Housing instability is a major driving force behind many of my mental health presentations. I know I’m not alone in this.
According to the Health of the Nation Survey, 71% of GP presentations involve mental health. Is it just me, or is the housing crisis one of the biggest underlying factors instigating this?
(Yes, and inflation and yes, obviously more broadly multifactorial, increased diagnosis, etc.)
Again and again, I am finding that housing is a major driving force behind many of my mental health presentations.
It may be a bias of mine. Both my wife and I changed our careers through postgraduate study. We dug into our savings to do so and started our financial lives again during the peak of the covid housing boom. Housing instability has been the order of the day for us until this year.
Still, as much as it impacted us – for example, rapidly moving house while Kate was 35 weeks pregnant, triggering a preterm scare – I could see it was worse in those around us and my patients.
I had junior doctors start, only to resign weeks later because they couldn’t find stable accommodation. Emergency housing dried up, and I watched domestic violence victims being discharged into the care of perpetrators because they had nowhere else to go.
Now that I’m in general practice, I’m seeing it more and more.
People are stuck in housing situations they don’t want to be in: adult children with parents, parents stuck with adult children, separated couples, abusive relationships – the list goes on.
For those in stable accommodation, there is pressure as well – long hours and multiple jobs are keeping couples apart and parents away from children to service the rent or mortgage.
The fall into homelessness and couch surfing is also more frequent than ever, and housing services are swamped.
When dealing with my patients in housing crisis, I am helpless and trying to find workarounds to provide care – such as, keeping the insulin stocks at the pharmacy to ensure it is refrigerated.
Housing is a necessity, so it is no wonder that when it becomes unstable, unaffordable and increasingly unachievable, we see people crumble.
Increasingly, young people, in particular, have lost an internal locus of control. It has been taken by gross inaction by consecutive governments on both sides of the political divide, and there is no hope on the horizon.
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This is an issue that is tearing at the fabric of our society and is breaking the social contract for many Australians.
It is an issue that, although profound and impacting public health, is being left out of the national dialogue of issues surrounding general practice. The generational wealth gap (largely driven by housing) is impacting the health of the nation, and I am seeing it in my rooms.
I often joke that mixed-billing practices should swap to privately billing pensioners and to bulk billing young families. It’s always a bit hard to swallow bulk billing a pensioner before their second overseas trip for the year, as they live in their four-bedroom multimillion-dollar house, while charging the young family who is struggling. Obviously, I am generalising here.
Because of my profound socialist tendencies, I frequently fail to walk my talk on private billing, so often my family and I end up footing the bill for government inaction – we will not be engaging in a holiday this year.
While the government is being bullish on the affordability of primary care, another expensive necessity, their response to housing is lacklustre to say the least.
As they dance to the tune of dropping the price of healthcare, they actively state that it is not their policy to drop house prices, arguably the number one driver behind inflation and a major driver in cost overheads for healthcare.
Show me a politician who doesn’t have housing investments, and I’ll show you a hen’s tooth.
But, dare I suggest, as GPs we are also relatively silent on this issue. (Cue, the cries to keep in my lane.)
Yes, the world of primary care has a lot going on right now, but the housing crisis has been the elephant in my consult room that no one seems to talk about.
Anecdotally, there are multiple reasons for this: it’s not clinical, so it’s “not our job”, it’s generally all a bit hopeless, and perhaps, demographically, it’s not impacting us or not in our interest.
Most GPs are in the fortunate position to own their own home (again generalising, but I would be happy to be proven wrong).
Even I have recently managed to get on the property ladder by the skin of my teeth via a prolonged stint in the in-laws’ garage.
Yes, the housing crisis is not medical, and yes, we are not real estate agents, politicians, economists, or property developers. And yes, maybe I should stay in my lane.
But we are general practitioners, and like it or not, this issue has become medical adjacent and is finding its way into our consultation rooms.
I thought the fringes of holistic care extended to nature prescribing, but increasingly, I want to add, “referred to a financial advisor” to my GPCCMPs.
Is it our responsibility to speak up about this more? And if so, what do we do about this as a profession? Should there be a housing affordability RACGP Special interest group – perhaps me alone in a Teams meeting, projecting slides of income-to-house-prices over the past 30 years.
Should our colleges be challenging the government more on this from a public health perspective? In light of the government’s recent approach to the MBS restructuring – an issue very much in our wheelhouse – I feel that even our strongest attempts at political pressure on any aspect of the housing issue would be like butterflies on a windowpane.
Personally, being on the other side of this great housing divide, I feel like the air is cleaner and the grass is actually greener. What am I going to do about this issue and its impacts on my patients?
Well, write this article, obviously, and tag my college in it (#RACGP), but otherwise, for now, I’m stuck watching every patient who I see struggling with the property ladder, bear the same weight that was so recently on my family.
I want to give them hope or reassurance, but I know I can’t, as it seems the diagnosis is likely terminal, and help isn’t coming.
Dr Patrick Gough is a GP registrar and medical director of Medibetter.
