War ‘difficult to justify’
Mentally ill sent to jail
By Chris Lindsay
People with mental illness are still locked up in jail in NSW, says the head of a State parliamentary inquiry into mental health services.
Dr Brian Pezzutti (Liberal MLC) says: "NSW is the only mainland State to incarcerate forensic patients and, as far as I can determine, only one of a few in the Western World.
"One third of the people in NSW prisons have a mental illness but they are locked up in their cells for 11 hours a day, dressed in prison clothes and fed prison food.
"In Victoria and Queensland they are not locked up, wear their own clothes and cook their own food."
The inquiry's recommendations reflected its concern at the imprisonment of people who were found not guilty of an offence because of mental illness.
Dr Pezzutti said that many people found not guilty or unfit to plead by reason of mental illness are sent to jail anyway. "It's a case of 'not guilty, proceed to jail'," he said.
The parliamentary committee has recommended that, as a matter of urgency, the NSW Ministry of Health build maximum and medium security forensic mental health units outside prison.
Dr Pezzutti said the current problems follow the "deinstitutionalisation" of mental health patients that began in the 1970s and accelerated after the Richmond Report 20 years ago.
"Since the deinstitutionalisation of mental health services, community care is focused on home care," he said. "However, a reliance on this is clearly deficient, considering that a high percentage of the homeless also have a mental illness.
"For adequate treatment and care of people with a mental illness in the community, funding, staff skill mixes and facilities must all be substantially increased.
"There is no longer any long term care for these people.
"NSW has the poorest funded mental health system in Australia."
Dr Pezzutti acknowledged that the government had increased funding to mental health services by $107.5 million in 2000, but said the committee had heard repeatedly that it was not enough.
The committee has adopted a recommendation from the St Vincent de Paul Society that an office of mental health be set up in the Premier's Department to co-ordinate services to the mentally ill.
Its report states that one in five people will suffer a mental condition during the next year and that two in five "will have a major mental illness some time in our lives."
Sr Myree Harris, president of the Vinnies' advisory committee for the care of people with mental illness, told the inquiry that "experts from all government departments and from non-government agencies working together" were needed to improve the lives of those with mental health problems.
People with mental illness needed "integration back into the community as a fully functioning person. It is a holistic thing", she said.
Dr Pezzutti described the Josephite sister as "a tireless advocate for improved services and conditions of mental health services" and said that, after considering the evidence before it, the committee agreed with her recommendation.
However, the Government members on the committee disagreed, arguing that services should be co-ordinated through the Health Department.
"We believe additional resources should target services rather than setting up additional bureaucracies," said Labor MLC John Hatzistergos.
He said the Government's preferred approach was "to increase long-term rehabilitation services in appropriate acilities, including community and hospital settings and involving the expertise of non-government agencies".
The push for the decriminalisation of drugs was one of the causes of the increase in problems such as schizophrenia.
"We have to deal with the problem, but there should also be a lot of effort put into prevention," he said.
Many people with mental illness were very challenging cases with disturbing activity, Mr Hatzistergos said. Recruiting nurses and health professionals into this area was not easy.
"There is no simple solution," he said.
Dr Pezzutti said the inquiry received 303 submissions from private citizens, mental health professionals, government and non-government organisations and heard evidence from 91 witnesses.
"I was almost overwhelmed by the detail and quality of the submissions and the high calibre of the witnesses," he said.
The Vinnies submission also raised the problem of people with mental illness who had drug and alcohol problems as well.
Sr Myree and Colin Robinson, a research officer with St Vincents, told the committee that people doubly disabled in that way tended to "fall through the cracks".
"They are often shuffled back and forth between services which take responsibility for treatment of only half the condition," Mr Robinson said.
Health services refused to take responsibility for the drug and alcohol problems - and the drug and alcohol services refused to treat the mental health problem.
The result was that the person got no assistance at all.
"That is why it is so important that the office of mental health be set up in the Premier's department," Mr Robinson said.
He said the committee had recognised that a Vinnies report into the mental health situation in NSW, Long Road to Recovery, published several years ago, had been the impetus for the inquiry.
"The St Vincents membership and conferences were reporting the deteriorating situation where people with mental illness were not getting any treatment," he said."This was clearly evident in the homeless people's hostels that we run, and the many people we visited who were isolated, lonely and depressed.
"People were getting no treatment, not even counselling. Sometimes the St Vincents visit was the only human contact they had had in weeks. "When people are homeless and untreated their behaviour can be difficult at times, and it is hard to get them immediate treatment as the mental health teams are overworked and only respond to a crisis."