OPINION ARTICLE

21st April 2008

Brendan Nelson’s recent recommendation, that Australia should seriously consider returning to a system of psychiatric institutional care for people with a mental illness, is archaic and concerning.

People affected by mental illness are among the most vulnerable and disadvantaged in our community who, in institutional care, suffered widespread abuses; sexual, physical and psychological as well systematic discrimination and a consistent denial of rights. 

This abuse was definitively reported in the 1993 National Inquiry into the Human Rights of People with Mental Illness undertaken by the Human Rights and Equal Opportunity Commission (Burdekin Report).

Psychiatric institutions were closed with good reason and sadly the Opposition Leader is out-of-touch with the mental health system and the needs of the people it serves.

The Burdekin Report was conducted with reference to Australia’s international treaty obligations, in particular the United Nations Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care, which recognize the ‘right to be treated and cared for in the community’ and emphasise the concept of the ‘least restrictive alternative in relation to treatment’. The report repeatedly documented our failure to comply with these fundamental human rights standards.

And yet Mr Nelson is encouraging us to go back there.  I must ask why?

His allusion to the violent nature of people with a mental illness is misleading and unfortunate.  People with a mental illness are not inherently violent and leading the public to believe this is the case, simply feeds the stigma that society has towards mental illness.

Research in fact shows that people with severe mental illness are more than 11 times
more likely to be victims of a violent crime than the general population .

The Burdekin report also reiterated that violence is not a symptom of mental illness “It should be emphasized, at the outset, that mental illness does not equate with criminality, nor the propensity for violence”.

A fundamental element in this discussion is that of recovery.  People can and do recover from mental illness, even the most severe mental illnesses, and they are much more likely to do this when they are in an environment which allows them to build relationships, find hobbies, study, undertake meaningful employment and simply be part of society.

Social inclusion – not exclusion, is the key to recovery.  The Burdekin Report highlighted 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.

There are sound foundations to the model of community care.  It provides people with the respect and dignity they deserve as human beings and contributing members of our community.

Locking people in institutions and excluding them from society has the ironic effect of perpetuating the social isolation, loneliness, poor self-esteem and social exclusion that many people with a severe mental illness often feel

This is not to say that the current system is perfect – it isn’t.  There is still a long way to go and I agree with Mr Nelson that there is certainly an urgent need for community support for people with a mental illness. 

We must invest in community support services that offer people individual solutions, because a ‘one size fits all’ approach to recovery just isn’t appropriate.  An investment in early intervention in the community will reward the community in the longer term through lower levels of disability and distress.

With the World Health Organisation predicting that by the year 2020 depression will be one of the biggest health problems worldwide there needs to be significant and immediate financial investment in this critical area of health care.

People with a mental illness are no different from the rest of the community.  They want jobs, relationships, and to be valued, contributing members of their community.  It therefore makes sense that these are things that are most valued as part of the recovery process – I urge Mr Nelson to seriously consider his recommendations that taking these things from people is the solution to solving any crisis in the mental health system.

As members of society we must also take responsibility for the role we play in the mental health of our community.  We must ensure we encourage inclusive communities that support – not prevent – recovery; communities that foster acceptance and education about mental illness, not discrimination and isolation.

Robyn Duff is the CEO of Mind (formerly Richmond Fellowship Victoria & South Australia), Australia’s largest non-government provider of mental health services.