05 Feb What if we had an “opt-OUT” system for mental-health check ups?
When it comes to organ donation rates in different countries around the world there are stark differences. Explicit consent rates in some countries (e.g. Austria, France and Hungary) are over 99%. That means effectively every person has agreed, before their death, to be an organ donor. In a number of other countries, however, such as Denmark, Germany and the United Kingdom, those same consent rates are below 20%. Here in Australia we sit at about 64% which is not bad, but still below the 70% experts argue would be preferable.
Looking just at the more extreme ends of the spectrum, why would Austria and France have rates so much higher than Denmark and Germany? Do they care more about others? Do they care less about keeping their organs after death? Well, like many areas of life there are almost certainly multiple answers to this question, but one difference stands out like a metaphorical sore thumb.
In the high consent countries, organ donation is opt-out. That is, it’s assumed people will provide consent, but they’re still given an option not to. The default position, then, is organ donation. In the low consent countries, the opposite situation exists; one has to opt-in to give consent for organ donation. This isn’t a difficult thing to do, usually just requiring the ticking of a box on a drivers’ licence application or renewal, but it still requires action or decision. And as can be seen from the aforementioned figures, that ultimately leads to markedly different consent rates and beyond that, substantial differences in lives saved.
I’ve seen the same principle work in many other areas of life. Having worked with many of the most successful people in my capacity as a Consulting Psychologist and Executive Coach, one thing has stood out time and time again when comparing the happy and successful with the not so happy and successful. When asked how they find time amidst busy schedules for activities that others struggle to fit in they invariably respond with something along the lines of … it’s the first thing I put in my calendar (or on my to-do list).
A great example of this was a man, Frank Dern, who I interviewed for a book I wrote several years ago on positive ageing. At the age of 82 (at the time of writing), Frank was still running full marathons, along with keeping up his involvement in many other activities including being an active member of Rotary International and his local church. The morning I interviewed Frank it was cold and dark and rainy. At 9.30 he’d already been for his run and when I asked him how he keeps getting up early, and running, even on a winter’s morning, he quite simply stated, “it’s just what I do”.
For Frank Dern, and the others to whom I referred earlier, running and their other priorities were the default; they’d effectively set up an opt-out system. They all acknowledged there were times it was necessary to be flexible, or to change plans, but the de facto position was running; or in the other instances whatever activity had been determined to be important.
Now this article is not about organ donation; or about running or even professional success. It’s about something about which I’m even more passionate – mental health. You would have read or heard the statistics; so, I won’t repeat them here. But suffice to say that pretty much every single one of us will be affected by mental ill-health at some stage in our lives, either directly or indirectly (that is, through a loved one, friend or colleague).
In recent years, much has been done to improve the provision of services and access to services (geographically and financially); and it’s important to acknowledge how far we’ve come in this domain. Further, there’s also been significant progress in terms of smashing the stigma associated with mental ill-health and, therefore, making it much less scary for those thinking of seeking treatment. Although we still have a long way to go it is, again, important to note the progress that’s been made.
Despite these gains, however, we still have an opt-in system; a system where individuals have to recognise they have a problem, be aware that help is available, make contact with a service provider and organise an appointment and then turn up for that appointment and follow through with any treatment recommendations that might be made. Each of these steps is difficult in its own way, and if one reflects back on the sizeable differences seen earlier between organ consent rates when one simple “tick” is required (99% down to less than 20%) it’s not hard to imagine what a difference might be found when multiple, more complex and challenging steps are required as in the case of engaging in a psychological intervention.
But what if we made mental health assessment opt-in? Given the extremely high prevalence rates, not to mention the enormous associated cost to our society, surely this warrants some consideration?
And in case you’re wondering, making an aspect of health care “the default” is not, by any means, unprecedented. Regular health and development checks are recommended for all babies and young children born in Australia to see they are growing and developing normally, and to find health problems so they can be treated early. Vaccination is essentially built in to this system.
These checks are recommended by the National Health and Medical Research Council of Australia. Although the timing and frequency of health checks vary between states and territories, they are generally recommended at birth, one to four weeks, six to eight weeks, and at four, six to nine, 12 and 18 months of age. Then at two, three to three and a half, and four to five years of age. Further, shortly before or after a baby is born, parents are given a Child Health Record booklet as a way of keeping track of their child’s progress.
It goes without saying that not every parent follows these guidelines 100% as recommended. And that’s just life. But in essence, these “check ins” are the health experts’ version of Frank Dern’s “it’s just what I do”; they’re the recommended default; and as a result, the majority of parents follow them.
What I propose today is two-fold – what if we were to extend the period of monitoring beyond 5 years of age? And what if we were to extend the focus assessment beyond standard “physical” checks to include screening for well-known psychological risk factors? Standard tools already exist for a relatively quick and easy (initial phase) assessment; and research strongly supports the benefits of early identification of warning signs allowing for earlier intervention for and even prevention of psychological disorders.
What if we had an opt out system for mental health check-ups? What if we had a healthier and happier society?