Burdekin: NATIONAL INQUIRY

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

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.

Elderlytreatment

Approximately half of 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.