Guest Writer's Forum

Graeme Fear
Co-ordinator Mental Health Issues
St Vincent de Paul Society

In 1992, a decade or so on from the Richmond Report and the subsequent deinstitutionalizing of care for the mentally ill, al1 Australian governments started a process that became known as the National Health Strategy. By 2002, total spending on mental health services in Australia had increased in real terms by 65 per cent since 1993, and as a proportion of overall health expenditure was similar to mental health expenditure in other developed countries.

So why is it that the system still fails many mentally ill people?

The reduced reliance on stand-alone psychiatric hospitals and the expansion of community-based and primary mental health care, as outlined in the National Mental Health Strategy, are to be applauded, however structural reform has been patchy and very uneven and the "felt" reality of consumers, carers and the Non-Government Sector who provide the bulk of accommodation, rehabilitation, outreach, social and recreational programs in the community is that the situation is deteriorating rapidly. Government health departments focus principally on hospital-based care services and exit whenever possible from direct involvement in social programs, rehabilitation and accommodation - those services are mostly left to an under-resourced Non-Government Sector. Even though more resources have been al1ocated to non-­government programs they still account for only 5.5 per cent of total state mental health expenditure.

The fact is that medical intervention is only one factor in regaining and retaining wellness. Resources are unreasonably skewed far too much towards services provided by the medical profession, with disastrous results. Anne Deveson in her book "Resilience" quotes a community-based psychiatrist:

"Mental Health professionals have col1uded in the systematic colonization of the mentally ill by becoming their politically appointed custodians or foster families for their own good. In the process they have inadvertently broken their spirits and disempowered their families. What we think people need and what they need are very different. We think residential accommodation - they think home. We think medication - they think employment."

It is critical that there are social and emotional supports available to people with mental illness in the community, as that is where they live. Very few live in hospitals, nor do they spend much time at community mental health facilities getting medicated. The system we now have is setting people up to fail! They are often discharged from acute care prematurely with a bottle of pills, and no one responsible foe the ongoing management of their illness. Many have alienated themselves from family and friends and the resulting social isolation and loneliness can mean that the vicious cycle starts all over again - sometimes with very tragic results.

There is currently a Federal Government Senate Enquiry into the Mental Health System and why the National Mental Health Strategy is not working (yet another one!). The Society has made a submission to that enquiry with a number of recommendations. With our unique relationship and services in the community the Society has a very significant role to play in providing assistance to the mentally ill - not as clinicians but as friends and "brokers of services".