Page 395 - Week 02 - Tuesday, 7 March 2006

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to my heart, and that is the way that people are treated in the mental health system and the impacts and cost impacts that that has had.

I think that one of our greatest policy failures over the last 25 years has been the way that we treat people with mental disorders. For a whole lot of good motives and idealistic vision, we decided a few years ago that the mentally ill should not be locked away in psychiatric hospitals—nor should they be—but should integrated into the community, that bedlam should be a thing of the past. But in most jurisdictions the result of this policy is far from the happy outcome that was predicted by the policy makers at the time.

People who were once kept in psychiatric institutions are now free to roam the streets, and that is what they literally do in many cases because they are homeless. If they are not homeless, they are holed up in boarding houses where they have to leave after breakfast and come back late in the evening, and they roam the streets. Alternatively, they are in prison. The 2003 report of the New South Wales corrections and health service concludes that 78 per cent of male and 90 per cent of female reception prisoners were found to have had a psychiatric disorder in the 12 months before they presented to the prison system. This is not a mistake. Nine out of 10 female reception prisoners in New South Wales had a psychiatric disorder in the 12 months prior to their presentation.

The ACT is no better. Last year’s report by the Mental Health Council of Australia, the Brain and Mind Research Institute and the Human Rights and Equal Opportunity Commission entitled Not for service identified eight major deficiencies in our mental health system, including a totally inadequate approach to management of forensic mental health issues—that is all the people in prison—a lack of basic hospital and rehabilitation services, little attention to the issues of early intervention and a large role played by police and emergency service in acute mental health care.

A sign of our failing public health system is the way we treat people with mental health issues. As we know, the costs of not addressing mental health are huge, not only in economic terms but also in moral terms. We know, for instance, that depression alone costs six million working days a year and that keeping somebody in prison who is mentally ill costs something like $65,000 a year per prisoner with a mental disorder.

What actually happens in the system is that, for the most part, people with mental disorders cannot get admission and those who do get admission to institutions and hospitals are given the psychiatric equivalent of a bandaid treatment. This is not just my opinion. The ACT Community Health Services Complaints Commissioner’s report states:

Some agencies and services perceived the triage and crisis assessment and treatment team service operating as barriers to treatment.

It goes on to say that the people observing the CAT team formed the view that some patients in all categories who were in need of services did indeed have difficulty with access. Another facet that they noted was what was termed a “tolerance of psychosis” by mental health staff that reflects a preparedness to see treatment as unnecessary when others believe the patient is so sick that treatment is essential.


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