Approaches to the treatment of mental health illness
- Written by Dr Michael Schirripa
In your experience, what are the key differences in how society views mental health compared to mental illness?
This question underscores an important point about perception and the use of language, as society tends to feel far more comfortable speaking about “mental health” rather than “illness”, even though the two are inherently linked, they are often influenced by the same factors and variables.
I think that society values and appreciates the concept of “lifestyle” choices, such as exercise for example, when it comes to mental health but with mental illness I think the focus is more on disability, permanency and medication. In reality, there are many common features that ding “mental health” and “mental illness" together which means that the illness can be well managed and can restore an individual's ability to function as they would wish to.
What impact does this stigma have on individuals living with mental illness, and how does it affect them?
Stigma has a profoundly detrimental impact on individuals who experience mental illness. It can lead to a great sense of shame and guilt and this can then worsen into feelings of not wanting to live anymore. Increased stigma has been found to be a direct correlate of deliberate self-harm and suicide. Stigma also leads to increased isolation as individuals form the belief that they are destined to be alone and that they cannot come forward and speak about their symptoms and struggles. Stigma directly leads to people not seeking out treatment for their illness.
Why do you think there is still such a strong stigma attached to mental illness, despite increasing awareness of mental health issues?
Public mental health campaigns have produced improvements in terms of reducing stigma, although, yes, it does still remain an issue. There remains significant untrue, misinformation out there in broader society about the nature of mental illness and how it is treated. This still occurs in the popular media, via sensationalised news reports and depictions on TV and in movies, and also now on social media. For example, there is still a strong belief that medications used to treat mental health conditions such as depressive illnesses will “turn people into zombies” or “permanently change their personality” both of which are erroneous but are still believed by many people. Social media posts, often made by ill-informed people, can still promote these myths. This leads to further stigma and reduces the chance that someone will come forward and seek out help and treatment.
What do you think is needed to break down this stigma or to see an improvement?
Three words: education, education, education. It is all about public health awareness campaigns delivering simple and consistent messages about the importance of seeking help for mental illness and how to seek that help. These messages need to reduce isolation and let sufferers know that they are not alone. Public education also needs to debunk myths about treatment and how treatment can these days take many forms, not all of which simply focus on medication. In addition, I think that people like to also hear stories about how sufferers have overcome their struggles and symptoms by seeking out appropriate therapies.
In your own words, what are the most prevalent mental illnesses in Australia?
Depressive and anxiety disorders are the most prevalent mental illnesses in Australia directly impacting around 1 in 5 Australians at any one time.
Depressive disorders are seen when a person has a pervasive and severe sense of despair, not just transient, everyday sadness. It often lasts for some weeks. This condition can also lead them to stop enjoying life, stop socialising and have a pattern of withdrawal from others, including loved ones. Self-care can diminish. It can also lead to sleep and energy problems, appetite disturbances, a loss of libido and memory and concentration problems. When severe it can also lead to thoughts of death and suicide.
Anxiety disorders, in general, are characterised by persistent, intense fear, panic and worry. It can interfere with people’s ability to sleep as they are “unable to shut their brain down”. It can also lead to avoidance of their usual activities, such as work, recreation or socialising, often due to fear and apprehension. It is often accompanied by physical symptoms such as chest pain, sharking, feeling short of breath, nausea and diarrhoea.
How do you treat patients who are diagnosed with a mental illness?
Broadly, I treat my own patients in two ways: with medication and/or psychotherapy (or ‘talking therapy’).
This follows a detailed assessment of not only their current complaints and symptoms but also what type of treatment they may have had in the past and, importantly, what has and has not worked for them. For example, if they have tried medication before what was the effect? Did they experience side effects? How do they feel now about medication approaches or would they prefer a different method? This is also governed by the nature of their illness and how severe it is. (Often the more severe the condition the more likely it is that it will positively respond to medication, such as antidepressants).
The ‘talking therapy’ technique can also take several forms and again depends on the specific issues or symptoms faced by the patient. Some patients do best with a very specific “here and now” approach to symptom management, such as cognitive therapy and behavioural approaches, whereas others want to delve into their pasts to really understand where their symptoms emerged from and make more “fundamental" changes. Both approaches are valid but again depend very much on the goals of the person and how severe their condition is.
The important message is to tailor a treatment approach to the individual person in front of you and not simply adopt a generic, ‘one size fits all’ approach.
What advice do you have for people who know someone living with a mental illness on how to support them?
Just listening is very powerful and is the first initial step. Finding a private, safe space that allows the person to feel relaxed enough to verbalise what they are feeling is extremely helpful. Encouraging your loved one to open up about what they are experiencing is very important as it gives them the experience of not only being heard but putting into words feelings and thoughts that have been very difficult to express. This in itself can be very therapeutic. Taking a non-judgemental approach is also therapeutic.
I would then encourage that person to seek out professional mental health help. If they have a GP they trust then that is an excellent place to start or alternatively there are online options, such as Beyond Blue, that can provide excellent links to other services that may be of benefit. If it is an emergency then there are also 24-hour community-based acute mental health services that can be contacted on the phone.
I also think that letting the other person know that you are just “there” for them is also very valuable and offering practical support, if possible, such as taking them to appointments can also be invaluable as it helps that person to feel less alone.
If you had the power to wave a wand and implement three changes that would drastically improve the lives of those living with a mental illness and remove the stigma, what would you do?
What a great question! Firstly, I would continue with a huge public education program through the media (mainstream and social) with simple, clear and accurate messaging about the real help that is out there for mental illness. This would allow people to come forward and not feel so isolated.
Secondly, I would fund far more tertiary education places for people to seek out professional careers in the mental health industry – especially as clinicians. We are under-resourced in terms of therapists and alleviating this would provide so many more treatment options for sufferers.
Thirdly, people who live outside of capital cities, in the regions, have much less access to mental health support and treatment, and I would make huge investments in technology infrastructure so that people, no matter where they live, can take up the option of telehealth consults with a mental health professional as the research evidence is that these consults are just as helpful as “face to face" consultations.
Are there any specific initiatives or campaigns that you believe are particularly effective in challenging stigma and promoting understanding?
The national Push-UP Challenge and R U Ok Day are two excellent campaigns that reduce stigma and reduce the sense of isolation that sufferers of mental illness feel. These are very inclusive campaigns that speak to a range of issues that people may face if they are experiencing an illness.
Initiatives such as Beyond Blue also provide excellent and accurate information about symptoms of mental illness and how to get help. This is delivered in a platform that is also easy to access and is not intimidating for the user.
Do you have anything else to add?
Contemporary approaches to the management of mental health conditions are focusing more and more on a person’s functional abilities, rather than just “symptoms”. As such there is a greater emphasis now on an examination of what a person wants to do with their life, or alternatively, how they feel their mental health issues may be holding them back from making certain choices or from living the way they wish. This is a very person-centred approach and this approach to restoring function is very important and often yields excellent outcomes.
About Dr. Michael Schirripa
Dr. Michael Schirripa is a distinguished psychiatrist with over two decades of experience in the field, encompassing both private practice and forensic settings.
Maintaining a thriving private practice in Adelaide, Dr. Schirripa offers compassionate care to individuals facing mental health challenges and living with mental illness. He believes that everyone deserves support and to be heard while they navigate life's challenges, and supports patients through talk therapy and comprehensive biological (medication) treatment (if needed).
Dr. Schirripa's approach aligns perfectly with this year's R U OK? Day theme, "Any Day." Through his work he witnesses the transformative impact meaningful conversations have on mental well-being every day.
Beyond his private practice, Dr. Schirripa possesses extensive experience in forensic psychiatry, providing psychiatric assessments for courts, treating patients within secure mental health facilities, and addressing complex mental health issues in prison populations.
