Mental Illness and Stupidity 3/6/20
Quite early in my Parliamentary career I was approached and discovered 4 problems with mental health in NSW. A fellow medical student, now psychiatrist approached me and said that the system was far worse than formerly.
I had worked as an after hours call doctor in 1977 and 1983 and found that mental hospitals did not want patients sent to them, and would try to talk referring doctors out of sending them. At first they would say it was not in their catchment area, then that the patients were not really mentally ill and I did not actually know what I was talking about. Eventually I tired of this game, so I would call and tell them a brief history, my diagnosis and that the ambulance with or without police escort was on its way.
So when my psychiatrist friend said it was a lot worse I was surprised. She explained that Nick Greiner closed all the long-stay mental hospitals for a supposedly community-based service with supported accommodation, but the alternative was never funded, and the system had staggered on ever since.
Then I was in an inquiry into the rise in the NSW prison population and a government prison psychiatrist had found large numbers of mentally ill and developmentally delayed people falling foul of the law. He explained that if they became dysfunctional they could not pay for the electricity and rent so became homeless. They had no chance of getting through the complexities of Centrelink and getting money, so eventually they were caught shoplifting in order to eat and ended up in the Magistrate’s court, where, if he did not divert them, they went off to gaol. He had a pilot scheme in Sydney and ?Port Macquarie to divert them to supported accommodation at hugely reduced cost.
I went for a long weekend near Port Macquarie and met an older lady on the beach, who, hearing I was a politician said that this made me a cad and a bounder who was of no use in the major social problem which was mental health. Accustomed to this assumption about politicians, I remonstrated mildly, and she told me her story of her schizophrenic son, who had gone in and out of supported accommodation and prison for 30 years without getting much help.
Finally I want to a conference on homelessness where I met a community mental health nurse who described how after long weekends she would go to the parks and under the bridges to look for her homeless patients, to see if they were alive to take their medication. I asked that she write a summary in point form of the problems of NSW mental health. She did so, and her excellent report formed the terms of reference of the NSW Mental Health inquiry which I initiated. I asked Brian Pezutti to chair it. He was a Liberal, and had the credibility of having been an Assistant Health Minister. He was also a very thorough and meticulous anaesthetist, retiring at the next election, and keen to do something useful before he went.
The Labor government agreed to the Inquiry because I had the numbers in the upper house. The Inquiry came out in 2002 (NSW Health System Worst in Aust SMH 10/12/2002).
It resulted in a number of things. The budget the following year in NSW rose by $320 million, but mental health money was also quarantined so that it could not be siphoned off to fund Emergency Depts or ICUs further down the budget allocation tree. Most significantly it triggered a Democrat-initiated Federal Mental Health inquiry which put psychologists on Medicare and hugely increased the mental health workforce.
Needless to say, diversionary schemes were part of the recommendations, as without support, mentally ill and developmentally delayed people cannot do the functions that are needed to manage a life in society. There appeared to be some progress and the complaints from mental health workers for some time changed from, ‘we cannot afford staff’ to ‘we cannot fill our positions’.
As the time has passed, it seems that the situation has slipped back. The history of these inquiries is that there is a fuss, things improve for a while, then go back until another inquiry finds the same problems.
So I was discouraged to read that a program to divert mentally ill people from Gaol is to be axed, because some bean counter thinks it is too expensive. According to the Dept of Corrective Services it cost $181.85 per day to keep a prisoner in NSW gaols, which is $1,273 a week, or $66,375 a year. It is dubious that a support scheme could not be organised for less than this, but the idea that the only thing that matters is whether it saves money seems an appalling way to run society. Surely we should figure out what we want to do, workshop how to do it efficiently, and then work out how to fund it.
If a diversion plan is to be axed, let the NSW government tell us that there are good diversion schemes already working and prove it by having an independent body affirm that there is not an excess of mentally ill or developmentally delayed people in prisons. If such schemes existed, why was there this new one set up? There is a long history of ‘pilot schemes’ being set up to deal with a political problem, and then quietly dying when the political heat goes off.