Not For Service – An Australian Perspective.
 

It is not often that I write just a serious article – usually there is something of a quirky nature that I can manage to fit in.  But the subject of this article, unfortunately, is all too true of the mental health system in Australia and depicts a scandalous state of affairs that has gone on for far too long!

It is based on a paper produced by the National Mental Health Council of Australia, the Brain and Mind Institute in association with the Human Rights and Equal Opportunity Commission entitled, “Not for Service - Experiences of Injustice and Despair in Mental Health Care in Australia.[1]

To give a basic history of mental health care policies in Australia since the 1990’s we start with Australia’s signing of the United Nations ‘Principles for the Protection of People with Mental Illness and the Improvement of Mental Health Care (UN General Assembly Resolution 46/119, 17 December 1991; United Nations, 1991)[2], which emphasised community based care options and respect for the basic rights of persons with mental illness.

In 1993 the ‘Report of the National Inquiry into the Human Rights of People with Mental Illness (Burdekin Report; Human Rights and Equal Opportunity Commission 1993)[3], was published and made recommendations for the care of people with a mental illness, especially in regards to housing and the deinstitutionalisation of sufferers to bring them into the wider community.  Naturally the idea of bringing people out the institutions and into the community brought with it great opportunities denied them if they were – out of sight - out of mind.  However, the move to more community based treatment and care not only meant the closure of a number of asylums, it did not lead an increase of facilities or options for receiving adequate medical treatment or even the basics of housing and clothing that so many of us take for granted.  In fact, the Burdekin Report itself, makes mention of the problem of substandard boarding houses and availability of employment opportunities that were not being addressed by the States or the Commonwealth.

In this latest report the focus was on the changes, if any, that had been made to the services available to the mentally ill and their carers.  Their access to treatment and the way they were treated when they were able to access treatment was markedly different between those presenting with a physical versus a mental illness in all States.
 

This list is the criteria that the report based its findings on.[4]

i) access to professional care, particularly in emergency and other acute care settings;

ii) treatment with dignity and concern for the individual irrespective of location of care;

iii) prioritisation of safe and high quality services;

iv) an emphasis on clinical care, rather than ‘containment’ of those with mental disorders;

v) earliest possible access to professional care in acute and non-acute circumstances;

vi) response to individual needs, including recognition of the complexity of comorbid substance

abuse, personality dysfunction or socio-economic deprivation;

vii) coordination of health, welfare and related community support services;

viii) access to programs and support to live independently and work;

ix) respect for the legitimate interests of family and carers in accessing care and participating in

ongoing treatment decisions;

x) support for those who provide direct clinical services;

xi) provision of appropriate community housing options; and,

xii) access to appropriate medical as well as psychological services.

 

In short what the report highlights is that after more than 12 years of mental health reform in Australia, people seeking help for mental health issues face serious risk of being ignored, trivialised or neglected.  In short – no better in many ways than highlighted in the Burdekin report some 12 years ago!

While every State queried by the reports authors advised of significant initiatives that they had made in their State’s mental health programs or systems, clearly many sufferers and their carers were still being let down by systematic failures.  In some surveys between 28-42% of consumers and 42-55% of carers had negative experiences when dealing with the mental health system in their State. As Ian Hickie,

Professor of Psychiatry and Executive Director Brain & Mind Research Institute, University of Sydney, stated in his foreword to the report, It should be clearly unacceptable within our health systems for somewhere between a third and a half of persons to report such negative experiences”,[5]

 

It should be noted that following this publishing of this report, both the Commonwealth Government and the states, have made substantial financial commitment increases to programs and policies to better mental health services in Australia.  As in the past –only time will tell!

A friend of mine living in our most populous State rang me recently as he was not feeling very well and was concerned that he might harm himself, and we spent a bit of time together on the phone and he shared some of the experiences that he had gone through himself recently.  I knew that the mental health systems in some States were bad and I had some experience of it in my stay in Queensland to a degree, but the way that he had been dealt with, both at his General Practitioners surgery and the hospital, border on the criminal in my opinion.

When he presented at his local surgery, his normal doctor was away, and although he told the locum that he was suicidal and did have the means at home (a shotgun) and he intended to use it.  He was told to go home and see his own doctor next week when he came back off holiday.  He then went to the local hospital and presented with the same situation – suicidal intention, severe depression and a history of treatment at that very hospital, and yet he was still not admitted because his file had been marked, ‘Not for service’, meaning he was in the too hard basket and was on his own.  So he again was sent home!  Fortunately when his own doctor did arrive back, my friend managed to get some help and hospital access.

I include just three examples from the Not for Service report because they show the affects that our failing system had on these individuals and their families.

His suicide was tragic, made all the more so because it was preventable, we believe, but for the inadequacy of the public mental health system. [X] died just two weeks after his first suicide attempt, eight days after his discharge from the Canberra Hospital psychiatric unit, two days after being refused admission to the psychiatric [unit] following a second suicide attempt, and within hours of contact with the mental health crisis team. On the day of his death, [X] had contact with the mental health system no less than three times. [Suicide occurred early in 2004] (Anonymous, Australian Capital Territory, Submission #288)[6]

I was amazed on one of my visits to see my mother so distressed that after two days they were sending her home to us the family to give the care she had not received in the Hospital. May I add also that this particular incident occurred after her third attempt on life. She was so frightened because she knew she was not any better…it was having a huge affect on the whole family. The answer to my question to the doctor about how many attempts would be enough. Apparently the answer to that question as found out was five. Because on the fifth occasion, at approximately 1:30pm on the 15th October 2003, my mum decided to douse herself in petrol and set herself alight.

(Carer, Son, Queensland, Submission #184)[7]

In the past I have been told by CAT [Crisis Assessment and Treatment] team members whilst in crisis “You know more about your diagnosis than we do, Call us back if you can't get it under control”. In those days control usually meant I would SM [self mutilate] so badly I would have to sew or patch myself up. How far does a person have to go to say I need help and I need it now? (Consumer, Victoria, Submission #112)[8]

Yes, I do have a serious side, and this neglect of my fellow sufferers and human beings really bugs me.  Just like when people find out you have a mental illness and you can see their eyes roll in their heads and you can almost feel the, ‘Whoops – another nutcase here’, rolling out of their mouths.

Let us hope that all of the fine words and financial commitments made following the release of this report do make a difference to care in Australia.  I really do hope for positive change but reserve the right to see what happens five or ten years down the track.

Does this report sound similar to your countries’ mental health system?  I would love to know if you have similar stories to tell and maybe by sharing them the load might be lightened a little.

Graham Brown

5 August 2006

 

References:

 

  1. Not for Service - Experiences of Injustice and Despair in Mental Health Care in Australia- A report of the consultations by the Mental Health Council of Australia and the Brain and Mind Research Institute in association with the Human Rights and Equal Opportunity Commission.  www.mhca.org.au

 

  1. Report of the National Inquiry into the Human Rights of People with Mental Illness (Burdekin Report; Human Rights and Equal Opportunity Commission 1993).

 

[1] Not for Service - Experiences of Injustice and Despair in Mental Health Care in Australia-

[2] Principles for the Protection of People with Mental Illness and the Improvement of Mental Health Care (UN General Assembly Resolution 46/119, 17 December 1991; United Nations, 1991)

[3] Report of the National Inquiry into the Human Rights of People with Mental Illness (Burdekin Report; Human Rights and Equal Opportunity Commission, 1993)

[4] Not for Service - Experiences of Injustice and Despair in Mental Health Care in Australia- Executive Summary, p.12.

[5] Not for Service - Experiences of Injustice and Despair in Mental Health Care in Australia- Executive Summary, Foreword, p.vii

 

[6] Not for Service - Experiences of Injustice and Despair in Mental Health Care in Australia- Executive Summary, p.17

[7] Not for Service - Experiences of Injustice and Despair in Mental Health Care in Australia- Executive Summary, p.17

[8] Not for Service - Experiences of Injustice and Despair in Mental Health Care in Australia- Executive Summary, p.18

 

 

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