pair of socks, and then basically I threw the dog in the car. […] So flat panic.
The spectrum of actions from frenzy and flight to freezing reflects the model of “affective tolerance”. When stress exceeds what we can tolerate, we can become hyper-aroused and may have racing thoughts and act impulsively.
Or we may experience hypo-arousal, where we shut down and feel numb and passive.
Our brains consist of three basic parts: the brain stem, limbic system and cortex. These are sometimes described as the primitive, emotional and thinking brains.
In most situations, our thinking brain mediates physical responses to the world around us.
But under high amounts of stress, this connecting loop between the more reactive emotional and physical parts of our brain and our thinking cortex becomes separated. University of California, Los Angeles, professor of psychiatry Dan Siegel describes this as flipping our lid.
Flipping our lid is an automatic response and, from an evolutionary perspective, it’s a highly useful one – we don’t have time to think about whether or not to run when our lives are threatened.
have accessed information on what it means to be mentally prepared
have previous experience of bushfires
are mindful (have the ability to stay present)
use an active coping style such as the AIM model (anticipate, identify, manage)
have low levels of stress and depression.
Currently, the most accessible resource on developing mental preparedness is the Australian Red Cross RediPlan guide which includes preparing your mind based on the AIM (anticipate, identify, manage) model.
Many of those who’ve suffered from illness or disease would have received the advice to “stay positive”. Is this sage advice that can truly have a positive effect on health, or an added burden for someone who is already suffering – the need to also feel good about it?
We asked five experts in various fields whether a positive mindset can affect outcomes for those suffering from illness and disease.
Five out of five experts said yes
However, they had some important caveats. It depends on the disease – for example, one expert said studies in cancer have not found positive thinking affects disease progression or the likelihood of early death.
And while our mental health can have powerful effects on our physical health, the perceived need to “stay positive” can be an added burden during a difficult time. So it’s also important to remember grief is normal.
Here are the experts’ detailed responses:
If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: email@example.com
Erica Sloan is a member of the Scientific Advisory Board of Cygnal Therapeutics. Jayashri Kulkarni receives funding from the NHMRC.
Among 18 to 25 year olds, one in three (35%) reported feeling lonely three or more times a week. We also found that higher levels of loneliness increases a young adult’s risk of developing depression by 12% and social anxiety by 10%.
Adolescents aged 12 to 17 reported better outcomes, with one in seven (13%) feeling lonely three or more times a week. Participants in this age group were also less likely to report symptoms of depression and social anxiety than the 18 to 25 year olds.
Young adulthood can be a lonely time
Anyone can experience loneliness and at any point in life but it’s often triggered by significant life events – both positive (such as new parenthood or a new job) and negative (bereavement, separation or health problems).
Young adults are managing new challenges such as moving away from home and starting university, TAFE or work. Almost half (48%) of the young adults in our survey lived away from family and caregivers. Almost 77% were also engaged in some sort of work.
Young people at high school may be buffered from loneliness because they’re surrounded by peers, many of whom they have known for years. But once they leave the safety of these familiar environments, they are likely to have to put in extra effort to forge new ties. They may also feel more disconnected from the existing friends they have.
During this transition to independence, young adults may find themselves with evolving social networks, including interactions with colleagues and peers of different ages. Learning to navigate these different relationships requires adjustment, and a fair bit of trial and error.
Is social media use to blame?
The reliance on social media to communicate is often thought to cause loneliness.
No studies I’m aware of have examined the cause-effect between loneliness and social media use.
There is some evidence that those who are lonely are more likely to use the internet for social interactions and spend less time in real life interactions. But it’s unclear whether social media use causes more loneliness.
While social media can be used to replace offline relationships with online ones, it can also be used to both enhance existing relationships and offer new social opportunities.
Further, a recent study found that the relationship between social media use and psychological distress was weak.
Is loneliness a cause or effect of mental ill health?
Loneliness is bad for our physical and mental health. Over a six-month period, people who are lonely are more likely to experience higher rates of depression, social anxiety and paranoia. Being socially anxious can also lead to more loneliness at a later time.
The solution isn’t as simple as joining a group or trying harder to make friends, especially if one also already feels anxious about being with people.
While lonely people are motivated to connect with others they are also more likely to experience social interactions as stressful. Brain imaging studies show lonely people are less rewarded by social interactions and are more attuned to distress of others than less lonely counterparts.
When lonely people do socialise, they are more likely to engage in self-defeating actions, such as being less cooperative, and show more negative emotions and body language. This is done in an (often unconscious) attempt to disengage and protect themselves from rejection.
Lonely people are also more likely to find reasons people cannot be trusted or do not live up to particular social expectations, and to believe others evaluate them more negatively than they actually do.
What can we do about it?
One way to address these invisible forces is to help young people think in more helpful ways about friendship, and to understand how they can influence others through their emotions and behaviours.
Parents, educators and counsellors can play a role in educating children and young people about the dynamics of evolving friendships. This might involve helping the young person to evaluate their own behaviours and thought patterns, understand how they play an active role in building relationships, and to support them to interact differently.
helping young people identify their strengths and learn how they’re important in forging strong, meaningful relationships. If the young person identifies humour as a strength, for instance, this might involve discussing how they can use their humour to establish rapport with others.
Educational programs can do more to address the social health of young people and these discussions can be integrated into health education classes.
Additionally, because young people are already frequent and competent users of technology, carefully crafted digital tools could be developed to target loneliness.
These tools could help young people learn skills to develop and maintain meaningful relationships. And because lonely people are more likely to avoid others, digital tools could also be used as one way to help young people build social confidence and practise new skills within a safe space.
A cornerstone of any solution, however, is to normalise feelings of loneliness, so feeling lonely is seen not as a weakness but rather as an innate human need to connect. Loneliness is likely to negatively impact on health when it is ignored, or not properly addressed, allowing the distress to persist.
Identifying and normalising feelings of loneliness can help lonely people consider different avenues for action.
We don’t yet know the lifelong impact of loneliness on today’s young people, so it’s important we take action now, by increasing awareness and giving young people the tools to develop and maintain meaningful social relationships.
Michelle Lim, the author of this piece, is available for a Q+A on Tuesday the 1st October from 3pm-4pm AEST to take questions on this topic. Please post your questions in the comments below.
This year’s budget includes $448.5 to modernise Australia’s Medicare system, by encouraging people with diabetes to sign up to a GP clinic for their care. The clinic will receive a lump sum payment to care for the person over time, rather than a fee each time they see their GP.
The indexation freeze on all GP services on the Medicare Benefits Schedule (MBS) will lift from July 1, 2019, at a cost of $187.2 million. The freeze will be lifted on various X-ray and ultrasound MBS rebates from July 1, 2020.
The budget announces $461 million for youth mental health, including 30 new headspace centres, some of which will be in regional areas. But it does little to address the underlying structural reforms that make it difficult for Australians to access quality and timely mental health care.
In aged care, the government will fund 10,000 home care packages, which have been previously announced, at a cost of $282 million over five years, and will allocate $84 million for carer respite. But long wait times for home care packages remain.
Other announcements include:
$62.2 million over five years to train new rural GPs
$309 million for diagnostic imaging services, including 23 new MRI licences
$331 million over five years for new pharmaceuticals, including high-cost cancer treatments
$107.8 million over seven years for hospitals and facilities including Redland Hospital, Bowen Hospital, Bass Coast Health and Ronald McDonald House
$70.8 million over seven years for regional cancer diagnosis, treatment and therapy centres
$114.5 million from 2020-21 to trial eight mental health facilities for adults
$43.9 million for mental health services for expectant and new parents
$35.7 million over five years for increased dementia and veterans’ home care supplements
$320 million this year as a one-off increase to the basic subsidy for residential aged-care recipients.
Here’s what our health policy experts thought of tonight’s budget announcements.
A hesitant step forward for Medicare
Stephen Duckett, Director, Health Program, Grattan Institute
Medicare funding is slowly creeping into the 21st century. The 19th-century model of individual fees for individual services – suitable for an era when medicine was essentially dealing with episodic conditions – is being supplemented with a new fee to better manage the care of people with diabetes.
The precise details of the new fee – including the annual amount and any descriptors – have not yet been released. But it should encourage practices to move towards a more prevention-oriented approach to chronic disease management, including using practice nurses to call patients to check up on their condition, and using remote monitoring technology.
The budget announcement contained no evaluation strategy for the initiative. The government should produce such a strategy soon.
Support for aged and disability care
Hal Swerissen, Emeritus Professor, La Trobe University, and Fellow, Health Program, Grattan Institute
The budget has short-term measures to address major issues in aged care and disability while we wait for the royal commissions to fix the long-term problems.
The National Disability Insurance Agency (NDIA) is struggling with the huge task of putting the National Disability Insurance Scheme (NDIS) in place.
There has been a major under-spend on the on the scheme. Price caps for services such as therapy and personal care are too low and nearly one-third of services are operating at a loss. The under-spend would have been more if there hadn’t been a last-minute budget decision to significantly increase service caps, at a cost of $850 million.
$528 million dollars has also been announced for a royal commission to look at violence, neglect and abuse of people with disabilities – the most expensive royal commission to date.
There is more funding for aged care. Currently, 130,000 older people are waiting for home care packages – often for a year or more. Nearly half of residential care services are losing money and there are major concerns about quality of care.
The short-term fix is to give residential care $320 million to try to prevent services going under. The budget includes 10,000 previously announced home care packages, at a cost of $282 million, but that still leaves more than 100,000 people waiting.
Little for prevention, Indigenous health and to address disparities
Lesley Russell, Adjunct Associate Professor, Menzies Centre for Health Policy, University of Sydney
Preventable diseases and conditions are a key factor in health inequalities and rising health-care costs. The two issues looming large are obesity and its consequences, and the health impacts of climate change.
There is $5.5 million for 2018-19 and 2019-20 for mental health services in areas affected by natural disasters, and $1.1 million over two years for the Health Star rating system – otherwise nothing for primary prevention.
The Treasurer did not mention Closing the Gap in his budget speech, and there is little in the budget for Indigenous health.
Just $5 million over four years is provided in the budget for suicide-prevention initiatives. And the Lowitja Institute receives $10 million for health and medical research.
$6.3 million to continue the development of the Health Data Portal for services funded under the Indigenous Australians Health Program.
Inequalities and disparities
Disadvantaged rural and remote communities will (ultimately) benefit from efforts to boost National Rural Generalist Training Pathway, with $62.2 million provided over four years. This was a 2016 election commitment.
Peter Sivey, Associate Professor, School of Economics, Finance and Marketing, RMIT University
There are no major changes to public hospital funding arrangements in this year’s budget.
Funding for public hospitals is predicted to increase at between 3.7% and 5.6% over the forward estimates. However, these figures are contingent on the new COAG agreement on health funding between the Commonwealth and states, which is due to be finalised before the end of 2019.
The states will be hoping to wring some more dollars from the federal government given their soaring public hospital admissions and pressure on waiting times.
Government spending on the private health insurance rebate is projected to increase more slowly than premiums at between 1.8% and 3.2% because of indexation arrangements which are gradually reducing the rebate over time.
Smaller targets for mental health
Ian Hickie, Co-Director, Brain and Mind Institute, University of Sydney
Numerous reports and accounts from within the community have noted the flaws in Australia’s mental health system: poor access to quality services, the uneven roll-out of the NDIS, and the lack of accountability for reforming the system.
The next federal government faces major structural challenges in mental health and suicide prevention.
Not surprisingly, this pre-election budget does not directly address these issues. Instead, it focuses on less challenging but worthy targets such as:
continued support for expansion of headspace services for young people ($263m over the next seven years) and additional support for early psychosis services ($110m over four years)
support for workplace-based mental health programs ($15m)
support for new residential care centres for eating disorders ($63m).
A more challenging experiment is the $114.5 committed to eight new walk-in community mental health centres, recognising that access to coordinated, high-quality care that delivers better outcomes remains a national challenge.
Despite the commitment of health minister Greg Hunt to enhanced mental health investments, the total increased spend on these initiatives ($736.6m) is dwarfed by the big new expenditures in Medicare ($6b), improved access to medicines ($40b), public hospitals ($5b) and aged care ($7b).
It will be interesting to see whether mental health reform now receives greater attention during the election campaign. At this stage, neither of the major parties has made it clear that it is ready to deal directly with the complex challenges in mental health and suicide prevention that are unresolved.
New funding for research, but who decides the priorities?
Philip Clarke, Professor of Health Economics, University of Melbourne
The budget contains several funding announcements for research.
The government will establish a Health and Medical Research Office, to help allocate money from the Medical Research Future Fund (MRFF). This will be needed, as the budget papers commit to a further $931 million from the MRFF for:
Clinical trials for rare cancers and rare diseases
Emerging priorities and consumer-driven research
Global health research to tackle antimicrobial resistance and drug-resistant tuberculosis.
In addition, the budget includes:
$70 million for research into type 1 diabetes
a large investment for genomics (although that is a re-announcement of $500 million promised in last year’s budget)
a series of infrastructure grants to individual universities and institutions, such as $10 million to establish the Curtin University Dementia Centre of Excellence.
The government appears to be moving away from allocating medical research funding through existing funding bodies, such as the National Health and Medical Research Council (NHMRC), towards allocating research funds to specific disease areas, and even to individual institutions.
This is a much more direct approach to research funding, but it raises a few important questions. On what basis are these funding decisions being made? And why are some diseases considered priorities to receive funding? There is very little detail to answer these questions.
Australia’s allocation of research funding through the MRFF is diverging from long-held traditions in other countries, such as the United Kingdom, which apply the “Haldane principle”. This involves researchers deciding where research funding is spent, rather than politicians.
* This article has been updated since publication to clarify the 10,000 home care packages have been previously announced.
With each new version of the widely-used manual of mental disorders, the number of mental health conditions increases. The latest version (DSM-5) lists around 300 disorders. To complicate things, many share common features, such as depression and anxiety.
The manual is a useful guide for doctors and researchers, but making a diagnosis is not a precise science. So if the “experts” are still debating what’s what when it comes to categorising disorders, it’s not surprising misconceptions abound in the community about certain mental health conditions.
We learn about mental health conditions in a number of ways. Either we know someone who has experienced it, we’ve experienced it ourselves, read about it or seen something on TV. Movies and TV series commonly portray people with mental illness as dangerous, scary and unpredictable. The most popular (mis)representations are of characters with multiple personalities, personality disorders, schizophrenia and bipolar disorder.
While the media is an important source of information about mental illness, it can misinform the public if reported inaccurately, promoting stigma and perpetuating myths. And research shows negative images of mental illness in the media (fictional and non-fictional) results in negative and inaccurate beliefs about mental illness.
Dissociative identity disorder
“Multiple personality disorder” or “split personality disorder” are colloquial terms for dissociative identity disorder. Despite being colloquially named a personality disorder, it’s actually a dissociative disorder.
A personality disorder is a long-term way of thinking, feeling and behaving that deviates from the expectations of culture. Whereas in dissociative identity disorder, at least two alternate personalities (alters) routinely take control of the individual’s behaviour. The individual is usually unable to remember what happened when an alter takes over: there are noticeble gaps in their memory, which can be extremely distressing.
The popular TV series “The United States of Tara” actually does a pretty good job of portraying dissociative identity disorder. The main character has a series of alters and experiences recurrent gaps in her memory.
While it used to be considered rare, dissociative identity disorder is estimated to affect 1% of the general population, and is typically related to early trauma (such as childhood abuse). People commonly confuse dissociative identity disorder with schizophrenia. Unlike schizophrenia, the individual is not imagining external voices or experiencing visual hallucinations: one personality literally “checks out” and another appears in their place.
Borderline personality disorder
Borderline personality disorder is often misconstrued. People with this condition are often portrayed as manipulative, destructive and violent. In reality, these behaviours are driven by emotional pain: the person has never learned to ask effectively for what they need or want.
It is also often assumed “borderline” means the person almost has a personality disorder. The term “borderline” here creates some confusion. First introduced in the United States in 1938, the term was used by psychiatrists to describe patients who were thought to be on the “border” between diagnoses (mostly psychosis and neurosis). The term “borderline” has stuck in the diagnosis, but there is now a much better understanding of the causes, symptoms and treatment.
Those with borderline personality disorder have difficulties regulating their emotions. This contributes to angry outbursts, anxiety and depression, and relationships fraught with difficulties. It’s also commonly associated with trauma (such as childhood abuse or neglect).
Many actions of a person with borderline personality disorder (such as self-harm and overdose) are done out of desperation in an attempt to manage difficult and intense emotions.
While borderline personality disorder and bipolar disorder can look similar (mood problems, impulsive behaviour and suicidal thinking), there are several key differences.
Bipolar disorder is characterised by extreme mood swings – from severe lows (depression) to periods of high activity, energy and euphoria. The different mood states can seem like a personality change, but a return to the “usual self” occurs once mood stabilises.
While depression is part of borderline personality disorder and bipolar disorder, those with bipolar disorder experience significant “up” mood swings. This is known as mania in bipolar I disorder and hypomania (less intense mania) in bipolar II disorder.
Bipolar mood episodes last longer (four days or longer for “ups” and two weeks or longer for “downs”), with periods of wellness in between, and are less likely to be triggered by external events. And bipolar disorder is more likely to run in families, disrupt sleep patterns, and psychotic symptoms (delusions, hallucinations) can occur during mood episodes.
We all have ups and downs, but bipolar disorder is much more than that with extreme, recurrent mood episodes that are not only distressing, but have a significant long-term impact on key areas of a persons’s life. Positively, with the right treatment, good quality of life is entirely possible despite ongoing symptoms.
Schizophrenia, meaning “split mind” in Greek, is often confused with dissociative identity disorder. However, the “split” refers not to multiple personalities, but to a “split” from reality. People with schizophrenia may find it difficult to discern whether their perceptions, thoughts, and emotions are based in reality or not.
Hearing voices (auditory hallucinations) is a common symptom, along with seeing, smelling, feeling, or tasting things others can’t. Unusual beliefs (delusions), including some that cannot possibly be true (such as a belief that one has special powers) are also common. So too is disordered thinking, where the person jumps from one topic to another at random, or makes strange associations to things that don’t make sense. They may also exhibit bizarre behaviour including socially inappropriate outbursts or wearing odd clothing that is inappropriate to the circumstances.
Other symptoms of schizophrenia look a lot like depression, such as an inability to experience pleasure, social withdrawal and low motivation. Depressive symptoms are also present in schizophrenia, but are slightly different in that emotion is diminished altogether, rather than a depressed mood per se.
Mental health conditions don’t come in neat packages
Unlike physical conditions, we don’t have a biological test that can magically tell us what mental condition we’re dealing with. Mental health practitioners are carefully trained to observe symptom patterns: the right diagnosis guides the appropriate treatment.
For example, first-line treatment of schizophrenia and bipolar disorder often focuses on medication. While dissociative identity disorder and borderline personality disorders are treated primarily with psychological therapy.
Mental health conditions are serious – whether disorders of personality, mood or somewhere in between. Improved understanding and balanced representation of these conditions is needed to shift stigmas and misconceptions in the community.