Category: Australia

Aged care failures show how little we value older people – and those who care for them

Aged Care photo

As the royal commission begins investigating the failures of the residential aged care sector, it is important such a review also considers the broader socio-political factors that have contributed to this crisis.

The commission needs to go beyond the institutional problems at individual aged care facilities, as these are a symptom of a much broader rejection of ageing in society and marginalisation of older people.

Negative stereotyping of older people is reinforced in the media, and this both informs and reflects societal attitudes. In Western society especially, we fear dependency, invisibility and dying. Aged care is a silo of these fears. And until it affects us personally, we ignore it.

How older people are marginalised in society

We have an expiry date in our society. This is not the date we die, but a time when our skills and knowledge are no longer considered to be valid or useful. Our value is largely determined by our economic contributions to society. But for many older people, this is difficult to demonstrate because they’re no longer in the workforce.

The economic impact of societal rejection of ageing is significant. Modelling by Price Waterhouse Cooper indicates that Australia’s gross domestic product would increase by almost 5% if people were supported to work longer. And data from the Australian Bureau of Statistics reveal that many Australians would like to retire later if they could.

Yet, there is evidence that older people are routinely denied work. In 2016, Age Discrimination Commissioner Susan Ryan said there was an urgent need to “tackle the discrimination that forces people out of work years before they want to leave”.

While older people should be supported to work longer if they wish, over half of Australians between the ages of 65 and 80 report a moderate or severe disability, resulting in greater dependency. A 2017 study of late-life dependency published in The Lancet found that, on average, older people will require 24-hour care for 1.3 to 1.9 years of their lives.

However, it is important that older people are not considered redundant in their societal role when dependency increases.

Aged care workers are also undervalued

Residential aged care facilities fulfil an essential role in our society. Yet, our recent ethnographic study in two residential aged care facilities in Victoria shows how this role has been compromised by an under-skilled, under-valued and overworked aged care workforce.

Older people were exposed to a revolving door of anonymous workers, significantly reducing opportunities for teamwork and fostering relationships between staff and residents. In one of the not-for-profit facilities, a single registered nurse was responsible for the care of 73 residents. This contributed to the delegation of an increasing range of tasks to unregistered personal care assistants with minimal training and delays in recognising signs of health deterioration among residents.

A reliance on general practitioners also increased the likelihood of hospital transfer. And hospital transfers can sometimes prove harmful, with previous studies showing that the noisy, fast-paced environment, bright lights and anonymous faces can have a negative impact on residents, particularly those with dementia.

Within the healthcare sector, aged care has the lowest status of all specialty areas amongst nurses and doctors. Recruiting appropriately qualified and skilled people to work in aged care is thus a constant challenge. Australia is expected to increasingly rely on imported labour to staff its aged care sector in the near future.

Ways to fix the system

Encouraging more healthcare professionals to enter the aged care sector will require a multi-pronged approach, starting with finding ways to engender more professional respect for those working in the field.

Greater emphasis also needs to be placed on improving the gerontological expertise of aged care workers. This can be strengthened by prioritising aged care in medical school education and recognising “nursing home” care as a specialist medical area. It is also imperative that personal care assistants receive greater recognition of their roles and duties.

Registration of personal care assistants as third-tier health care professionals is well overdue to ensure better oversight of their training and scope of their practice.

We also need to recognise the importance of human connection in residential aged care facilities. This requires strategies to build better relationships between residents and staff, and developing a formula for more accurate staffing allocations that reflect the real time commitments involved in aged care.

Who bears the ultimate responsibility?

It’s not enough to be shocked by the aged care scandals uncovered by the media and the decision to appoint a royal commission to investigate. We must also make older people, their contributions and end-of-life needs more visible. Increased funding and oversight will only come when we collectively say it’s important.

It is incumbent on us to ensure that residential aged care facilities do not operate as holding bays for the silenced, or wastelands for the discarded, where the occupants are expected to demand nothing and be as little cost to society as possible.

We have an opportunity to reconstruct the delivery of residential aged care. Let’s begin with the end in mind: a society that not only values older people, but values the resources required to provide the care they need and deserve.

Article from:

The Conversation

 

 

Leave Australia Day alone.

 

Australian flag

I am a proud Australian. Even prouder because I left another country and took up citizenship in what I consider to be one of the most tolerant and beautiful nations on this earth.

Australia for all intents and purposes was born on 26th January 1788. January 26 marks the landing of the First Fleet, a convoy of 11 ships carrying convicts who landed at Port Jackson in 1788. This event represents the founding of the colony New South Wales; the most populated state in Australia.

Because it marks the day of colonisation, Aboriginal Australians have launched major campaigns and renamed it Invasion Day. That may be so but the reality is prosperity started coming to this nation when the first Europeans landed and to put it frankly a great many indigenous people have prospered from that. And so they should.

In recent years, efforts have been made to make the holiday include all Australians, and in 2013, the Australian flag and Aboriginal flag were raised on the Sydney Harbour Bridge for the first time on Australia Day. It hasn’t worked.

Now there are moves afoot to move the day and instead mark the celebration of Indigenous living in this nation. Now I don’t have a problem with that and nor should any decent thinking Australian. However I do object to removing European history from our nation.

Captain James Cook.

Face it. Captain James Cook was one of the greatest explorers and navigators in history. In three voyages, Cook sailed thousands of miles across largely uncharted areas of the globe. He mapped lands from Australia and New Zealand to Hawaii in the Pacific Ocean in greater detail and on a scale not previously achieved. As he progressed on his voyages of discovery, he surveyed and named features, and he recorded islands and coastlines on European maps for the first time. He displayed a combination of seamanship, superior surveying and cartographic skills, physical courage, and an ability to lead men in adverse conditions. Cook was attacked and killed in 1779 during his third exploratory voyage in the Pacific while attempting to kidnap Kalaniʻōpuʻu, a Hawaiian chief, in order to reclaim a cutter stolen from one of his ships. He left a legacy of scientific and geographical knowledge which influenced his successors well into the 20th century, and numerous memorials worldwide have been dedicated to him. He is held in such high regard in Hawaii that the British national flag sits in a corner of the state flag.

When he sailed down the east coast of Australia in 1770 and later came ashore he found a land that explorers had searched for for years. The Dutch actually landed on the west coast a century before but did not realise where they were and laid no claim. Upon his return to England the government was so keen to colonise the new found lands that they began to empty their jails and ship people off. Most were sentenced to seven years penal servitude and the voyage must have been hell. Nobody really knew what to expect and upon arrival they foolishly tended to ignore and attack the native people rather than try and learn how to live off the land from them.

But that does not mean all those who landed on those leaking ships were bad. For sure they had never encountered a land like this before and it must have been a daunting task working in conditions that were to say the least harsh. Many were thrashed for a minor infringement and yet the colonial leaders turned a blind eye to promiscuity. Slowly but surely the more adventurous took off and found riches unknown before. A land that was blindingly hot, dry, often without fresh water and full of animals and insects they had never encountered before gradually became one of the richest nations in the world. Australia is now rated as the 18th richest nation in the world.

But I digress. I’m no fan of our new Prime Minister Scott Morrison but when he said these words I had to agree: “We don’t have to pull Australia Day down to actually recognise the achievements of Indigenous Australia, the oldest living culture in the world; the two can coexist,.

“Australia Day is Australia Day … You can’t pretend your history isn’t your history.

“That’s the day the flag went up in Farm Cove. That’s the day the course of the nation changed.”

And so be it. You can argue about an invasion, you can argue about disease and killing and nobody with any sense will argue against you on those subjects. They are our shame and we should never forget them. But the Australia that has gradually changed in over 200 years has brought world standards in health, housing and opportunities (if you choose to take them) to make a success of your life.

To put it bluntly you don’t have to ignore your past but life is what you make it. I know one lady whose ancestors were convicts on that fleet. She is a Judge in Sydney now.

For the record it is thought the First Fleet carried the following:

The First Fleet consisted of 11 ships carrying approximately 1,487 people. As far as records show, this included:

  • 759 convicts,
  • 13 children of convicts,
  • 252 marines, wives and children
  • 20 officials
  • 210 Royal Navy seamen
  • 233 merchantmen

And the journey of the First Fleet took about 8 months to travel the 15,000 miles between England and Australia. Nowadays a Qantas plane can go from Australia to England in 19 hours. We’ve come a long way.

Parts of this essay are attributed to Wikipedia.

 

The right to die with dignity is mine and mine alone.

I have the right to die in the manner I choose. I’m not talking about suicide but rather if I have a terminal disease or if I suffer an illness that leaves me in a vegetative state.

Frankly I have seen far too many people suffering from a terminal illness and the look in their eyes says it all – get me out of here.

At the moment in Australia I have to travel overseas if I am terminally ill and wish to no longer be a part of this earth that I have inhabited for many long years. That frankly is ridiculous and boils down to several factors. Politicians who don’t have the guts to make that final decision, religious zealots who influence the politicians and threaten them with block votes at election time (voting is compulsory in Australia)  and people who feel that life and death is not in their hands but some other being in the ether, or sad world in which they live.

And frankly many doctors are too frightened to take on these lobby groups. On the other hand I have seen a medico quietly help a very sick and dying person go to another life and there has been no pain.

But we have to understand that although 99% of doctors are highly intelligent sometimes they are extremely stupid prolonging the life of a person who is in intense pain.

One doctor told me once that he would not increase the morphine dose for a dying, elderly woman because she might become addicted. She died two days later in  agony.

Don’t get me wrong. I enjoy living in this world and hope to live for many years longer and although my body is telling me it is getting old I’m still happy to enjoy the company of others, walk with my dog, enjoy a good meal, listen to good music, read books and carry on living. At the same time I live in fear of having an illness such as a severe stroke where I am unable to look after myself and will simply lay there wishing to die as soon as possible – is that too much to ask?

If you have ever seen a person who has had a severe stroke then you will understand what I am saying.

I have lost count of the amount of times the various legislators in this nation have considered euthanasia, or the more politically correct term assisted dying.

Currently euthanasia is illegal in Australia but Australian states can legislate on the issue. It was legal for a period in the Northern Territory and in November 2017 legislation to allow assisted suicide passed the Parliament of Victoria but will not come into effect until mid-2019. A patient can elect not to receive any treatment for a terminal illness and can also elect to have their life support turned off. And other states are now considering it – but I’m not hopeful.

The Australian Think Tank Australia 21 recently stated: The issue of how we, as a society, regulate VE and AS arises in a particular social, demographic and medical context. For example, Australia has an ageing population and the baby boomer generation is now (and will increasingly be) involved in medical decisions as they come to the end of their lives. This generation will not be passive recipients of paternalistic medical practices, and will insist on greater input in and control over their dying process. At the same time, VE and AS are issues that are of significant interest to the public and are issues about which there is majority public support for reform.

Further, this debate occurs in the context of ongoing advances in medicine. Lives can be sustained in circumstances that have never previously been contemplated, and decisions need to be made about whether to give life-sustaining medical treatment, or allow the individual to die. There have also been significant improvements in palliative care which have enabled pain in dying patients to be managed to the extent that has not been possible in the past.

An omission to provide life-sustaining medical treatment is lawful in Australia, unless the patient is deemed mentally incapable of consent.

According to Wikipedia: In 2011 the Supreme Court of New South Wales gave a two-year suspended sentence to a 66-year-old man who had facilitated the death of his long-term 78-year-old partner by helping her overdose on drugs and suffocating her. The deceased suffered from severe pain arising from a spinal condition. Furthermore, the deceased had expressed a wish to die in a suicide note written prior to her death. The court convicted the man of manslaughter. The court accounted for the accuser’s substantial impairment at the time the act was committed as well the fact that he voluntarily revealed his involvement in the commission of the offence.

Exit International made TV ads arguing for voluntary euthanasia, which were banned just before they were scheduled to broadcast in September 2010.

In 2018 Liberal Democrats legislator David Leyonhjelm introduced a bill into the Senate to remove the federal ban on the Australian Capital Territory and Northern Territory legislating for euthanasia. The bill was given priority in the Senate and was subject to a conscience vote for both the Coalition Government and opposition Labor Party, though it was defeated at the second reading stage by 36 votes to 34.

Just two votes or three if it were to pass was all it would have taken. Surely that tells our politicians something?

In the meantime I have to hope that I’ll die quietly in my sleep and be no burden to any person and that includes my family, my doctor, nursing staff and carers.

Just a small addendum.  If you have concerns about dying go and see a lawyer and make a Living Will. It will relieve your family of the burden of having to make a decision they don’t really want to make but know they probably should. And tell your doctor if you are having surgery that you have a written Do Not Resuscitate order in place should something go wrong and you end up on the vegetable table.

Written with references from: Wikipedia; Think Tank 21.      

 

 

 

Medicinal Marijuana in Australia.

SICK Australians with some of the worst ailments will no longer wait months for relief or be forced to turn to the black market to access medicinal cannabis with the government green-lighting the legal sale of marijuana products for medical use in Australia.

Australia has finally jumped a medical hurdle that will make it easier for people with chronic illnesses to obtain legal supplies of medicinal marijuana. Well, a little bit easier, every good thing comes with a caveat in this nation where the words ‘nanny state’ is a constant.

For years now people with debilitating and wasting diseases such as cancer, epilepsy, Alzheimer’s,  M.S, arthritic discomfort and nausea from chemotherapy have had to rely upon modern drugs and methods of pain treatment with the use of chemically produced pain killers  or chemicals which by and large treat a symptom but not the associated problem and ongoing crisis.

Now the Australian government has decided that the time has come for doctors to be allowed to provide patients who meet strict criteria to have access to medicinal marijuana. But if you are thinking ‘wow what an amazing step’ think again. Like all things a government does things are not going to be that easy.

Weed Tweets ™ (@stillblazingtho) | TwitterDoctors have already been importing the drug, but they’ve been doing it on a patient-by-patient basis.

This involves a long process of approvals through the states and a government department known as the Therapeutic Goods Association, who require ‘paperwork’ (there you go, paperwork – just what an overworked doctor needs) outlining the evidence and potential benefits and it’s also reliant on the availability of the drug overseas.

Because of the need to bring the marijuana in from overseas some people have had to wait months before they actually receive their treatments, and when you are dying or suffering a debilitating disease every day in that month counts.

As of now, though, it will be easier to import medicinal marijuana from approved international suppliers, which means the product will be able to be imported in bulk and warehoused in Australia until it’s needed. And some places in Australia will be given approval (with the necessary paperwork) to grow the product under very strict conditions.

So does that mean it’ll now be easier to get?

Yes and no. A patient who already has approval to use medicinal marijuana will no longer have to wait for the product to be imported, assuming that product is one that has met all of the import regulations.

But for those who don’t already have a prescription, it won’t be any easier to get one as a result of this change.

And it will be quite hard to access the product because medicinal marijuana isn’t approved by the Therapeutic Goods Association (TGA) as a registered good. Only a government Minister could approve a product without giving the appropriate government department permission to use it.

Patients will need special approval to take it, and the TGA will provide two ways to go about getting this:

  • Firstly, doctors can apply to become “authorised prescribers” of specific non-listed drugs to patients with particular medical conditions
  • Secondly, doctors can apply for medicinal marijuana on behalf of their patients through the “Special Access Scheme”

In both cases, doctors need to be able to show that the drug would be of benefit for a particular patient with a particular disease, and the application processes are stringent.

One never ceases to be amazed at how a government bureaucrat can make a decision about a person they have never met and their health and pain whereas a doctor with years and years of firsthand experience cannot!

As well, the use of marijuana for medical purposes still needs to be legal in the state or territory in which a patient lives.

And naturally all the various states and territories have different rules and regulations, another hurdle through which a patient will have to jump.

One medico hedged her bets this way: “Doctors here don’t want pressure to provide scripts yet because we want to make sure it’s actually safe and effective first.”

And for those who may have thought that Australia was about to become the Holland of the South Seas, think again. You won’t be able to role a joint and harmonise with the world because your doctor has cracked the government code of bureaucracy. The medicinal marijuana they prescribe is most likely to be in the form of a liquid tincture, a dermal patch or synthetic spray.

At least for some there is relief on the horizon.

 

Australian strawberry industry on the edge as hunt for needles continues.

SYDNEY – Australia is warning culprits in a worsening fruit contamination crisis they could face 15-year jail terms. Police are investigating dozens of reports of sewing needles being found in containers of strawberries across the country. Many are thought to be copycat acts of sabotage.

‘Parasites’ and ‘cowards’ is what government ministers are calling those responsible for contaminating fruit across Australia.

StrawberryThe police are investigating more than 100 reports of shoppers finding needles concealed within strawberries and other fruits.

The perpetrators could face prison terms of up to 15-years – a penalty similar to crimes such as child pornography and financing terrorism.

‘Obviously we mean this to have the maximum deterrent affect possible and we do not resile from the fact that it is a very strong response and it has been a strong response delivered very swiftly this week. But it is precisely what is needed to draw a line under this conduct and stop it from having another week of damage done to our fruit growers and to our farmers,’ said Australia’s Attorney General Christian Porter.

Empty shelves, normally stocked with strawberry punnets, are seen at a Coles Supermarket in Brisbane, Australia, Sept. 14, 2018.

Fruit producers say their industry has been hit by commercial terrorism, but some farmers say there has been a hysterical overreaction to the scandal.

Grower Angelo Demosi said a calm approach to restore confidence is needed.

‘It is important that we take the foot forward to ensure that wholesalers and growers can assure consumers that the product is safe,’ said Demosi.

Braetop Berries strawberry farmer Aidan Young is seen before he destroys strawberries following the nationwide needle scare, on his farm in the Glass House Mountains in Queensland, Australia, Sept. 20, 2018.

Australian strawberries being exported overseas now have to pass through metal detectors.

Melissa Fitzgerald, a food science expert at the University of Queensland, said tamper-proof containers are another option.

‘It is possible that packaging technology will be brought on board so that people cannot open the strawberries or open the fruit and put something like a needle in it,’ said Fitzgerald.

As the hunt for the saboteurs continues, Australian authorities are offering large rewards to help catch them.

How the Australian residential aged-care system doesn’t care about older people’s emotional needs

All humans have fundamental needs. These are physiological (food, drink, clothing, sleep), safety (emotional security, physical safety, health), love and belonging (friendships, community), esteem (respect, dignity) and self-actualisation (accomplishment, personal development).

For people living in Australia’s residential aged-care facilities, these needs are often not met.

Most residents do not feel they are loved or belong in the facility. Like aged-care resident Neda Borenstein, whose secret camera footage broadcast on ABC’s Four Corners showed her singing the Australian national anthem in bed while she waited more than three hours to be changed. “I’m just a number,” Neda told her carer when she finally returned to help her up.

Less than one-third of residents we interviewed said they were friends with another resident. This means most don’t have the social support associated with friendships. Most residents said they felt socially isolated, which is associated with poor well-being.

A 2016 study of residents’ lived experiences in an aged-care facility found many felt they had little dignity, autonomy or control. Outside of meal and structured activity times, people with dementia spend most of their time stationary, alone and doing very little or nothing.

One study looking at interactions between residents and their carers showed residents were alone 40% of the time they were observed. When staff were present, they mostly did not engage verbally, emotionally or physically with the resident.

Aged-care facilities can also feel psychologically unsafe to residents. Residents with dementia may be locked in secure units or physically restrained, using mechanisms such as bedrails or restraining belts.

Residents sometimes don’t get along. They might argue yell, swear, pinch, hit or push each other. We don’t have good data about how often resident-to-resident verbal and physical aggression happens, but it can result in injury and even death.

The consequences of unmet needs? Residents can react negatively when their needs are not met. They become bored, sad, stressed, cranky, anxious, depressed, agitated, angry and violent.

In people with dementia, we used to call these reactions “behavioural and psychological symptoms of dementia” (BPSD). But people with dementia have been pointing out these are normal human responses to neglect, not symptoms of dementia. Almost all (90%) aged-care residents display one or more of these negative reactions.

In many facilities, staff “manage” such reactions with the use of sedating antipsychotic medications. But clinical guidelines recommend looking at the reasons people may be reacting that way and addressing those before medication.

Needless treatments: antipsychotic drugs are rarely effective in ‘calming’ dementia patients

Half of nursing home residents have symptoms of depression, and a third have symptoms of anxiety. More than half of residents have been found in studies to behave in ways that might suggest they no longer wish to live. This includes refusing food or medication, one-third of residents having suicidal thoughts and a small number of nursing home residents actually taking their own lives.

Why does Australian aged care fail to meet fundamental human needs?

We might not be spending enough on aged care to enable providers to meet fundamental human needs. Australia spends about 1% of its GDP on long-term care – less than the OECD average of 1.5%.

Private investment in aged care is growing, as have residential aged care profits, but it’s a difficult industry in which to make money. Insufficient funding translates to insufficient staff and less skilled staff. Our funding system rewards dependency, and there are no funding incentives for providers to improve the psychological webeing of residents, or go beyond that to help them flourish

Friendships are an important part of healthy ageing. from shutterstock.com

People looking for a nursing home don’t have any independently provided information by which to compare quality or performance.

The National Quality Indicator Program – a program for measuring care in residential aged-care facilities that began in 2016 – was meant to provide information for people trying to compare facilities on clinical indicators of care quality.

But participation in the program is voluntary for providers. Neither quality of life nor emotional well-being indicators are included in the suite of quality indicators (even though one has been trialled and found to be suitable). We also don’t know if or when the data might be published.

What is needed?

We need a fundamental shift in community, government, service provider, staff and regulatory expectations of what residential aged care does. Our model of aged care is mainly about clinical care, while neglecting emotional care.

For instance, friendships are a unique social interaction that facilitate healthy ageing, but many residents told us that the social opportunities in their nursing home did not align with their expectations of friendship.

 

We need our model of care to be a model of a home. In a home everyone contributes, has a say in what happens in the home (such as the menu, interior design, routine and functions), is able to invite their friends to their home for a meal, and can leave during the day and come back at night. A home is a safe place, where people are loved and nurtured, and where they can be active and fulfilled.

Extract from ABC Four Corners program Australia.

(C) ABC Australia

 

 

Australian veterans suicide rate far too high – and not enough it being done.

Suicide rate among defence veterans far higher than for those currently serving

National Mental Health Commission says reason for phenomenon requires further investigation

National Mental Health Commission says ADF must improve the preparation it gives personnel for life beyond the service.
National Mental Health Commission says ADF must improve the preparation it gives personnel for life beyond the service. Photograph: Dave Hunt/AAP

The rate of suicide among current serving Australian defence force members is much lower than the general population, but higher for those who have left the force, particularly if under 30 years of age.

The National Mental Health Commission says the reason for this phenomenon needs to be better understood, requiring further investigation.

It says the Australian Defence Force (ADF) must improve the preparation it gives personnel for life beyond the ADF, and then provide support services from the moment of discharge for the duration of post-service life.

The final report of the Commission’s review of the suicide and self-harm prevention services available to serving and ex-serving ADF members and their families was released on Thursday.

It relied on interviews with more than 3,200 serving and ex-serving ADF members, family members, and experts. It found current and former ADF personnel could access a range of suicide services, and a survey conducted for the review found 80% of current ADF members described their experience of those services as fair, good, very good or excellent.

But it heard a range of poor experiences of services, and feelings of cynicism, distrust, frustration, abandonment and loss, with many ADF members unaware that services existed, and barriers preventing some from accessing services.

According to the Australian Institute of Health and Welfare, the suicide rate among current serving ADF members is much lower than the general population.

When adjusting for age, when compared with all Australian men, it says the suicide rate is 53% lower for men serving in the ADF full time – a statistically significant difference.

But the suicide rate is 13% higher for men who have left the force.

The commission says this suggests the Australians recruited for military service may be at lower risk than the general population, and features of military service may also protect against the risk of suicide.

But it says more needs to be done to ensure suicide and self-harm is prevented among current and former ADF personnel.

Peggy Brown, chief executive of the National Mental Health Commission, said barriers still existed that prevented some ADF members from accessing suicide services, including stigma attached to mental health issues, the culture within the ADF, and the perception that seeking mental health treatment could have a negative impact on career progression.

“I guess what’s interesting about this is that, if that’s the reason why people are deferring seeking help then it’s more likely that their mental health state will actually deteriorate, and then it will actually impact on their career, rather than if they seek help early,” she said on Thursday.

Brown said the report identified no glaring gaps in services, but found the ADF and government ought to engage better with families.

The Commission has made 23 recommendations, including that the government specifically engage former members of the ADF aged 18–29 years, who have left the service in the last five years, and who could be at risk of suicide or self-harm.

It says further investigation is required to understand why ex-ADF members under 30 face a higher risk of suicide than the general population.

More support needs to be provided to families of current and former members, it says.

Regarding suicide rates among current and ex-personnel, he said initial figures showed there was no correlation between those who had served overseas and those who had committed suicide.

“As a matter of fact, it shows those who have stayed here, the incidence is slightly higher,” he said. “But we really need to do a lot more work in this area, and that’s why we really are now beginning to drill down [into new data].”

Statistics from the Australian Institute of Health and Welfare

A recent study found 292 certified suicide deaths among serving and ex-serving personnel between 2001 and 2014.

The total included 84 suicide deaths in the serving full-time population, 66 in the reserve population and 142 in the ex-serving population.

Men accounted for more than nine in 10 suicide deaths (272 deaths, 93%) over that period, while women accounted for 20 deaths (7%).

Nearly three in five suicide deaths among serving and ex-serving personnel were of people aged 18–34 (170 deaths, 58%).

Of these, 66 deaths (23%) were among people aged 18–24; 58 (20%) were people aged 25–29; and 46 (16%) were aged 30–34.

  • For information and support in Australia call Lifeline on 13 11 14, Mensline on 1300 789 978 or Beyond Blue on 1300 22 4636

(c) Guardian Australia

Mental health help in Australia is a joke

GPs struggle in a system ill-equipped to deal with mental health

I sat in the waiting room staring at my hands, willing them to stop shaking. Anxiety was a fighter jet, roaring through my cells, dropping grenades from head to toe.

When the doctor called my name I shuffled after her, a shrunken version of a self I no longer recognised. Fixing her eyes on a computer screen, she hammered the keys and asked me to explain why I was there.

Our complex emotional pain is being treated with six-minute medicine by time-poor GPs, says Jill Stark.
Our complex emotional pain is being treated with six-minute medicine by time-poor GPs, says Jill Stark.

Photo: Christopher Nielsen

When I told her I was experiencing what felt like an acute recurrence of the depression and anxiety I’d grappled with since I was a teenager she pushed a sheet of paper across the desk and I began to tick boxes.

During the last 30 days, how often did you feel hopeless? … During the last 30 days, how often did you feel so nervous that nothing could calm you down? … How often did you feel so sad nothing could cheer you up?

Ten questions, scored from one to five, with one being ‘none of the time’ and five ‘all of the time’. Under 20 is well. Over 30 is a severe mental-health disorder.

“You got 25, which means you’re only mild to moderately depressed, so there’s not much to worry about,” she said, reaching for the prescription pad before asking if I was suicidal.

I thought about it for a while and said no. “Good. These ones aren’t prescribed very often these days because they’re much easier to overdose on. But you’re not suicidal, so that’s fine.”

Less than fifteen minutes after I sat down I stood on the street weeping. I had no support, no plan for how I was going to make it through the day, armed only with the knowledge that should I want my kill myself the drugs I’d been prescribed were well-equipped for the job.

Journalist Jill Stark.

I wish this was an isolated experience. But since documenting my mental health battles in my recent memoir Happy Never After, I’ve been inundated with messages from people across Australia telling similar stories.

Our complex emotional pain is being treated with six-minute medicine by time-poor GPs struggling to meet demand in a system woefully ill-equipped to deal with the mental health challenges of modern life.

It was revealed in recent days that GP waiting rooms are crammed full of patients with psychological problems.

Research released by the Royal Australian College of General Practitioners found that 62 per cent of people visiting a doctor are presenting with mental health problems – significantly more than any other medical condition.

College president-elect Dr Harry Nespolon said doctors are in an impossible situation, forced to either charge patients for more time to manage these complex problems or wear the out-of-pocket costs themselves.

“As access to psychologists and psychiatrists can be restrictive, to say the least, GPs must not only work as the frontline of support – but as the entire support model, something which is currently not supported by patient Medicare rebates,” he said.

How much longer can we continue like this? When will we stop treating emotional health as the poor cousin to physical health?

We are in the grip of a mental health crisis. We have the highest Australian youth suicide rate in a decade. More people are depressed, anxious and medicated than at any other time in our history. If trends continue, clinical depression will be the second most disabling condition behind heart disease by 2020.

Raising awareness is not enough. The time for wristbands and hashtags has passed. We have learned to ask R U OK but when the answer is ‘no’, too often there is nowhere to go.

Our Medicare system needs to better reflect the times we live in and the health problems we face. Doctors need the financial support to offer longer consultations for patients with complex psychological needs.

And as a matter of urgency, we must stop rationing psychological services to ten subsidised sessions per year.

When I was at my lowest point, I saw my psychologist twice week just to keep my head above water. I raced through my Medicare sessions in five weeks.

At almost $200 per hour, I then had to raise almost $400 a week just to stay in therapy and out of hospital.

There are few other areas of healthcare where we place such arbitrary limits on a patient’s ability to recover.

Through life’s lottery I was fortunate enough to have a supportive employer, and family who could afford to fund my therapy. Without their assistance I honestly don’t think I’d be alive.

Not everyone is so lucky. Many people are no longer here because they couldn’t afford their mental illness. It’s a devastating indictment on a system that is fundamentally broken.

We must demand better. The chances of surviving our emotional pain should not be determined by the balance of our bank accounts.

Lifeline: 13 11 14

Jill Stark is a Melbourne journalist and author of Happy Never After

(c) Fairfax Media Australia.

Don’t expect to fly on the A380 with Qantas SYD-LAX – it can’t do it!

Qantas: Engine Problems Mean Its A380s Can’t Fly to the U.S. Big Problem.

You’d think that the Qantas A380 saga would be winding down by now, but you’d be wrong. Qantas is still struggling with the fact that it can’t operate the A380 to the U.S. because the engines simply can’t handle it. This means that things continue to get worse for engine-maker Rolls-Royce, and I imagine legal bills have only started to pile on. Rolls needs to get this thing under control, because right now Qantas is in a bad place.While Singapore and Lufthansa both use the Rolls-Royce Trent 970, Qantas had to use the 972 to get 2,000 pounds more thrust for its operation. There actually isn’t much of a difference in the engines at all, but one is rated to give a little more power. For Qantas, that little bit extra is really important.

Qantas has re-started flights from Sydney to places like Singapore on the A380, because it doesn’t need full thrust to operate that route. However, the prize has always been flights to Los Angeles, and that’s a different story.

A380 engine

At nearly 7,500 miles, Qantas needs every bit of thrust to get off the ground at LAX with a full passenger load and a lot of fuel. And that full thrust requirement is apparently why Qantas is having bigger engine problems with this air plane than anyone else. Any time you use full thrust, you put more stress on the engine. Engines are supposed to handle that just fine, but not in this case.

Qantas has now found that it can operate no more than 75 flights at top thrust before it needs to replace an engine. That’s ridiculous, considering each engine can cost $10 million or more. And it leaves Qantas with a huge problem.

Rolls-Royce had suggested last month that Qantas operate the engines with less thrust. That suggestion is completely worthless since it would mean Qantas could carry a mere 80 passengers on the LA to Sydney route. The airline might as well just operate a 747 at full capacity for a lot less cost with a lot more passengers. If it can’t carry a full load on the A380, that air plane is worthless.

The funny thing is that Qantas didn’t even want the more powerful engines in the first place. It opted for the same ones as Lufthansa and Singapore originally, but then Airbus announced the A380 would weigh 5 tons more than planned. That pushed Qantas to order the higher-thrust engines in order to make the air plane viable on the LA route.

So now Qantas is stuck between a rock and a hard place. It has A380s on the property but it can’t fly them where it wants without needing a multi million dollar engine change every few months. Rolls-Royce is going to have to fix this problem or Qantas is going to have to find an alternative.

Nancy-Bird and Minister Anthony Albanese

(Picture) Nancy Bird Walton – the first aviatrix in Australia. Qantas named their first A380 in her honour

The silver lining for Qantas is that it’s not going to be responsible for any of the cost here. Rolls-Royce and Airbus (to a lesser extent, if any), however, are going to have to open up those wallets. For Qantas, however, it would much rather just have an air plane that functions properly. Instead, Qantas now has to go through its peak travel season without the ability to use the A380 to the U.S.

© 2010 CBS Interactive Inc.. All Rights Reserved.

Cancer, sex and intimacy: Patients call for honest heads-up about impact of treatment

 Annie Gaffney and Kylie Bartholomew ABC Australia

Woman in her 50s smiling in a tree-lined park Photo: Three years after cancer treatment, Lynne Essex hopes to still have sex again. One day. (ABC Sunshine Coast: Kylie Bartholomew)

Lynne Essex was diagnosed with endometrial cancer when she was 54. It has been three years since her treatment, but she still has not had sex.

“No-one told me anything about what would happen, how sensitive the area would be where I had the radiation,” she said.

“Because it was endometrial, the vaginal area is all very sensitive, and that’s what scares me about having sexual relations.

“I haven’t been in a partnership for about seven years.”

Ms Essex had a hysterectomy, but a few months later the radiation that was used to shrink another tumour tore a hole in her bowel, leaving her with an ileostomy bag.

Three pictures of a woman with an ileostomy bag, singlet covering and then clothing over the singlet. Photo: The ileostomy bag is an external pouch that collects waste from the bowel. (ABC Sunshine Coast: Kylie Bartholomew)

Despite her terminal prognosis, she is determined to embrace life and dating opportunities.

But she said that journey had been made more difficult because she was not informed by doctors about the impact of cancer treatment on her sex life, and instead had to resort to her own research, and support service Bloomhill Cancer Care.

While Ms Essex has had “a couple of chances” at having an intimate experience over the past few years, she has been too scared.

“The fear has been there to actually go all the way,” she said.

Media player: “Space” to play, “M” to mute, “left” and “right” to seek.

Audio: ‘It’s about trying new ways of pleasuring’ (ABC News)

“My bones have gone like osteoporosis now and I’ve had fractures in my pelvis, pubic bone and sacrum because of it.

“I think my situation [wearing an ileostomy bag] was I just wanted to hide it.”

Therapist calls for more sex talk

Woman smiling at the camera Photo: Jocelyn Klug says couples can experience greater sexual pleasure after a cancer diagnosis because they are open to exploring new ways of pleasuring each other. (Supplied)

Ms Essex’s story is not surprising to sexologist Jocelyn Klug.

“I’m always hearing of patients who have not been informed of the consequences of treatment on their sexuality,” she said.

“For many doctors there’s an awkwardness. They don’t want to be seen to be prying and I think this is generally about their respect for the patients.”

Ms Klug urged patients to speak up to their partner and doctor.

“Most couples struggle to talk openly about sex and so when we don’t communicate, we’re left making assumptions,” she said.

“Find the courage to bring up this topic [to your doctor] and ask ‘What is the impact on my sex life?'”

She said far too many couples ended up avoiding sex and intimacy post-treatment.

“Sadly for a lot of people, because of sexual dysfunction following cancer treatment they … feel that being able to be sexually intimate with a partner is far too challenging.”

‘I’m just so self-conscious about having to poo all the time’

A couple walking toward the beach, holding hands Photo: David says being open about sex with his wife and medical team has been vital to getting through his cancer journey. (ABC Sunshine Coast: Kylie Bartholomew)

David (not his real name), a 36-year-old husband and father of two, was diagnosed with rectal cancer last year.

The tumour was located about 10 centimetres inside his rectum close to lymph nodes, bladder, bowel and the parts of his anatomy that affect erectile function.

But unlike Ms Essex’s experience, David was given detailed information from his doctor about the impact of surgery and treatment on his sexual function and overall health.

“I was told to bring my will in and make sure my affairs were in order,” he said.

“He [the doctor] couldn’t tell me if I was ever going be able to wee again properly or if I’d get any function back at all sexually.

“They said after six months if it’s not doing anything, it’s probably not going to do anything. It was devastating.”

Surgery was successful for David and his erectile function returned after a few months, but a brief stint wearing an ileostomy bag affected his confidence.

“Having a shit bag as I called it was pretty awful, and I felt pretty unattractive,” he said.

Man and woman's hands joined, wearing wedding rings Photo: David says it can take hours to prepare his body for sex with his wife. (ABC Sunshine Coast: Kylie Bartholomew)

Eventually, David had the stoma reversed but that has left the young dad feeling anything but back to normal, because without a rectum he has limited bowel function and still soils himself. A lot.

“Once the stoma was closed, I was doing a poo up to 40 times a day,” he said.

“Trying to be intimate with that going on, it’s not happening.

“If I think we might be getting jiggy with it, I’d have to prepare by lunchtime that day … to prepare what I eat and then I don’t eat or make sure that I’ve had a shower because I’m just so self-conscious about having to poo all the time. It’s all awful.”

David continues to have ongoing support from his psychologist, psychiatrist and doctor.

“All my treating team and my nurse at Bloomhill, they all quite regularly bring it up [his sex life] as a major factor to consider,” he said.

Lynne’s story ‘not unique’, professor says

Close up of a woman in her 50s Photo: Lynne Essex is scared about having sex after going through cancer treatment. (ABC Sunshine Coast: Kylie Bartholomew)

University of Sydney professor of medical oncology Fran Boyle said experiences such as Ms Essex’s were not unique, but the urgency of treatment could be one factor that prevented doctors from having a conversation with their patient about the impact of treatment on their sex life.

“I think there are probably situations where cancer treatment happens suddenly,” she said.

“Decisions need to be made very quickly and they are often life and death decisions with really quite complex decision-making and trade-offs.

“We know that under time pressure things that are difficult to talk about, and sex is one of them for many people, is often the thing that is going to get left out.”

Professor Boyle believed there could be greater scope for surgeons to raise the topic with patients, and called for compulsory communication training for them to facilitate that conversation.

She said there was likely to be an improvement in the medical fraternity in the future, with some changes underway within the Clinical Oncology Society of Australia.

“That will include things like monitoring bone health, emotional concerns and sexual health as well, so I think you’ll see an improvement in that area going forward, and we’d love to work with anyone who has access to patients to make that happen,” she said.

Courtesy Australian Broadcasting Corpration Australia.