‘A national disgrace’: Inside Australia’s failing mental health system
Matt Berriman, who suffers from bipolar disorder, says Australia’s mental health system almost cost him his life when he was admitted four years ago. Now he wants to see change.
It’s the kind of memory most people keep locked away, never to be spoken of out loud. Trauma has a way of blanketing such memories in silence.
The sedative injections. The involuntary admission to locked public hospital wards. The security guards by your bedside in the emergency department, every hour, every minute of the day and night. Matt Berriman, the former chair of peak body Mental Health Australia, prefers to speak of it now in the abstract, situating his personal experience in a national policy context.
“The system is in disarray,” says the Melbourne-based entrepreneur, who in 2020 was admitted to a public hospital psychiatric ward after a suicide attempt. “The people that need the care, especially in the acute and moderate space of mental illness, that care is just non-existent for most people.
“I personally was let down by the mental health system as a patient and that nearly cost my life. Then I was failed by the government and the Prime Minister.
“Anyone that knows what it’s like day to day, exposed to the mental health system, it’s a very sad state of affairs. It means many people dying. It means many people suffering needlessly every day.”
Like about 1 per cent of Australians, Mr Berriman suffers bipolar disorder. About another 250,000 Australians live with schizophrenia, their families struggling under an untenable caring load barely alleviated by a mental health system that is largely failing those with the most acute needs. As this week’s Cast Adrift news series has reported, and a policy report by The Australian and the Australian National University has documented, the shortfall in the provision of healthcare, social services and housing for sufferers amounts to about $8bn a year.
The nation’s hospitals have fewer than half the psychiatric inpatient beds needed, and billions of taxpayer dollars are being wasted through the failure to provide secure housing to those with complex needs. If secure housing with wraparound healthcare were provided, spending on often ineffective programs would no longer be needed and up to 75 per cent of psychiatric inpatient hospital admissions could be avoided.
“It’s an absolutely atrocious state of affairs,” says Brian Burdekin, who in 1993 as the nation's first human rights commissioner documented widespread ignorance about the nature and prevalence of mental illness in the community, systemic discrimination and enormous wasted cost. Professor Burdekin says that 30 years on, underfunding and neglect are still rife.
“It is outrageous, it’s a national disgrace,” he says. “I mean, this is systemic and systematic discrimination against people with psychiatric disabilities.
“We are subjecting hundreds of thousands of Australians affected by psychiatric disabilities to discrimination, marginalisation and even victimisation.
“We are without question one of the wealthiest countries in the world. If our government says they cannot afford better care for these very vulnerable and disadvantaged Australians, that is a lie. And to perpetuate this lie is a cruel national disgrace.”
Experiencing the same sense of outrage as Professor Burdekin, Mr Berriman quit his position as chair of Mental Health Australia six months ago. Mr Berriman’s bipolar disorder is now well managed with the help of a private psychiatrist. But he knows that for so many others, the story is very different. He calls this “one of Australia’s greatest health failings in generations”.
He saw the political failings first-hand even as he was deluged with people seeking help.
“I’ve sat with community members on a Sunday morning near my local cafe, with people who have just been ejected from the public system still with their hospital wrist band on, begging me to get (them) back into a facility whilst having an episode,” Mr Berriman says.
“I’ve talked down a business leader off a building roof; I’ve tried to help friends’ daughters caught up in the rising crisis of eating disorders and self-harm, not able to wait months to get treatment, coping with imminent threat to their children’s health and safety. I’ve seen the ongoing challenges of household-name sports stars needing support without the stigma of losing their job and a PR fallout. I could go on; unfortunately it’s only scratching the surface of thousands of direct discussions I’ve experienced since (going) public with my plight.
“Governments for decades have left some of our most vulnerable behind, and we’re all paying for that from diminished health, loss of life, lost productivity, and this will continue for many years to come.”
This is not rhetoric: this was Mr Berriman’s experience at the coalface. As chair of Mental Health Australia, tasked with high-level advocacy and policy development on behalf of more than 160 mental health organisation members, he never managed to get into Anthony Albanese’s office, despite countless entreaties. So he quit.
Federal Health Minister Mark Butler this week described the long-time neglect of the severely mentally ill as “a stain upon the nation”. “Words are words,” Mr Berriman says. “What’s a stain and a legacy on this government is the lack of care they’re providing to five million-plus Australians that need it.
“My experience was continual sidestepping. A lot of ‘give us time, it’s complex, we will get there’.
“Five million-plus people have mental illness, of which 4000 of them are dying by suicide a year, which is four times the road toll.
“What I experienced was government basically trying to silence me from having a public voice in the media that was going to damage them, while they were obfuscating their responsibilities. It’s just sad.”
Professor Burdekin, also a lawyer and one-time top diplomat, echoes the concerns.
“As someone who has had the privilege of advising former prime ministers and deputy prime ministers on this issue, to see this discrimination and marginalisation continuing today, 30 years after my report, I am both disgusted and dismayed. Our governments need to be held accountable. Talk is cheap. There must be action.”
Australia’s spending on mental health as a proportion of the overall health budget has slumped to less than 7 per cent. This is half of what the World Health Organisation says should be the minimum benchmark. The funding is far less than under the Howard government. Although spending on mental health has increased year on year, as a proportion of the overall budget it has been shrinking for over a decade. The situation has prompted an industrial flashpoint in NSW, where an extraordinary three-quarters of underpaid public sector psychiatrists have lodged resignation letters with their union. The situation in other states, notably Victoria and Queensland, is a little better. But at the federal level, most funding for mental health goes to low-acuity initiatives.
“The evidence is absolutely crystal clear – we are short-changing people with psychiatric disabilities by a huge amount,” says Professor Burdekin. “Our total health budget in Australia is about 50 per cent of what it should be.
“I live within a stone’s throw of a major hospital in Sydney which is very close to a lot of homeless people, and mentally ill people sleep on the streets. I could go up the road any day of the week if I have a heart attack, if I have chickenpox, and get excellent care.
“Yet people with mental illness go in, they might get assessed for a couple of days, they might get new medications, then they’re put out back on the streets again. The number of the homeless living with mental illness is huge. The evidence I have very clearly establishes that at least 75 per cent of homeless people are suffering mental illness.”
“The problem for me, in terms of a human rights perspective, is not only the tremendous cost that these people pay, that their carers pay, who are stressed out beyond belief, but the inhumane treatment these people are repeatedly subjected to. They’re frequently subject to seclusion and restraint. They’re cycled out of hospital after two or three days. The whole system is still playing catch-up, and we’re still so badly behind. Our governments must be held accountable.”
It’s a truism to say deinstitutionalisation, which was formalised as national policy after the 1993 Burdekin report, was not matched by the promised resourcing in the community.
“It’s not just that we deinstitutionalised people without putting money back,” Professor Burdekin says.
“We should have started correcting the situation after the (1982 NSW) Richmond report, but we didn’t. What we did was grab with both hands the message that this is inhuman to keep people locked up when you should let them live in the community, when anybody who knows anything about psychiatric disability knows that for people, a lot of people, a very large number of people, they can live successfully in the community, but they need appropriate community-based care.
“Community-based care, as I recommended in my report – and millions and millions of dollars went into it, then diminished over time – means that you need crisis teams. You need an adequate number of psychologists and psychiatrists.
“Today, we are still having people who are suffering psychosis shot to death by the police. People are being killed around Australia who are sick, people who need adequate care and attention before the situation escalates to them being floridly psychotic. It is a national shame.”
