Foxes, Hedgehogs and Mental Health

My AFR column today is on mental health, arguing that while there are some good youth programs, we shouldn't ignore the potential for mental health interventions before age 12 and after age 25.

Narrow Mental Health Focus, Australian Financial Review, 12 April 2011

An essential characteristic of great innovators is their single-minded focus. Imagine how much poorer the world would be if the Wright Brothers had been part-time trainspotters, if Bill Gates had spent half his childhood studying archaeology, or if Howard Florey had split his time equally between economics and medical research.

The great Oxford philosopher Isaiah Berlin once divided thinkers into hedgehogs, who know one big thing – and foxes, who know many little things. Using this metaphor, most scientific breakthroughs are performed by hedgehogs, whose unwavering focus on a single goal is what cracks the nut. By contrast, policymakers often need to be foxes, recognising that the world’s problems are complex, and that most challenges cannot be boiled down into a single idea.

In mental health policy today, considerable attention has been given to a pair of youth-focused approaches: headspace (for moderate mental ill-health) and EPPIC (for serious mental illness). Both strategies have shown promising results, with evaluations using matched treatment groups suggesting that headspace and EPPIC are effective.

While these results are impressive – and the work has been noted internationally – it is critical to keep the success of youth-based programs in perspective. The age range of 12 to 25 is undoubtedly an important one, but it is far from clear that this is the only point at which policymakers can intervene.

In lifecycle terms, most measures of mental illness peak are highest in the age range 35-44. According to the Australian Bureau of Statistics’ most recent National Survey of Mental Health and Wellbeing, this is the peak age range for affective disorders (such as depressive episodes) and anxiety disorders (such as post-traumatic stress disorder). The suicide rate also peaks in the age range 35-44. The average age of a suicide victim in Australia is 44, well above the eligibility age for headspace and EPPIC.

Like many physical health problems, mental disorders often have a long history – sometimes stretching back to adolescence. But it does not automatically follow that youth services will prevent problems from arising later in life. The Royal Australian and New Zealand College of Psychiatrists has noted that intervening prematurely could lead to patients being inappropriately labelled and medicated. As an analogy, we know that obesity and smoking can have their roots in the teenage years – yet it would be a mistake to think that either could be solved by a youth-only approach.

A whole-of-life approach to mental health requires a primary health care system that is better integrated, and in which doctors and nurses are trained to deal with mental disorders. It also involves investing in perinatal depression, direct suicide prevention, and crisis intervention (such as after the Victorian bushfires or the Queensland floods).

The other feature of the youth model is that it misses the potential for interventions before age 12. In one study, expert observations of toddlers correlated with suicide attempts in adulthood. Improving mental wellbeing at young ages requires high quality childcare, skilled teachers, and a system in which educators and medical workers are adept at managing minor problems and referring more serious issues.

Yet despite the evidence, Tony Abbott’s current mental health policy has just one approach: boost youth services. This is like having an education policy that focuses only on high schools, and dismisses the potential to improve skills through early childhood programs, apprenticeships or on-the-job training. And because Mr Abbott’s policy cuts back on other aspects of health care (such as electronic patient records), there is a risk that his plan would make the primary health care system even less adept at dealing with mental illness.

The good news in mental health is that the Australian suicide rate has steadily fallen over the past decade, and is now lower than at any time since the end of World War II. Funding has also increased, with federal mental health spending in 2010-14 nearly triple what it was in 2004-08.

But the bad news is that mental health still imposes a major burden on sufferers and their families. Australians with mental illnesses are overrepresented in our jail cells and on our park benches. Anyone who is passionate about reducing disadvantage – as I am – must be serious about addressing mental illness. And as any fox knows, you don’t solve a complex problem with simple solutions.

Andrew Leigh is the federal member for Fraser.
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Indirect Inaction

My friend and coauthor Joshua Gans has an article in the Drum about the benefits of pricing carbon over the Opposition's grab-bag of mandates and subsidies. He concludes:
The point is that this game could go on and on with very little impact and possibly negative impact on total emissions. And there is example after example of this. Think of the taxes required to employ all the inspectors and personnel to ensure that regulations are doing what you wanted without unintended consequences. Sure, it can be done but you will need a government that would make Lenin blush to make it happen.

Contrast that with a carbon price - by tax or trade. That requires none of this because it hits directly on the problem: emissions create external costs so we need everyone to build that cost into their decision-making. The problem is, as right-wing economist Frederick Hayek pointed out, that no-one has the information required to plan out what individuals might do themselves. By placing the decisions of environmental management in the hands of the people, you can let things work themselves out in a way the heavy-handed Government involvement cannot.

It is ironic that on climate change policy, politics are in the bizarro-world where the supposedly anti-market Greens side with Hayek while the supposedly pro-market Coalition sides with Lenin. The economic evidence strongly suggests that the Greens policies match their goals while the reverse is true for the Coalition. I can’t parse the dual hypotheses that either the Coalition just deny economic evidence or that they actually want more emissions and handouts to business. Perhaps one of their number can enlighten us.
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The Big Tent

I've recently purchased an 'Andrew Leigh - Supporting Our Community' marquee for use in community functions. If your local group would like to borrow it for a sporting carnival, school fete, carnival or community barbecue, we're happy to loan it out without charge. You'll need a station wagon or van to carry it. Setup is quite straightforward, and only needs two people. You can take it with the back wall, or without.

Some photos of the marquee are below. It's a strong one, and a good way of giving yourself some insurance against too much sun or rain on the day. Just call the office on 6247 4396 if you'd like to borrow it.

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Introducing Robert Putnam

I had the pleasure of introducing Robert Putnam at an ANU public lecture yesterday. Remarks below.
Introducing Robert Putnam’s public lecture on American Grace: How Religion Divides and Unites America
Australian National University
5 April 2011

I want to begin by acknowledging the traditional owners whose lands we meet upon today, and thanking the Crawford School, the HC Coombs Policy Forum, and the US Studies Centre for making today’s event possible.

The first thing I need to tell you is that there are three Robert Putnams.

  • The first Robert Putnam is a major figure in international relations. After working in the Carter White House, Bob developed two-level game theory, a model suggesting that international agreements will only be struck if they satisfy domestic constituencies. Putnam’s theory of two-level games, published in the journal International Organization, and in several influential books, revamped how many scholars thought about issues like global arms control agreements.

  • The second Robert Putnam is the world’s most influential scholar of social capital. In Making Democracy Work and Bowling Alone, he has shown that community life in America collapsed during the last forty years of the twentieth century. In Democracies in Flux, he shows that this is true in most developed nations around the world. And in Better Together, he has suggested a few ideas for revitalising community. Putnam’s work on social capital has earned him the Johan Skytte Prize (sometimes called the ‘Nobel Prize in Political Science’). It has influenced thousands of scholars, including my own slim volume, Disconnected, which looked at community life in Australia.

  • But it’s the third Robert Putnam that we’re here today to listen to. This is the Robert Putnam who has – with David Campbell – produced a 700-page book on religion in the US: American Grace.

How do these three Robert Putnams – this trinity of Robert Putnams – manage to produce such a volume of high quality output? The secret is that while most social scientists use an artisan model, Professor Putnam’s research model looks more like a well-run factory than a craft workshop. A team of research assistants craft memos that summarise research findings on a particular narrow issue. Before your memo is finalised, you must present it to the full team, chaired by Bob, and comprising graduate students in politics, economics and sociology. Only then does it make it through to the man himself, who digests the findings, and then uses it to churn out beautifully readable prose – usually at around 3 in the morning. Being part of Bob’s research team was a highlight of my time at Harvard – and I learned why one of my predecessors described him as ‘the General Motors of American academia’.

He is also famously good at multitasking. When I visited the US last April, I arranged to see Bob at his home in Cambridge. He met me with a warm smile, and said ‘my students arrive here in an hour, and I’ve promised them dinner – how do you feel about coming with me to help me shop?’. An hour later, we’d enjoyed a thoroughly enjoyable conversation about David Cameron, Barack Obama and Australian politics, and returned to the house with a carload of food just as the first students arrived. I know few people in the world who work harder than Bob – or have more fun doing it.

Bob’s talk today is about religion in America. The US holds a central fascination for many of us, a fascination aptly summed up by WH Auden:

'God bless the USA, so large, so friendly, and so rich'

But I’m sure we’ll also be looking to draw comparisons with Australia, so let me make a few.

In one sense, Australia is less religious than the US. Many Australians are comfortable describing themselves as atheists – yet only about 1 in 1000 Americans call themselves atheists. Weekly churchgoing in Australia has fallen from 1 in 3 in the 1940s to 1 in 8 today.[1] In the US, it has slipped only slightly, and still remains around 1 in 3.

Both countries’ Constitutions prohibit laws establishing any religion.[2] Yet the US Supreme Court has interpreted this to mean that religious schools cannot receive government money, while the Australian High Court has decided that religious schools can receive substantial government funding. Even as a student at Pennant Hills Public School, my sixth grade teacher Mrs Clements had us recite the Lord’s Prayer each morning. My US-born wife Gweneth gasped when I told her that.

And yet similarities exist too. In both countries, churchgoers are far more likely to vote for the party of the right. Like the US Democrats, we in the Australian Labor Party are sometimes tongue-tied in conversations about religion, too ready to vacate the pulpit. For every Biblical passage about sex, there are many more about social justice. We need to get better at engaging in honest and robust conversations with religious Australians.

It is now my enormous pleasure to introduce to you (the third) Robert Putnam. The world’s best known political scientist. A rockstar in the research world. A superb teacher. And a generous mentor.  Bob, the floor is yours.

[1] See Robert Putnam and David Campbell, American Grace, Ch 3 and Andrew Leigh, Disconnected, Ch 3. Since Christianity is the main religion in both countries, I use the simple term ‘churchgoing’ to cover all forms of religious attendance.

[2] See the First Amendment to the US Constitution, and section 116 of the Australian Constitution.
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Capital Hill on ABC24

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SkyNews AM Agenda 4 April 2011

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Talking Climate Change

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The Simple Street Party

As my engineering friends might say of politics, the negative feedback loop works better than the positive feedback loop. So I was chuffed to receive an email from Melbournian Belinda Pearson, who'd followed up on one of the suggestions in the final chapter of Disconnected.
Having heard you talk about street parties ('By Design' I think?) and talked to older residents in our small Melbourne street about 'once-upon-a-time street parties', we decided to go with it - simple, no alternatives for rain, no  suggestions or prescriptions about morning tea.  To our delight about 60 people wandered up and mingled.  What a feeling to know that most of the people in our street want to know others in the street.

If you'd like to follow in Belinda's footsteps, my simple template invitation is here, or you can use Andrew Heslop's slicker version, designed for 'Neighbour Day'.
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What I'm Reading

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Work for the Headline

So Tony Abbott wants to expand Work for the Dole. I wonder whether he might want to pick up a report commissioned by the Howard government, which concluded that the program reduced the chances of jobseekers finding employment?

Jeff Borland  & Yi-Ping Tseng

This study examines the effect of a community-based work experience program - Work for the Dole (WfD) - on transitions out of unemployment in Australia.   To evaluate the WfD program a quasi-experimental exact matching approach is applied. Justification for the matching approach is a ‘natural experiment’ - limits on WfD project funding - that it is argued constituted a source of random assignment to the program.  Participation in the WfD program is found to be associated with a large and significant adverse effect on the likelihood of exiting unemployment payments.  The main potential explanation is existence of a ‘lock-in’ effect whereby program participants reduce job search activity.

Then again, maybe Mr Abbott is more interested in policies that sound good than those which actually deliver results. That certainly seemed to be the approach of former Minister Mal Brough, who clearly felt that the test of a good policy was whether you could find a talkback listener who liked it.
Questions without Notice, 27 May 2004

Mr ALBANESE (Grayndler) (3:09 PM) —Is the minister aware that Work for the Dole participants are painting murals, making candles and putting on puppet shows? Is the minister also aware of the Borland and Tseng report commissioned by the government, which concluded the Work for the Dole program's `effect on exit from unemployment payments becomes progressively more negative'? When will the government get serious about preparing the unemployed for real jobs by adopting policies like Labor's Youth Guarantee: Learn or Earn policy? Why did the minister yesterday announce more `play for the dole' projects, including kite making?

Mr BROUGH (Longman) (Minister for Employment Services and Minister Assisting the Minister for Defence) —This is not an unexpected attack from the member for Grayndler. He is a member who just cannot say anything positive, does not understand or appreciate the positive nature of Work for the Dole—what it does for individual self-esteem and employability and what it does for the community. I invite the member for Grayndler to actually sit down with some of these purposeful individuals, who are trying to do something for themselves and their community and build a better self-esteem and a better opportunity for themselves. That is what Work for the Dole does.

I am very well aware of the report in today's Melbourne press, which went on to be on 3AW today. And it was interesting, because a number of personnel that are participating in those particular programs rang the program. I have got some of them here. One was a 58-year-old. As a 58-year-old she, or this person, volunteered. Now she or `Dale'—I don't know whether Dale is male or female; I did not actually hear, I am just reading from the Media Monitors report—says: `I am 58 and I don't have many qualifications.' She, oh it is she, says she is unemployable and is defending Work for the Dole. This is the person that we are here to help—a 58-year-old, mature worker who wants a hand. We make no apologies for helping these people and for what they are doing.
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Cnr Gungahlin Pl and Efkarpidis Street, Gungahlin ACT 2912 | 02 6247 4396 | | Authorised by A. Leigh MP, Australian Labor Party (ACT Branch), Canberra.