"Healthy Solutions for Children: Making the Right Choice"
Convention on the Rights of the Child and the State of Mental Health Services in Australia and How Young People in Australia are Affected
Association for the Welfare of Child Health (AWCH) 2005 Conference
Parramatta Carlton Hotel 28-29 April 2005
Keynote presentation Opening Plenary
Dr Sev Ozdowski OAM
Australian Human Rights Commissioner and Acting Disability Discrimination Commissioner
I would like to acknowledge the traditional owners of the land on which we stand, the Eora People, and pay my respects to their elders both past and present, and in particular, Aunty Gloria.
Thank you to Professor Kim Oates, for his kind introduction; Mem Fox and David Bennett, my fellow speakers in this opening session, our hosts, the Association for the Welfare of Child Health, Delegates - in particular young people, Association for the Welfare of Child Health's volunteers and parents. My welcome also goes to Dr Robyn Sullivan, Director general of the Queensland Department of Child Safety who worked as an Assistant Commissioner on the HREOC Inquiry into Children in Immigration Detention.
In September of this year in Geneva , the United Nations committee responsible for oversighting the Convention on the Rights of the Child will consider Australia 's Second and Third Reports on the extent of our compliance with this important treaty.
It is the most widely adopted Convention in the history of the United Nations, Australia 'signed-on' in 1989, and it formally establishes children's legal right to special protection and care.
It covers everything from education to health, both physical and mental, to the right to play and the right to family unity. Article 24(1) of CRC requires the Commonwealth to ensure that all children within Australia enjoy: " the highest attainable standard" of physical and mental health that Australia can offer.
As it is stated in the formal treaty language:
" States Parties recognise the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services". (Art. 24 (1)).
CRC is a very powerful tool, which is why it formed the backbone to my recent report to Federal parliament on children in immigration detention, titled: " A last resort?"
Amongst the many findings and recommendations made by that Inquiry, perhaps the most devastating was the following:
"Furthermore, the Government's failure to implement repeated recommendations by mental health professionals to remove children with their parents from detention amounted to "cruel, inhumane and degrading treatment".
Let me briefly give you one case study from the report to add a little flesh to the dry bones of that 'finding': and I refer now to the case of a 13 year old child who had been seriously mentally ill since May 2002.
This boy had regularly self-harmed . In February 2003 a psychiatrist examining the boy wrote the following:
"When I asked if there was anything I could do to help him, he told me that I could bring a razor or knife so that he could cut himself more effectively than with the plastic knives that are available."
There had been approximately 20 recommendations from mental health professionals saying that he should be released from detention with his family. Some said that removal from detention was a matter of urgency.
When finally released, (after 3 years detention, and 2 years after mental illness diagnosis) as refugees, following an RRT finding, into the Adelaide community, all members of the family were severely mentally traumatized; prescribed heavy, daily medication, too ill to work and requiring extensive community support and assistance.
In other words, we locked them up, we traumatised them and now as they join the Australian family, we are going to have to pay a price for that treatment. But when we started looking at what sorts of treatment are available, a whole new picture of human rights concerns emerged from the shadows.
Mental health consultations
In the latter part of 2004 I, jointly with the Mental Health Council of Australia and the Brain and Mind Research Institute, conducted community consultations on mental health issues. It is some 11 years since the Human Rights Commission published the Burdekin report on mental health, and it seemed timely, in light of CIDI, to re-visit the topic.
We went all over Australia : Perth , Brisbane , Sydney , Canberra , Bunbury in WA, Rockhampton and Broken Hill - to name but some of our destinations - and invited mental health workers, carers and consumers to share their mental health experiences with us.
And it will come as no surprise to most of you here, that we were overwhelmed. In fact, some of you may well have attended a consultation.
The story that unfolded is not a pretty one.
The people consulted make two main points.
One, that there is increasing evidence that widespread use of common drugs such as cannabis, amphetamines, alcohol and ecstasy is contributing to an increased rate of mental illness among young people. In addition they are making those young people even more disturbed when they finally present for care.
And two, that in the treatment of mental illness, it is the state government services that are failing in the delivery of proper care.
Not only is there a general lack of services, but there is a huge shortage of services that cater specifically to adolescent children who need help.
It is often a tragic tale of medical neglect and community indifference. Those with a mental illness are still being blamed for being sick. It affects those who care after the ill in every State and Territory. And, tragically, it affects the young more than we would like to admit.
I listened to many, many first hand accounts where alcohol and drugs were linked to schizophrenia and depression.
Stories about violent behaviour, suicide attempts and endless bouts of hospitalisation or imprisonment.
It makes young people " thrash around on the wings of madness " - to use Jo Buchanan words, while the authorities seem unable to stem the tide.
You see, there are almost no services available to deal with both drug addiction and mental illness at the same time. Medical policy dictates that drug addiction be treated first, before the mental illness is tackled. But the reality is that they are often interconnected.
And the failure to treat a dual diagnosis may lead to at least 20 years of life expectancy being lost.
Suicide rates in teenagers and young adults remain historically high. We were told a great many stories of preventable suicides of young people.
Let me tell you two of them:
A Central Coast teenager was admitted to a psychiatric unit because of attempted suicide. He was prescribed Valium and released next day with no follow up. He died hours later after throwing himself in front of a moving train. The coroner found that he was inadequately assessed and discharged too early, because an on-going shortage of beds in the unit.
In Canberra we were told about a young man with a history of depression, and openly suicidal, who jumped from a sixth floor balcony only two days after being refused admission to the psychiatric unit following a second suicide attempt.
The most frequently mentioned gap in mental health services was the absence of early intervention and other specialist services for young people. In all States I received reports of children and young people being admitted to inappropriate adult facilities. Also emergency services are overburdened and often inaccessible.
In WA I was told about a twenty year old man who reported to hospital suffering from an episode. The hospital's clinical response was to chemically induce sleep for 20 hours, because there was no psychiatrist available.
A NSW hospital clearly took the " lock 'em up and throw away the key " mentality a step too far recently.
It locked a mental patient and his two accompanying young police officers together in a room, and refused to let them go until a doctor arrived. The constables remained 'locked up' with the patient, even after their police sergeant made a direct request to hospital officials for their immediate release.
We are also seeing a pattern of underspending and lack of investment in mental health. There are some brave words by some State governments - but little real action.
With one exception- Western Australia took action. Within six weeks of signing up to a National Mental Health Plan, the West Australian Government withdrew $4 million dollars from mental health services.
Although I'm pleased to report that in the wake of the publicity from our visit, the WA Government reversed the decision.
Indeed, amongst all the consultations, the anecdotal evidence about the State Governments, particularly those of South Australia , New South Wales and Western Australia , has not been encouraging.
The anecdotal evidence also suggests a lack of appropriate accountability for money earmarked for mental health.
Arguably it is easier to deal with physical health than with mental health problems.
I have been given accounts of some mental health money from the Federal Government being diverted into the general hospital system. This may have been less of an issue when we treated the mentally ill in hospital. But now when community release is the preferred clinical response, we have a duty to back the community with the additional money.
The issue of community resources, or lack of them, also has particular application for young people still within the family environment. And I refer here to the issue of the young person's "carer or carers' being removed from the home due to their own mental illness.
In these cases, that young person, and typically in these scenarios we are talking about more than one child, may be left in the home with insufficient community support mechanisms to ensure they are properly attended to, while their carer is receiving treatment for their mental illness.
Finally to this already explosive cocktail can be added the stigma and stereotypes that surround the mentally ill and you see the extent of this bleak picture. Truly, all this gives flesh to the pattern of neglect which has been described by the phrase: "Out of hospital, out of mind".
The need for urgent action is clear.
What, in light of the consultations, do I think could be done?
But before I address the issue of action that is needed, remember our old friend Article 24(1) of CRC that I began with?
The one that says: States Parties recognise the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health.
So everything I say hereafter must be viewed against that backdrop. So what could be done?
First of all, there needs to be real accountability about where the money is going with regard to mental health.
Second , it is a good time to look at prevention and early intervention, rather than face the high cost of the treatment, in the future.
About 20 per cent of Australian adults will be affected by a mental health problem each year. Three per cent will be seriously affected. Depression and anxiety disorders are the most common mental illnesses.
With treatment and support, the majority of people with mental illness can recover well.
Perhaps it would be appropriate for a Federal government to provide more effective leadership with respect to the national coordination of early intervention programs.
Or as somebody told us in Victoria : It is better to build a fence at the top of the cliff, than to provide an ambulance at the bottom .
In fact, Australia leads the way in development of early intervention programs for mentally ill. They are being implemented overseas, but not in Australia .
Next, there must be priority given to the coordination of medical and psychological care or, in other words, drug and non-drug therapies.
Fourth , there must be a real commitment to new and innovative return-to-work schemes. We are quick to push people out of hospitals and into the community. But there are no jobs for them. Our success rate in this is the lowest amongst the OECD countries. This is a Federal government responsibility and at present I am conducting an inquiry into the nexus between employment and disability.
Above all, there must be more money put on the table. The money is needed for research, innovation and better services.
For example, more money is needed for research on links between drugs and mental illness in young people.
The Federal government, in the election context, committed an additional $110m to mental health; I await official confirmation of that 'promise' in next month's Budget.
Some of the State governments are making promising noises about 'new mental health money'.
But still, it must be acknowledged that Australia currently spends only about 7% of its health budget on mental health.
By comparison, other first world economies are spending between 10-14% of their health budgets on mental health. New Zealand now spends twice as much per capita compared with this country.
As the UN Committee on the Rights of the Child opined recently when reviewing a Member State 's (not Australia ) report on its compliance with CRC:
" The Committee joins the State Party in expressing concern at the long waiting list and delayed access to mental health services and professionals for children which are due to an insufficient number of psychologists and psychiatrists. The Committee encourages the State Party to explore ways of providing children with more timely access to mental health services and to address in particular the shortage of psychiatrists and psychologists".
I am suggesting today that the comment I have just quoted, which was incidentally addressed to Norway , certainly resonates strongly in the current Australian scene with regard to timely access for young people to mental health services. In fact it will be interesting to see how we fare before the same Committee in September in Geneva in this regard.
Because it must be borne in mind that although our state governments are responsible for mental health service delivery, and it is they who are lagging, it is the Commonwealth Government who is accountable to the Committee for Australia's performance.
Australia is an extraordinarily wonderful and diverse nation in every respect: physically, culturally and socially.
It has a proud record in the area of human rights and a commitment to the notion of "a fair go".
But surely, the ultimate test of our commitment to human rights and our "fair go" ethos, as a nation, is not what we aspire to, is not the Conventions we sign and not what the oversight Committees say (although external oversight can be useful for "keeping the bastards honest").
Our own benchmark should be surly how we treat our most vulnerable and powerless and most definitely our younger people.
(This paper draws on research by the Mental Health Council of Australia including Groom, Hickie, Davenport , Out of Hospital Out of Mind . )