Getting help is not one thing

THE STATISTICS

Fewer than half of Australians with a mental disorder saw a health professional for it.

In 2020–2022, 4.3 million Australians aged 16 to 85 had a mental disorder in the previous twelve months. Only 45% of them saw a health professional for their mental health, and men were far less likely to than women (36% against 51%). GPs were the most common professional seen (36%), followed by psychologists (21%). The help exists. Getting to it, and getting the right kind, is the harder part.

Australian Bureau of Statistics, National Study of Mental Health and Wellbeing, 2020–2022.

GETTING IN EARLY

Most mental illness starts between 12 and 25. Treating it at 45 is like treating heart failure 30 years after the first heart attack.

Adolescence is not a slide into chaos. It is a move from unregulated moodiness towards an adult who can manage their own mood, with plenty of bumps along the way. Moodiness, sensitivity to what peers think and some experimentation are all part of it. Self-harm, thinking about suicide and pulling away from friends are not, even though they are often dismissed as a phase. The signs worth acting on are the ones that persist and start to affect school, friendships and daily life. Getting help early does two things. It keeps a young person safer through the episode, and it teaches them what their early signs look like and what works for them, so if it happens again at 24 or 40 they recognise it. Go early. The worst outcome is a false alarm.

A SKILL YOU KEEP

CBT is not a therapist telling you your thoughts are wrong. It is a set of skills you learn so that eventually you do not need the therapist.

Cognitive therapy was developed in the 1960s by Aaron T. Beck, who noticed that depressed moods could be traced back to thoughts people could put into words: ‘I am worthless’, ‘nothing will change’. Those thoughts lead to doing less, and doing less leaves nothing to challenge them with. One of the first steps is simply writing a thought down. Once it is on paper, it becomes a thought you are having rather than who you are. The behavioural half matters just as much. Someone too anxious to go to a party never gets the evidence that the first few minutes pass, so sometimes you change what you do first and the thinking follows. Most of the work happens between sessions, as experiments that gather information rather than pass or fail. CBT is meant to be focused. If nothing has shifted after three months, that is a problem with the therapy, not with you.

TARGETING

Most treatments for depression reach the whole brain. TMS reaches one circuit, and people often start thinking more clearly before they feel any better.

Transcranial magnetic stimulation passes a rapidly switching current through a coil held against the scalp. This creates a magnetic field that reaches a couple of centimetres into the brain and makes the nerve cells there fire. Repeated daily over several weeks, it changes activity in that area and in the circuits it connects to. For people whose depression has not responded to several medications, around half or more get meaningful benefit. Side effects are mostly a tapping sensation and sometimes a headache, and people stop because of them no more often than they stop a placebo. There is a very small risk of seizure, which is why people are screened first. What often returns first is not mood but concentration: a newspaper by the bed, then a magazine, then a book. A GP can refer you, and treatment is overseen by a psychiatrist.

STILL BEING TESTED

Psilocybin and MDMA can now be prescribed in Australia. That is not the same as knowing who they help, or for how long.

In February 2023 Australia became the first country to let authorised psychiatrists prescribe psilocybin, the active ingredient in magic mushrooms, and MDMA for treatment-resistant depression and PTSD. Usually a medicine has to prove it works, is safe and is worth the cost before it gets near a patient. Here the order was reversed, largely because people were already using these drugs outside medicine. A small number of good studies show short-term benefit. The largest found the highest dose worked best and also caused the most side effects. The trip is the treatment, not a side effect, but it lasts six to eight hours, it can go badly, and there is no stopping it partway. Whether the benefit lasts is still unknown. Ian’s advice is to try for a clinical trial first and, failing that, to choose a centre that is honest about what it does not know.

Recorded in February 2023, before prescribing began.

WHAT IT WAS BUILT ON

A chatbot that listens is not the same as one that helps. What it was built on decides which one you are talking to.

Therapy is hard to get, and plenty of people are already talking to general chatbots about their mental health. They listen well, never get tired, and are there at nine on a Sunday night. But they are trained on everything, so they cannot reliably tell a helpful answer from a harmful one, and they are not built to recognise risk. Tools designed for mental health care work differently. They ask the questions a clinician would, about sleep, routine and getting outside, and use the answers to shape what comes next. James argues we are asking the wrong question: the test should not be whether AI therapy is perfect, but whether it does better than the long wait most people face now. Ian’s team is developing AI tools for mental health care. How far these tools should be trusted, and how they should be regulated, is still being worked out.