Mental Health

25 Nov 2004 archivespeech
This speech is to move that the Social Development Committee investigate and report upon the range of assessment and treatment services for people with mental health disorders in South Australia.

The Hon. J.M.A. LENSINK: I move:

That the Social Development Committee investigate and report upon the range of assessment and treatment services for people with mental health disorders in South Australia, with particular regard to

1. The adequacy of funding and staffing of mental health, particularly in community and accommodation services;

2. Best practice in the treatment services for people with complex needs who have contact with the mental health, forensic and/or corrections systems;

3. The incidence and management of mental health in the prison population;

4. The impact of legal and illegal drugs on the mental health of both the general public and prison population.

5. The efficacy of diversion programs upon rates of recidivism;

6. The criteria for the release of mental health patients who are potentially dangerous;

7. The adequacy of supervision of offenders after release from institutions, including those on parole;

8. The adequacy of offender discharge plans;

9. The identification of offender's mental health difficulties; and

10. The definition of mental health in so far as the correc¬tions system is concerned.

I am indebted to my colleague the Hon. Angus Redford, who I have now been able to consult on the finer details of this motion. Most members would be aware of these issues, because, unfortunately, they have had quite a high profile for some time. They have come to my attention since I have been in this place; I do not think I have stopped hearing about the issues in relation to people who have complex needs and who have mental health difficulties and who come into contact with the corrections system.

As a new member of the Social Development Committee, I sat on the inquiry into supported accommodation, which has since reported. We had evidence at that time from Jonathan Phillips, who is the head of Mental Health in South Australia. I will quote from some of the evidence, because it really does illustrate some of the points I am trying to make. In talking about mental health in South Australia, Mr Phillips said in his opening statement:

 . . . mental health services in the state have fallen behind mental services in all other jurisdictions in this country.

This is a very worrying situation which needs to be corrected, and it is going to need everyone from parliament to the humblest person in this community to work together to catch up on lost time. The situation is more alarming in that, on a national scale, South Australia spends a reasonable amount of money in the mental health area. It is never enough—Australia does not look good against other nations. But South Australia is putting money towards mental health care. It is how that money is used and how the public can best be assured that they are going to get proper services

. . . mental health services in the state are heavily institutionalised, and a great deal more money—some 50 per cent—is going to one hospital alone. This means that mental services in the community are significantly underdeveloped in terms of what they should be, and of course that includes accommodation. . .

It will be necessary, as a matter of some urgency, to move towards a situation where, like all other modern mental health services, the services community-focused and delivered from the community, with assertive community health teams, admissions close to home in the suburbs where people live, and appropriate accommodation for those who are unfortunate enough not to be able to buy or rent their own.

The Hon. Terry Cameron, a member of the committee, then asked this question: Is it possible that the mentally ill people in this state are somehow the unwitting victims of a bureaucratic bun fight, or a bun fight that is taking place somewhere?

Dr Phillips said:

Indeed, yes. It is terribly important to accept that people with serious mental health problems are the most vulnerable members of the community, and of course they will be pushed hither and thither by the bureaucratic process, the political processes and every other process.

The Hon. Terry Cameron then asked: Any idea of what sort of dollars?

Dr Phillips said: Yes, and I am giving a round figure—probably around about $30 million is needed over a period of about six years.

Associate Professor Graham, who also gave evidence that day, talked about that $30 million and said: Transitional funds in this sense will be used predominantly to, for example, if you take a patient out of a hospital bed, you cannot close the bed nor can you close the ward. In order to make the savings, you actually need to close a whole range of infrastructure. So, in taking 10 beds out of a 30 bed ward, you still do not make any savings. It is not until you actually close a series of wards that you can, in fact, make the savings and transfer the savings, or reallocate the moneys into supported accommodation or community-based mental health services.

 The Presiding Member, the Hon. Gail Gago, asked some questions about ACIS teams. In relation to some of those details, Dr Phillips responded as follows: The issue of ACIS teams is, in my view at the present time, I regret to say, very unsatisfactory. As an acute community response service, ACIS, by definition, must be a 24-hour service. Mental health takes no notice of the clock. At the present time, there is no 24-hour service in the state whatsoever.

He goes on to describe a telephone triage call system. He said: It is amazing what a highly skilled nurse at the end of a telephone at 2 a.m. in the morning, with her drop-down protocols on her computer and all the technical information she needs at her fingertips, can do in terms of acute triage. I have looked at the costings of this and, in fact, the bigger it is, the less it costs.

He then goes on to discuss the housing provisions, which he describes as `labyrinthine', and expresses a desire for non-government organisations to play a greater role in the provision of mental health services.

 Since August last year, we have read a number of articles in the newspaper in relation to mental health. Of course, we read about the unfortunate pillorying of Frances Nelson, who is very well-regarded in the community and knows her job very well. In August last year, she talked about under resourcing in mental health in relation to escapees from Glenside.

She stated: . . . they are doing a very difficult job with very few resources, but it really does make you wonder what is going on when the head of the department hasn't even been told by his own staff about an escape.

Mike Rann's response was to criticise the Parole Board for allowing this person to be transferred to Glenside, saying that it had ignored the issue of public safety. He said that he would overhaul the Parole Board, including provisions that the board's first priority in determining its role would be public safety. As I will demonstrate in some of my later comments, he is the one at fault here, because the inadequate provision of mental health services puts the public at risk and not the Parole Board, which seeks to determine whether people ought to be released; whether they are safe to be released; and whether there is adequate supervision, re¬sources, procedures and so forth.

We continue to witness a series of Glenside escapes, largely driven by the fact that places such as James Nash House are under resourced, which means that people spill over to Glenside. As it is not the same sort of facility, it is perhaps not able to cope in the same way. Despite having had a security review, a number of its recommendations have not been acted upon, and widespread problems continue in that system. Issues have been cited relating to the Courts Admin¬istration Authority not informing the Parole Board about the release of mentally ill offenders into the community, and this causes some fairly self evident problems. It remains to be seen whether these have been implemented, but risk assessments at that time had still not been completed as regards the admission of patients and annual reviews of the medication of long-term patients and so on.

In September last year, the public was informed that violent criminals on community supervision licences were becoming an issue, and Frances Nelson called for an urgent review of state laws making the Department of Human Services responsible for their detention. In an article dated 26 November, the lead paragraph states: Killers, rapists and robbers who are likely to reoffend walking the streets without supervision because they are former mental health patients, Parole Board chief Frances Nelson said yesterday.

She further stated that community safety was paramount, but often offenders are walking free who are not complying with their medication. This culminated in an article that she wrote in the Sunday Mail of 21 December in which she stated that the serious issue of offenders with mental health problems has been ignored. She continued: A significant number of people in our community are incapable, through no fault of their own, of living independently.

This is the crux of it. She further stated: A large proportion of offenders with mental health difficulties could we kept out of the criminal justice system if they were managed appropriately. The key word is `managed'. People could be managed and supervised with less security but with sufficient supervision to prevent them from hurting others. It requires the commitment of resources. . .

That is the point I made previously in response to Mike Rann's criticism that the Parole Board was endangering public safety: in fact, it is the lack of resources. Frances Nelson continues:

 It also makes economic sense. . . it costs $73 000 a year to keep a prisoner in a maximum security prison. Numerous studies have been done on this subject and the cost of proper management would be less than half the cost of keeping someone in jail.

There is insufficient bed space to accommodate all the people having difficulties. At that time, there were difficulties with Catherine House, which was under threat of closure due to lack of funding. Her final comment is:

A true measure of commitment to community safety is the importance afforded to mental health issues and the provision of proper resources to deal with them.

 Because it is under resourced, another issue is the Parole Board's ability to deal with parole applications, which leads to delays of some six months and a backlog and overcrowd¬ing in our state's gaols. A comparison was made with the Independent Gambling Authority, which receives some 10 times the amount of resources yet has a much lighter workload when compared with the Parole Board.

As the council is aware, as this issue has been raised here previously, the Deputy Presiding Member of the Parole Board, Phillip Scales, decided that he would not continue in that position. The article, dated 20 July this year, states: He Phillip Scales said the Government's tough on crime policy was `generally presented in the context of harsher sentences and expanding prisons, although such expansion has now been put on hold, with the result that prisoners' accommodation is in disarray'.

This is one of the key points: There must be far more emphasis placed on appropriate treatment for prisoners in rehabilitation, otherwise they will come out worse than they went in and the community will suffer the consequences.

The point has been made by Frances Nelson at some point that everyone who is currently in our prison system is likely to come out at some point, so clearly we would rather that they were better rehabilitated than when they went in.

There was another prisoner escape on 21 July this year. It involved a paranoid schizophrenic who had refused to take his medication and should have been placed in secure care after breaching his parole. He could not be admitted to James Nash House because there were not enough beds so he was therefore diverted to Glenside, from which he escaped. Then we had another one about the same time who threatened staff with a syringe of blood. The comments made at the time were that it was another case that demonstrated that the community is at risk because the government will not put enough into mental health resources in relation to people who offend. It has been estimated some 15 per cent of the state's 1 600 parolees have mental health problems. The recurring theme is: resources, resources, resources—and do not blame the public servants and those who are in charge of assisting these people because they are doing the best they can. Those people include parole officers, people within the mental health system, the Parole Board and other people within the corrections system.

At the end of July, we were provided information again through The Advertiser about a review conducted by the Department for Correctional Services and what was then the department of human services, which showed that informa¬tion shared between the agencies on individual offender's mental health was patchy and fragmented and that criminals with chronic mental illnesses were being released into the community without psychological assessments or discharge plans and are not being followed up by mental health services.

In early August the Rann government announced that it would review the mental health system because it had been criticised as being 20 years behind the rest of the nation. We had criticism from Dr Grace Groom, Chief Executive Officer of the Mental Health Council of Australia, who described our system as dysfunctional, unresponsive and under-funded, and that a lack of rehabilitation was failing South Australia's mentally ill.
Frances Nelson has also made the point that some people within our corrections system are using the defence of drug-induced psychosis so that they can be deemed insane and were allowed their addiction to avoid prison. This is leading to a number of such people remaining in the community when perhaps they are a danger to themselves and the rest of society. The shortage of mental health beds at James Nash House and Glenside compounds this problem because, as facilities that are meant to service people in that area, they are unable to cope with the demand.

One of the other issues that I found of interest is illicit drugs. David Caldicott from the Royal Adelaide Hospital, who deals with a number of overdose people, has remarked on the rates and volatility of some of the drugs that are around. It is reasonable for us to recognise that a lot of these drugs are dangerous to people in the long term and can cause them to have psychoses and schizophrenia, endangering themselves and people in the community. Some of these drugs are increasingly being used. The demand is increasing in this area and the number of people who have more serious problems is also increasing.

The Public Service Association has also joined the call for more resources for mental health. Some of its members are saying that they are under a great deal of stress and are having a lot of difficulty dealing with the demands of the system.

In an article on 7 August, some of the statistics on the difficul¬ties faced by people who fall within these gaps made interesting reading:

60 per cent of inmates have not completed year 10;

60 per cent are below functional levels in literacy and numeracy;

44 per cent are long-term unemployed at time of offence;

5 to 13 per cent are intellectually disabled;

75 per cent have alcohol and other drug problems;

32 per cent are in for alcohol and other drug-related offences;

64 per cent are from broken homes;

75 per cent of women have been physically or sexually abused;

81 per cent of women are suffering post traumatic stress disorder;

17 per cent of males are pathological gamblers;

46 per cent are problem gamblers;

50 per cent of males have consumed alcohol at a level the World Health Organisation classifies as dangerous;

16 per cent are obese—which is below the rest of the population and is the only score on which they do better;

70 to 80 per cent are smokers;

39 per cent of women and 21 per cent of males have attempted suicide;

hepatitis B and hepatitis C rates are 17 times higher than the community rate;

and depression, schizophrenia and antisocial personality disorder are at five, 10 and 20 times community rates.

 Comments have been made by Peter Severin, Chief Executive of the Department for Correctional Services, who said that the state's prisons were receiving increasing numbers of prisoners with some form of mental illness, so again we have recurring themes. Unfortunately for the community, when comments were made in relation to the women's prison at Northfield about its need for an upgrade, the fact that it was out of date and plagued by racial and drug problems, we had some very helpful (I say with my tongue in my cheek) comments from the Premier and Kevin Foley. They said that prisons were not their priority—`It is very easy to avoid going to prison, don't commit the crime.' Obviously we will not be tackling any of the problems in this system when they have those sorts of attitudes.

The thing that really topped it for me in terms of whether or not this issue was being dealt with at all was when Monsignor David Cappo, Chair of the Social Inclusion Unit, made some comments last week in relation to mental health. At a conference on crime prevention, a meeting of the Australian Crime Prevention Council, he called for urgent action on the state of mental health, particularly affecting our prison system. He said:

. . . the rate of depression is 10 times the community rate, the rate of antisocial personality disorder 20 times the community rate and 64 per cent of people with mental disorders who are in prison also have a drug problem.

 He also said that `you can't deal with mental health in isolation'. That is a very important point because a number of agencies in our system do not communicate very well with each other and linkages need to be strengthened between them.

He also says that we need to look at ways of diverting a lot of people who are currently in prisons who really could be—if treated properly with good mental health care and perhaps other forms of custodial treatment—coped with and treated and helped, and that would cost government a lot less than locking up people in prisons. Once again these are repeating themes. I have heard them continuously through evidence on various committees since I have been in this place. I have also heard some comments from people from OARS in relation to people who are released from prison and who walk out the door with no support services. For them the survival instinct kicks in and that can often lead to recidivism.

I do not believe in being a nanny. I believe that we need to try to make people as independent as possible in their lives, but clearly a number of people do not have great life options to start with.

If members look at the rates of literacy, abuse and so forth, they have not had the best start in life and they probably need to develop some life skills and to learn some better social skills in order to be reintegrated. However, if we are going to take the attitude that they are thrown out without any form of supervision, then we are not only disadvantaging them but the general public. As has been stated several times in the last 18 months, it is also a public safety issue. In the interests of doing the right thing by people who have these difficulties and the general public, we should have this inquiry, and I would urge all members to support the motion.