Mental health a national tragedy

There is news in The Weekend Australian that shames us all. Natasha Robinson reports on the miseries endured by the estimated 2 per cent of adults who live with severe and chronic mental health conditions. Fortunately, she also details work by the Australian National University on practical ways to help. And if 2 per cent of people seems insignificant given the legion of legitimate demands on the public purse, the number means there are about 350,000 Australians, many of whom, as professor of medicine and health economist Steve Robson says, have “no home, no help, no hope”.

The pain the severely mentally ill suffer is brutally plain to their families and to the cruelly stretched staff of the care system, but it is easy for most of us to dismiss as not our problem. That is until we see a person sitting in a park screaming in fear of demons, real to them as creations of their untreated illness. And it is incalculably more appalling when madness leads to violence. In April, Joel Cauchi, living with schizophrenia and disconnected from healthcare, killed six people and wounded 10 more in a Sydney shopping centre before a police officer ended the horror. The confronting question then was: How did government ever allow the circumstances that led to it? The other question we must answer is: How do we come as close as money and compassion can deliver to protect society from the rare attacks on others by the mentally ill and save them from the far more common harm they inflict on themselves?

It is long clear how government created a class of Australians without homes, help and hope. For millennia people with severe mental illness were locked up, supposedly for their own good, but generally for the convenience and undoubtedly sometimes for the safety of society. But such institutions were prisons and run without interest in the rights of their inmates. So a generation ago they were closed on the assumption that most mentally ill people were no threat to society and their conditions would be better managed in the community.

The problem was that letting out was not the same as looking after, and we now live with the aftermath of a policy based on care that was never there. It still isn’t, largely due to state governments ducking their duty to run primary health systems – much as they recently did when they hospital-passed care to the commonwealth’s National Disability Insurance Scheme. The ANU-Weekend Australian report finds Australia needs 17,750 psychiatric inpatient beds but is 10,000 short. The mental health workforce is 30 per cent under strength. The promise of community care, that people can manage when they have support services connected to stable housing, cannot be delivered.

There is now unmet demand for 31,000 supported accommodation places. And in their absence people bounce between hospital, homelessness and prison. All of which is unjust and expensive. The ANU estimates an extra $1bn is needed to provide psychosocial supports to those living with severe mental illness and enough housing would cost $6bn through to the end of the decade. However, estimates indicate that adequate support reduces the need for mental health services by 74 per cent. It also could cut hospitalisations by 70 per cent and the length of admissions by three-quarters. Patients who end up in prison cost $3000 a day. Nineteenth-century French novelist Victor Hugo famously said: “Build a school, close a prison.” Add community care to the quote and it applies to Australia now.

The equity and economics add up. The calculation for state and federal health ministers is whether they should start spending. There is never enough government revenue for all society’s needs, and mentally ill people are politically powerless, certainly compared with the well-resourced advocates of NDIS support for children with learning disabilities that do not prevent them functioning in their communities. But the powerlessness of Australians with severe mental health conditions that consign them to poverty and pain makes the case that they have been abandoned for too long.