Reconciling Class Privilege and Mental Illness
By Hannah Billett
I used to think Australia’s mental healthcare system was excellent. Now I believe it is utterly flawed, but the fact I used to sing its praises is a perfect encapsulation of why it is so broken. Mental illness and the importance of asking for help have gone from cultural taboos to mainstream topics. Australia spent around $10 billion in 2017-2018 on mental health services, which is the result of small but steady increases over the past decade (1). Some argue, correctly in my opinion, this should be increased further, but it is also important to interrogate how this money is distributed. Who benefits? In my opinion we have not reckoned with the effect that inequality has on treating and recovery from mental illness.
My privilege in growing up in a comfortable upper-middle class family was not something I gave a lot of thought to as an adolescent. While my parents, as well-meaning progressives, educated me about poverty and reminded me how lucky we were on a regular basis, the concept of class privilege was unfamiliar to me. Mental illness, however, was not. I have been living with mental illness for most of my remembered life. A combination of difficult experiences as a child, genetic predisposition and an apparently intrinsic sensitivity manifested in a brain I can only describe as broken. My battle with depression, anxiety and bulimia was the defining experience of my adolescence. I was too preoccupied with the dark void in my stomach and the demons that lurked behind my eyelids for any critical analysis of my place in an economic hierarchy.
The biggest barrier I experienced in accessing mental healthcare was my own reluctance to be honest with my parents, but once I had uttered those magic words – “Mum, I need help” – everything changed for me. Receiving treatment for mental illness is an inherently confronting and challenging process, but I benefited from the best the Australian healthcare system had to offer. I have been lucky to receive treatment from psychiatrists, psychologists, dieticians and counsellors over the past years who have been instrumental in my recovery. Mental healthcare is highly personal and not everyone I met was a great fit, but I had the luxury of returning to my (non-bulk billing) family GP as often as needed for referrals to specialists, usually located in private hospitals and clinics.
I never thought about the cost of my own treatment. In hindsight I realise my parents’ private health insurance covered some of the gap between the Medicare rebate and the fees. Our class privilege meant my family did not have to make financial sacrifices to afford my care. In conversations with my prescribing psychiatrist about the different medication I was trying, my parents’ questions were about potential side effects, not whether the new drug was covered by the Pharmaceutical Benefit Scheme. Class privilege presents in other ways too. My mother was able to work part time, which meant she was able to drive me all over town to my various appointments during the day and be available when I needed someone to be there for me. I didn’t truly appreciate it at the time, but it did all work out. My broken brain and I started to heal. We will never be perfect, but we are better, something I never could have imagined during the depths of my illness.
Another way my privilege manifested was that my parents were able to help me move interstate for university once it became clear my hometown was full of triggering places and traumatic memories. As I made new friends in my new city, some of them shared with me that they were struggling with their own mental health. By this point, I was fairly stable and advanced in my recovery, so I imagined myself as a mentor figure, guiding my friends through the process. I wanted to be a figure of inspiration, someone who they could see had been to the dark places but had come out the other side healthy and happy. What happened instead was a wakeup call. While their stories are not mine to share, I was horrified on their behalf. I watched helplessly as they sat for months on public hospital waiting lists or burnt through their ten Medicare-subsidised psychology sessions for the year in a matter of months. I found my earnest recommendations of treatments and programs that had truly helped me greeted with raised eyebrows and an unspoken question: “who is going to pay for that?”
It’s indulgent and so typical of someone with privilege to talk about personal growth stemming from the suffering of others, but it is also unfortunately what was needed to shake me out of my bubble. Witnessing the contrast between my experience and that of one of my closest friends broke my heart. Both of us were young women living in a major city in Australia. We had similar diagnoses and from how she talked I knew she was experiencing similar thought patterns to my own at the height of my illness. There was one key difference: through the accident of birth, I was born into a family with money and she wasn’t. This one disparity set her up to have access to significantly fewer resources than me and, through no fault of her own, has made her journey of recovery significantly more challenging than mine.
This might all seem very obvious. Money makes everything easier. However, it is important to interrogate this inequity further. Healthcare is not a luxury item. Healthcare should be provided on the basis of need, but this is clearly not the experience many people have when trying to receive mental healthcare. People from the poorest quintile experience mental distress at a rate five times greater than those in the wealthiest (2). The fact the people most likely to need help are those with the greatest barriers to accessing it indicates Australia’s mental healthcare system is designed without enough consideration given to class disparity. This makes sense when you consider the type of people in positions of policy-making power. The system is designed by politicians, public servants and medical professionals, who are statistically more likely to be from privileged class positions. It is clear the mental health system they built benefits people like them, rather than those who are most likely to need it.
When you realise the extent of your privilege, and its ability to exist alongside your mental illness, it can be profoundly upsetting. It’s also very confusing when you simultaneously feel terribly unlucky to be living with the pain of mental illness. It might seem appropriate to self-flagellate, to feel shame for the privileges you’ve had compared to others. However, such feelings are not constructive, nor are they fair. I deserved the care I got. I was profoundly ill and live with the impact of that experience to this day. My privilege does not negate my mental illness. However, it does explain why I had excellent treatment and why others do not. This case has allowed me to recover to the extent that I am able to hold down a job, have successful relationships and live a mostly happy life. This shows that mental health issues are eminently manageable from a biomedical perspective. Australia has skilled mental health professionals and effective treatment protocols. What we lack is equity in service access.
Instead of wallowing in guilt, I believe those of us who experience privileged access to mental healthcare have an obligation to advocate and work to make the system more equitable. For me, this looks like seeking academic training in health policy, with plans to make that my career, and making financial contributions to mental health organisations. For others it will look different, but we all need to play a role. It should not be left to those with the least means to reform the system. The treatment I received shouldn’t be a perk of class privilege, it should be the standard that every Australia has access to, regardless of their financial position. Quality mental healthcare exists – now we need to make everyone can get it.
