Mental ill-health not moral failure: Archbishop Coleridge

COVID-19 pandemic is a threat in many ways – physical, social, political and economic. But it’s also putting pressure on the mental health of many people in ways both seen and unseen. Those who are at high risk, and those who love them, may be especially anxious.

The loss of jobs and income from businesses, together with underemployment and insecure work, place enormous pressure on people trying to provide for themselves and their families. Isolation has also been very difficult for many – and dangerous for those who are in situations of family strife and domestic violence. These can be stressful times for people in decisionmaking positions. It’s not easy to balance care for public health and safety and the need for social connection, economic activity and other essential communal activities – including public worship. Many of us will experience a mental health problem at some point through our lives – and this may well be the time.

In the Social Justice Statement, To Live Life to the Full: Mental Health in Australia Today, the Catholic Bishops of Australia encourage faith communities, governments and each one of us, to make mental health a priority.

We want to say clearly that mental ill-health is not a moral failure, the result of a lack of faith, or of weak will. Jesus himself was labelled mad (Mark 3:21; John 10:19) and, like us, he suffered psychological distress (Luke 22:44; Matt 26:37; Mark 14:33; John 12:27). People experiencing mental ill-health are not some ‘other’ people, they are ‘us’. People in our families, faith communities, workplaces and society are suffering mental ill-health – and they can be of any age or socioeconomic background. Whoever and whatever they are, they need our understanding and support.

We commend the mental health support provided by volunteers and staff of Catholic organisations, hospitals, schools, and community health services, and we encourage you to reach out to them if you or your loved ones need support.

We know too that there are gaps in the mental health system that need to be addressed. Social determinants including poverty, living conditions, and personal security are significant contributors to mental ill-health. They place people who are already vulnerable or disadvantaged at greater risk of ill-health and of falling through gaps in the system.

During this time of pandemic, we have often heard it said that “we are all in this together”. The quality of our care for the people who are the most vulnerable or disadvantaged will be the test of whether or not this is true. A commitment to the common good means attending to the good of all of us, without exception. It means paying special attention to those who are most often overlooked, sidelined or excluded.

It is surely time for us to make mental health a real priority, so that all people may know the fullness of life which Jesus offers (John 10:10).

We are all in this together

The test of our society’s commitment to the common good is the care we show for the people who are most vulnerable or disadvantaged. Pope Francis explains in his encyclical Laudato Si’:

In the present condition of global society, where injustices abound and growing numbers of people are deprived of basic human rights and considered expendable, the principle of the common good immediately becomes, logically and inevitably, a summons to solidarity and a preferential option for the poorest of our brothers and sisters. This option entails recognising the implications of the universal destination of the world’s goods … it demands before all else an appreciation of the immense dignity of the poor in the light of our deepest convictions as believers.

A commitment to the common good means attending to the good of all of us, without exception, paying special attention to those who are most often overlooked, pushed aside, or fall through the gaps.

We know that social determinants including poverty, living conditions and personal security are significant contributors to mental ill-health. There is no doubt that these factors place First Nations people and communities, asylum seekers, refugees and humanitarian entrants at a disproportionate risk of poor mental health.

What is the quality of our care for these groups? Are we really all in this together? First Nations people and communities Aboriginal and Torres Strait Islander people continue to be over-represented on key measures of disadvantage including lower life expectancy, poverty, imprisonment and ill-health, both physical and mental.

Social and economic disadvantage is a cause of higher levels of mental illness among our Indigenous sisters and brothers. Behind this disadvantage lies the history of dispossession, which is itself the cause of intergenerational trauma.

European settlement brought alcohol, diseases, poverty and new forms of violence. The destruction of physical and spiritual links to country has had disastrous impacts on identity, culture and language. Australia’s history is marred by massacres, generations of children stolen, imprisonment and First Nations people pushed to the fringes.

The death rate from intentional self-harm is twice as high for Aboriginal and Torres Strait Islander people as for non-Indigenous Australians. This rate has increased dramatically over the past decade, from 17 to 24 in every 100,000 people.

Being incarcerated poses a risk of ill-health and self-harm. It is very alarming, therefore, that the imprisonment of Indigenous people is increasing – from around 7,500 to 10,500 over the past decade. First Nations people make up three per cent of the Australian population, but almost a third of people in prison.

Clearly there is a pressing need for the development of collaborative and culturally appropriate mental health services. Better linkages with the criminal justice system are needed to promote diversion from custody.

Much more is needed too. In 2017, Indigenous Elders and leaders from around Australia gathered at Uluru for the Aboriginal and Torres Strait Islander Referendum Convention. They issued the Statement from the Heart, which emphasised the nation’s need for greater truth-telling and Indigenous empowerment in decision-making:

Proportionally, we are the most incarcerated people on the planet. We are not an innately criminal people. Our children are aliened from their families at unprecedented rates. This cannot be because we have no love for them. And our youth languish in detention in obscene numbers. They should be our hope for the future. These dimensions of our crisis tell plainly the structural nature of our problem. This is the torment of our powerlessness.

The Statement from the Heart calls for constitutional reforms to establish a First Nations Voice and Makarrata Commission to underpin agreement-making with government. The empowerment of an Indigenous voice and self-determination in all decisions that affect the lives of their communities is aimed at bringing the values of fairness, truth and justice to Australia’s relationship with First Nations people and communities. It is about stepping up to the unfinished business of our past and ensuring the right of each person to flourish and live life to the full. That call is yet to be answered in a spirit of national solidarity.

Refugees and asylum seekers

The common good is both universal and intergenerational because the human dignity of people does not depend on their location in time or space. As the COVID-19 pandemic has made painfully clear, we are one human family. We are called to loving relationships with all people regardless of nationality or visa status.

A commitment to the good of all, especially the most vulnerable, must include those people who have been locked in Australia’s offshore immigration detention centres. At the end of 2012, Australia resumed its offshore processing of asylum seekers, transferring people who arrived by boat to Nauru and Manus Island in Papua New Guinea. Over 4,000 men, women and children have passed through these centres since that time.

In September 2019, there were around 600 people still detained in Nauru and Papua New Guinea. It is estimated around 70–75 per cent have been determined to be refugees. Some have been in detention for up to seven years.

Many immigration detainees already experience poor mental health as a result of the disasters and wars, persecution and torture from which they have fled. They experience high levels of depression, anxiety and post-traumatic stress. Fleeing entails the experience of great insecurity and involves many risks such as human trafficking and forced labour, harassment and abuse.

How is it that we as a nation have spent around $1 billion a year to establish and run offshore detention centres that we know breach key international human rights obligations, including that no one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment?

Detaining people in inhumane conditions and refusing them resettlement in order to send a message to people traffickers treats vulnerable people as a means to an end. The damage done in the meantime has compounded their trauma and mental ill-health.56 The policy seems aimed at breaking their spirits, but it does the rest of us spiritual harm too.

The deterioration of mental health in those held offshore is evident in extremely high levels of self-harm. Several people have died by suicide both in offshore detention facilities and facilities in Australia. People are cutting themselves, self-battering and attempting to hang themselves. The respective rates of self-harm on Nauru and Manus Island have been estimated as being 45 and 216 times the Australian rate for hospital-treated self-harm.

We are especially aware of the risk of self-harm, assaults and sexual abuse of children in such environments. The 2014 Australian Human Rights Commission report, The Forgotten Children, found that children were endangered by the violent environment of centres and their close confinement with adults suffering high levels of mental illness.

A third of parents with children in detention had moderate to severe mental ill-health and one-third of children had mental health conditions serious enough to be referred for psychiatric treatment if they were in the Australian community. A recent study of conditions on Nauru confirms the huge risks to children in detention.

National bodies representing psychiatrists, psychologists, doctors and other mental health professionals have repeatedly condemned the disastrous mental health impact of detention. We join their call for an end to prolonged inhumane detention and for the transfer of high-risk groups including children and people with mental ill-health to care in the Australian community.

The marginalisation and incarceration experienced by the First Australians and also the latest people to come to Australia raise real questions about our commitment to the common good. We are called to reach out to these people at the fringes who have been ignored and harmed by our society. They too must share in the good of all of us. As Pope Francis explains:

[God] impels us constantly to set out anew, to pass beyond what is familiar, to the fringes and beyond. … Unafraid of the fringes, he himself became a fringe (cf. Phil 2:6-8; Jn 1:14). So if we dare to go to the fringes, we will find him there; indeed, he is already there. Jesus is already there, in the hearts of our brothers and sisters, in their wounded flesh, in their troubles and in their profound desolation. He is already there.

Moving forward as Church and as a society

We have seen that the causes of mental illness lie in the social, economic, political and cultural context as well as within the person. Poverty, discrimination, trauma and violence frequently result in or contribute to mental ill-health. There can be no doubt that the institutional harm done to the most vulnerable in Australia is an instance of structural sin. This harm is reflected in the mental health issues, such as intergenerational trauma, suffered by individual people, families and whole communities. Both the harm and the causes must be addressed.

We Bishops, as leaders in the Catholic Church in Australia, are painfully aware of the failings of so many Church people and entities to protect and care for children and vulnerable adults in institutions. We again say sorry to the Stolen Generations and their families for the Catholic Church’s complicity in the removal of Aboriginal and Torres Strait Islander children from their Indigenous families. We say sorry to all the survivors of childhood institutional abuse and their families. We commit ourselves to continue to advocate for the humane and just treatment of asylum seekers, refugees and humanitarian entrants.

Because structural sin is non-voluntary and non-individualistic, it can be difficult to grasp our personal and collective responsibility to put things right where possible, and to work for positive change. The sinful personal choices of many people over time can become entrenched in organisational culture, policies, social processes and in institutions. Particular moral responsibility for these situations cannot then be attributed to specific individuals only. All of us who inherit these situations share in the responsibility to address them.

Breaking down structures of sin and building up structures that might better mediate God’s grace is part of our mission to transform the world – that it may be on earth as it is in heaven. The witness of those whose physical, mental or spiritual wellbeing has been harmed challenges us all to work for change.

Called to live life to the full

While the thief comes only to steal, kill and destroy, Jesus has come that we may have life (Jn 10:10). This promise is made in the context of the parable of the Good Shepherd – a story of intimate connection, care and protection (Jn 10:14).63 It is through connection with God, and the quality of relationships into which this calls us, that we will experience the fullness of life in body, mind and spirit, both personally and communally. In the farewell discourse John reports Jesus’ warning to his disciples: In this world you will have trouble. But take heart! I have overcome the world. (Jn 16:33)

Intimate connection with the heart of God may require us to embrace and find meaning in the vulnerability and suffering that comes with loving. It will draw us to work to eliminate that suffering which cuts people off from God, each other, and the rest of creation – suffering that denies people and communities participation in the fullness of life.

We have identified a range of matters that require reflection and action in our parishes and local communities, and in government policy and service provision. As Bishops, we are confident that the energy, insight and commitment needed are present among members of the Catholic community and all people of goodwill.

Together, we promote the fullness of life for all when we ensure appropriate care for everyone experiencing mental ill-health:

• when we reject stigmatisation,
• when we work for the transformation of social determinants of mental ill-health,
• when we call for policies and service provision that meet the needs of the poorest, most marginalised and recognise in them the face of Christ Jesus.

As we seek the fullness of life for all under the care of our Australian governments, we recall these words Pope John Paul II spoke to mental health workers 25 years ago:

Whoever suffers from mental illness always bears God’s image and likeness in themselves, as does every human being. In addition, they always have the inalienable right not only to be considered as an image of God and therefore as a person, but also to be treated as such.

In our parish communities, our institutions and throughout the Church in Australia, we have a duty to break through the stigma of mental illness. As Church, we have the opportunity and responsibility through the Plenary Council 2020 to consider at a deeper level our care for these most vulnerable of our brothers and sisters.

We are called to restore the Body of Christ by making mental health a key priority, acknowledging and including people living with mental ill-heath within our communion and the heart of Australian society.