By Peter Boyle
Coolibah is a day centre, run by the Brotherhood of St Laurence, for isolated older people in Melbourne's inner city. But according to the Barry Pearce, the centre's coordinator, these days Coolibah is constantly having to turn away young people with apparent mental disorders. Elderly tenants of rooming houses complain they are being intimidated by aggressive and disturbed younger tenants.
As a member of Victoria's Council for Homeless Persons, Pearce testifies that about half of the homeless people seeking refuge in night shelters in Victoria have some form of mental disorder.
Welfare agencies operating in Australia's inner cities bear the brunt of the crisis in mental health system; they have to deal with the growing number of mentally ill people who have been thrown onto the streets over the last two decades. Pearce's story is repeated by countless other welfare workers in a sad confirmation of the shocking findings of human rights commissioner Brian Burdekin in his report on the plight of the mentally ill in Australia.
Burdekin's 1000-page report, released on October 20, presented damning evidence that Australia's treatment of the mentally ill breached United Nations standards. Tens of thousands of mentally ill people are being denied their basic human rights in hospitals, prisons and the community, he found. He called on the federal government to get tough on state governments, which administer most public mental health services.
Father Peter Nordern of Victoria's Catholic Social Service Secretariat is pessimistic about the responses of federal and state governments to the Burdekin Report. The mentally ill are the most disadvantaged and powerless group in Australia, he told Green Left Weekly, and more often than not politicians and the community at large pretend they do not exist.
Coalition state governments dismissed the report's findings as outdated. Federal Labor minister for community services Brian Howe sought to play down the report, describing it as "anecdotal" and not based on expert study. Graham Richardson, the federal minister for health, said that the Keating government was not considering increasing spending on programs affecting the mentally ill.
Howe has set up an interdepartmental committee to "study" Burdekin's recommendations — presumably until the public has forgotten about them.
Rumours are floating around Canberra that the government is not going to reappoint Burdekin when his term as human rights commissioner expires in December. Burdekin's strong public interventions around human rights have got under the skin of many state and federal ministers.
'Most accurate'
By contrast, non-government welfare groups have welcomed the report. Nordern says that the report's descriptions of the mental health system are "most accurate and most up to date". His assessment is based on direct observation from the Catholic Church's many welfare workers in the field and from parishes.
Bronwyn Pike, the Uniting Church's director of justice and social responsibility, agrees. With some 60 agencies, the Uniting Church is the largest provider of community services outside the government in Victoria, so it should know, she said.
There are embryonic self-advocacy networks of the consumers of the mental health system. One of the better organised of these is the Victorian Mental Illness Awareness Council. Its "one and two-half-person" staff has been funded by Victorian governments since the 1981 International Year of the Disabled, but this funding is now "under review" by the Kennett government.
Nevertheless, VMIAC's acting coordinator, Rod Salvage, was willing to confirm that the mental health system is in a mess and "getting worse", despite the protestations of governments.
The organisations represented by Nordern, Pike and Salvage all made submissions to Burdekin's inquiry, which took three years to complete. Now they are keen that its findings be acted on. Many other groups made submissions but are wary of speaking up against governments because they depend on them for funding.
Ironically, at the heart of the problem highlighted by Burdekin are government programs ostensibly aimed at ending the age when mental "asylums", as they were once called, were hellish institutions to which the mentally ill were condemned sometimes for life. Over the last few decades, governments have been "deinstitutionalising" mental health care, closing down beds in institutions and supposedly moving patients to more humane and enlightened community-based treatment.
The process began in the early 1970s with the introduction of long-acting medications. Patients now could be released into the community and only drop in for regular doses of their prescribed medications. In 1983 the NSW government's Richmond Report on mental health argued for deinstitutionalisation on humanitarian and health grounds; this spurred the process on.
A question of money
But the problem, workers in the area explain, is that while hospital beds for patients with mental illnesses were closed down, insufficient money was allocated to alternative community facilities to care for the mentally ill. In 1960 there were 281 beds per 100,000 people in institutions for the mentally ill in Australia; by 1992 this had fallen to 40 beds per 100,000, according to the Burdekin Report.
Deinstitutionalisation has been pursued by Coalition and Labor governments primarily as a means of cost cutting. If appropriate community-based facilities were to be set up to deal with people with mental illnesses, says Nordern, governments would have to spend more, not less.
Governments have not been willing to do this. As a result, thousands of people with mental illness were cast out of mental health institutions into cheap rooming houses, prisons, police lockups and the streets — and it is here that Burdekin found the worst human rights abuses against the mentally ill.
The incidence of mental illness — particularly among the young and the aged — is increasing dramatically, the Burdekin report found. One in five Australians have or will develop some form of mental disorder.
Approximately 246,500 people in the 15-20 year old bracket suffer from some form of mental disorder, and 82,000 of these require specialist treatment. Yet there are only 30 acute adolescent psychiatric beds in the Victorian system, the same in NSW, virtually none in Queensland and Western Australia and none in South Australia.
Where do the serious cases end up? In prison. Some 50% of the inmates in youth detention centres have mental illnesses, according to expert witnesses heard by Burdekin.
Dementia is the most common mental illness affecting the aged. The number with this illness in Australia is expected to grow from 140,00 to 200,000 in the next 10 years. They are often abused, neglected, wrongly sedated or locked up in nursing homes or rooming houses.
With the immediate responsibility for most mental health programs and institutions, state governments have come under the heaviest fire from the embattled workers on the front line.
Bronwyn Pike says Burdekin identified just some of the victims of Kennett's "slash and burn" approach to health and welfare. Kennett was encouraging selfish individualism at the expense of community responsibility.
Health and Community Services Union Victorian secretary Kaye Williams, who also welcomed the Burdekin Report, told Green Left Weekly that the Kennett government was still closing beds, cutting staff and cutting back on psychiatric services in community health centres. This was rendering it almost impossible for the mentally ill to find a hospital bed when they needed one.
Quality of care for the mentally ill is being seriously eroded, she added. HACSU is currently fighting proposed amendments to the state's Nursing Act which would allow hospitals to employ nurses with only general training as psychiatric nurses. Victoria will be the first state to erode the quality of care of the mentally ill in this way if the legislation goes through, Williams warned.
Bronwyn Pike hopes that federal Labor will deliver on some of Burdekin's recommendations. The federal government could "use its economic levers" to put pressure on state governments to do something about these human rights abuses, and it could educate the public on the issues. In addition, there are areas covered by the Burdekin Report that were federal responsibilities, she said. These include aged care.
Canberra could also carry out many positive steps through programs run by the Department of Employment, Education and Training, Pike said.
The Burdekin Report also noted that homeless mentally ill people were routinely denied access to social services and medical care, both of which are federal responsibilities. These people often fell foul of the federal government's campaigns to restrict entitlement of social security payments and the strict requirements for proof of identity.