Prevention United is part of the new portfolio of impact partners funded by Future Generation Global. Can you briefly describe what you do?
We are a mental health promotion organisation focused on promoting mental wellbeing and preventing the onset of mental health conditions, like depression and anxiety disorders. We don’t offer treatment or counselling support for people already affected by these conditions. Instead, we try to keep people mentally healthy and to stop these mental health conditions from occurring in the first place.
You founded Prevention United just over five years ago. What was the catalyst for that?
I was a GP who’d always had a strong interest in and passion for mental health. A lot of my career was spent as a clinician supporting people with mental health difficulties but I also worked for the Victorian Health Department in their mental health team and various not for profits, looking at ways we could improve services for people impacted by mental health difficulties.
Then, about 10 years ago, I started to realise that we were spending all this time, effort and money helping people who have a condition – which, of course, is important – but that we weren’t really doing anything to try to stop mental health conditions from occurring in the first place. Organisations that I had worked for, like Beyond Blue, did that as one aspect of their work, but it wasn’t the main game. I felt that this was a big gap. So, along with two colleagues I’d met at Beyond Blue, Luke Martin and Lachlan Kent, we decided to set up our own organisation with an exclusive focus on wellbeing and prevention.
Why do you think that a focus on prevention has been lacking in the mental health sector, when this type of approach has been so effective in other areas, like cardiac disease, skin cancer, strokes and diabetes?
That’s a great question. I think part of it is that the mental health care sector has so many problems. Governments spend so much money trying to fix a broken system that they don’t have anything left over to spend on wellbeing promotion and mental ill-health prevention. Of course, we do need to look after people who are experiencing serious mental health difficulties, but that has meant we’ve just kept kicking the wellbeing and prevention can down the road.
The attention that governments have given to prevention has waxed and waned over the years. There was a bit of a spurt in the early 1990s, and then again around 2000, but interest died off because there wasn’t enough advocacy from people within the sector. That’s why, at Prevention United, we focused on advocacy from the very start. We needed someone to speak up about the importance of prevention. Everyone else in mental health is just calling for more money for mental healthcare. Both are important.
Along our advocacy journey, we’ve had to counteract a couple of obstacles. The first was the sense that there’s not enough evidence around what works in the prevention space. So, we did a lot of literature reviews and evidence summaries to show that there actually is good, solid scientific evidence. Other people were sceptical about the cost benefits, so we summarised the literature on cost effectiveness.
A lot of the past five years has been spent counteracting the myths and misunderstandings that the public, people in the sector and politicians have about prevention. We’re starting to see some real shifts now, with people beginning to understand that it’s important and it can be done. We just haven’t quite yet got to the pointy end, where they’re saying, “Yes, and here’s your money!”
So what is the case for prevention?
We know that good mental health drives creativity, better learning and productivity. It’s also like a fuel that drives better health behaviors, better connections with others, and more civic participation. When you’re on top of your mental health, you’re feeling good, functioning well, relating well to others, contributing better to society – and that’s got an economic benefit as well as a personal benefit.
By contrast, when you’re experiencing serious mental health problems, all of those things are the reverse. You find it harder to do stuff, you’re more withdrawn socially, you’re having arguments with friends and family, you’re less productive at work, you may not even be able to work. There are economic and social costs associated with that.
In health, we always say that an ounce of prevention is worth a pound of cure. That doesn’t mean we can prevent every condition every time. However, if we can reduce people’s risk of mental health problems, then there are strong economic and moral reasons for doing so.
Another powerful – and sobering – argument for prevention is that, as a community, we have been putting more money into mental health every year since 1990. We’ve now got more money in the system and more people using services than ever before. But when you look at the prevalence of mental illness, particularly among young people, it’s going up in a really steep way. The rates of young people with serious mental health conditions or dying by suicide are horrifying. All this money and all these new programs are not making a difference.
What this means is that we can’t just expect to do the same thing and get a different result. We believe we have to up our game and put a little bit more energy into wellbeing and prevention – because what we’re currently doing simply isn’t working!
We’re clearly in the midst of a youth mental health crisis. What do you think is driving this?
We recently did a study on this and our team wrote a discussion paper. But before I get into that, let’s go back a step. Our mental health is affected by so many influences. There are intrinsic things, like our genetic profile, family history and personality. But, by and large, most of the risk factors that contribute to poor mental health are environmental. What’s going on in our home life? Are we bullied at school? Are we under too much stress at work and not given enough support? What’s happening in the economy and broader community?
For this study, we looked at risk factors that are unique to this generation and we found a few things. Number one – top of the pops – was digital technology and social media. While there’s a lot of good stuff with social media, particularly in the way it provides a means for lonely people to connect with others, there’s also a lot of bad stuff. People spend too much time on screens, so they are not out there exercising. They’re on their screens late at night, so they’re not sleeping properly. Then there’s misinformation and cyber bullying – and I think this generation is exposed to that in a much higher volume than anyone else.
Secondly, young people have very real concerns about climate change. They understand the implications of climate change because they’re living those implications. You’ve got kids caught up in massive flood, bushfire and drought events. And yet, they look around and see that not enough is being done to combat that – and that raises their anxiety levels really high.
Then, of course, we had COVID, which affected the mental health of a lot of young people, particularly in Victoria and New South Wales. Lockdowns meant a lot of young people were separated from their friends and were unable to connect with their study or work.
Finally, there’s been an increase in the risk factors we’ve known about for years, like child abuse and neglect. Child abuse and neglect are the single biggest cause of mental illness in the community and yet a recent study by various universities, called the Australian Child Maltreatment Study, found extraordinarily high rates of emotional, physical and sexual abuse still happening. Some 30-35 per cent of young people said that they’d experienced emotional abuse in the form of put downs, criticism or a lack of being valued and loved. That’s really harmful for your mental health. So, we have a problem with child abuse and neglect, we’ve still got a problem with domestic violence and we’ve still got a problem with bullying.
Then, added to all this, are financial worries. Young people are coming out of university with high debts, housing affordability is shot, and the job market is more insecure.
So, ultimately, there is not one single smoking gun risk factor, but rather a bunch of problems that are happening simultaneously. These are all adding up to cause a cumulative impact on young people. The result is that we now have the most unhappy and anxious cohort of young people we’ve probably ever seen in Australia. That’s a real worry.
So what do we do now?
Well, it just goes to the point that either we keep waiting for young people to become depressed, anxious or develop an eating disorder, and then hope that the GP, psychiatrist or psychologist helps them. Or we try to identify the risk factors that cause these problems and tackle those instead.
But that’s where things get complicated. There are so many variables, so how do you create a system of connected initiatives that can then start to make a difference? It’s not like one program or one organisation can solve the problem. So we, as a country, have to do what Future Generation Global has done and invest in a variety of different organisations, then get them to work cooperatively to ensure that there are good things happening in communities across Australia. We’ve got to make sure we are doing something about child abuse, domestic violence and bullying in every community. We’ve got to be building resilience and social connectedness among young people in every community. And we’ve got to empower young people to get involved and feel good about life in every community.
That’s not going to be done by one organisation based in Canberra, Sydney or Melbourne. It’s got to be done by a whole lot of interconnected organisations. That’s what Future Generation Global is doing – and we think it’s a great model for the Federal Government to roll out. Then, all you need is a way of making sure all these organisation are working together, like an orchestra conductor.
At Prevention United, we’ve just put out a solutions paper, in which we talk about establishing a Centre for Youth Wellbeing that would have that role of orchestra conductor. Then we need a grants program that would provide funding for the types of initiatives that Future Generation Global is supporting. We need more BackTracks, more Mind Blanks and more Smiling Minds out there, doing their good work in communities.
As you say, Future Generation Global has put together a portfolio of not-for-profit organisations and we are measuring not only their individual impact, but their collective impact. What do you hope the group can achieve – and what’s realistic for the group to achieve?
First up, you want to see improvement for each individual organisation. They’ve all got funding which will allow them to grow their own internal capabilities and capacities, but on top of that you want to see that they are achieving their goals. Take Mind Blank, for example. It uses drama-based approaches to connect with young people, build their self-esteem and self-worth, and improve their mental health. So, it will have to measure whether that’s been achieved. If it has, big tick. The same goes for all the other organisations.
But then, what we really want to see is a downward shift in distress and anxiety at a community, or population, level. That’s not something that any individual organisation can measure; it has to be done by the Australian Bureau of Statistics or a government department. All each individual organisation can show is that it’s making a difference to the mental health of the young people who use its programs and services.
Then you start getting into the critical mass or collective impact argument. It’s Gestalt Psychology: the whole is greater than the sum of its parts. Whether 14 organisations doing good work is enough to see a shift in the prevalence curve remains to be seen. I think it’s a good start, but we need more. So we are asking the government to look at what Future Generation Global has done, and do something similar – but on a larger scale.
I noticed that you recently called for applicants for a Youth Advisory Group at Prevention United. How important is it to listen to young voices as we work towards a solution?
It’s 100% crucial. It’s early days for us, but we’ve asked our Youth Advisory Group to look at our solutions paper and provide some feedback. When it comes to our proposed Centre for Youth Wellbeing, we believe we need a young person to be Co-CEO or Deputy CEO and we need a Youth Advisory Committee that reports directly to the CEO. We need to have youth representation in every program area, on every working group and on every steering committee, so that young people’s voices contribute to the decisions this organisation takes. We really think that there’s not enough emphasis on giving young people a say in what is needed to improve their mental wellbeing. We want to involve young people in that conversation. We want to talk to them not only about what services they need when they’re depressed or have an eating disorder, but also about what they need to keep mentally healthy.
What’s the ultimate goal for Prevention United?
The ultimate goal is to convince governments, particularly the Federal Government, that they can no longer ignore prevention. We want them to allocate money in every single budget towards promoting wellbeing and preventing mental ill health – in much the same way that every budget has something around mental health care. We’re already seeing some positive changes at the state level. Victoria is working on its first ever plan to promote good mental health and prevent mental illness. Queensland has released a new mental health strategy, which includes a focus on prevention. Tasmania is developing a new prevention and early intervention strategy. That’s great because it all starts with governments accepting that we need to act.
Our second big aim is to build the capacity of the mental health promotion workforce, both by getting more people into the sector and by improving their expertise. We’ve got an entire workforce out there who have been working for decades on the prevention of heart attacks, strokes, cancers and so on. Now we need a workforce that prevents depression, anxiety and eating disorders and builds mental wellbeing. So, we’re doing a lot of training to try to make this happen.
So what would your top tips be for people looking to maintain good mental health – or promote it in their children and grandchildren?
There are four domains of action. The first is the lifestyle bucket. That includes things like regular physical activity, a healthy diet, getting enough sleep, drinking responsibly, not using illicit substances, learning relaxation strategies, getting out into nature, participating in the arts and taking part in activities that boost your self-esteem. All of those things are good not only for your physical health, but also for your mental health.
Connections are the next big thing. Humans are social animals. We get really depressed when we’re lonely and really happy when we’re connected to others and feel like we have a support network. Relationships don’t just happen; you have to work on them. And you have to work to build your social network and supports.
The next bucket is mindset. Humans have a tendency to think in very unhelpful ways. We tend to see the worst in situations, catastrophise and blow things out of proportion. There are techniques you can learn from clinical psychology that help you to maintain a more balanced, realistic mindset and enable you to regulate your emotions. This is important because how we think affects how we feel.
The last thing is making sure you have a sense of purpose in your life. You have to find the thing that gets you out of bed and gives you a sense of satisfaction and accomplishment. If you feel a bit aimless and unsure of what’s important to you, your mood drops.
All of these self-care behaviours are really important, but we have to back them up by also eradicating harms such as child abuse and neglect, family conflict and violence, and bullying. I know that sounds overly ambitious and almost too hard to tackle. But if 50 odd years ago, when half the population was smoking cigarettes every day, we’d said, “Well, what can you do about it? That’s just the way it is,” then we’d have cancers, heart attacks and strokes going through the roof. Instead, we said, “No, let’s do something about it. Let’s change the way people behave.” It took a lot of time, effort and different strategies – from marketing to legislation – but we got the rates down from 50% of the population smoking every day to about 11%. That’s a huge reduction and it has saved so many lives. So why is tackling child abuse and neglect any different to tackling smoking? The big difference is we’re not paying any attention to it, we’re not putting money into it and we’re not taking a systematic approach to it. If we did, and we got it right, we’d save a lot of people from depression, anxiety, eating disorders, borderline personality disorders, schizophrenia and suicide. It’s pretty worth it!
Finally, what do you hope our shareholders take out of this interview?
I hope that they realise that their money is doing a lot of good. Philanthropy can do things a bit differently from government. It can take a few risks, try new innovations. It can look for people who aren’t the usual suspects and give them support.
It’s great that Future Generation Global is backing small-to-medium organisations and giving them a chance to do something innovative. Government is ultimately responsible for the mental health care system, so if that’s broken, it’s up to government – not philanthropy – to fix. But philanthropy can still look for initiatives that will turn the tide and I believe investing in promotion and prevention may be able to do that.
Investing in our youth is also absolutely vital because they are our future. Research shows that if you go through your young adult life in good shape, psychologically, emotionally and socially, then you will perform well as an adult. But if you struggle with your mental health, it can have long-term, enduring consequences throughout your adult life. So, now is the time to get things right!
For more information, visit Prevention United’s website.