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Burdekin: NATIONAL INQUIRY

Disability Disability Rights

NATIONAL INQUIRY INTO THE HUMAN RIGHTS OF PEOPLE WITH MENTAL ILLNESS
LAUNCH OF REPORT

Brian Burdekin
Federal Human Rights Commissioner 1986-1994

CHAIRMAN OF THE INQUIRY
SYDNEY 20 OCTOBER 1993

Brian Burdekin

Note: This is the text of notes used by the Commissioner
as the basis for his speech rather than the exact text delivered

Introduction

Good afternoon ladies and gentlemen. Welcome to the
launch of the report of the national inquiry into the human rights of
people with mental illness. This report is the result of extensive research;
public hearings in all States and Territories; and oral evidence and written
submissions from over 1300 witnesses. I have been extremely fortunate
to have the assistance of two commissioners with a long standing interest
in the area of mental health - Dame Margaret Guilfoyle and Mr David Hall.
I want to record my sincere appreciation for the enormous commitment they
made to this inquiry and for their valuable advice.

This project has been the most difficult task I have
ever undertaken,- not only in terms of the massive amount of evidence
we received, but also because of the complexity of the issues involved.

Without their assistance, and without the outstanding commitment of a small
number of our staff this report would not exist.

Why a national inquiry

My initial reason for conducting this inquiry came from evidence presented to
the homeless children's inquiry which suggested that in many areas the
human rights of individuals affected by mental illness were being ignored
or seriously violated.

Further research also indicated:

  • widespread ignorance about the nature and prevalence of mental illness in the
    community;
  • widespread discrimination;
  • widespread misconceptions about the number of people with a mental illness who
    are dangerous;
  • and a widespread belief that few people affected by mental illness ever recover.

Incidence of mental illness:

Approximately 1 in 5 adults
have, or will develop, a mental disorder at some point in their life -
- that represents over 3 million Australians.

Schizophrenia

Approximately 1 percent of the population (170,000) suffer from schizophrenia.
It therefore affects more Australians than many other better known illnesses.

20-30 percent of people who experience an episode of schizophrenia recover without
ever needing to be rehospitalised;

Aproximately 40 percent suffer recurrent episodes over several years;

And approximately 35 percent will be affected throughout their lives.

Different from other inquiries

This inquiry differed from previous inquiries and royal commissions in
several important aspects:

  • First, it was a national inquiry. One of our primary aims was to evaluate the laws and
    provisions which exist in each state and territory (this had not been
    done in any previous inquiry).
  • Second, there has now been sufficient time for
    the effects - and defects of deinstitutionalisation to
    become apparent.
  • Third, this inquiry was conducted from a rights-based approach (rather
    than a service based perspective). This constitutes a major shift in
    emphasis.
  • Fourth, the inquiry was conducted with reference to
    's international treaty obligations,
    which are binding on us as a matter of international law

The inquiry process

The inquiry was formally announced (after 12 months preliminary research) in
June 1990.

Public hearings commenced in in April
1991 and over the next 15 months hearings were convened in a wide range
of cities and regional centres across .

Witnesses

456 witnesses appeared before the inquiry during its formal hearings.

Private hearings, informal meetings and public forums for consumers were also
held in conjunction with the public hearings

Written submissions

The inquiry also considered over 820 written submissions from individuals affected
by mental illness, carers, community
organisations, clinicians, other mental health professionals and government
authorities.

Appreciation of consumers support

I want to place on record our thanks for the many thousands of hours of work
that those submissions represent. I also want to take this opportunity
to thank those people who were prepared to speak openly about their personal
experiences even though for many this was difficult. This report is a
testimony to their courage and determination.

The report

Our primary concern in the preparation of this report has been to carefully
consider and accurately represent the evidence received. Apart from individuals
who requested confidentiality, every witness to the inquiry is named in
the appendices to the report. The endnotes are also a valuable source
of additional information and must be read in conjunction with each chapter.

Cost

It is clear from evidence presented in this report that the cost of mental illness
in terms of human lives and suffering is enormous. In addition to the
pain suffered by consumers, these costs include disruption to family life,
and sometimes unbearable pressures on other family members, who often
feel powerless to assist the
person who is ill.

Estimating the financial costs - both to the individual and to society - is a complicated task because of the differing degrees of disability experienced
by consumers and the lack of data available in this area.

But the costs of our current neglect in terms of violations of the most fundamental
rights of many thousands of Australians affected by mental illness are
clearly documented in the report. They demand an urgent, concerted and
effective response.

Human rights

Before referring to some of the inquiry's major findings I want to emphasise
the importance of the title of our report - human rights and mental illness.

International instruments incorporated in federal law stipulate that individuals
affected by mental illness are entitled, without discrimination, to the
same range of human rights as everybody else.

The most relevant international standards in this area are undoubtedly the Principles
for the Protection of Persons with
Mental Illness and for the Improvement of Mental Health Care, adopted
by the United Nations General Assembly in 1991 with 's full
support.

Since this inquiry began the Health Ministers of the Commonwealth, States and
Territories have made an explicit commitment to ensuring the rights set
out in these principles are embodied in mental health legislation - and that governments institute effective mechanisms for protecting these rights.

The principles

These principles make it clear that:

  • It is not acceptable to have lower standards for mental health care, in terms
    of either standards or resources, than in the rest of the health system.
  • Discrimination on the basis of mental illness is not permitted
  • A person being treated for a mental illness must be accorded the right to recognition
    as a person before the law.

The principles reaffirm that individuals who have a mental illness or who have
experienced mental illness have the right to protection from:

  • exploitation -- whether
    economic, sexual or in other forms
  • abuse -- whether physical or in other forms and
  • degrading treatment.

As this report makes clear, many of these rights are only honoured in the breach.

Least restrictive alternative

The principles also give important emphasis to the concept of the 'least restrictive
alternative' in relation to treatment and require an individualised plan
for treatment, (which must be reviewed regularly).

They recognise the right to be treated and cared for as far as possible in the
community, and the right to treatment suitable to each person's cultural
background.
At the same time, treatment in the community must have adequate resources
to provide effective care.

Clearly, therefore, there are now well defined international standards applicable
to a wide range of human rights problems confronting Australians affected
by mental illness.

This report repeatedly documents our failure to comply with these fundamental
human rights standards.

States rights

There is, in some quarters, a view that because State governments are largely
responsible for the provision of services in the area of mental health
care, the federal government cannot impose standards and call states to
account for neglect and abuse of human rights.

I reject these notions entirely. States do not have rights, they have responsibilities.
Individuals have rights. States have a responsibility to respect and guarantee
those rights - - more
particularly so where the people involved are among the most vulnerable
and disadvantaged in our community.

In my view the federal government has an overriding responsibility to ensure
that where states are not respecting the rights of disadvantaged Australians,
it will (as occurred with the environment), take special measures to guarantee
fundamental human rights standards.

What we found

It is clearly not possible in this statement to detail all of the findings and
recommendations made by the inquiry. The following is therefore an overview
of the main themes which emerge from the evidence and some of our most
significant findings.

Stigma and discrimination

Ppeople affected by mental illness are clearly among the most vulnerable and
disadvantaged in our community.

Tthey suffer from widespread, systematic discrimination and are consistently
denied the rights and services to which they are entitled.

The stigma and suspicion directed at people affected by mental illness is a
major barrier to their full and equal enjoyment of life -- creating fear and isolation when people are most in need of tolerance and understanding.
The level of ignorance and discrimination still associated with mental
illness and psychiatric disability in the 1990's is completely unacceptable
and must be addressed.

Carers

The effects of discrimination and stigmatisation are also felt by those caring
for individuals affected by mental illness. 'Community care' for the lucky
ones, is more often than not provided by family -- particularly the female members. Carers spoke passionately about the needs of
consumers and about their struggle - to the point of exhaustion - to obtain professional advice and appropriate treatment.

The task of providing continuing and continuous support and care at home often
extends over many years -- and the stresses associated with providing that care are compounded by what
families perceive as an almost total lack of understanding, recognition
or support from government agencies, health care professionals and the
community at large.

If was also clear that carers are denied information and excluded from important
decisions concerning the care and treatment of their relatives.

The needs most consistently identified in evidence to the inquiry included a
desperate lack of

  • respite and domiciliary care
  • counselling and family therapy
  • better recognition of and sensitivity to relatives in the primary carer role
  • and more information and consultation.

With the shift to community care, the burden borne by thousands of families
has intensified - in some cases beyond endurance.

Children of people affected by mental illness

The children of those affected by mental illness are seriously disadvantaged
and are also often seriously at risk.

Mental health professionals and service providers often do not inquire about
the existence of any dependents when interviewing or admitting an adult
with a mental illness.

As a result, the needs of children of mentally ill parents are largely ignored.

Young people who do not receive appropriate support may be adversely affected
for the rest of their lives.

School age children with a parent affected not only suffer serious disruption
to their home and family life, but are also likely to undergo extremely
stressful school and social environments, with little or no assistance
in dealing with their parent's illness or the resulting stress.

Inpatient care - findings

There must be a range of inpatient facilities.

At present:

  • the lack of crisis teams to assist with psychiatric emergencies places many
    consumers and their families at serious risk.
  • it also means that the police are often forced to intervene to take seriously
    ill people to hospital - 'criminalising' the process and reinforcing
    stigma and fear in the community.
  • the rights of people with mental illness
    to inpatient care in a safe, therapeutic environment are frequently
    ignored or abused.
  • existing mechanisms to investigate grievances
    are frequently inadequate.
  • some form of long term institutional care
    must be retained for the small proportion of people whose psychiatric
    disability is so severe that they will not be able to live in the community.

Community care - findings

Others require hospital care only infrequently. However the widespread inadequacy
of community health services is an indictment of
our society's lack of concern for people with mental illness.

The inadequacy of existing community mental health services to treat, care for, and support people with mental illness living in the community is disgraceful.

Very few community mental
health services have established systematic follow-up procedures. There has been virtually no systematic retraining of

psychiatric hospital
staff to work with people in a noninstitutional seti'ing in the community.

Procedures for discharge planning and for co-ordination of services for community treatment and care of people with mental illness are generally inadequate and,in many instances, non-existent.

Treatment - human rights

  • In general, the savings resulting from deinstitutionalisation have not been
    redirected to mental health services in the community.
  • These services remain seriously underfunded, as do the non- government organisations
    which struggle to support consumers and their carers.
  • Cclearly there needs to be a range of inpatient facilities, providing for acute
    care, medium-term treatment and genuine 'asylum' (in the true sense
    of the word).

Employment

A number of barriers combine to deny Australians affected
by a psychiatric disability the opportunity to obtain work - particularly
work commensurate with their abilities and interests.

Their exclusion from the labour market often causes inequality and poverty.

Barriers to employment include lack of access to vocational and educational training,
the debilitating effects
of psychiatric illness and treatments, job design and negative employer
and community attitudes.

Vocational rehabilitation for people with a psychiatric disability has been
neglected by governments.

The diverse needs of those affected by mental illness mean that a range of graduated,
transitional, vocational and rehabilitation services need to be developed.

Education and training

Many individuals with psychiatric disabilities are unable to participate in
existing education and training programs - and are therefore denied the opportunities that education and training can offer.

Special education programs and services are required to assist people with mental
illness to achieve their potential.

The lack of educational programs is particularly acute for children and adolescents.

Accommodation - findings

One of the biggest problems for people with a mental illness is the absence
of adequate, affordable and secure accommodation.

Access to appropriate accommodation is often the most important single factor
in the success of failure of those with chronic mental illness living
in the community.
The inquiry established that the policy of deinstitutionalisation has
largely failed -- and that it will not succeed until it is accompanied by appropriate policies
on housing - and an adequate allocation of resources.

It is outrageous that government housing programs for people with disabilities
exclude Australians with mental illness, due to inflexible criteria and
poor coordination between departments and agencies.

For example, the supported accommodation assistance program (SAAP), the main
source of funding for crisis services for homeless people, excludes services
specifically for people with mental illness.

This is clearly discriminatory.

It is also appalling that homeless shelters, refuges and boarding houses
are now functioning, de facto, as a major component of the 'accommodation'
provided by our society for thousands of Australians affected by mental
illness. The living conditions in many of these establishments are disgraceful.
Few have trained mental health workers on staff, and there are rarely
any decent opportunities for rehabilitation. Untrained boarding house
staff are often involved in dispensing medication.

As a community we cannot afford to continue to turn a blind eye to the human
rights abuses which are so prevalent in this area - this inquiry demands an urgent response to these issues.

Special needs groups

Many of our most vulnerable citizens - individuals with special needs, such
as:

  • children,
  • adolescents,
  • elderly people,
  • the homeless,
  • women,
  • Aboriginal and Torres Strait Islander people,
  • people from non-english speaking backgrounds, those with dual and multiple disabilities,
  • people in rural and isolated areas and prisoners

are, inexcusably, left to suffer without any appropriate services.

Elderly people

Some of the most damning evidence received by the inquiry concerned the treatment
of elderly Australians with mental illness.

Our health system frequently ignores elderly people who are mentally ill, or
assigns them the lowest priority.

The evidence established that elderly people are more likely to get drugs, less
likely to receive psychotherapy, and less likely to use outpatient services
than younger patients. Many elderly Australians are frequently denied
any appropriate medical care. There is little recognition in our community
that psychiatric disorder is at least as prevalent among the aged as among
the young - and that these elderly people also have special needs.
The most serious mental illness, such as schizophrenia and manic depression
are found among the elderly. But two disorders - which can be particularly distressing - affect tens of thousands of elderly Australians.

Depression in elderly people

Approximately 50 percent of elderly people have at least one symptom of depression.
According to expert opinion, depression among the elderly often goes undiagnosed,
(but it may be twice as common as dementia). A recent study found depression
in over 10 percent of those over 65. Even on a conservative estimate,
this would mean over 100,000 Australians suffer this painful condition.

Elderly - suicide

The evidence suggests we are paying a very high price for our neglect (one measure
of depression is the suicide rate, which is higher among people over 65
than in any other group). The rate for men aged 70-79 is the highest for
all males.

Ironically, depression is one of the most curable mental illnesses. It is often
unnecessarily left completely untreated. All too often it is not even
diagnosed.

Elderly - dementia

Dementia currently affects about 5 percent of Australians over 65. However, this figure sharply as age increases
- and approximately
20 percent of those over 80 are afflicted.

At present 100 -- 140,000
Australians are estimated to be suffering - moderate to severe dementia. But because of our rapidly
aging population over 200,000 Australians will be affected within the next ten years.

Elderly - treatment

Approximately half of 's dementia sufferers
live at home -- alone or with relatives.

Many also live in residential facilities.

But, tragically - and
inexcusably -- many are homeless or live in boarding
houses or refuges, where they frequently receive
no decent care or atrention.

Others are unnecessarily, still confined in psychiatric
hospitals.

Elderly - general findings:

It is appalling that:

  • while general practitioners are the main contact point with the health system for elderly people, they
    often fail (because of inadequate training) to recognise mental disorders in these
    patients.
  • Depression, in particular, is undiagnosed and therefore untreated in literally
    thousands of cases.
  • general mental health services frequently fail to recognise and meet the needs
    of elderly people affected by mental illness.
  • research and training on mental illness in the elderly are seriously deficient
  • many older people with dementia are being denied their right to treatment in
    the least restrictive environment:
  • a. Approximately 3000 people with dementia are still confined to
    psychiatric wards
  • B. Inadequate support services in the community are forcing many older people
    unnecessarily, or prematurely, into institutional care.
  • C. Outdated, inappropriate design and funding arrangements for nursing homes
    result in some residents who have dementia being physically restrained
    or
    "sedated" as a method of control.

These practices constitute serious human rights violations.
Using medication as a "management tool" - instead
of for therapeutic purposes is outrageous.
It is what you might call the "gulag school of psychiatric medicine" - using drugs not to help treat and cure inpatlents - but to 'restrain' them for the conventence of "management".

It is also essential that carers of aged people with mental illness
urgently receive respite and other support services.

Homeless:

The inquiry found that poor inter-sectoral links, the ambivalent stance of the
private sector and a reluctance on the part of government agencies
to co-operate in the delivery of services to people with mental illness have contributed to the alarming situation described in this
report.

One group particularly affected by this lack of co-ordination is homeless people
affected by a mental illness.

Homeless Australians (of whom there are an increasing number) suffer a high
rate of physical and mental health problems.

On the streets the mentally ill find neither adequate food nor shelter. Nor
are they likely to receive any appropriate treatment.

Incidence:

A recent
study found that 90 percent of agencies working with homeless adults reported
psychiatric illness as a significant problem.
20- 30 percent of residents in inner
refuges suffer from schizophrenia.

One distinguished psychiatrist (representing the Royal Australian and New Zealand
College of Psychiatrists, estimated that 50-75 percent of homeless people in our refuges and shelters have histories
of major mental illness.

  • refuges, charities am) voluntary agencies providing shelter or services to
    the homeless have had to shoulder the burden of caring for the homeless mentally ill as a
    result of deinstitutionalisation. Governments and bureaucrats have largely
    failed to recognise or support them in that role.
  • government departments which should be providing services, such as income support,
    health and other services, are reluctant to deal with homeless people
    affected by mental illness.
  • few services exist for homeless women - where they do exist they will rarely accept women with children.
  • mental health services generally are woefully lacking in country areas.

Support for the homeless mentally ill in rural areas is virtually non existent.

Women:

Evidence presented to the inquiry focussed on four areas of particular concern
to women:

  • diagnosis and treatment of mental illness
  • post natal depression
  • the psychological effect of violence, and
  • the absence of adequate shelter

The lack of specialist knowledge about post natal depression is a major problem.
Post natal depression affects a very large number of women of
Australian women - (approximately 1 in 7 women), but many get no assistance.
And for those women this illness can pose a major risk - to their own lives and to their children.

. women who have a history of childhood abuse, sexual assault or domestic violence
are more likely to be affected by mental illness or mental health problems

.

The inquiry urges government to address the need for prevention and early intervention
programs as discussed in this report - particularly in relation to violence against women.

Children and adolescents:

Approximately 15 percent of young people experience mental health problems;

5 percent suffer from recognisable psychiatric disorders and more than 1 percent
have serious psychiatric disorders which warrant specialist intervention.
(These estimates conform with Aamerican data which indicate that 90 percent
of all psychiatric disorders have their onset in adolescence or early
adulthood.)

50 percent of mental illnesses first affect young people between the ages of
16 and 18.

Our existing system is failing Australian young people in a number of critical
areas:

  • failure to recognise that a child is suffering from a mental illness or disorder.
  • reluctance to identify a child or young person as suffering from mental illness
    (which means that they often remain untreated or are handed over to
    another agency which does not have the expertise to help).
  • many young people never receive appropriate assessment or referral - and consequently drift into 'at risk' lifestyles.
  • failure to recognise that childhood neglect and abuse can substantially contribute
    to the development of mental health problems.

There is a desperate shortage of services - with none at all in many regions. Most services are grossly under resourced.
Many lack appropriate trained staff and there is generally little integration
with related services.

The serious deficiencies in child and adolescent mental health services and
the resulting placement of children in completely inappropriate facilities
- often at great personal risk - indicate that our society pays lip service to the notion that our children are
'the hope of the future'.

Young people constitute over a third of our population.

Yet the best we can do is place young people with mental health problems in
general medical wards, adult psychiatric hospitals, inappropriate temporary
foster care.

Damning evidence was also received about children and adolescents being placed
in remand and detention facilities by default - because no one had been able to provide assistance at an early stage and because
there were no mental health facilities available when a crisis occurred.

(The police themselves were appalled by the lack of alternatives in assisting
young people with mental health problems.)

It is completely unacceptable that disturbed and mentally ill adolescents end
up in our juvenile justice system - where they frequenthy receive no assessment or follow-up treatment.

A recent south Australian study found that 17 percent of young people had been
living on the streets prior to being remanded in custody, another 23 percent
had been living with friends, and 18 percent had been in institutionalised
care. Only one quarter of the remanded group (aged 11-17) had been living
at home before being detained, and the majority had left school between
13 and 16.

Suicide:

Our young people are paying an enormous price for this neglect. There has been
an alarming increase in the suicide rate among adolescents aged over 15.

The rate for girls has doubled.

People with dual or multiple disabilities:

Many thousands of Australians who suffer from mental illness are also affected
by some other disability. Specialist services for these particularly disadvantaged

Australians are almost non existent. As a result, tragically, they are
shuffled from agency to agency - without finding anyone who will assume responsibility
for their
care.

People with mental illness and an intellectual disability

Two percent of the population is affected by intellectual disabilities and the
prevalence of mental disorders in that population is 30-50 percent. We
are talking about an extremely large number of Australians. (at least
100,000 people.)

The difficulties confronting those affected with mental illness and intellectual
disability are compounded by a scandalous shortage of appropriate psychiatric
services.
Their needs are often ignored - because they fall between the two areas of
service delivery.

People affected by both mental illness and substance abuse disorders, hearing
impairment, or by head injury suffer similar disadvantage - in a system where their fundamental human rights to basic standards of treatment
and care are often ignored. At best, many are treated as if their conditions
are mutually exclusive.

The lack of appropriate services leads to what one psychiatrist described as
errors of 'omission' and 'commission'. Errors of omission occur because
of a lack of specific services for those affected by dual or multiple
disabilities. Errors of commission, on the other hand, include inappropriate
use of medication to control behaviour.

Aboriginal and torres strait islander people

Mental illness among 's indigenous peoples cannot
be understood in the same terms as mental illness among non-aboriginal
Australians (for various reasons set out in the report.)

Clearly, past neglect means not enough is known about the prevalence of mental
illness among Aboriginal and Torres Strait Islander people.

What does emerge from the evidence, however, is that the dispossession of Aboriginal
and Torres Strait Islander people, the removal of children from their
families, and their continuing social and economic disadvantage have created
widespread mental health problems.

But mental health services rarely deal with the underlying grief and emotional
distress experienced by aboriginal people.

In the 1990's aboriginal people are still being removed from remote communities
for treatment in town. This is frequently destructive to their mental
health -
particularly for elderly
people.

Witnesses suggested that many aboriginal people act out their problems in anti-social
and self destructive behaviour. Much of this behaviour is either undiagnosed,
misdiagnosed or treated as a police problem.

This leads to contact with the criminal justice system, where aboriginal people
are labelled as socially deviant - and their mental health problems are exacerbated.
This is particularly a problem for aboriginal youth. Many young men spend
their formative years (between 15 and 19) in prison and are permanently
alienated from their communities as a result.

The inquiry was told that there are clear links between behavioural and mental
health problems such as low self esteem, alienation and substance abuse
an]) the high incidence of juvenile offending in aboriginal communities.

(One study conducted in Campbelltown, NSW, found that approximately 80 percent
of the young people before the courts were charged with drug and alcohol
related crimes.)

Mainstream services inappropriate for Aboriginal and Islander people

Existing mainstream mental health services are not equipped to deal with problems
of this kind.

The services that do exist are inadequate and culturally inappropriate for Aboriginal
people. Aboriginal and Torres Strait Islander witnesses considered that

self-determination is the only effective way to tackle the crisis in Aboriginal
mental health. Self determination, in this context, will involve providing
Aboriginal people with the training, power and resources to determine
their own mental health strategies within their own terms of reference.

People from non-english speaking backgrounds

Approximately 3.2 million Australians, or 20 percent
of the population, are migrants from non-english speaking countries or
the children of migrants.

Although our society is becoming increasingly culturally
diverse, evidence to the inquiry established that the mental health system
is failing to meet the needs of a large number of Australians from non-english
speaking backgrounds.

The situation is particularly alarming for refugees,
women and the elderly.

Witnesses suggested that up to 15 percent of refugees
are suffering from mental illness as a result of experiences in their
homelands.

People in rural and isolated areas

More that 5 million Australians live outside our major
urban centres and more than half of those live in small rural towns or
remote areas.

Isolation, social factors associated with living in
small communities and the effects of the rural recession are contributing
significantly to mental health problems.

Community mental health care is inadequate, and the
lack of inpatient facilities means that people are generally transferred
to city hospitals or given inappropriate care in a local hospital.

The demands of services in country areas far exceed
supply, with the result that recruitment is notoriously difficult.

Vacancies remain unfilled for long periods and the strain
on the small number of mental health professionals is enormous.

In the circumstances, the disturbing high rate of suicide
in rural areas is not surprising. Young men are most at risk. The suicide
rate for young men in country communities has increased by 500- 600 percent
in the space of one generation.

Forensic patients and prisoners

It should be emphasised, at the outset, that mental
illness does not equate with criminality, nor with a propensity for violence.

Evidence established that a great deal of mental illness
goes undiagnosed in jails.

An expert witness in
estimated that up to 5 percent of prisoners have a serious psychiatric illness, and approximately
20 percent suffer from mental health problems which require treatment
or counselling.

Mentally ill people detained by the criminal justice
system are too often denied appropriate health care. This denial of treatment
often leads to further offending, longer incarceration and aggravation
of mental health problems.

The conditions in many Australian prisons and police
cells clearly breach our international obligations relating to treatment
of prisoners.

These conditions are particularly detrimental to inmates
affected by mental illness or disorder.

The situation for women and Aboriginal and Torres
Strait Islander people and young prisoners is particularly disturbing.

Although the rate of mental illness is higher among
female prisoners, appropriate mental health care for women is virtually
non-existent.

Aboriginal and Torres Strait Islander people are massively
over- represented in prison and police custody. Although it has been shown
that incarceration is particularly damaging to their mental health, forensic
mental health services are systematically failing to meet the needs of
Aboriginal detainees.

Lack of support for mentally ill people released from
jail is another serious problem. Discharge procedures are often totally
inappropriate. Too often the system fails to provide even minimal support,
which could prevent people affected by mental illness coming back to jail.

For example, psychiatrists are generally not even informed
when an inmate whom they are treating is about to be released or transferred
to another jail.
There are neither case management plans, nor any effective system of notification.

The inquiry also found that injustice is being done
to individuals who are found unfit to be tried or not guilty of an offence
on the grounds of insanity.

Indeterminate detention 'at the governors pleasure'
is a clear breach of human rights.

Rights

2.5 years ago, I opened hearings of this inquiry
posing the fundamental question - do Australians with mental illness get
equal priority in:

  • the allocation of resources
  • treatment
  • research
  • protection of their human rights

Despite some minor improvements over the last three
years, the answer to that question is a resounding "no".

The deprivation, discrimination, marginalisation and
stigmatisation still suffered by the hundreds of thousands of Australians

affected by mental illness is a national disgrace.

Balancing of rights:

It should be clear from the terms of reference for this
inquiry that respect for human rights requires a balancing of rights.

Balancing the rights of people with mental illness with
the rights of family, carers and the community needs to be the subject
of
informed community debate. Particularly relevant to the debate are issues
concerning: institutionalisation or community care; and
the right to receive and to refuse treatment. But informed debate is hampered
by:

  • fear and lack of understanding in the community
    about the nature of mental illness and its treatability;
  • a general lack of understanding about the extent
    to which people with mental illness can and do live the same types of
    lives as those led by people who never experience mental illness;
  • maldistribution of mental health services;
  • a lack of locally accessible assessment, treatment,
    follow-up and support services;
  • a lack of culturally appropriate services.

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