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Disability Rights: Not for Service - Report: Part 6_3

Not for Service: Experiences of injustice and despair in mental health care in Australia

PART SIX: ANALYSIS OF SUBMISSIONS AND FORUMS AGAINST THE NATIONAL STANDARDS FOR MENTAL HEALTH SERVICES

6.3 QUEENSLAND

ANALYSIS OF SUBMISSIONS AND CONSULTATIONS FROM QUEENSLAND AGAINST THE NATIONAL STANDARDS FOR MENTAL HEALTH SERVICES

In summary, information presented in this section was gathered from 47 submissions (see Appendix 8.3.3) and presentations made at community forums attended by approximately 110 people (see Appendix 8.1). A draft copy of this report was sent to the Premier and Minister for Health for comment. An analysis of the response from the Queensland Government (reproduced in Appendix 8.4.3) and an overall review of mental health service delivery in Queensland is contained in Part 2.7.3.

6.3.1 STANDARD 1: RIGHTS

The rights of people affected by mental disorders and/or mental health problems are upheld by the MHS.

Human rights in regional and especially remote areas, are often infringed upon, because of lack of resources and very poor (if any) government funding. In fact in many areas services are being drastically reduced because of dramatic cuts in both Federal and State funding.

(Consumer Advocate, Queensland, Submission #16)

Under this Standard, submissions and presentations indicate concerns about:

  • people with mental illness not being informed of their rights and advocates not sufficiently trained and resourced to protect their rights;
  • lack of respect for patient dignity and the right to the least restrictive form of treatment;
  • access to advocates and support people not being actively promoted;
  • protocols not being followed to protect the rights of people with mental illness in the criminal justice system; and
  • problems with the current complaints process and requests to various organisations to assist with the protection of rights of people with mental illness.

6.3.1.1 People with mental illness not being informed of their rights and advocates not sufficiently trained and resourced to protect their rights

Reports were received that raise many concerns about the protection of rights of people with mental illness. In particular, it appears that some people are not being provided with a written and verbal statement of their rights and responsibilities as soon as possible after entering the Mental Health Service (Standard 1.2) in a manner that is understandable (Standard 1.3). Also, concern was expressed by one consumer advocate that even if people are aware of their right to have an independent advocate at any time during their involvement with the Mental Health Service (Standard 1.6), many advocates are not sufficiently trained or resourced to carry out this function.

Here in Queensland there is no booklet, as in other states to inform people of their legal rights and worse still, there are very few advocates or consultants to ensure people are aware of their rights. Also many of the advocates and consultants are under trained and under resourced. Further infringing upon the rights and well being of the mentally ill.

(Consumer Advocate, Queensland, Submission #16)

[The following are what I put as necessary] Patients to be provided at the earliest time with a list of their rights and all avenues of complaint. (author's emphasis)

(Carer, Father, Queensland, Submission #141)

6.3.1.2 Lack of respect for patient dignity and the right to the least restrictive form of treatment

Concern was expressed about practices involving degrading treatment during their involvement with the MHS. The practices referred to in the following quote indicate that relevant legislation, regulations and instruments protecting the rights of people with mental illness or mental health problems are not being complied with in all cases (Standard 1.1).

I have a friend in Queensland who has been diagnosed with Borderline Personality Disorder. Recently when she was in hospital she lacerated her vagina. Staff made her publicly take off her clothes and, nude, explain what she had done in a room full of staff at changeover. This sort of treatment is more than disrespectful. It is cruel and barbaric.

(Consumer, Australian Capital Territory, Submission #287)

Concern was also expressed that about occasions when an inability of people with mental illness to access treatment and support services when necessary resulted in their declining health and entry into the criminal justice system. The provision of treatment and support in prison is not in the least restrictive environment or support which imposes the least personal restriction of rights, and is clearly not the optimal environment for mental health care.

Prison is an expensive housing option for the mentally ill: it is also a grave abuse of their human rights.

(Anonymous, Queensland, Submission #67)

6.3.1.3 Protocols not followed to protect rights of people with mental illness in criminal justice system

According to Standard 1.1: 'Staff of the MHS comply with relevant legislation, regulations and instruments protecting the rights of people affected by mental disorders and/or mental health problems'. This includes a variety of legislation and departmental codes of conduct. One carer in particular expressed concern about the way her son was treated and the lack of dignity accorded to him and that protocols were not followed:

My beef is with the police - it was reported that he had a mental illness and the police threw him in the cell with nothing, not a bucket to pee in or anything. He told them he had a mental illness and they didn't follow the protocol.

(Carer, Mother, Queensland, Rockhampton Forum #9)

The police soon phoned and told me of this and that the Government Medical officer would be seeing my son soon. This was now Sunday. Sometime during that day a decision was made not to call in the GMO and that only Blue Care nurses would attend to my son's head injury. My son's case manager was actually on call that day at Mental Health and I phoned her. She said nothing could be done by them to help my son unless the GMO requested that they attend my son. As the GMO was never called in there was no way my son could get help from Mental Health! Basic rights denied! No amount of pleading on my part changed this. No attempt was made by Mental Health at any time he was in the watchhouse to get help for my son. (It is a case of 'who you are and what you are' in this town as to whether 'strings are pulled' on your behalf or not). ...I believe that Mental Health, the law and the judiciary all have let my son down when he needs care!

(Carer, Wife and Mother, Queensland, Submission #52)

Corrections staff encourage a culture of violence. Prisoners who ask for protection are sneered at. If they resort to fighting, they are treated with 'respect'. People with damaged brains are being rewarded for solving difficult problems with their fists, so that their integration into community is further compromised. A policy that provides for a parallel justice system for vulnerable people would alleviate much unnecessary suffering ...

(Anonymous, Queensland, Submission #67)

6.3.1.4 Access to advocates and support people not promoted

Concerns were also raised that the rules and procedures to ensure a fair hearing of a person with mental illness before the Mental Health Review Tribunal are not being fully implemented. Standard 1.6 states that: 'Independent advocacy services and support persons are actively promoted by the MHS and consumers are made aware of their right to have an independent advocate or support person with them at any time during the their involvement with the MHS'. The fact that people are appearing without an advocate or support person could also imply that they are not receiving written or verbal information about their rights in a way that is understandable to them and their carers (Standard 1.3).

When I sit on the [Mental Health Review] tribunal it distresses me the lack of support that patients have. I leave feeling that natural justice has not been done.

(Consumer, Queensland, Brisbane Forum #12)

6.3.1.5 Complaints process and requests to assist with rights protection - all of no help!

A number of carers also expressed concerns that complaints procedures were not easily accessed, responsive or fair (Standard 1.10). Carers who had followed the procedures felt that justice had not been done and that they were given inadequate responses. Carers felt that many statutory bodies and processes designed to assist with the protection of rights of people with mental illness had also been unable to assist them when necessary.

...daughter-in-law who was seriously mentally ill but had difficulty accessing care. She attempted to jump off a moving ferry, she said the voices told her to jump off. She was finally transported to hospital at 10am and assessed by the mental health assessment team. She was then sent home in a taxi and murdered her nephew. [Y], Acting Director met with the family - no answers. The Queensland Health Minister said she was satisfied that the responses had been adequate. But she had previously murdered her own child first and was hospitalised and then released ...Inadequate sets of responses.

(Family Member, Queensland, Rockhampton Forum #2)

The CJC [Criminal Justice Commission] found 'no serious acts of misconduct occurred' but some police officers were reprimanded as a result ...

(Carer, Wife and Mother, Queensland, Submission #52)

I also feel Human Rights Commission let me down early in the piece as when I contacted them for help I was told because another Commission was already involved they could not be involved as well. The following year I was told this was not so.

(Carer, Wife and Mother, Queensland, Submission #52)

In mid-2000 I attended a cabinet meeting and presented my son's story at a round-table conference involving the Minister for Police, Police Commissioner and his Deputy. The outcome was that complaints regarding watchhouse matter should be made within (I think) 24 hours! So much for justice ...

(Carer, Wife and Mother, Queensland, Submission #52)

My son was in an extremely agitated state and when I spoke to an officer regarding his need to see a doctor he just said 'he'll be right'. The next day he appeared in court still in an agitated state, still in his blood-stained clothes and because he was regarded a danger to himself and others he was remanded to Etna Creek for 6 weeks! In those ensuing 6 weeks I spoke to people from the Criminal Justice Commission, Health Rights Commission, Members of Parliament, the director of Mental Health, Legal Aid and eventually the Human Rights Commission and Anti-Discrimination. No-one it seemed could help my son!

(Carer, Wife and Mother, Queensland, Submission #52)

Most members of our group have experienced similar problems to many I have experienced and included in this submission, but they are reluctant to speak out publicly. Any complaints made via the appropriate channels within the service about the unit have, to date, only been 'turned around' making it seem like the carer / consumer is actually at fault.

(Carer, Wife and Mother, Queensland, Submission #52)

[X] reported to staff 28th September 2002 that unwelcome sexual contact had occurred with a male patient. Staff ignored this report preferring to regard it as delusional behaviour ...[Y] and the family tried unsuccessfully on many occasions to arrange family meetings to discuss with staff [X]'s best care ...On 16th October 2002, [Y] phoned the hospital asking to be put in contact with an appropriate person to express his concerns about [X]'s welfare. His call was put through to Acting Team Leader, [Z] who took the complaint and promised to investigate and call back. Even though staff had known since 28th September no return call was made to [Y]. At no time has any officer for Queensland Health advised the proper complaints procedures to be followed or indeed that the process followed was incomplete ...Our situation is so frustrating that it makes it difficult for me to focus properly. One of the reasons was that we had just received notification from Audit and Operational Review of Queensland Health that there was to be no proper examination of our concerns and we were dismissed as it were. Tends to make it tough. Because nobody tells you how these things work and what the tactics are, the enemy is always several moves ahead. And believe me enemy is the right word. There is no negotiation and the complainant is the problem never anything else.

(Carer, Husband, Queensland, Submission #124)

Six years ago my husband took his own life after being released from Brisbane Hospital when staff knew that the previous evening he had attempted suicide. I could get no support or answers for his four children - even after writing to the Brisbane hospital ombudsman, the Brisbane Police, the coroner's office for an autopsy report. I engaged a lawyer ...to no avail. I dropped the search for answers when the lawyer told me it was too hard. For years my children and I have had to carry the weight of their father's suicide with the only answer being that it was sad but too bad, there was nothing anyone could do. Well the Sunday program has raised all my angry again at the indifference of the Medical community of Queensland at the time and I still want answers for my children as to why the system failed their father.

(Carer, Wife, Queensland Submission #85)

Particularly sickening is the patient review / complaints system, where in Queensland "trust me Beattie" and AWU country, the various bodies act to justify and protect the inhuman treatment, creating huge backlogs to justify their continuing existence.

(Carer, Father, Queensland, Submission #141)

The large number of concerns raised about the rights of people with mental illness and mental health problems, as evidenced through the forums and submissions documented here and other advocacy agencies, is sufficient for a worker at the Office of the Public Advocate to support a larger inquiry.

We are charged with providing support to people with psychiatric disability - I would strongly support a much broader inquiry.

(Office of the Public Advocate worker, Queensland, Brisbane Forum #14)

A carer suggested that official visitors should be appointed to carry out random visits to ensure that the rights of people with mental illness are being protected at all times.

"Official visitors" to have widespread appointment support, to have access to all facilities at all hours with no notice given and no set routine. To see patients on request as well as inspections.

(Carer, Father, Queensland, Submission #141)

6.3.2 STANDARD 2: SAFETY

The activities and environment of the MHS are safe for consumers, carers, families, staff and the community.

Public safety must be paramount. In this case the assessing clinicians completely and totally ignored the wider public safety concerns to the patient to his family and to the wider public.

(White Wreath Association Inc, Queensland, Submission #81)

Under this Standard, submissions and presentations indicate concerns about:

  • inadequate treatment and support services to ensure the safety of consumers, carers and the community; and
  • safety not ensured in hospital environments.

6.3.2.1 Inadequate treatment and support services to ensure the safety of consumers, carers and the community

The only way the people I have mentioned will receive help is if they harm themselves severely or someone else which is more than likely and why should carers have to wait for such a result.

(Carer, Queensland, Submission #109)

As documented elsewhere in this Report, consumers and carers also raised concerns about their inability to access to treatment and support services during times of crisis (particularly when a threat to self or others or immediately after a suicide attempt).

[X] was on medication and her father apparently had been going to the [Rockhampton Mental Health] Unit advising them of the changes in [X] but they (M.H.U) ignored her father's concerns. On [date] 2003 [X] went to the mental health unit seeking help as she was hearing voices. They turned her away (this has been confirmed by the Rockhampton Police). Approximately 4pm on [date] 2003 [X] (after returning home) stabbed her nephew [Z] aged 3 yrs 11 months approximately 6 times in the chest (I have since been advised [X] did exactly the same thing to [X] as she did to her own child 5 years ago). [Z] died not long after ...1. We are looking for answer as to why the M.H. Unit turned [X] away from help on a public holiday. 2. Ignored [father's] pleas that he knew ([X] was living with him) there was something wrong with [X] ...4. Why was [X] discharged from the John Oxley Centre against her father's wishes into the care of the Rockhampton M.H.Unit. Some one has a lot to answer for after [X]'s unnecessary murder.

(Family Member, Queensland, Submission #43)

Two consumers died at Xmas one who self harmed and took it too far - we referred him to the service as he was very distressed and out of control he was assessed by a case manager as ok but died within the following week; The second went to the service begging to go into the unit as he knew that when he got this depressed he was at risk - this was our experience in the past and he was hospitalised and kept safe; they refused on this occasion - he took his own life a couple of days later.

(Anonymous, Queensland, Submission #113)

I believe if I were to have had counseling from the mental health team at Rockhampton when I required it I would not had had slapped the lady and would not have a criminal record now.

(Consumer, Queensland, Submission #192)

Concern was also expressed about the lack of follow-up and support services to ensure the safety of family members, service providers and the community.

More than half of the time within 48 hours, to a week, of her release we would be back at the emergency room when the medication had worn off and the delusions had returned full force and often she had lashed out at myself or my grandparents. ... We do understand that my mother makes it terribly difficult for the mental nurse to give her her medication, but still it happens all too often; when she will go without medication for a period of 2 weeks or longer. We are not only concerned for her, but for others whom she may come across when she is in an agitated state.

(Anonymous, Queensland, Submission #82)

As far as I can assess, community safety has been ignored. There is a high probability of antisocial behaviour and crime. There is no support or buddy system. Personnel at halfway facilities have not training in mental health issues. During their prison stay, offenders are encouraged to undertake rehabilitation courses such as substance abuse and substance abuse relapse programs. However once out of the predictable and structured institutional environment and experiencing high anxiety and with no community support network...if they get the offer of a quick fix from a drug dealer, it is not surprising that they would accept. Moreover, dealers hang around halfway facilities and prey on anyone who looks vulnerable: it is a system designed for failure.

(Anonymous, Queensland, Submission #67)

My brother has had so many hospital experiences where he should have been assessed and put into the mental illness acute care unit to stay. But never was. He has hung himself (survived) got cut down by his girlfriend at the time. He has drinking problem from using it for so long to cope. He has a self mutilation problem. He cuts himself with knives, stanley knives, any sharp instrument really. I have myself even taken him to the hospital and they have sent him home with me saying he's not a harm to himself. He has so many cuts over his body I've lost count. I mean cuts that have needed stitches. His last episode was only 2 weeks ago. He stabbed himself in the chest and ran the knife down to his stomach (20 stitches) on the outside and was lucky to have not hit any heart, bowel, major artery at all. Lost a lot of blood and pushed the knife in so deep is went through his breast bone. It was quite horrific. Once again he was sent home to us. Friday 3am in the morning this accident occurred. He was home Sunday morning with us. I am just so stunned that they think he is safe to be home when he can do such horrific things to himself. As our family we can't tie him down, we have to watch him 24 hours around the clock. If he disappears and goes drinking which he did one day later it is just so frustrating, tiring, and sad that there is no help. I thought he would get assessed by a psychiatrist at least and maybe had to stay in for so many days to be monitored. But no ...Sorry to have prattled on. What can I do - to help to fight for more funding - more help - more support.

(Carer, sister, Queensland, Submission #159)

My dearly missed mother struggled with her demons over a period of four to five months. In this time she attempted suicide on four occasions. It seemed that my mother's case was put into the ("too hard") basket and she was thrown on the scrap heap. We the family were left to figure it out in many ways on our own, and been sent back home to be shared among the family to help care for her and keep watch on twenty four (24) hours a day, seven days a week ...At this stage of my wonderful mother's sad story, it was having a huge affect on the whole family. The answer to my question to the doctor about how many attempts would be enough. Apparently the answer to that question as found out was five. Because on the fifth occasion, at approximately 1:30pm on the 15th October 2003, my mum decided to douse herself in petrol and set herself alight.

(Carer, Son, Queensland, Submission #184)

6.3.2.2 Safety not ensured in hospital environments

Concern was expressed that policies and procedures are not offering sufficient protection for consumers to feel safe in hospital settings. Standard 2.2 states: 'Treatment and support offered by the MHS ensure that the consumer is protected from abuse and exploitation'. The notes to Standard 2.2 state that safety is 'considered in terms of physical, social, psychological and cultural dimensions'. Standard 2.3 further states: 'Policies, procedures and resources are available to promote the safety of consumers, carers, staff and the community'.

In my last admission (one year ago) to a public hospital I was assaulted and many of my things were stolen and some jewellery was flushed down the toilet. I do not blame the other patient because she was very unwell but I expect to be safe when I get admitted to hospital ...

(Consumer, Queensland, Submission #204)

A few years ago a friend suffering from major depression and a high suicide risk was hospitalised in a large public hospital. The environment was appalling - there was no comfortable or safe place to meet and visit with patients and we were forced to sit outside in the car park so she could have a smoke, this was also to escape from the bizarre behaviour of other patients, which was disturbing and frightening to my friend She witnessed patients being assaulted by fellow patients (with no provocation on her part, one woman had a scalding cup of coffee thrown into her face by a male inpatient), had some possessions were stolen, was fearful of other patients and their behaviour and was mostly left unsupervised despite being a high suicide risk. I regularly witnessed patients absconding from the unit and also saw them at the nearby shopping centre, which was accessed by a very busy main road. Patients with quite bizarre behaviour were with patients with less confronting behaviours and this was frightening to those patients and also their relatives and friends. It was certainly no place to being to heal and the whole situation was quite traumatic for her as well as her friends and relatives. Upon her eventual discharge she was forced to wait for up to 6 weeks for a follow up psychiatric appointment. Luckily she had a wonderful GP.

(Clinician, Queensland, Submission #105)

It is likely that aggression to staff and financial risks from adverse events relating to the management of dementia and delirium in hospitals are rising. These issues deserve further attention.

(Clinician, Queensland, Submission #140)

Concern was also expressed by one carer that the consequence of a lack of appropriate safety procedures is increased police intervention:

I don't know how many times I had to get the police because he had absconded from hospital.

(Carer, Mother, Queensland, Submission #168)

6.3.3 STANDARD 3: CONSUMER AND CARER PARTICIPATION

Consumers and carers are involved in the planning, implementation and evaluation of the MHS.

No submissions or comments were received pertaining to this Standard.

6.3.4 STANDARD 4: PROMOTING COMMUNITY ACCEPTANCE

The MHS promotes community acceptance and the reduction of stigma for people affected by mental disorders and/or mental health problems.

My son had schizophrenia and he's now dead as well - he committed suicide. The community didn't understand and when people found out he had a mental illness they dropped him like a hot potato.

(Carer, Mother, Queensland, Rockhampton Forum #9)

Under this Standard, submissions and presentations indicate concerns about:

  • high levels of stigma and discrimination;
  • social isolation experienced by consumers and members of their family;
  • discrimination in employment settings;
  • discrimination by real estate agents;
  • stigma and stereotypes being perpetuated by the media; and
  • the impact of insufficient community education and lack of access to services on stigma.

My daughter has bipolar disorder ...My daughter has been able to return to teaching. But the point I want to make is that we still need to do a lot to educate the community.

(Carer, Mother, Queensland, Rockhampton Forum #12)

6.3.4.1 High levels of stigma and discrimination

Standard 4.1 states that activities are to be designed by the MHS which 'promote acceptance of 'people with mental disorders and/or mental health problems by reducing stigma in the community'. According to many reports received from consumers, carers and clinicians the level of stigma and discrimination being experienced across the State and across settings (e.g. in the community, in the workplace, with real estate agents and via the media in general) is still very high. Such discrimination is one of the key barriers to the realisation of the social, economic and political rights of people with mental illness.

People with a mental illness are treated like the 'untouchables' in India. ...carers are unpaid slaves and carers are also untouchables.

(Anonymous, Queensland, Rockhampton Forum #8)

There is an extraordinary amount of discrimination against people with a mental illness.

(Clinician, Queensland, Brisbane Forum #7)

For those left behind by these tragedies the hurt is no less traumatic and yet society's response to these surviving families and friends is vastly different from the help offered in other kinds of medical and social tragedies. It seems that no one cares or understands that the families and friends of suicide victims are in as much need of help and support as other members of our Australian society and are just as deserving of our understanding and respect. We have been creating - in the wider community - awareness of the misunderstandings relating to mental illness and providing community education concerning the lack of appropriate treatment.

(White Wreath Association Inc, Queensland, Submission #81)

Community attitudes need to change, to move away from a fear of 'madness' and accept that mental illness is a common and serious condition, which has the capacity to ruin many lives if unacknowledged and untreated.

(Carer, Wife and Mother, Queensland, Submission #157)

Furthermore, the mental health system appears to have failed families and their unwell relatives despite the rhetoric of responsive care and support. It shows little evidence of any commitment to useful change or of meeting the real needs of vulnerable clients and their concerned family members. Public education is imperative in bringing the illness out into the open and in stopping people suffering in silence. Thankfully, out of negative experiences, many positive, personally fulfilling experiences validate families' sacrifices.

(Carer, Wife and Mother, Queensland, Submission #157)

One carer expressed concern about the number of people with mental illness who do not acknowledge that they have an illness and that is probably due to the stigma associated with mental illness.

...the stats show that more than 50% of people with a mental illness don't acknowledge they have an illness. This community is a small community and there are tensions - we need to change but if its going to happen / change then we need to educate and address stigma - get a hold of the National Mental Health Plan. We must call on the community for understanding and action to improve the system.

(Carer, Queensland, Rockhampton Forum #14)

6.3.4.2 Social isolation experienced by consumers and members of their family

Not surprisingly, given the reports of the high levels of stigma and discrimination being experienced by consumers in Queensland, people with mental illness and mental health problems will be unlikely to share their stories or seek support from those in the community, or even close family and friends. Reports were received from carers describing feelings of social isolation and being unable to turn to anyone for assistance or support.

Mental illness is a 'hidden' disability for families who are labelled and marginalised along with their unwell relative. Their predominant theme is loss - of the 'well' relative, a lifestyle, a rightful place in their community and their identity as spouse, parent, child or sibling. They become carers, not by choice, but through love and obligation.

(Carer, Wife and Mother, Queensland, Submission #157)

He somehow got out of the hospital and went home to try and commit suicide. He wrapped wire around his neck and thumbs and then put the wire in the electrical socket in his bedroom. He didn't die. He somehow got a taxi back to the hospital and they had to amputate both thumbs ... We are not to tell outsiders of the way in which my uncle lost his thumbs. He didn't want to go out or do anything because people would ask him how this happened. I believe he tells them that he was in an accident. So, you will never get a true record of how many people depression is affecting whilst people won't tell the whole story.

(Consumer and Family Member, Queensland, Submission #94)

Neither my son nor I could turn for help, as no one was interested in helping us. I was afraid and afraid for my son. We were alone, inexperienced and left to cope the best way we could with our son's condition. My family and I were treading thin ice constantly as we thought what ever we said or did would aggravate our son's problem. I NOW KNOW BETTER THAT THIS WAS NOT THE CASE. All of this was extremely hard to cope with and the worst part was we had to do this in silence. (author's emphasis)

(Carer, Mother, Queensland, Submission #81)

[X] finally lost all hope and on the 29th of May 1999 he laid himself on a train track. ... Because of the myths and stigma associated with mental illness his condition became worse. He had nobody to turn to about his problem, as mental illness is something that is not discussed in our society. I also did not have anyone to turn to. It was like something very shameful had hit our family.

(Carer, Mother, Queensland, Submission #81)

6.3.4.3 Discrimination in employment settings

Many reports were received describing various barriers for people with mental illness to participating successfully in the workplace. These included problems with application forms, disclosure during the application process, lack of support when employed and termination as a result of mental illness. Many of these problems could be addressed by activities associated with Standard 4.2: 'The MHS provides understandable information to mainstream workers and the defined community about mental disorders and mental health problems'. Employment and support in the workplace by co-workers are seen as critical in the rehabilitation phase and successful reintegration into society at a social and financial level.

I feel lucky that I only have clinical depression. At least I can go to work and lead a relatively "normal" life. I know of a lot of people who can't. I know people who have never been able to go back to work after a major depressive episode and I am sure there are a lot of people in our community who have never been diagnosed with depression.

(Consumer and Family Member, Queensland, Submission #94)

A cousin who worked for the blue nurses in NSW was looking for work. She couldn't get work any more because of her mental illness she ended up killing herself.

(Anonymous, Queensland, Rockhampton Forum #5)

It is very difficult for people with a mental illness to get reemployment - if we have been sick and we have had a period away from work then we end up with a 6-month gap in our resume - how do we explain that when we know that if we mention we have a mental illness then we won't get a job?

(Consumer, Queensland, Brisbane Forum #11)

...issues that are regularly presented to our offices ...Job application forms with questions regarding "Have you ever had a mental illness?".

(Office of the Public Advocate worker, Queensland, Brisbane Forum #14)

I can provide examples of people who have been rejected for employment based on the fact that they have a mental illness. I have a friend who was told by her psychiatrist not to mention that she has a mental illness.

(Anonymous, Queensland, Brisbane Forum #15)

I also have a lot of contact with people who have had bad workplace and insurance issues - people who have been working and then need time off work and try to get income support have great difficulty. I also have many clients who have had depression and have lost their jobs because of their illness.

(Clinician, Queensland, Brisbane Forum #20)

Employment discrimination - what to tell interviewing panel about one's mental illness - do you have to disclose?

(Anonymous, Queensland, Submission #49)

...disabled adults received less income that the non-disabled in all the selected countries, but whereas the 16-nation mean was to receive 80% of the non-disabled income, in Australia the figure is only 44%. This puts Australia a long way behind even the second-last place getter the United States (59%), and more than 30 percentage points lower than nearly all the other countries ...{from "Inequality And Social Welfare, Ross Gittons (ed), page 153; personal income of disabled persons aged 20-64 as % of that of non-disabled people, late 1990s)]

(Anonymous, Queensland, Submission #49)

A female client hospitalised with major depressive episode and a high suicide risk took sick leave from her job, only to be eventually fired due to her illness. This occurred despite the fact that she was planning on returning to work and was progressing well. She later returned to work with another company (she didn't disclose her history).

(Clinician, Queensland, Submission #105)

I advise clients not to disclose to their employer if they currently have or have had depression or any other mental health condition, as ignorance and stigma remain high in the general community and they are likely to be penalised for their honesty.

(Clinician, Queensland, Submission #105)

I became the target of persistent, malicious rumours about symptoms of my illness. I attempted to address this informally to protect the reputation of some colleagues but was unsuccessful. One day I overheard a senior officer perpetuating this behaviour (some seven months after the allegations began) ... What helped me in reclaiming my life - I had an overwhelming desire to regain my pre-illness self (I maintained working with the help of supportive supervisors).

(Consumer, Queensland, Submission #313)

6.3.4.4 Discrimination by real estate agents

One consumer also reported being discriminated against when looking for rental accommodation.

Housing difficulty - if you present to a real estate agency and declare that you are on a disability support pension you aren't assisted - you'll be rejected!

(Consumer, Queensland, Brisbane Forum #11)

6.3.4.5 Stigma and stereotypes perpetuated by the media

How do we get through to the media the need for them to portray fair and true descriptions of people with a mental illness and not contribute to perpetuating stigma?

(Consumer, Queensland, Brisbane Forum #11)

From concerns raised primarily at the consultation forums in Brisbane and Rockhampton, it appears that any activities by the MHS to reduce stigma in the community must also address education of media personnel to modify their portrayal of people with mental illness and comparative references.

There is a lot of discrimination about mental illness in the media and reporting of crime. Data in media is often incorrect.

(Anonymous, Queensland, Brisbane Forum #16)

I'm from the bush and I have bipolar disorder. I agree with the previous speaker that there are many shocking articles in the media that shape the community's attitudes. Stigma is the biggest thing to fight.

(Consumer, Queensland, Brisbane Forum #12)

I head about something on radio national this morning. Someone referred to Mark Latham as needing medication and nurse ratchet. They said the Labor Party has to put him on medication. They were suggesting he had a mental illness and they obviously thought it was okay to make fun of this. That people with a mental illness shouldn't be offended somehow.

(Consumer, Queensland, Brisbane Forum #11)

Politicians and many journalists are contributing to the stigma we experience. It seems to me that rather than improving the use of discriminatory language over the years has gotten worse. It's not as if some politicians don't have real mental illnesses, they do. Some have even attempted to kill themselves.

(Consumer, Queensland, Brisbane Forum #11)

Stigma - how do we get a fair and true description of mental illness in to the media?

(Anonymous, Queensland, Submission #49)

...was seriously mentally ill but had difficulty accessing care. She attempted to jump off a moving ferry, she said the voices told her to jump off. She was finally transported to hospital at 10am and assessed by the mental health assessment team. She was then sent home in a taxi and murdered her nephew ...Current Affair did a story on incident - no permission to televise. Media portrayal of these issues.

(Family Member, Queensland, Rockhampton Forum #2)

Depiction of personality disorders (and specifically Borderline Personality Disorder) is rare in the propaganda that is being churned out by government agencies and organisations like SANE. This is despite the growth in community education about mental illness since the original Human Rights and Mental Illness Report was published early in the 1990s. In the few places where people who have been diagnosed with Borderline are included the descriptions are unfair, unflattering, sometimes wrong and judgemental.

(Consumer, Queensland, Submission #204)

6.3.4.6 Impact of insufficient community education and lack of access to services on stigma

Coupled with insufficient community education, the fact that consumers can only access services when they are in crisis reportedly makes it extremely difficult for consumers to be accepted into the community and to overcome the community's stigmatising attitudes and negative perceptions about mental illness. The following quote demonstrates the variability in behaviour according to mental state and the impact this has on behaviour while living in the community:

I don't know how many times I had to get the police because he had absconded from hospital. If these poor patients were kept locked up and treated aggressively when they first get to hospital, it would be better for everyone concerned, most of all the patients. My son is a very nice person and upstanding citizen when well, but does some terrible things when he is ill ...

(Carer, Mother, Queensland, Submission #168)

6.3.5 STANDARD 5: PRIVACY AND CONFIDENTIALITY

The MHS ensures the privacy and confidentiality of consumers and carers.

Under this Standard, submissions and presentations indicate concerns regarding confidentiality.

6.3.5.1 Confidentiality

But no-one from Mental Health would speak with me on the cop-out of patient confidentiality.

(Carer, Mother, Queensland, Submission #91)

The complex task of balancing consumers' right to confidentiality and carers' right and need to access information that will assist in their caring duties remains a vexed issue. A number of carers expressed concern and frustration both with current confidentiality policies and procedures and with the perceived failure of some clinicians to engage the family as much as possible. Furthermore, these concerns could also indicate that these policies and procedures are not being made available to consumers and carers in an understandable language and format (Standard 5.2) in order for consumers and carers to understand their rights and responsibilities. Standard 5.3 states: 'The MHS encourages, and provides opportunities for, the consumer to involve others in their care'.

Respondent F. spoke of her husband's in-patient psychiatrist as "abrupt, arrogant ...I was supposed to defer to his 'expert' knowledge". Due to privacy legislation, most respondents felt they had not been given a full description of their relative's diagnosis. Respondent C. stated, "even my family doctor would not discuss my son's condition with me ... how could I continue to care for him if I did not know what to expect?" Confidentiality considerations can be an excuse for lack of family members' inclusion in care planning.

(Carer, Wife and Mother, Queensland, Submission #157)

We as a family were not allowed to be involved with my son's treatment because of the confidentiality law. The law states, that my 19-year-old son - suffering mental illness and living at home - was deemed an adult so we were excluded from his treatment. This was thrown at me - his mother - in every direction and I tried extremely hard trying to contact my son's Doctor's, Psychiatrist and various organisations, but to no avail. (author's emphasis)

(Carer, Mother, Queensland, Submission #81)

The CONFIDENTIALTY LAW needs to be amended. There is no other illness in society that the medical profession do not involve the families or carers. However once a person has been diagnosed with mental illness the confidentiality law is used and abused to the detriment of the family and carers. An example of this abuse is if a person has been diagnosed with cancer, heart attacks, diabetes etc the whole family is involved however if a person who has been diagnosed with some form of mental illness the confidentiality / privacy act comes into play. SO WITH OR WITHOUT THE CONSENT of the person who has been diagnosed with mental illness we the families and carers who are the community care givers and providers MUST be involved, consulted and our opinions respected in determining the health and happiness of our loved ones. Exactly in the same way other illnesses are treated. (author's emphasis)

(White Wreath Association Inc, Queensland, Submission #81)

The following case scenario was outlined by White Wreath Association to reinforce the point:

Phone call from a mother very concerned about her daughter [X] 25 years of age. Her daughter constantly is talking of suicide. Mother does not know what to do. Mother can't handle situation. Daughter has punched and threatened to kill her mother. Mother afraid not only for herself but also for her daughter. Mother feels helpless. Mother can't cope anymore with her daughter's abuse, mood swings and threats. Mother feels ashamed that she wishes it all would end. Mother feels isolated and alone. Mother can't find any help. No service in place to help Daughter or Mother to cope with what is happening. CONFIDENTIALITY LAW EXLUDES MOTHER TO INTERVENE OR USE HER (MOTHER) AS A KNOWLEDGE SCOURCE TO HELP HER DAUGHTER. (author's emphasis)

(White Wreath Association Inc, Queensland, Submission #81)

6.3.6 STANDARD 6: PREVENTION AND MENTAL HEALTH PROMOTION

The MHS works with the defined community in prevention, early detection, early intervention and mental health promotion.

Under this Standard, submissions and presentations indicated concerns about:

    the lack of focus on prevention and early intervention;

  • the lack of available rehabilitation programs; and
  • problems with mainstream social agencies discriminating against people with mental illness.

6.3.6.1 Lack of focus on prevention and early intervention

Concerns was expressed about the lack of a preventive focus in the delivery of mental health services, despite the emphasis of such an approach in Standards 6.4 (capacity to identify and respond to the most vulnerable consumers in the community), 6.5 (capacity to identify and respond as early as possible) and 6.6 (treatment and support to occur in a community setting in preference to an institutional setting). In particular, it was noted that the lack of a preventive focus was resulting in deteriorating illness and increased need for acute care which could not be met by the current number of beds available in inpatient settings.

Prevention is obviously better and cheaper than a cure, but this is not happening resulting in a lack of available beds in our psychiatric wards.

(Carer, Mother, Queensland, Submission #10)

SANE Australia however, noted that the Queensland Reducing Suicide Action Plan 2003 is being implemented, including projects aimed at identifying and responding to vulnerable consumers and projects which promote mental health and prevent the onset of mental disorders and/or mental health problems (Standard 6.3):

The Queensland Reducing Suicide Action Plan 2003 is being implemented, with staff working on education, prevention and intervention projects at a number of sites, including two indigenous projects.

(SANE Australia, National, Submission #302)

6.3.6.2 Lack of rehabilitation programs

There's a real lack of services to help people get back into society to rehabilitate.

(Clinician, Queensland, Brisbane Forum #7)

Rehabilitation programs are acknowledged as a critical step in the reintegration process back into full life after a period of illness and the prevention of relapse for many people with mental illness. Such programs would include living skills programs, respite and social programs.

Access to rehabilitation programs is covered under Standard 6.8: 'The MHS ensures that the consumer has access to rehabilitation programs which aim to minimise psychiatric disability and prevent relapse'. However, both a clinician and a carer expressed concerns about the lack of rehabilitation programs available to help in this regard. These programs are essential to assisting people with disability to promote and protect their social and economic participation rights as evidenced in the following report:

We have a son ... with a mild intellectual disability ...2 years of age and remained in that job for ten years feeling a 'normal' part of the community ... Due to all this floundering over the past two years our son now 34 has regressed to a point where he is now in a community care unit seeming as though he has lost all hope of getting anywhere, his hygiene medication and budgeting skills at an all time low. My husband and I both 70 are no experts in mental health but feel had there been positive intervention in the beginning instead of lying about home he would be less reliant on the medical system now, plus the government spending good money into these job agencies which are totally dysfunctional.

(Carers, Parents, Queensland, Submission #150)

6.3.6.3 Social needs are not being met through the use of mainstream agencies

Standard 6.9 states: 'Wherever possible and appropriate, vocational and social needs are met through the use of mainstream agencies with support from the MHS'. Concern was expressed by Self-help Queensland that some consumers have been turned away from local neighbourhood centres on the basis that these centres can not afford the public liability insurance. Such discrimination only adds to the high levels of stigma experienced by people with mental illness and referred to previously.

We get a lot of requests from people who need access to self-help groups for people with a mental illness. They get turned away from neighbourhood centres. They have nowhere to go because they can't afford the public liability insurance.

(NGO worker, Queensland, Brisbane Forum #18)

One Early Intervention Project Worker in Rockhampton however reported that a large and active and positive community group exists in that area.

The Rockhampton community has a large and active network. It meets on a monthly basis - a good network needs to communicate with each other. They very much are working together.

(Early Intervention Worker, Queensland, Rockhampton Forum #19)

6.3.7 STANDARD 7: CULTURAL AWARENESS

The MHS delivers non-discriminatory treatment and support which are sensitive to the social and cultural values of the consumer and the consumer's family and community.

Under this Standard, a presentation at the Rockhampton forum indicated concerns about:

  • social and cultural prejudice from MHS staff towards Indigenous people with mental illness; and
  • the delivery of treatment which is seen as insensitive to the social and cultural needs of Indigenous people with mental illness.

6.3.7.1 Social and cultural prejudice by staff towards Indigenous people with mental illness

Concern was also expressed that discriminatory treatment is being delivered to Indigenous people with mental illness due to prejudice by some staff within the MHS. In the report presented, the result of such attitudes was to deny an Indigenous person access to treatment resulting in suicide. It is possible that improved monitoring by the MHS would assist in addressing 'issues associated with social and cultural prejudice in regard to its own staff' (Standard 7.5). This circumstance also indicates the benefit of regular cross cultural training of staff and the need for staff to have 'knowledge of the social and cultural groups represented in the defined community and an understanding of those social and historical factors relevant to their current circumstances' (Standard 7.1).

My son committed suicide 2 years ago. There are a lot of deaths here amongst indigenous youth. Before he killed himself my son went to the mental health unit and they told me he was suffering from behaviour problems - the perception was that because he was an indigenous young man that he was 'sloshed out'. We were told that he wasn't suicidal.

(Carer, Mother, Queensland, Rockhampton Forum #3)

6.3.7.2 Treatment to Indigenous people with mental illness is not delivered in a manner sensitive to their social and cultural needs

Evidence was presented which suggests that some mental health services have not been planned and delivered in a manner which 'considers the needs and unique factors of social and cultural groups represented in the defined community and involves these groups in the planning and implementation of services' (Standard 7.2). The following submission also specifically identified the need for cross cultural training as discussed above.

The other thing, I find we have indigenous persons in the mental health unit - it's not okay just to put a black face there - just to have contact with indigenous people. We need our workers to be fully trained and get off their butt and do something.

(Carer, Mother, Queensland, Rockhampton Forum #3)

By far and away the most prominent mental health concern facing the communities to which I travel [remote communities in Central and North West Queensland] are those of accumulated grief and loss and the intergenerational consequences of such losses. The history of colonization and cultural oppression represents over and over as symptoms of trauma, depression, drug and alcohol abuse, relationship breakdown and self harm. Tragically, the current, mental health system seems ill-equipped to deal, in culturally appropriate ways, with the complexities of Indigenous health.

(Clinician, Queensland, Submission #285)

6.3.8 STANDARD 8: INTEGRATION

6.3.8.1 Service integration

The MHS is integrated and coordinated to provide a balanced mix of services which ensure continuity of care for the consumer.

As a GP I have terrible trouble accessing services for people with a mental illness.

(Clinician, Queensland, Brisbane Forum #7)

Under this Standard, submissions and presentations indicate concerns about:

  • components of the MHS which are unwilling to provide integrated and coordinated care;
  • high staff turnover resulting in problems with continuity of care;
  • the ability of general practitioners to treat people with mental illness or mental health problems; and
  • difficulties accessing case managers.
6.3.8.1.1 Difficulties in organising integrated and coordinated care with components of the MHS

Clinicians raised concerns at their frustration with components of the MHS when trying to organise integrated and coordinated care for their consumers. Concerns were expressed that some clinicians were choosing only easy or 'lucrative' consumers, and thus discriminating against consumers with complex cases or who were poor. Additionally, concerns were raised regarding crisis assessment teams not appropriately assessing risk of self harm and discharging their duty of care and delivery of quality treatment.

One can usually find a specialist physician or surgeon to follow up difficult cases, offering whatever support they can. As a GP, I find it frustrating when psychiatrists will not do likewise. It appears that psychiatry operates in a comfort zone that conveniently defines the most troublesome and least lucrative cases as outside their concern. I often diagnose a life-threatening personality disorder but can't arrange any specialist support.

(Clinician, Queensland, Submission #42)

4 weeks ago a young man came to see me. He was suicidal, he had several crises in his life he was trying to deal with and he had been self-medicating. I see many people like him - they are not bad people but people who need assistance from society. I managed to get him assessed by a crisis assessment service - that in itself was a really big win! But the crisis service was going to send him home with some phone numbers. Fortunately I had organised to see him and threw a spack attack and asked them how they would feel if this young man was dead in the morning.

(Clinician, Queensland, Brisbane Forum #7)

[With regard to remote communities in Central and North West Queensland] Further inadequacies become evident with the local mental health system insisting that an individual must present with a clinical diagnosis in order to receive any type of service intervention. This policy flies in the face of research and the National Mental Health Strategy which emphasis the need to provide interventions early and to prevent the actual incidence of mental illness. I have personally found it very difficult to make referrals to Queensland Mental Health service due to barriers within the system. Employees within state mental health cite lack of resources and difficulties attracting staff to remote areas for their inability to accept referrals.

(Clinician, Queensland, Submission #285)

Concern was also expressed about the capacity of the sector to provide services to people with complex needs or people with dual diagnosis.

Collaborative service agreements between sectors that respond to the needs of people with dual diagnosis are required.

(Brain Injury Association of Queensland, Queensland, Submission #60)

These concerns would indicate that Standards 8.1.1 ('an integrated MHS is available to serve each defined community'), 8.1.3 ('There are regular meetings between staff of each of the MHS programs and sites in order to promote integration and continuity'), 8.1.5 (documented polices and procedures are used to promote continuity of care across programs, sites, other services and lifespan) and 8.1.6 (specified procedures to facilitate and review internal and external referral processes within the programs of the MHS) are not being met.

One clinician stated that many people within the health system are trying to provide integrated care to consumers in their community:

If someone is dealing with sexual issues they have to link with other service providers - NGOs, Anglicare, St Vincent's, Relationships Australia etc. We do try to respond to the issues in the community.

(Clinician, Queensland, Rockhampton Forum #7)
6.3.8.1.2 High staff turnover resulting in problems with continuity of care

Concerns were also expressed regarding the high staff turnover in various components of the MHS and that this impacts on the ability of the MHS to deliver continuous and integrated care.

...there are major problems in mental health and I would classify these into two particular areas. Firstly the mental health services are basically out-patient based services and appear to have a high turnover of professional staff resulting in poor continuity and frequent early termination of patient treatment programs. Sufferers of mental illness find it more difficult than most to adjust to continually changing professional staff.

(Dr Bruce Flegg MP, General Practitioner and Liberal Shadow Minister for Health,
Queensland, Submission #39)

More than once the police local have said that it is not their problem and we should call her mental health worker, who is 100kms away and never able to take our call because she is so busy she is rarely in the office. More often also, the mental health worker who is in charge of my mother's care, changes twice a year, and she is periodically moved between the West End Mental Health Clinic to the one at Ashgrove (I can never remember if it is Ashmore or Ashgrove).

(Anonymous, Queensland, Submission #82)
6.3.8.1.3 General practitioners lack the skills to treat people with mental illness or mental health problems

One consumer also expressed their concern that in their experience, general practitioners do not possess the skills to treat mental illness.

I don't think general practice is skilled up or prepared or ready to deal with mental illness.

(Consumer, Queensland, Brisbane Forum #11)
6.3.8.1.4 Difficulties accessing case managers

Concern was expressed regarding the difficulties in accessing case managers to ensure continuity of care. Difficulties were associated with apparent changes in policies and procedures and lack of follow up. Standard 8.1.5 states: 'The MHS has documented policies and procedures which are used to promote continuity of care across programs, sites, other services and lifespan' and Standard 8.1.6 ensures that the MHS has specified procedures to facilitate and review internal and external referral processes. Standard 8.1.7 also requires that 'The MHS monitors its performance in regard to the above criteria and utilises data collected to improve performance as part of a quality improvement process'.

Last year Central Coast Mental Health Services discontinued the practice of assigning case managers to individual patients which means that unless an ill person calls the Central Intake number asking for help, they will see no-one. This effectively means that a consumer has to decompensate to the stage where friends & family are begging for help. Previously a good case manager, seeing the consumer on a regular basis, would be able to observe a gradual deterioration and arrest it before the consumer required hospitalisation.

(Carer, Mother, Queensland, Submission #10)

The social worker he seen on Sunday advised that someone would be visiting him. Monday Mum took him to Dr [Z] at the Canbridge Centre. Then no-one came all week. On Friday he did his cognitive therapy on Friday [sic]. He only got a case manager recently, after he [tried to] hang himself. Cognitive Therapy has just started in the last couple of weeks.

(Carer, Sister, Queensland, Submission #159)

The case manager of this person often provides education for carers and community workers around the multiple psychological issues and sometimes physical issues as well and gets a sense of what is normal for that person at their best function in their own home. They facilitate coordinated care across agencies. This integration and awareness often disappears with the withdrawal of case management when the person no longer meets criteria for the psychogeriatric service. The potential consequence is earlier admission to an acute hospital bed or residential care. Theoretically, coordination of care can be achieved by the GP. Unfortunately many older people find visiting and waiting for the GP difficult and home visiting is a vanishing component of practice.

(Clinician, Queensland, Submission #140)

6.3.8.2 Integration within the health system

The MHS develops and maintains links with other health service providers at local, state and national levels to ensure specialised coordinated care and promote community integration for people with mental disorders and / or mental health problems.

Under this Standard, submissions and presentations indicate concerns about:

  • the difficulties experienced by consumers in accessing treatment for their physical heath care needs.
6.3.8.2.1 Lack of access to services to meet physical health needs

Consumers and a clinician expressed concerns about the difficulties faced by consumers in having their physical health care needs assessed and treated. Given that this report documents extensively the difficulties consumers face in accessing treatment and support for their mental illness, claims that, due to their mental illness consumers face barriers to accessing treatment and support for their physical illnesses are very concerning. This would also indicate that comprehensive health care is not being promoted for consumers (Standard 8.2.1).

In my experience doctors are very reluctant to accept that people with a mental illness have a physical illness.

(Consumer, Queensland, Brisbane Forum #17)

There's also very poor access to physical health assessments for people with a mental illness.

(Clinician, Queensland, Brisbane Forum #7)

My physical health needs are best attended to by my psychiatrist.

(Consumer, Queensland, Brisbane Forum #11)

On three occasions my son [X] has been admitted with physical problems which either had not been noted on admission or were ignored even when they had been noted. On one occasion he went three days before the symptoms were properly addressed. The end result was an emergency operation for the removal of a salivary gland with embedded calcium stones.

(Carer, Wife and Mother, Queensland, Submission #52)

...he had been assessed / worked with by CCU for 13 months ... Another concern is medical attention ... For instance his oral care - I doubt [X] has been to a dentist for a decade or more ... I also think [X]'s hearing is suspect and if he goes to a doctor occasionally - will he personally raise the issue of hearing? - I doubt it. So things go on unchecked.

(Carers, Parents, Queensland, Submission #150)

6.3.8.3 Integration with other sectors

The MHS develops and maintains links with other sectors at local, state and national levels to ensure specialised coordinated care and promote community integration for people with mental disorders and / or mental health problems.

Under this Standard, submissions and presentations indicate concerns about:

  • the lack of a whole-of-government approach to improving the quality of life of people with mental illness;
  • the lack of a whole-of-government approach to improving the quality of life of Indigenous people with mental illness and mental health problems;
  • children and youth in crisis and the need to integrate youth suicide prevention strategy and strategies for Indigenous youth;
  • housing;
  • police;
  • corrective services and the criminal justice system;
  • employment;
  • education;
  • wards of the state; and
  • the lack of coordinated care across sectors for older people with mental illness.

The necessity of a whole-of-government approach to specifically care for children who have become wards of the state was also specifically raised through this consultation process.

6.3.8.3.1 Whole-of-government approach needed to improve the quality of life of people with mental illness

Many submissions and presentations noted a lack of, and expressed the need for, a whole-of-government approach to solve the complex support needs of people with mental illness and their families and carers to live in the community in a dignified manner with the opportunity to participate socially and contribute economically. As described below, problems were reported about housing, employment, education, police and the criminal justice system. Many submissions identified that a broader governmental, societal and community approach was required:

There are questions around quality of life for people.

(Consumer, Queensland, Brisbane Forum #11)

The high levels of unemployment in Rockhampton contribute to the development of mental health problems. These people keep coming back and back but you see the deterioration - no support and no families, living in hostels.

(Anonymous, Queensland, Rockhampton Forum #17)

My concern is with the criminalisation of mental illness. Some people are punished over and over again. There's no housing and support available - so people will continue to get into trouble - so what we end up with is a system where people with mental illness are being socialised in prisons, socialised into criminal activity, criminal ways, they shouldn't be there in the first place.

(NGO worker, Queensland, Brisbane Forum #4)

Our people strike chaos at 21 -27 years. I feel the government is trying to dispense with them as their responsibility. There's no accountability between the states and the Federal governments about how the funding is spent or what is achieved with it.

(NGO worker, Queensland, Brisbane Forum #1)

The sector faces further difficulty with the way in which investment is divided between a 'medically focussed' health department and the 'disability focus' of Disability Services Queensland (DSQ) ... Moreover, the Alliance is concerned that the types of funding models that are currently available to the non-government mental health sector through DSQ do not meet the needs of people affected by mental illness and psychiatric disability. In fact, the Alliance would argue that the funding framework could at times be detrimental to the wellbeing of this group.

(Queensland Alliance of Mental Illness and Psychiatric Disability Groups, Queensland, Submission #218)
6.3.8.3.2 Whole-of-government approach needed to improve the quality of life of Indigenous people with mental illness and mental health problems

The need for a whole-of-government approach to address the myriad of health and social problems of Indigenous people was particularly identified as critical by one clinician:

In viewing health as Indigenous people do, in holistic terms, it is impossible to overlook the enormous influence social factors have on the mental health of the people of Western Queensland. Poverty, inadequate housing and isolation rank high in the list of challenges to people's general health and well-being ... Mental Health services which insist on providing individualized, clinical services cannot hope to be effective without also addressing the collective, environmental influences on mental health. As I write this I am aware that funding approval has been granted for the establishment of a Social Emotional and Well-Being Centre to be based in Mt Isa, for the purpose of providing education and support to Indigenous Health Workers. This is a hugely exciting prospect and will doubtless enhance the capacity of communities to engage early intervention strategies as well as respond to mental health emergencies. This is not a project of the local area Mental Health service, nor state government.

(Clinician, Queensland, Submission #285)
6.3.8.3.3 Children and youth in crisis - need for a whole of government approach

In particular, many submissions and presentations identified serious concerns about the paucity of services and integrated services to assist young people with mental illness or mental health problems. Coordinated services are seen as essential for early intervention to halt spiralling negative life consequences for young people resulting in homelessness, suicide, contact with the criminal justice system, separation from the family and being placed in foster care. Some interagency projects to address these were highlighted by Queensland Health. The need to integrate the youth suicide prevention strategy and initiatives for Indigenous youth is also seen as critical. The need for improved links at the national level and joint responsibility for many of these programs is likewise seen as critical.

The key issues as I see them are the lack of support services available to young people with comorbid mental health and drug and alcohol problems ...There is a lot of buck passing that goes on between mental health, justice and welfare departments. Ultimately these young people are primarily dealt with by the justice system. The other departments have failed them and they end up in trouble.

(Youth NGO worker, Queensland, Brisbane Forum #6)

We run a program for young people with dual diagnosis - young people at high risk. We had some funding for 12 months. We had $30,000 from the state and $100,000 from the Feds. We employ 2.5 counsellors. We are now unable to get any further funds so we are focussed on raising funds rather than getting on with the job. It is so difficult to get ongoing support from the State Government.

(NGO Service Provider, Queensland, Rockhampton Forum #18)

We are most concerned about "ping pong therapy". These kids who are diagnosed with difficult behaviour, nobody wants to treat them and they are bounced from one provider to another. We have to ask where are they going? Often they end up being place in foster care.

(Child and Youth NGO worker, Queensland, Brisbane Forum #9)

Too many young people deliberately kill themselves. Over the years, a dozen or more of the statistics have been my patients. Being poor, smelly, irritable or homeless should not be a death sentence. It's time we cut the crap about the tragedy of youth suicide and ensured a service actually gets provided for people who desperately need it.

(Clinician, Queensland, Submission #42)

Also, I have been astounded where child abusing shop keepers sell tobacco and alcohol to kids as young as 14 yet when reported to the authorities nothing happened. What about drug child abusers who provided marijuana to teenagers. I am starting to believe that, where post-pubic people are concerned the worst child abuse is the supply to teenagers of cigarettes, alcohol and marijuana,

(Carer, Mother, Queensland, Submission #91)

Some recent examples of inter-agency coordination include:

•  The Pine Rivers CYMHS [Child and Youth Mental Health Service] established a formal inter-agency forum over six years ago specifically to coordinate care for clients whose needs were not met by normal collaborative processes. Key agencies include CYMHS, the former Department of Families (now communities) and Education Queensland with other services coopted as required for specific cases. A similar interagency forum covers the rest of the Royal Children's Hospital Health Service District.

•  The Child and Forensic Outreach Service (CYFOS) regularly coordinates and participates in inter-agency meetings and discussions regarding the target group ...

•  Youth Justice Services (YJS) in Morayfield is the lead agency in an inter-agency forum for the Caboolture are that involves CYMHS, Alcohol Tobacco and Other Drugs Services (ATODS), Juvenile Aid Bureau (JAB), Education Queensland and Department of Communities / CYFOS / Indigenous representatives as required. All of these inter-agency processes work on individual case planning.

•  The CYMHS at Royal Children's Hospital has a number of projects addressing the needs of young people with multiple problems (e.g. a dual diagnosis working party, the Koping project, Future Families etc).

(Mental Health Unit, Queensland Health, Queensland , Submission #311)
6.3.8.3.4 Housing

Housing difficulties - many people with mental illness living in one public housing block - quality of life in supported care hostels / boarding houses ...

(Anonymous, Queensland, Submission #49)

The lack of available housing and accommodation options for people with mental illness was repeatedly raised as a critical gap in the attainment of mental, physical and social well-being. Concerns were expressed (as detailed in Standard 11.4.B Supported Accommodation) that the lack of available supported accommodation or other accommodation options resulted in people remaining in care for longer periods of time than necessary because there were no alternatives or becoming homeless. In particular, access to secure and safe accommodation is seen as essential in the process of reintegration into the community and improved mental health. The lack of available housing and accommodation options and the process of deinstitutionalisation and consequent lack of community services, have resulted in many people with mental illness becoming homeless; placed intolerable strain on families; and contributed to declining health and quality of life.

Where is it? The organisation I work for has tried for the last decade to supply appropriate, affordable supported accommodation for people with a mental illness / disability. We are exhausted, frustrated and generally confused by the inflexible poorly coordinated Government Departments that should be providing service to people with a mental illness. It seems to me that no single Department has the ability or inclination to play the lead role in the provision of service to this client group. (author's emphasis)

(NGO Service Provider, Queensland, Submission #40)

I have seen things which haven't changed at all. For example, the crisis homeless services which are funded under Commonwealth / State Housing Agreement. Initially these were 50 / 50 tied funds between States and the Feds. Queensland put in less than any other State ... The Victorian Government on the other hand put in 50 / 50 with the Federal Government and then put in an additional $12 million.

(Supported Accommodation and Assistance Program Service Provider, Queensland, Brisbane Forum #2)

In most cases no account is taken of special needs. One course that appears to provide some hope is to send a letter from a psychiatrist to the Department of Housing. However the housing stock offered may not suit the client and even if it is deemed to be acceptable, much needs to be done to get it set up after the release. There is a need for cooperation between Housing and Corrective Services to allow this transition to work better. Furthermore there needs to be a support team to get it to happen.

(Anonymous, Queensland, Submission #67)

So, when the politicians we approached told us that x many extra dollars were being spent on this and that, I was able to say, "but there is still no long term supported accommodation available." Not that it has made much impact on them. There is some crises accommodation, and some short term accommodation until other long term accommodation becomes available, but none of this latter is supported anyway. We will keep plugging away at this topic for the foreseeable future.

(Carer, Mother, Queensland, Submission #228)

There are 192 SAAP [Supported Accommodation and Assistance Program] Services like mine in Queensland. The Queensland Government did put in some funds to look at people with a mental illness but provided through HACC [Home and Community Care] services. I phoned HACC to seek advice about how funds would be distributed - there was no consultation.

(Supported Accommodation and Assistance Program Service Provider, Queensland, Brisbane Forum#2)

In response to the above claim, after attending the forum Queensland Health provided the following explanation:

Whilst the facts of this complaint are not clear, Queensland Health believes this complainant may be referring to the Resident Support Program (RSP), a pilot project in five sites which is actually not targeted at homeless people. The RSP aims to improve the quality of life for people with a disability living in private supported accommodation/hostels (as a priority), boarding houses and aged rental accommodation. Eligible residents receive services such as:

•  Community linking:- helping people to develop or rebuild relationships in the community through meaningful activities (e.g. social, educational, recreational and vocational opportunities)

•  Disability support:- assistance with personal care (e.g. showering, toileting, dressing / undressing and meals in the place where they live)

•  Key support workers:- support for people to get primary health care and / or linking to community based organisations for a range of non-health related services.

Disability Services Queensland (DSQ) is the primary finding agency ($1.6 million annually over three years) although Queensland Health also supports the RSP with Home and Community Care funding of $500,000 annually over the same period and $70,000 for project support. Some people living outside the five trail sites ( Brisbane , Ipswich , Toowoomba, Townsville and the Gold Coast) understandably may not be aware of these details of the project and may unfortunately have assumed that HACC funding was not being allocated equitably.

(Mental Health Unit, Queensland Health, Queensland , Submission #311)
6.3.8.3.5 Police

Due to diminishing access to mental health services, police have been increasingly called to respond to assist with people with mental illness, especially in times of crisis. While Memorandums of Understanding and protocols have been drawn up, evidence suggests that further education is required to more clearly protect the rights of people with mental illness who come into contact with the police and the criminal justice system.

My beef is with the police - it was reported that he had a mental illness and the police threw him in the cell with nothing, not a bucket to pee in or anything. He told them he had a mental illness and they didn't follow the protocol ... The police need education.

(Carer, Mother, Queensland, Rockhampton Forum #9)
6.3.8.3.6 Corrective services and the criminal justice system

Another consumer pleaded guilty to something they didn't do just so they could get into a "better cell" - a 14 week prison sentence was better than being sick and homeless.

(Carer NGO worker, Queensland, Brisbane Forum #22)

The criminalisation of mental illness was raised by many consumers and consumer advocates as being the inevitable result when services are not available to provide treatment and support, accommodation is not available and levels of stigma are high. Of serious concern were reports that prison (and any subsequent loss of rights) is seen as a positive option as it offers shelter and potential access to treatment. Insufficient treatment and support services were also noted for people with mental illness after release from prison. Again, the need for a whole-of-government approach is seen as essential to redress these problems both to prevent entry and to assist consumers post release. Evidence was presented that sufficient efforts are not being made.

My concern arises from the criminalisation of mental illness. Some people with a mental illness are being punished over and over again. Housing and support for these people has been so neglected that approximately 400 are now housed in mainstream prisons in south-east Queensland.

(Anonymous, Queensland, Submission #67)

Justice system - inappropriate placement of people with mental illness in jails. Buck passing for dual diagnosis.

(Consumer, Queensland, Brisbane Forum #11)

There's a real smokescreen here - Queensland Health has employed a project officer looking at the mental health of women in prison. One project officer! What sort of response is that?

(Prison NGO worker and Consumer Advocate, Queensland, Brisbane Forum #5)

Solicitors may have poor knowledge of mental health issues. A court liaison officer works at the Brisbane courts but mental health clients appearing at other courts have no access to this service.

(Anonymous, Queensland, Submission #67)

The release of prisoners is an area that has been neglected. These people experience high levels of anxiety. Moving home is listed as one of the times of highest anxiety in a person's life: setting up home after being in prison is an impossibly difficult task for some prisoners. Prison becomes the preferred housing option when transition to community is so neglected, even though prison is certainly not safe asylum.

(Anonymous, Queensland, Submission #67)

In my view, a focus on the number of prison days versus community days would be more likely to reveal economic costs of poor policies and practices, and forward the development of changed policies and practices that lead to successful release outcomes.

(Anonymous, Queensland, Submission #67)

In a letter from the minister for Corrective Services dated 15 June 2004, mention is made of a new pre-release program that 'will be introduced in all correctional facilities, with the intention of identifying needs and linking individuals with appropriate agencies'. This sounds all very well in theory, but no commencement date is given, nor any means of follow through to the community. Making vague allusions to some future plan that may or may not come into existence is not enough. Furthermore a joint post-release employment service is offered by Corrective Services and Employment and Training is mentioned. This service may exist, but people without support would not be able to gain access and others would not know about it. It is proposed that dedicated support service teams would provide necessary linkages through a thorough knowledge of this and any other services. It is proposed that the CAP program previously run by Volunteering Queensland and defunded by the incoming Borbidge government be resurrected: this type of access to meaningful activity is much more likely to provide successful outcomes for vulnerable people.

(Anonymous, Queensland, Submission #67)
6.3.8.3.7 Employment

Re-employment is also a critical component in the process of social integration and living a meaningful life with dignity in the community. However, concerns were expressed by one carer who had experiences with many providers that agencies are not providing adequate services.

Enrolling with job agencies who were supposed to deal with clients and their disabilities was a nightmare, only being able to register with one at a time - all keen to take you on their books so they receive government funding but as far as service goes - forget it. One agency failed to return calls, kept telling us nothing on the horizon jobwise, another told me not to worry ... the government spending good money into these job agencies which are totally dysfunctional.

(Carers, Parents, Queensland, Submission #150)
6.3.8.3.8 Education

Standard 8.3.2 states: 'The MHS supports staff, consumers and carers in their involvement with other agencies wherever possible and appropriate' and Standard 8.3.3 states 'The MHS has formal processes to develop inter-sectoral links and collaboration.' These Standards apply to the education sector, including schools, TAFE and universities.

Links with the education sector to assist with early identification and early intervention are seen to be critical in any set of strategies targeted at prevention and gaining the necessary skills to attain qualifications necessary for employment and participation in society. One carer reported that despite efforts from the clinician involved, the education sector did not appear to sufficiently accommodate the needs of the consumer and contributed to making matters worse.

In 1996 my son [X] was diagnosed with schizophrenia while he was a student at the Central Queensland University in Rockhampton. [X] desperately tried to continue his studies but he received no help or encouragement from the University. Dr [Y], who was [X]'s treating psychiatrist at the Rockhampton Mental Health Unit wrote a letter to the University explaining how Schizophrenia would affect [X]'s abilities. I contacted the Disability Officer at the University to explain [X]'s illness, but she refused to discuss it with me, saying she had to establish a relationship with [X]. [X] had no insight into his illness ...[X] changed to studying fewer subjects externally, but there were still problems with administrative tasks. He would enrol in subjects and be unable to carry out administrative tasks. He would fail to withdraw from subjects by the required date. Then he would accrue a HECS debt for that subject. He now has a large HECS debt. I wrote to HECS, enclosing a letter from Dr [Y], explaining the Situation, but HECS would not make any allowances for his illness. I would like Universities and HECS to develop an understanding of mental illness and their effects, so these institutions do not make matters worse. [X] was helped by many people, but not by anyone associated with the Central Queensland University.

(Carer, Mother, Queensland, Submission #65)
6.3.8.3.9 Wards of the State - need for a whole-of-government approach

I was also placed in Wolston Park Mental Hospital, as a child, by the Children's Department and there was nothing wrong with me ...we cannot get recognition or help with counselling as our situations are a little different to other state wards that were abused. You have no idea how hard it is to survive and then function after being through a place like that when there is nothing wrong with you and being young. I spent some time locked in with the criminally insane and that is something I will never forget and I cannot, for the life of me work out why children were put in there and then forgotten about.

(Anonymous, Consumer, Queensland, Submission #304)

Two submissions highlighted the need for the Government to adequately care, through a whole-of-government approach, for those children and adolescents placed in the State's care. These anonymous submissions claimed that they had been placed in adult mental health services when young and that gaps in multiple areas resulted in their deteriorating mental health, resulting in serious life consequences.

They never taught us any life skills at all such as how to manage money or even how to cook or how to have a normal conversation or how to inter-act with normal people. We were never taught how to look for a job or how to present ourselves to a prospective employer or even personal hygiene ... I find it very hard to understand why these people messed with children's lives as they did and got to walk away from the damage they had done and the responsibility that they had. How dare they ...I challenge any adult, let alone a child, to be drugged, bashed and abused and live in constant fear while living with the criminally insane and see how they come out of it. Then I would like them to try and function normally without any help from anyone or any Government Agencies.

(Anonymous, Consumer, Queensland, Submission #304)

Age 15 I was placed in a security ward with the criminally insane and other dangerous women and eventually men and women some were there under queens pleasure for crimes such as murder, rape, armed robbery etc. Wolston Park Hospital also called Goodna some girls before my time were sent from Karalla House a place for young girls who were terribly abused there and then also suffered at Goodna as young as 12yrs old, there were disabled kids sent there when I was there suffering still brings a tear to my eyes and I'm now 39 ...

(Anonymous, Consumer, Queensland, Submission #300)

I wonder how a girl who is striped naked by men and women while in a cell then forced to the ground injected with mind blowing drugs left there for days sometimes, what becomes normal behaviour of a child being subjected to this and other abuse.

(Anonymous, Consumer, Queensland, Submission #300)
6.3.8.3.10 Lack of coordinated care across sectors for older people with mental illness

A clinician expressed strong concern with the lack of integration and coordination between mental health and the general health and social service sectors in the provision of treatment and support for older people with mental illness in Queensland:

Relationship between mental health services and the general health and social services sectors. One of the most frustrating aspects of the current system of health care for older people is the lack of integration, continuity and coordination of care between the various agencies that provide assessment, treatment and support for people living in their own homes. Problems include:

•  repetition of assessment

•  multiple agencies

•  multiple, unconnected systems of documentation

•  inter-agency conflict

•  non-overlap of catchment areas

(Clinician, Queensland , Submission #140)

One of the richest sources of expertise, in many districts helping with the recognition of depression and psychosis, the Aged Care Assessment Services, cannot intervene past the point of assessment. They are also poorly integrated with State-funded agencies in many instances.

(Clinician, Queensland , Submission #140)

The development of models of integrated social and health services for older people are highly encouraged e.g. having a common shopfront for community-focussed social, psychogeriatric and geriatric medical services such as ACAS [Aged Care Assessment Services], psychogeriatric community service, community health, all with the same catchment area, with the capacity to:

•  provide assessment and case management and

•  to deliver specialist geriatric medical or psychiatric expertise as needed

with the aim of preventing hospital admission and delaying residential care placement, reducing replication of assessment and delays in approval of service packages and perhaps producing economies of scale through rationalisation of documentation, education and training and reception functions.

(Clinician, Queensland , Submission #140)

Policy for older people should reflect the high prevalence of physical and psychological morbidity among carers of older people (eg. Bruce et al. 2002). This "second patient" phenomenon is found more commonly than for carers of younger people. Carers are also more likely to be asked to speak for identified consumers and may have the official position to be able to make health-related decisions for those with impaired capacity. Existing policies around outcome and satisfaction measures may not do justice to this issue. The implementation of programs (e.g. Beyond Blue) arising from the NMHPs [National Mental Health Plans] seems relatively non-inclusive of issues particular to older people.

(Clinician, Queensland, Submission #140)

In conclusion, in an ageing society, omission of psychogeriatric issues in national mental health planning will become increasingly unrepresentative.

(Clinician, Queensland, Submission #140)

6.3.9 STANDARD 9: SERVICE DEVELOPMENT

The MHS is managed effectively and efficiently to facilitate the delivery of coordinated and integrated services.

...issues that are regularly presented to our offices ...One of the dilemmas is the culture of the mental health system - "toxic" culture of the mental health system.

(Office of the Public Advocate worker, Queensland, Brisbane Forum #14)

Under this Standard, submissions and presentations indicate concerns about:

  • the current state of mental health services in Queensland;
  • lack of funding and resources;
  • concern about the relocation of community based services back to hospital settings;
  • lack of consultation with consumers, carers and service providers;
  • planning and accountability;
  • need for staff training and development;
  • staff attitudes;
  • rural and regional issues;
  • support for critical services provided by NGOs;
  • the cost of care and access to psychiatrists and psychologists;
  • low regard for psychogeriatric planning and policy development; and
  • research.

6.3.9.1 Concerns about the current state of mental health services in Queensland

While the majority of this Report documents a variety of concerns regarding the current state of mental health services in Queensland, some reports were received indicating that improvements had been witnessed and that not all hope is lost.

Brian Burdekin's 1993 report is just as valid today as it was eleven years ago and in some instances the situation is worse, e.g. with psychiatric clients losing case management support; and the decrease in housing stocks.

(Anonymous, Queensland, Submission #67)

The present policy of incarcerating vulnerable people in mainstream prisons in the first place is questionable. As Sally Satel states, 'Releasing [mentally ill people] from the large state institutions was only a first step. Now we must do what we can to free them from the "cold mercy" that comes from criminalising mental illness.'

(Anonymous, Queensland, Submission #67)

While funding to the State mental health services has increased in recent years, Queenslanders continue to report many problems with access to services - still far too few mental health workers based in the community, difficulty finding in-patient beds when people are acutely ill, and a continuing shortage of supported accommodation.

(SANE Australia, National, Submission #302)

...a larger theme of inequity across the entire health system. That is, Australians acknowledge and have come to demand their right to the best available healthcare in times of need, but the rights of people affected by mental illness have not been as well recognised within the overall system ... The Alliance supports the call for an adequately resourced, ethical and effective public mental health system. We believe that there are numerous inadequacies within the current system both in terms of resources and culture. However, the Alliance is concerned that increasing investment in the public mental health system without also investing in the community sector will continue a cycle of dependence on hospital care.

(Queensland Alliance of Mental Illness and Psychiatric Disability Groups, Queensland, Submission #218)

My comments are experience is related primarily to adult services. Not all changes are bad for example integrating and outsourcing and essentially referring people on to be managed in the community. The way in which this was carried out though was appalling (a bit like deinstitutionalisation i.e. no community support when moving people out) and of course this only works if there are the community supports available and they are appropriate ...

(Anonymous, Queensland, Submission #113)

Let me say at the outset I consider that in general mental health services are better in Queensland than they were one or two decades ago. I would solely attribute this improvement to adult and children's mental health facilities around the State. Prior to this the advent of these facilities it was often impossible to access mental health for patients in the areas in which I work.

(Dr Bruce Flegg MP, General Practitioner and Liberal Shadow Minister for Health, Queensland,
Submission #39)

On a positive note though I believe there is an attempt to work with the standards and have policies in place, which support these. The paperwork looks great. There are as always good case managers and bad and there are some very good ones who care and do have expertise. They are the minority though and the service criteria is shrinking making it harder and harder for people to access and for the good case managers to work effectively.

(Anonymous, Queensland, Submission #113)

There are also very few community and NGO based services. What are available are woefully undermanned, under staffed and under-funded. Surely the right to adequate services is a basic human right?

(Consumer Advocate, Queensland, Submission #16)

Prisoners with a mental illness may become prisoners for life, or revolving door prisoners. The criminalisation of mental illness is a disgrace. There are 400 people with a psychiatric diagnosis in SE Queensland prisons. They may be a released without any notice being given to the IFMH prison liaison officer. There is no mental health service in low security facilities. This is of particular concern in that prisoners are sent to a high security facility if they become unwell: consequently, they may attempt to hide their illness and become even more unwell. Prisoners may be released with less than one-day notice. My son was taken on short notice to a halfway facility where staff had no understanding or training in mental health support. My son arrived but his antipsychotic and antibiotic medications were still at the prison. He phoned me in a highly anxious state. He 'borrowed' medication from another prisoner for that night and the next day he was given leave to go to the allocated hospital (which is not the hospital he was previously assigned to in the community) where he sat for four hours to get a script.

(Anonymous, Queensland, Submission #67)

The Alliance is also concerned by the increasing public call for a return to more "protectionist" responses in the treatment and support of people who experience severe mental illness.

(Queensland Alliance of Mental Illness and Psychiatric Disability Groups, Queensland, Submission #218)

In reference to the "Mental Ill Health System" which has gone backwards since the sell out of mental hospitals, and is now basically "drag em in - drug em up - chuck em out". ... The following are what I put are necessary: 1. Total Federal control of the "ill health system"; 2. Restoration of Mental Health hospitals with their various stages ... by whatever name; 3. Various types of supervised and unsupervised abodes. 4. Eliminate the "Death Camp mentality".

(Carer, Father, Queensland, Submission #141)

It wasn't until sometime later that I heard that some regulatory bodies refer to (sections of) Queensland Health as consistently displaying a 'toxic culture'.

(Consumer, Queensland, Submission #313)

6.3.9.2 Lack of funding and resources

Many problems were raised related to the current lack of funding and funding distribution across rural and regional areas, which results in lack of staff and resources to deliver quality mental health care. Submissions stressed that their concerns in this regard were not directed at clinicians but at the realisation that insufficient funds and resources were being allocated for clinicians to provide or organise quality care. Lack of funding and resources were also identified as part of a package of problems in recruiting staff to fill vacancies in rural and regional areas.

Only 8% of health budget in Australia goes toward mental health while incomparable countries (N.Z., U.K.) spend 13%.

(Anonymous, Queensland, Submission #49)

There is not enough staff in hospitals.

(Consumer, Queensland, Brisbane Forum #11)

...it's not about the providers but it's the system that's chronically under funded.

(Clinician, Queensland, Brisbane Forum #7)

In January of this year, I spent three days in the psychiatric ward at the Gold Coast Hospital. I found the level of care was very good, but it is hopelessly underfunded.

(Consumer and Family Member, Queensland, Submission #94)

Need for more staff for people with acute condition

(Anonymous, Queensland, Submission #49)

Case managers are burned out and/or distressed by their inability to provide a quality service or simply join the fold and deliver a sub standard service.

(Anonymous, Queensland, Submission #113)

We have not had a full time psychiatrist for approx 3 years while our nearest MHS in the same region has got 2.5 psychiatrists. Issues are inability or lack of recruitment strategies.

(Anonymous, Queensland, Submission #113)

It appears as if there is a significant shortage of bed space in Queensland for people who require sectioned or voluntary admission.

(NGO worker, Queensland, Brisbane Forum #3)

It appears that there are insufficient doctors available at the Rockhampton Mental Health Unit to cope with the patient load. Added to this, as some of my documentation shows, one has to question the quality / ability of some of the doctors that are available. Perhaps their very workload precludes them from being the doctors they would like to be.

(Carer, Wife and Mother, Queensland, Submission #52)

The Queensland government has had a lot of catching up to do, and spending has increased in recent years. As well as a long-term capital works program to create mental health units in general hospitals, the Beattie government is creating an additional 100 positions for mental health clinicians in 2004. These will contribute to staffing the Mobile Support Teams being introduced in some parts of State.

(SANE Australia, National, Submission #302)

The downsizing of the larger psychiatric facilities has been accompanied by an expansion in community mental health services. Overall, mental health staffing numbers have continued to increase since the commencement of the mental health reform process. Queensland employed 2837 staff in 1993/94, rising to 3978 staff in the financial year 2002/03 - an increase of 28%.

(Mental Health Unit, Queensland Health, Queensland, Submission #311)

6.3.9.3 Concern about the relocation of community based services back to hospital settings

Concern was expressed regarding the recent pattern to relocate community based services to hospital sites primarily for financial reasons. It was suggested that this effectively "re-institutionalises" services, works against all the aims of community based service delivery and emphasises the medical model of mental health.

As in NSW, Queensland is drawing back community-based services into hospitals. Some non-government organisations have also been located within hospitals in addition to non-in-patient clinical services. The Association for Mental Health now has to operate out of an old ward at Wolston Park, for example. This institution, established in 1865, was never closed down. Instead it received a $50 million redevelopment to re-open in 2002 as 'The Park' - different name, same place: a brand-new 192-bed institution with extended care, rehabilitation, dual diagnosis, secure, forensic and adolescent programs all together in the same nineteenth century grounds.

(SANE Australia, National, Submission #302)

Rather than calling for a return to hospital and institutional care, the Alliance calls for real investment in the community and in community-governed organisations. People with mental illness want to live in the community - not in hospitals. They have a right to housing, employment and to flexible treatment and support. Queensland has an urgent need to exploit the potential of the non-government sector in providing recovery-focused services, which are cost effective and respect the rights of people affected by mental illness.

(Queensland Alliance of Mental Illness and Psychiatric Disability Groups, Queensland, Submission #218)

6.3.9.4 Rural and regional issues

As mentioned above, planning and resource allocation for services located in rural and regional areas needs to consider a multiplicity of factors that may hinder the operation of such plans or fail to cater appropriately for the differing needs of those communities. For example, the recruitment and retention of staff in rural areas is problematical.

Our community is adversely affected by a lot of really tough issues - issues of drought, transient population, Uni students away from home and little support etc.

(Anonymous, Queensland, Rockhampton Forum #11)

...issues that are regularly presented to our offices ... Regional and rural issues - distress in country areas is much worse than in Brisbane.

(Office of the Public Advocate worker, Queensland, Brisbane Forum #14)

6.3.9.5 Lack of consultation with consumers, carers and service providers

Concerns were also expressed that consumers, carers and service providers are not being listened to (and that they have a right to be heard) and are tired of consultations which result in no changes and are not meaningful. Standard 9.8 states: 'The strategic plan is developed and reviewed through a process of consultation with staff, consumers, carers, other appropriate service providers and the defined community' and Standard 9.9 describes the process for such a plan (e.g. consumer and community needs analysis and a service evaluation plan including the measurement of health outcomes for individual consumers). These concerns suggest that even when consumers and carers are involved such processes are not being adhered to in a meaningful way and also indicate that criteria listed under Standard 3 (consumer and carer participation) are also not being met.

I am constantly amazed at how many people in the community have experienced difficulties with the service over the years and it continues unabated, theirs and my constant frustration that nothing changes and that the treatment of consumers and carers remains poor. We have brought many issues up and were tired of our own voices and frustrations; we each have our own stories it just goes on ...

(Anonymous, Queensland, Submission #113)

I hope, somehow through enough people contacting organisations such as yours, that we can try and help people. I don't blame the Government for things in life, but I have paid taxes and feel I have a right to be heard about where my money should be going.

(Consumer and Family Member, Queensland, Submission #94)

However, SANE Australia reported steps to strengthen consumer and carer participation

Another positive step has been the appointment of Carer as well as Consumer Consultants in a number of Health Areas, which will hopefully give both a voice in planning and review of services.

(SANE Australia, National, Submission #302)

6.3.9.6 Planning and accountability

Some submissions expressed concerns that planning and accountability mechanisms do not accurately portray the state of service delivery or identify gaps and problems which need to be addressed to meet the needs of consumers and carers who are attempting to access treatment and support services.

The manager frequently reports how low their hospitalisation and recidivism rates are. The wards are frequently empty and some staff complain that they are bored and have nothing to do. The district manager supports this because the costs are kept down. The service is lauded as innovative and a model to aspire to but they have these stats because they don't admit people or tell them to go somewhere else.

(Anonymous, Queensland, Submission #113)

Partnerships are proposed, ideas of collaboration are spoken of, meetings are held and boxes are ticked to say that these things are happening but very little changes in how the clinical sector works with the community.

(Anonymous, Queensland, Submission #113)

I not only provide this but make complaint to the HREOC and MHCA regarding the incompetent and inhuman treatment of patients in the system and the self serving "cover up club", which has a vested interest in this continuing.

(Carer, Father, Queensland, Submission #141)

...I want someone to see what is happening at the Rockhampton Mental Health Unit and someday changes for the better may be made. I have been dealing continually with the unit for nearly six years now and in spite of seeing four different directors at the helm, in my opinion the inconsistencies, the mismanagement, the unrealistic expectation of 'normal behaviour' from unwell people who are far from 'normal' and indeed a strange lack of understanding of people with a mental illness in general, appear to be deeply ingrained and the only constant.

(Carer, Wife and Mother, Queensland, Submission #52)

6.3.9.7 Need for staff training and development

Standard 9.17 states: 'The MHS regularly identifies training and development needs of its staff' (for example with reference to industry-validated core competencies for mental health staff) and Standard 9.18 states 'The MHS ensures that staff participate in education and professional development programs'. The White Wreath Association Inc. expressed concern that some clinicians might need to update their skills with regard to treatment and support strategies in order to ensure that any decline in patients mental health or harm to self or others, was not attributable to their skill deficiencies.

Personal accountability of Clinicians who refuse to update their skills and thereby cause loss of life. In this case the very practices of the Psychiatric Profession was to push the patient closer towards suicide and murder suicide.

(White Wreath Association Inc, Queensland, Submission #81)

6.3.9.8 Staff attitudes

Similarly, concerns were expressed about poor staff attitudes towards consumers indicating that staff are in need of training in order to change their attitudes and behaviours (decrease discrimination) and be more supportive when dealing with people with a mental illness.

Stigma exists right across our system.

(Clinician, Queensland, Brisbane Forum #7)

Prosperity and pleasantness are common causalities of severe mental illness. One would hope that psychiatrists, of all people, could accept this but like most doctors, psychiatrists rarely show enthusiasm for, or understanding of, patients who are neither cashed up nor personable.

(Clinician, Queensland, Submission #42)

Also during his last admission to hospital [before completing suicide], staff also told myself and other family members that [X] was becoming too dependent on the hospital system and would not be readmitted to hospital. Myself and my daughter were both also told by hospital staff in another meeting that it was all [X]'s fault, this admission and that he needs to start taking responsibility for himself. How can someone who has a mental illness and lacks insight into their illness take full responsibility for their life. This was the first time my son had ever admitted himself to hospital, [X] knew he was unwell ... On previous occasions the police have had to always be involved in getting him there. [X] was finally starting to accept that he had a mental illness.

(Carer, Mother, Queensland Submission #117)

6.3.9.9 Lack of support for critical services provided by NGOs

Concerns were also expressed about the insufficient level of funding provided to the NGO sector and accountability practices to ensure services meet the changing needs of the defined community (Standard 9.15).

I want to speak about a major project implemented by Queensland Health. We regard it as a system attempt to exclude people with a mental illness. When the project was first introduced it was called Project 500, then it was downsized and called Project 300 and then finally it became Project 54. QLD Health used the initial funds to train workers (4 years). But there was no equity in the project - most of the funding was going to those people in the institutions ... A lot of others didn't get access to care because of this project.

(NGO worker, Queensland, Brisbane Forum #1)

There is a broader issue which relates to funding the n.g.o sector and how the local managers are involved in this that needs to be part of the review e.g. local MHS mangers have a great deal of input into n.g.o funded services and yet ours for e.g. has never stepped foot in the place ...Many consumers who utilise our service have nothing to do with the clinical services - we should be assessed based on our merit and performance: our relationship with the local service is only as good at that which the manager allows.

(Anonymous, Queensland, Submission #113)

The Alliance believes that there needs to be more recognition of the role of the non-Government sector in providing cost effective psycho-social rehabilitation and support services to assist people in their recovery rather than a return to institutional forms of care.

(Queensland Alliance of Mental Illness and Psychiatric Disability Groups, Queensland, Submission #218)

With the exception of a few well-established organisations, the non-government sector is still relatively underdeveloped in Queensland (comparative to states such as Victoria and NSW).

(Queensland Alliance of Mental Illness and Psychiatric Disability Groups, Queensland, Submission #218)

More investment is needed in the non-government sector. Queensland's non-government mental health sector is very poorly resourced and thereby limited in the services that it can offer to people affected by mental illness.

(Queensland Alliance of Mental Illness and Psychiatric Disability Groups, Queensland, Submission #218)

In Queensland we hear about Government and Non-Government services needing to work more collaboratively, which to me means small community organisation providing more support with no help from Government. How can Community organisations be truly expected to work together when Government forces us go through a competitive tending process to provide service?

(NGO Service Provider, Queensland, Submission #40)

However, recent improvement in funding of NGO's was noted by SANE Australia:

Funding for non-government organisations providing community support has increased by 50% since two years ago, from 5.2% to 7% of the mental health budget.

(SANE Australia, National, Submission #302)

6.3.9.10 The cost of care and access to psychiatrists and psychologists

Consumers and clinicians expressed serious concerns that due to the lack of services available though the public mental health sector, consumers were increasingly forced to pay for care (to see psychiatrists and psychologists). Additionally, concerns were expressed that even those prepared to pay had difficulty accessing services due to long waiting lists. Many people though were unable to consider such options for financial reasons.

The cost of care is an issue. People can't afford care.

(Consumer, Queensland, Brisbane Forum #11)

Also affordable access to psychologists is on my wish list. The Allied Health EPC Initiative will not satisfy the latter need because minimum criteria for a Care Plan cannot always be met esp for young people, the red tape remains unreasonable and the allied health funds/# of services are limited.

(Anonymous, Queensland, Submission #260)

For those people who need psychological services that sort of care is only available in the private sector. It's expensive and hard to access also.

(Clinician, Queensland, Rockhampton Forum #7)

Earlier this year I discovered a psychiatrist was charging a patient of mine weekly consultation gap fees of up to one quarter of her income. On top of this she was charge non-attendance fees for missed appointments. And naturally, she was missing appointments - because she couldn't afford to pay for them.

(Clinician, Queensland, Submission #42)

I once heard a professor of psychiatry state that chronic mental patients taken against their will to hospital should pay their ambulance bill if they were not covered. His apparent rationale was that anybody in chronic ill-health would be mad not to ensure that they had ambulance cover.

(Clinician, Queensland, Submission #42)

Consumers come to us and tell us that if we don't pay for their prescriptions they'll have mood swings. We call mental health services and ask for their help but the people are back on our doorsteps the next day.

(NGO worker, Queensland, Rockhampton Forum #6)

Another factor in mental health consumers 'missing out' on appropriate services and timely treatment is the users pays system. Many simply cannot afford the cost of luxury 'private' services and many cannot afford the cost of private health insurance. Health insurance is becoming more and more out of reach for the 'average' Australian, let alone for someone who tries to exist on a disability support pension.

(Clinician, Queensland, Submission #105)

I believe that the State Government has to stop out sourcing care like counseling to business like Center care and Life line because people like me are some times required to pay for services that should be free.

(Consumer, Queensland, Submission #192)

6.3.9.11 Psychogeriatric planning and policy development

The need for psychogeriatric policy development and planning to meet the needs of older people living in Queensland was discussed:

But no analysis of mental health issues for older people can omit dementia even if it is not covered currently under the "mental health" policy umbrella. The population of those aged 80 and over is predicted to increase by 500% across the period 1991-2041 as the general population increases by 50% and age is the strongest risk factor for the development of dementia. Its significance lies in:

•  Implications for demand on residential care and community services

•  High prevalence of psychological sequelae such a depression (30-40% incidence across lifetime with Alzheimer's), behavioural disturbance (~90%) and psychosis (20-30%)

•  Reduced availability of acute beds for elective surgery and other indications through delays in placement and acute failure of community based support ("social admissions")

•  High rates of morbidity among carers

•  Misuse of psychotropics especially in residential settings

•  Safety issues for paid and unpaid carers and fellow inpatients or residents

•  Special requirements for the assessment of impaired capacity, eg issues around driving

•  The fact that older people in mental health assessment and treatment settings often have comorbid cognitive impairment and benefit from environments and trained staff who understand their needs

•  Demented people are sometimes inappropriately housed in treatment settings designed for other mental disorders

(Clinician, Queensland , Submission #140)

Comprehensive mental health planning for this age group should consider disorders that are not necessarily dealt with by the public mental health sector as the lead agency. Mental health training is an enormous asset for those dealing with dementia and the potential contribution of mental health professionals is significant. To this extent, dementia must not be forgotten in any global description of older people's mental health. Just as no policy discussion of general adult mental health can avoid mention of substance use disorders, so cognitive disorders such as dementia and delirium must not escape attention in any review of psychogeriatric policy.

(Clinician, Queensland , Submission #140)

Data around the impact of dementia and delirium are needed to plan services.

(Clinician, Queensland , Submission #140)

6.3.9.12 Research

One submission was received expressing concern that more funding needs to be allocated to research to improve the mental health of the community. According tho Standard 9.31: 'The MHS conducts or participates in appropriate research activities' and Standard 9.30 states 'The MHS routinely monitors health outcomes for individual consumers using a combination of accepted quantitative and qualitative methods'.

More money need for research into the social causes / effects - beneficial therapies - biological causes.

(Anonymous, Queensland, Submission #49)

6.3.10 STANDARD 10: DOCUMENTATION

Clinical activities and service development activities are documented to assist in the delivery of care and in the management of services.

No submissions or comments were received pertaining to this Standard.

6.3.11 STANDARD 11: DELIVERY OF CARE

Principles guiding the delivery of care: The care, treatment and support delivered by the mental health service is guided by: choice; social, cultural and developmental context; continuous and coordinated care; comprehensive care; individual care; least restriction.

Under this global Standard outlining the principles underlying care, submissions and presentations indicate concerns about the right to treatment and care and individual choice.

6.3.11.1 The right to treatment and care and individual choice

A number of submissions by carers were received and presentations made regarding the right to access treatment and care when a consumer fails to acknowledge their illness or comprehend the repercussions of failure to access treatment. Some other submissions expressed their concerns somewhat differently, arguing the problem was not with the emphasis on individual choice, but more a problem about the choice of treatment offered and approach of clinicians.

However I have always wondered is there a point where the rights of the individual should be overlooked? Or does there come a time or a point where an individual's rights are not as important as full medical treatment and care. I hate to see a system that not only often cannot help the individuals that rely on it, but one that also fails to recognise the families behind the individuals.

(Anonymous, Queensland, Submission #82)

We are still discussing some issues we discussed through the Burdekin era. The dichotomy between the right to freedom and the right to access care and treatment. At a political level, we want things to change, we need to get political.

(Carer, Queensland, Rockhampton Forum #14)

It seems that the decision of treatment is entirely taken out of the hands of the family or carer and left to the sufferer. In most cases to find their own cure. The Public Mental Health System at present - processes people - they do not treat patients individually with the good will and respect that they deserve. The system we have is only too willing to allow this process to continue. In my opinion no other method of treatment is considered, or recommended in the Public Health System. The exception being pharmaceutical methods where there is limited explanation of how much and how often to take the prescribed medication and their possible side affects. The message to us was that you can't help those who won't help themselves. Yet people suffering mental illness are less able to help themselves. (author's emphasis)

(Carer, Mother, Queensland, Submission #81)

The concerns of the family and the patient must be paramount.

(White Wreath Association Inc, Queensland, Submission #81)

6.3.11.1 Access

The MHS is accessible to the defined community.

Under this Standard, submissions and presentations indicate concerns about:

  • the lack of services in rural areas;
  • access not possible even if there is a risk of harm to self or others;
  • police are becoming the de facto mental health service;
  • inability to access services generally;
  • access is limited to those with 'serious mental illness';
  • access to psychologists is easier for those who can afford to purchase care in the private sector;
  • access denied due to past forensic status;
  • lack of services for youth with drug and alcohol problems; and
  • carers need to be heard.

A lot of my clients I see come to me with bad experiences they have had when trying to access care. It's a sad reflection on the system if it is making people more traumatised!

(Clinician, Queensland, Brisbane Forum #20)

An inability for consumers to access treatment and support services, within both the community and inpatient care, often results in the infringement of a whole series of rights for consumers, carers and the community. For the consumer, the consequences of these infringements can include increasing disability and hence consequent inability to care for one's self or others, participate socially, or work or study. In some cases, the potential for harm to self or others, incarceration, homelessness and poverty can result.

Increasing disability can also exposed the consumer and their family to discrimination and social exclusion. This often results in the further deterioration of the consumer's mental health. For example, for consumers in rural and smaller regional areas, their ability to access care often required long trips to metropolitan or large regional centres and social dislocation if hospitalisation is required.

Early intervention should focus on maintaining life skills and personality - trying to keep family supportive and involved - explaining to the patient exactly what their condition is, what treatments are to be tried and what side effects / benefits can be expected.

(Anonymous, Queensland, Submission #49)

For children and youth, a failure to gain access to services at this time of their life or for educational bodies to make sufficient accommodations, places their future at risk.

For carers, the burden of care due to a family member's illness is exacerbated when the family member becomes increasingly ill due to lack of treatment and support services in the community. This further disrupts carers' ability to participate socially and to work. Family isolation and increasing instability were also frequently reported due to the lack of community support and acceptance (high levels of stigma and discrimination) and lack of family-centred approaches to treatment and support. For the community, the inability to access care resulted in an infringement of their right to safety and a disruption of their social and economic cohesion.

The number of callers into Lifeline regarding mental health problems is going through the roof. It seems that for many people they have no other option other than to phone Lifeline.

(NGO worker, Queensland, Brisbane Forum #19)
6.3.11.1.1 Lack of services in rural areas

In Queensland, the State's vast geographical area poses serious challenges to the planning and delivery of services to meet Standards 11.1.3 ('mental health services are provided in a convenient and local manner and linked to the consumer's nominated primary care provider') and 11.1.5 ('the MHS ensures effective and equitable access to services for each person in the defined community'). For people living in many areas of Queensland there are no services which were convenient and local. Access to care involves long distances by car, a significant barrier for those who are not so readily mobile or do not have their own transport.

My wife got ill when we were living in Emerald - every time she got ill it was a car trip back to Brisbane - that's how we got care, I drove her down here. I don't know how people who couldn't get to Brisbane could get care when they needed it.

(Carer, Queensland, Brisbane Forum #21)

The statement by a clinician in Rockhampton that the closest option for long term care is in Toowoomba indicates the magnitude of the problem. The social dislocation for both the consumer and carer, if such an option is exercised, is high.

The Bailie Henderson Unit in Toowoomba is the only option for long term care. We have a high dependency unit but the vast majority of people are in community based care.

(Clinician, Queensland, Rockhampton Forum #7)
6.3.11.1.2 Access not possible even if there is risk of harm to self or others

...I was once a very depressed, suicidal individual and the gov't hospitals and health care systems did absolutely nothing to help me when I was screaming out for help at the time!

(Consumer, Queensland, Submission #73)

A constant theme throughout many submissions was not only an inability to access services when needed, but that access was also difficult when consumers were at risk of self harm or harm to others. According to this information it would appear that standards 11.1.4 'The MHS is available on a 24 hours basis, 7 days per week' and 11.1.2 'The community to be served is defined, its needs regularly identified and services are planned and delivered to meet those needs' are not being met.

There's a lack of access to services - acutely suicidal and very distressed and they are turned away.

(Anonymous, Queensland, Brisbane Forum #8)

On the day in question - a Saturday - my son stopped taking his medication (even though the sticker warned 'do not stop taking this medication abruptly'- these guys don't read these things when they are ill). As a result he became extremely psychotic. The first advice from Mental Health Unit was 'bring him in Monday morning'! Next advice was to call police which we did on two occasions. My son was absent for the first call-out. Unfortunately, the second call-out ended disastrously. My son arrived home quietly while the police were still there and 'gave himself up' (putting his hands up). However, for some reason the police officer (young and by his own admission, inexperienced in Mental Health matters) said 'we can't take you, you haven't done anything wrong' which caused my son to produce a small knife (which I later found out he'd been trying to slash his wrists with a short time before) - not in a threatening manner (he had his hands upwards again) but in an effort to get police to shoot him. The situation escalated and just as the police raised their guns to shoot him my husband hit my son from behind (with a heavy stick) wounding him and causing him to stumble thus saving my son's life. The outcome was the police told me they were taking my son to Accident and Emergency at the base Hospital to get the help he needed (and from there he would go to Mental Health). This never happened. On the way they diverted straight to the watchhouse.

(Carer, Wife and Mother, Queensland, Submission #52)

An 18 year old female client with depression rang me after making a suicide attempt by cutting her wrists. She was alone and had scared herself by this action being afraid of what she might do next. I organised an ambulance for her and based on previous experience, warned her that she may not be admitted into hospital. She too was subsequently sent home after having her physical wounds treated. As a student who had relocated from a rural area, she had no family in Brisbane and was quite isolated. It required considerable effort to ensure that she was not left alone in her vulnerable state until her parents could travel to be with her.

(Clinician, Queensland, Submission #105)

An experienced colleague who was concerned about the state of a client personally took the extremely distressed and suicidal client to hospital and waited all day for the client to be seen and assessed - the client was not admitted and was sent home ..."

(Clinician, Queensland, Submission #105)

A female client in her early 20's, suffering from depression, was aware that she was becoming suicidal. Being frightened at what she might do, she drove herself to a large public hospital for assistance. She was seen briefly and then sent home. She subsequently required admission into a private psychiatric hospital where she stayed for a number of weeks. As an articulate and intelligent young woman who presented 'well' instead of 'crazy' she was turned away.

(Clinician, Queensland, Submission #105)
6.3.11.1.3 Police are becoming the de facto mental health service

Due to the inability of consumers and carers to access mental health services during times of crisis, police are increasingly being called to assist as they are available 24 hours a day 7 days a week. Standard 11.1.4 states: 'The MHS is available on a 24 hour basis, 7 days per week'. Included in the notes to this Standard are crisis teams, extended hours teams and 'cooperative arrangements with other appropriately skilled service providers and community agencies including General Practitioners, private psychiatrists, general hospitals'.

Another unsatisfactory situation that exists is when someone 'phones the AC Team for advice regarding a psychotic patient, invariable the advice is 'phone the police'.

(Carer, Wife and Mother, Queensland, Submission #52)

Previously it was bad enough when each person had a case manager because the case managers were so overloaded that it often took a few days to get in touch with them. If they weren't on holiday, stressed out, they were away doing some course. Now it is practically impossible to get urgent help without calling the police whom I'm sure do not appreciate being expected to act as health care workers.

(Carer, Mother, Queensland, Submission #10)

More than once the police local have said that it is not their problem and we should call her mental health worker, who is 100kms away and never able to take our call because she is so busy she is rarely in the office.

(Anonymous, Queensland, Submission #82)

First presentation Saturday 20 March - waited in emergency approx 4-5 hours. Finally assessed by Psychiatrist for 30 minutes. Psychiatrist rang father at 11pm and asked him to bring pushbike. Dad refused saying my son is suicidal he needs to remain. The patient said he was suicidal and said he needed to remain. Doctor called taxi to take patient home. Taxi driver dropped patient off 10-15 km away from home. Doctor gave patient Largactil, Valium and other medication, which almost put him to sleep (even though the doctor said there was nothing wrong with the patient). Patient ended up sleeping in a bus shelter. Following Day 21 March patient became angry and agitated presented himself at Jacaranda Police Station (Logan) saying I'm not well I want to kill myself and others. Police took him to Logan Hospital (their response was more appropriate than the hospital response). Patient again waited 4-5 hrs assessed in 10-20 minutes sent to Pindari Salvation Army Hostel, there overnight. Father received a letter from son's GP requesting the patient be fully assessed. Doctor assessed patient as being schizophrenic. Saturday the 3 April parents out - patient took a knife to brother who was 17. Two other brothers ran to next-door neighbours - neighbours called police. Police came. Family arrived home same time police arrived. Police took patient to hospital. Family also tried to get patient admitted to P.A Hospital but told that he was not in their catchment area. What other life threatening condition would a patient be refused hospital admission? ...Most importantly this mans concerns were backed up by his entire family yet their concerns were treated with contempt.

(White Wreath Association Inc, Queensland, Submission #81)
6.3.11.1.4 Inability to access services generally

Other concerns were also raised regarding access. These included access being denied due to geographic boundaries, difficulties access inpatient services, and problems accessing services for people with dual diagnosis.

Things said here today resonate with the types of issues that are regularly presented to our offices: Access to inpatient services; Dual diagnosis; Acquired brain injury; People exhibiting self-harming behaviour

(Office of the Public Advocate worker, Queensland, Brisbane Forum #14)

I want to tell you about a couple of cases. The first one is about a young person who tried to seek help and was refused care because of a geographic boundary. Another consumer who pleaded guilty to something they didn't do just so they could get into a "better cell" - a 14 week prison sentence was better than being sick and homeless.

(Carer NGO worker, Queensland, Brisbane Forum #22)

I have personally had clients tell me of their experiences where they have been refused treatment or treated with disdain after presenting themselves at hospital for assistance and treatment for a mental health condition ...

(Clinician, Queensland, Submission #105)

Considering the high rate of suicide amongst young people in Australia I find it absolutely appalling that when people do seek treatment and assistance they are refused, given minimal attention or are treated poorly by being labelled as being malingerers

(Clinician, Queensland, Submission #105)

This policy of keeping clients and clinics / hospitals tied causes more problems in the community. A client who was feeling unwell went to the Gold Coast hospital but was told to go to Caboolture, an impossible task for someone in his condition. Just imagine someone with appendicitis being told to get themselves to a different hospital! If a local address is supplied, they may be admitted: that is, psychiatric clients need to remember to tell lies in order to access treatment. In the absence of transition support with assurance of housing and support on release, prisoners also give fictitious release addresses.

(Anonymous, Queensland, Submission #67)
6.3.11.1.5 Equity - access for all - not just 'serious mental illness'

Concerns were also raised that access was being limited to those consumers with 'serious mental illness' and not, as stated in Standard 11.1.5 'equitable access to services for each person in the defined community'.

I have also noticed that the mental health teams in Queensland have narrowed their focus and are shifting the goal posts. What is the definition of serious mental illness? Why don't they define exactly for us who they will and who they won't treat. At least then we would know what we're dealing with.

(Supported Accommodation and Assistance Program Service Provider, Queensland, Brisbane Forum #2)

Someone used the term serious mental illness and talked about the gate-keeping that goes with respect to who gets care and who doesn't. Actually, it really depends on bed availability!

(Clinician, Queensland, Brisbane Forum #7)

In the public mental health system the word 'serious' is taken to be short hand for psychotic illness. For those of us who have exceptionally serious problems which, after a while, don't appear to have an organic base this is disastrous. With all my experiences, awful, awful experiences I now get extremely angry when people use the words Serious Mental Illness and exclude people like me. It feels like a really big kick in the guts when they do this and yet we still see it time after time.

(Consumer, Queensland, Submission #204)
6.3.11.1.6 Equity - access to psychologists easier for those who can afford to purchase care in the private sector

Standard 11.1.1 states: 'The MHS ensures equality in the delivery of treatment and support regardless of consumer's ...socio-economic status'. However, one clinician in Rockhampton reported that if consumers required access to psychologists, these services are only available in the private sector, and scarce. This prevents people who can not afford to pay for such services from receiving the treatment they require.

For those people who need psychological services that sort of care is only available in the private sector. It's expensive and hard to access also.

(Clinician, Queensland, Rockhampton Forum #7)

There are also gaps in services for people with less severe disorders. For those people who need psychological services that sort of care is only available in the private sector. It's expensive and hard to access also.

(Clinician, Queensland, Rockhampton Forum #7)
6.3.11.1.7 Discrimination - past forensic status

A report was also received indicating that consumers were discriminated against on the basis of past forensic status. According to Standard 11.1.1 such discrimination is not to occur. Instead, the Standard states that: 'the MHS ensures equality in the delivery of treatment and support regardless of ...past forensic status'.

For those who are released their files are tagged to indicate they have been in prison and then the staff of the mental health services don't want to treat them.

(Prison NGO worker and Consumer Advocate, Queensland, Brisbane Forum #5)
6.3.11.1.8 Lack of services for youth with drug and alcohol problems

Given the reports above regarding difficulties in accessing services, it was not surprising to hear that consumers with complex needs found even further barriers.

The key issues as I see them are the lack of support services available to young people with comorbid mental health and drug and alcohol problems. They are shafted between services. It's very difficult to get support services because of the lack of specific diagnoses.

(Youth NGO worker, Queensland, Brisbane Forum #6)

The established system (both in NSW and QLD) attempts to distinguish between mental health problems and drug and / or alcohol problems. I find this distinction to be short-sighted and extremely unhelpful. Many people choose to self-medicate mental health problems, which can result in drug dependency. It is indefensible that such people should be refused a service from Mental Health because they "have a drug problem" or from Alcohol & Other Drug Services because they "have a mental illness". I have been on the receiving end of both arguments at various times, when advocating for individuals seeking treatment.

(Clinician, Queensland, Submission #285)
6.3.11.1.9 Carers need to be heard

Another example supporting claims that a crisis is required before services are provided is that carers may be unable to initiate a response from services or are not heard.

...admitted to hospital, after having to see 5 different people for a decision to be made that he needed to be hospitalised, instead of taking notice of his mother, and 8 hours after arriving at emergency he was admitted to Psychiatric ward.

(Carer, Mother, Queensland, Submission #168)

6.3.11.2 Entry

The process of entry to the MHS meets the needs of the defined community and facilitates timely and ongoing assessment.

Under this Standard, submissions and presentations indicate concerns about:

  • problems with entry via Emergency Departments;
  • excessive amount of time between time of referral and time of assessment; and
  • the amount of time between the assessment being undertaken and a diagnosis being made.
6.3.11.2.1 Problems with entry via Emergency Departments

Concerns were expressed about entry via emergency departments regarding problems with the assessment process and consumers having to repeat their stories many times. According to Standard 11.2.4: 'The entry process to the MHS can be undertaken in a variety of ways which are sensitive to the needs of the consumer, their carers and the defined community'. Notes to this Standard state that this process should be non-traumatic and non-damaging.

People with a mental illness also have to go through the accident and emergency department - they have difficulty in getting assessed.

(Anonymous, Queensland, Rockhampton Forum #13)

Standard 11.2.6 further states: 'An appropriately qualified and experienced mental health professional is available at all times to assist consumers to enter into mental health care'. One clinician reported the following problems with admission procedures.

When clients come through triage the client has to tell their story 5 or 6 times before they get to see a psychiatrist. I can't - as a worker in the community I cannot leave the client. They'll leave if I don't stay with them through the process. They have no other continuity.

(Clinician, Queensland, Rockhampton Forum #15)

Another issue of great concern for consumers and carers is the ongoing policy of having to take unwell Mental Health consumers to A&E [Accident and Emergency] at the Base Hospital for treatment / admission to Mental Health after hours - 'after hours' being between the hours of 4.30pm and 8.30am weekdays and all week-end. Considering these are high-incident times, this practice is totally unsatisfactory. As things stand currently, consumers / carers are required to sit for lengthy periods in the waiting-room at A&E until they are seen be a doctor who then contacts Mental Health. Car accidents and heart attacks take precedence over mental illness. (Earlier this year I had to take my husband to A&E at 11pm as a result of a psychotic reaction to new medication. We ended up leaving at 1.30am without ever having seen a doctor). It does not make any difference if you have a long history of mental illness and this episode is the same as previous episodes, consumers still have to go via A&E before you can access help from Mental Health.

(Carer, Wife and Mother, Queensland, Submission #52)
6.3.11.2.2 Excessive amount of time between time of referral and time of assessment

According to Standard 11.2.12: 'The MHS has a system which ensures that the initial assessment of an urgent referral is commenced within one hour of initial contact and the initial assessment of a non-urgent referral is commenced within 24 hours of contact'. One GP reported that the time between referral and assessments was usually 12 weeks.

As a GP who does a lot of mental health work and knows a lot of people in the system, I can get an assessment in 2 weeks if I pull strings - otherwise it is 12 weeks to get someone assessed.

(Clinician, Queensland, Brisbane Forum #7)
6.3.11.2.3 Amount of time between the assessment being undertaken and a diagnosis being made

The following report from a clinician raises concerns about the length of time between assessment, diagnosis and accessing the appropriate treatment and support services.

There is a single point of entry through the acute care team - they have an initial assessment and then a decision is made within a period of 4-5 weeks.

(Clinician, Queensland, Rockhampton Forum #7)

6.3.11.3 Assessment and review

Consumers and their carers receive a comprehensive, timely and accurate assessment and a regular review of progress.

Under this Standard, submissions and presentations indicate concerns about:

  • carers and service providers not being involved or listened to during the assessment process;
  • assessments focussing on risk;
  • problems with the review process;
  • high staff case loads;
  • a lack of opportunity to obtain a second opinion; and
  • long periods of time between reviews of involuntary orders.
6.3.11.3.1 Carers and service providers not being involved or listened to during the assessment process

According to Standard 11.3.5 the assessment process is 'comprehensive and, with the consumer's informed consent, includes the consumer's carers (including children), other service providers and other people nominated by the consumer'. However, evidence was presented indicating that carers and service providers who hold valuable information are being omitted from this process. These submissions indicated that as a result the patient was then inappropriately assessed and the requisite treatment and support were not arranged.

We know of 5-6 cases over the past few months. We don't wish to target Logan but we do wish to ensure that all Psychiatric Services including Logan lift their game to prevent further deaths. We point out that there has been a number of murders, police shootings/deaths in custody as a result of the initial assessment services not listening to the patient, patient's family and the police attempting in good faith to get help for the patient.

(White Wreath Association Inc, Queensland, Submission #81)

Such is the system that young registrars, untrained in psychiatry, are making judgements as to whether a person is mentally ill or not. (Qualified psychiatrists have difficulty doing this at times!) Thus appropriate help for the mentally ill is being denied and once again the carer is given no credence.

(Carer, Wife and Mother, Queensland, Submission #52)

That afternoon [X] was started on Zyprexa medication - appropriate for use in Bipolar Disorder and Schizophrenia. (I had been giving information since January 1999 which indicated [X] had these disorders, but no one would listen.) When is the system going to change and allow carers more input? We are the people who observe the most of our consumers' behaviours - a doctor usually only sees a consumer when he/she has 'pulled themselves together in an effort to appear well'. I am continually hearing this same story from carers.

(Carer, Wife and Mother, Queensland, Submission #52)
6.3.11.3.2 Assessments not focussing on mental health needs of consumer

Submissions were also received indicating concerns about the focus and purpose of assessments. One submission suggested that assessments appear to be focussing on assessment of risk of self harm or harm to others, rather than focussing on assessment for the purpose of determining treatment and support to halt deteriorating mental health and improve outcomes for the consumer.

The more recent shift though is firstly in the assessment process whether via a justice examination order or a voluntary assessment. I have witnessed and been told by case managers that the assessment in determining case management, hospitalisation or simply providing a service in whatever form, is based on risk, namely serious risk of self or others. This risk assessment though does not include risk of deterioration of mental health. There appears to be little concept of early intervention in practice for adult services ...or an unwillingness to implement it. For example I have witnessed an assessment of a seriously ill man who was unable to answer all the questions put to him by the registrar (because he couldn't concentrate or comprehend the questions, because he was so ill ... The final analysis was "because we cannot determine whether you are a risk to yourself and others, go back on your medication and go home". (author's emphasis)

(Anonymous, Queensland, Submission #113)

More recently a man with paranoid schizophrenia untreated and becoming increasingly paranoid was assessed via a JEO [Justice Examination Order]. The assessors provided feedback stating that while they agreed he was unwell, because he was not a risk to himself or others and because they could not prove or disprove his delusions of grandeur or beliefs that for e.g. aliens were coming to get him, that there was nothing they could do.

(Anonymous, Queensland, Submission #113)
6.3.11.3.3 Problems with the review process

One carer expressed concern with the management of her son's treatment during the review process which risked worse rather than improved outcomes for her son.

By this time, [X] seemed as if he felt he didn't really need to attend the unit as Dr [Y] had provided him with a script with seven repeats! I didn't even think this was possible. Dr [Y] apparently also increased the dosage. This meant that [X] was not being seen by anyone at Mental Health so his deterioration was going undetected.

(Carer, Wife and Mother, Queensland, Submission #52)
6.3.11.3.4 High staff case loads

As mentioned previously with regards to concerns about the lack of staff and overburdened staff (Standard 9 - Service Development), one clinician specifically raised concerns with regards to caseloads. According to the Standards the MHS is to have a process to monitor such loads. Standard 11.3.19 states: 'The MHS has a system for the routine monitoring of staff case loads in terms of number and mix of cases, frequency of contact and outcomes of care'.

We have case managers who have case loads of 20-30 people.

(Clinician, Queensland, Rockhampton Forum #7)
6.3.11.3.5 Lack of opportunity to obtain a second opinion

Standard 11.4.C.12 states: 'The consumer's right to seek an opinion and/or treatment from another qualified person is acknowledged and facilitated and the MHS promotes continuity of care by working effectively with other service providers'. A report from one carer suggests that either consumers and carers may sometimes be unaware of this right (and not informed of all their rights and responsibilities as soon as possible after entering the MHS - Standard 1.2) or this right to get a second opinion is not being actively promoted due to the scarcity of services and difficulty in accessing those that exist.

[The following are what I put as necessary] Patients right to have another medical opinion by widely supported practitioners or of their own choice.

(Carer, Father, Queensland, Submission #141)
6.3.11.3.6 Long periods of time before involuntary orders are reviewed

One carer expressed concern that reviews of involuntary orders were not occurring with sufficient frequency:

[The following are what I put as necessary] Involuntary patients to be taken before magistrate on each occasion with an early review by them.

(Carer, Father, Queensland, Submission #141)

6.3.11.4 Treatment and support

The defined community has access to a range of high quality mental health treatment and support services.

Under this Standard, submissions and presentations indicate concerns about:

  • lack of support services for consumers to live in the community;
  • lack of involvement of carers;
  • lack of treatment and support services for youth;
  • lack of treatment and support services for people with dual diagnosis (drug and alcohol);
  • lack of services for people with Acquired Brain Injury;
  • lack of services for people with personality disorders;
  • lack of services for people with eating disorders;
  • lack of appropriate treatment and support services for consumers in the criminal justice system; and
  • lack of treatment and support for people with mental illness after release.
6.3.11.4.1 Lack of support services for consumers to live in the community

An underlying theme in many submissions was that treatment and support services are not available for consumers in the community to address their mental illness and assist with recovery, rehabilitation and integration back into the community. Standards 11.4.3 - 11.4.8 state that the MHS will 'ensure' or 'provide' 'access to a comprehensive range of treatment and support services' which are specialised with regard to age, stage in the recovery process, dual diagnosis, cultural factors, and which address 'the physical, social, cultural, emotional, spiritual, gender and lifestyle aspects of the consumer' (11.4.6). Additionally, Standard 11.4.10 states: 'The MHS provides the least restrictive and least intrusive treatment and support possible in the environment and manner most helpful to, and most respectful to, the consumer'. The statements below express concern about the lack of treatment and support received for consumers to recover and remain well in the community.

In the last 5 years, my mother has been to hospital approximately 20 times, and this may not seem like a great deal, but it is; especially when she arrives there because she has not had her medication, which her mental nurse is to administer via injection either weekly, fortnightly or monthly. Most recently my mother went without proper medication for 6 weeks! Yet no one felt it was important to inform her family of this, we are never informed of her progress or if there are any problems even though we have asked repeatedly.

(Anonymous, Queensland, Submission #82)

We have a son ... with a mild intellectual disability ... 22 years of age and remained in that job for ten years feeling a 'normal' part of the community. In 2001 our circumstances changed, our son was looking for a change of employment also ... he applied for hospitality work on Hamilton Island ... The move was obviously too much pushing him over the edge causing psychosis - he returned within a week a raving lunatic. We contacted our local hospital where he was admitted for 2/3 day treatment and discharged with no back up service as to rehabilitation, the only place being a 'drop in centre' with no stimulation. We had subsequent visits to a doctor at Queensland Mental Health Clinic together with a psychologist who visited periodically - a complete waste of time and money to pop in asking our son what he had been up to, which our son was not going to divulge honestly anyway through his illness eventually diagnosed as Schizophrenia.

(Carers, Parents, Queensland, Submission #150)

We went through months of absolute trauma because he wasn't kept locked up and given aggressive treatment when he needed it. It wasn't until I started sending emails to people at the top that we got any action.

(Carer, Mother, Queensland, Submission #168)
6.3.11.4.2 Lack of involvement of carers

Despite Standard 11.4.9 acknowledging the involvement of carers ('there is a current individual care plan for each consumer, which is constructed and regularly reviewed with the consumer and, with the consumer's informed consent, their carers and is available to them'), carers repeatedly reported being excluded from assessment and treatment planning. Given the reported problems with access and limited services available in the community, practices which involve carers to assist with the delivery of care and achieve the best possible outcomes for consumers would both help recovery and protect many rights of people with mental illness.

Any intervention on my part was resented by the medical staff and at one stage was told bluntly by my son's doctor to stop diagnosing (I must say this is the diagnosis he has finally been given - but that gives me no joy).

(Carer, Wife and Mother, Queensland, Submission #52)

With all of this confronting us as a family we were still told by the Public Health System that our son was OK. His illness was not taken seriously even though two previous [suicide] attempts were made. Our families concerns and our opinions were never acknowledged or taken into account.

(Carer, Mother, Queensland, Submission #81)

I was his full-time carer and always saw [X] on a regular basis, nearly every day. The hospital was not willing to listen to us ... Maybe if the hospital had listened to our family or [X] or kept our son in hospital longer he would have had a chance. The mental health system also needs to start listening to the family members or the mentally ill person when they say they are unwell.

(Carer, Mother, Queensland, Submission #117)

Respondent B [family member]. stated, "I was completely ignored, completely!" ... Respondent D. [family member] complained, "Rhetorical offers of help never eventuated!" ... Respondents [family members] were made to feel like interlopers and were constantly disempowered and intimidated by 'expert professionals' with a 'cure at all costs' medical model mentality ...

(Carer, Wife & Mother, Queensland, Submission #157)

At present the law is formulated to protect the consumer's rights and to ensure that they are not wrongly committed to mental institutions as happened in the past. However, I believe it has gone too far and often the consumers are still disadvantaged because they are now not getting the help they need. Often their very illness causes them to have lack of insight and their carers do not have any legal rights to be able to help them (if they are over 18 years). I believe if a consumers lives under the same roof as their carer, allows them to cook and care for them 24/7, buys and administers their medications, that the consumer is giving unwritten consent to that carer to be involved in every level of that care and this should be recognised by law.

(Carer, Wife and Mother, Queensland, Submission #52)
6.3.11.4.3 Lack of services for youth

As mentioned earlier in this Report (8.3 Integration) a paucity of services exist to provide treatment and support for children and youth in Queensland. Many submissions were received conveying this concern and many indicated that the services for this age group need to be broader in their approach than treatment just for 'mental illness' as other mental health problems and life crises were generally associated with this age group (e.g. behaviour problems, drug and alcohol, homelessness). Standard 11.4.3 ensures access to a 'comprehensive range of treatment and support services which are, wherever possible, specialised in regard to a person's age and stage of development'.

Young people's mental health services are the most difficult to access. Often they are told they are not sick enough and then told they can't get care because they have a comorbid drug and alcohol problem.

(Clinician, Queensland, Brisbane Forum #7)

For a decade, I've provided GP services at a health clinic for homeless young people. Sadly many are no longer alive. Now and then, I get a call to let me know. Last week a death in the park. Last month, a suicide.

(Clinician, Queensland, Submission #42)

My youngest son in 2003 had incredible mood swings, which based on what I know now could have been based on alcohol and marijuana abuse. I asked him to see Mental Health. They prescribed medication which, based on what the internet told me, was a front line treatment for bi-polar disorder. But no-one from Mental Health would speak with me on the cop-out of patient confidentiality. The so-called student counsellor at school was useless, and compounded the problems, whilst again refusing to bring family in on counselling and suggested treatment. It seems the Mental Health doctor invited [X] to bring me in on it, but he refused, so the doctor would not even talk to me.

(Carer, Mother, Queensland, Submission #91)

Finally I would draw your attention to the declining Queensland Government support for accommodation, particularly support for accommodation and inpatient treatment option for under 18s.

(Dr Bruce Flegg MP, General Practitioner and Liberal Shadow Minister for Health,
Queensland, Submission #39)

A submission received from Queensland Health recognises the need for youth mental health services and discusses the Queensland Government's response.

The Future Directions for Child and Youth Mental Health Policy Statement (1996) outlines a need for acute treatment services with a 24 hour response capacity. From 1998 - 2001 specialised inpatient units for children and adolescents were commissioned at the Royal Brisbane and Royal Children's, Logan, Mater, Toowoomba, and Robina Hospitals. There are now 61 beds in Queensland providing a range of services to children and young people with serious mental health problems. This includes 10 beds at the Child and Family Therapy Unit at Royal Children's Hospital, which enables mental health professionals to work with families in a safe, specialised environment. In addition to the acute beds there are 15 beds at Barrett Adolescent Unit for adolescents with complex needs requiring longer term treatment and support.

(Mental Health Unit, Queensland Health, Queensland, Submission #311)

It should be noted that hospitalisation is potentially disruptive to a child or adolescent's normal life, including school, family, and social networks. Treatment in an inpatient setting therefore is seen as only part of the spectrum of intervention. Care and treatment of children and adolescents is conducted primarily on an outpatient basis by Child and Youth Mental Health Services (CYMHS).

(Mental Health Unit, Queensland Health, Queensland, Submission #311)

Almost every Health Service District in Queensland has a CYMHS, with approximately 280 staff across the state, working in areas from infant mental health to the mental health needs of young adults.

(Mental Health Unit, Queensland Health, Queensland, Submission #311)
6.3.11.4.4 Lack of services for consumers with dual diagnosis - drug and alcohol

Standard 11.4.7 states: 'The MHS ensures access to a comprehensive range of services which are, wherever possible, specialised in regard to dual diagnosis'. In the notes to this Standard, this includes dual case management with alcohol and other drug services. Concern was expressed that there are an insufficient number of such services to provide treatment and support to consumers with complex needs.

...there is an urgent need for an effective rapid access detox unit to address the increasing drift of young people to illicit drugs and subsequent MH disorders.

(Anonymous, Queensland, Submission #260).

The other "growth" area which is inadequately serviced is the management of substance abuse. It is important in managing substance abuse that treatment facilities are located in proximity to population centres as substance abusers often have reduced motivation and frequently experience transport difficulties.

(Dr Bruce Flegg MP, General Practitioner and Liberal Shadow Minister for Health,
Queensland, Submission #39)

Service protocols are required urgently to ensure that both QHealth Mental Health and Alcohol and Drug Services collaborate with services outside their domains.

(Brain Injury Association of Queensland, Queensland, Submission #60)
6.3.11.4.5 Lack of services for consumers with mental illness and Acquired Brain Injury

The lack of mental health services to provide treatment and support for people with Acquired Brain Injury (ABI) was raised by the Brain Injury Association of Queensland. In particular, Brain Injury Association of Queensland noted that as many people with ABI have very complex needs in addition to mental health problems (e.g. drug and alcohol or intellectual disability as a result of the brain injury) many consumers fell through service gaps due to eligibility criteria. Standard 11.4.7 states: 'The MHS ensures access to a comprehensive range of services which are, wherever possible, specialised in regard to dual diagnosis'.

It is with sadness that we report that little has changed for people with acquired brain injury since the "Burdekin Report" in 1993, in particular for those with a dual diagnosis of acquired brain injury and a mental illness or psychiatric disorder. A substantial proportion of people with ABI have a dual disability including mental health, drug and alcohol and intellectual disability (in some cases a mental illness contributed to the individual's brain injury). Service eligibility is commonly denied to these people and they 'fall through the gaps'. The inability for people with ABI to access mental health services compounds and amplifies the complexities of psychiatric and drug related disorders. In extreme cases, individuals with ABI are being inappropriately contained within the criminal justice system.

(Brain Injury Association of Queensland, Queensland, Submission #60)

In the context of this extensive and all-pervasive unmet need, there are certain conditions and circumstances that, individually or in combination, place individuals and carers in a highly vulnerable situation ... A number of people with mental illness acquire a brain injury and many people with an ABI develop serious depression or psychiatric disorders, which result in challenging behaviour. These people are denied access to mental health or specialised behavioural services that are vital to successful behavioural interventions. A parallel situation exists in regard to drug and alcohol abuse.

(Brain Injury Association of Queensland, Queensland, Submission #60)

People with ABI should be eligible for Mental Health and Drug and Alcohol services. A diagnosis of ABI and mental health or behaviour disorder should meet eligibility criteria for Mental Health Services. Mental Health Services have historically rationed services and excluded people with ABI. Mental Health Services also do not work well in collaboration with community supports. Mental Health Services require a 'cultural shift', which will likely only be initiated through a Whole of Government strategy.

(Brain Injury Association of Queensland, Queensland, Submission #60)

Alternative accommodation models need to be developed for people with disabilities at risk of inappropriately entering aged care facilities or the criminal justice system.

(Brain Injury Association of Queensland, Queensland, Submission #60)

Increased support is required for ageing parents who support people with a disability at home.

(Brain Injury Association of Queensland, Queensland, Submission #60)
6.3.11.4.6 Lack of services for people with personality disorders

Clinicians and consumers also raised concerns about the lack of services and discriminatory attitudes towards people with personality disorder.

As soon as anyone mentions the words Borderline Personality Disorder after your name you can just about be sure that some sort of punishment, derision, fob off, judgement or disdain is coming your way. Oh! How I hate this diagnosis. It's cruel and I believe does nothing that is the slightest bit helpful because it makes you feel like dirt.

(Consumer, Queensland, Submission #204)

Once you have a personality disorder label in your records it is almost impossible to get rid of it no matter what you do and no matter how much you try and redeem yourself. Whilst records remain in circulation that connects you with Borderline Personality Disorder you are destined to be treated offensively. The wost thing is that the more you try and defend yourself against it the more you seem to convince those observing you that you deserve it.

(Consumer, Queensland, Submission #204)

People with personality disorders and those who self harm are treated with contempt and a lack of understanding particularly by unit staff. There is little or no expertise in working with people with this disorder.

(Anonymous, Queensland, Submission #113)

There are limits on what we can do - impatient care is often contraindicated for people with a personality disorder.

(Clinician, Queensland, Rockhampton Forum #7)

But if you have Borderline Personality Disorder and you have been told that there is no treatment for that well in my view that's discriminatory when people are being told they can't get care.

(Clinician, Queensland, Brisbane Forum #7)

The suicide caused some reflection on my part. The 24-year-old was a troubled woman. I saw her 19 times over a two year period. She strode out of our final consultation, angry that I wouldn't prescribe strong sleeping tablets. She threatened to do something that would shock me. We both knew what she meant. Luckily for my own stress levels this episode took place months before her actual suicide ...My patient had rapid severe mood swings and tendency to self-harm. She met the criteria for borderline personality disorder ... This already disturbed young woman had problems dealing with the murder of a friend and I sought psychiatric help for her. She told me that community mental health service said she didn't have a mental illness. She was also assessed at a public hospital psychiatric unit and apparently told that she didn't need a psychiatrist. None of this surprised me, and I'm not blaming the clinicians who assessed her. Like most health care problems, the fault does not lie with individuals. They were merely following their training and, of course, to a degree restrained by the resources allocated to the public system. There was certainly nothing unique about the failure to achieve psychiatric support for this woman and I have been down this same path many times with many patients in many locations.

(Clinician, Queensland, Submission #42)
6.3.11.4.7 Lack of services for people with eating disorders

Clinicians, service providers and consumers expressed concerns about the lack of availability and quality of treatment and support services for people with eating disorders.

On a number of occasions I have sought admission for young female patients with life threatening eating disorders only to find that acute private care is almost unattainable. I have been advised by a leading eating disorder specialist that beds are so difficult in units that can handle this type of disorder that patients must be within imminent danger of death within less than seven days to meet their criteria for admission.

(Dr Bruce Flegg MP, General Practitioner and Liberal Shadow Minister for Health, Queensland,
Submission #39)

In the public system it is even worse. Essentially patients are taken in to the public system at the point that they require to be admitted to intensive care. Clearly these patients need beds in a general hospital setting with psychiatric capabilities and sadly this is diminishing. The recent closure of the Wesley Hospital's mental health ward has further exacerbated an ongoing shortage of mental health beds in general hospitals and given the nature of eating disorders there is the need for a socialised unit within the public system that has the capability of assisting the mental health issue whilst providing general life saving medical care.

(Dr Bruce Flegg MP, General Practitioner and Liberal Shadow Minister for Health, Queensland,
Submission #39)
6.3.11.4.8 Lack of appropriate treatment and support services for consumers in the criminal justice system

Although consumers who are subject to the criminal justice system are ensured access to a comprehensive range of treatment and support services (Standard 11.4.7) concerns were expressed regarding the availability and quality of such services. Problems were also raised regarding the lack of separate facilities for people with mental illness who are subject to the criminal justice system:

The prison psychiatrist was on leave for almost the entire time that my son was in prison so he received almost no psychiatric help during that time.

(Carer, Wife and Mother, Queensland, Submission #52)

I would also like to talk about the criminalisation of women in prison. In Queensland we've lodged a complaint with the Human Rights and Equal Opportunity Commission about the treatment of women in maximum security - it's a 54 placement Unit. The women in this unit are double belted, hand cuffed and left naked - the problem is there is no accountability ... We are hoping for a national inquiry about women in prison.

(Prison NGO worker and Consumer Advocate, Queensland, Brisbane Forum #5)

There is minimal medical support - only 1 worker. Psychiatrists recommend drugs and bomb them out. 3 women have been diagnosed with Post Traumatic Stress Disorder from being in that unit.

(Prison NGO worker and Consumer Advocate, Queensland, Brisbane Forum #5)

Women don't have as much access to lower security prisons. Most stay in high security.

(Prison NGO worker and Consumer Advocate, Queensland, Brisbane Forum #5)

My son was in an extremely agitated state and when I spoke to an officer regarding his need to see a doctor he just said 'he'll be right'. The next day he appeared in court still in an agitated state, still in his blood -stained clothes and because he was regarded a danger to himself and others he was remanded to Etna Creek for 6 weeks! In those ensuing 6 weeks I spoke to people from the Criminal Justice Commission, Health Rights Commission, Members of Parliament, the director of Mental Health, Legal Aid and eventually the Human rights Commission and Anti-Discrimination. No-one it seemed could help my son! ...It was the same blood-stained clothing he'd left our home in which meant he had been left in them from the early hours of Sunday morning until the Tuesday when he was given prison gear! This was in spite of the fact that he had fresh clothing available. Here was this injured, mentally ill young man trapped in the system for six weeks! ...My son was given an eighteen-month probationary period and a conviction was recorded which has given him cause for concern ever since.

(Carer, Wife and Mother, Queensland, Submission #52)

Until housing and support does become available for people with a psychiatric disability, why are those people who do offend not housed in separate facilities, on a farm for example. In mainstream prisons those who are vulnerable and suggestible are suffering abuse and some are learning even more antisocial behaviours.

(Anonymous, Queensland, Submission #67)

Vulnerable persons should not be in mainstream prison, however it would be irresponsible to have no management strategy or community safeguard when a person does offend. It is proposed that a facility such as Westbrook or Boystown be dedicated to house and support approximately 400 people with a psychiatric disability who are presently reinstitutionalised in highly inappropriate facilities; that is, mainstream prisons. It is envisaged that in five years, the population of such a parallel facility would include people would dwindle, as housing and support, including transition support for people leaving a structured institutional environment, is improved. Moreover it is proposed that any vulnerable person who is inappropriately housed in mainstream prisons be afforded asylum in a parallel justice system. This would include people with intellectual impairment; acquired brain injury by physical trauma; acquired brain injury of organic origin (schizophrenia); autistic spectrum disorder; and vulnerable personality. It is expected that psychometric testing and assessment would identify those who are suffering unnecessarily under the present system."

(Anonymous, Queensland, Submission #67)
6.3.11.4.9 Lack of treatment and support for people with mental illness after release from prison

The lack of coordinated treatment and support services for people with mental illness post release was previously mentioned under Standard 8.3 with regard to the need for whole-of-government approaches to circumvent poor release outcomes. In particular, the lack of advocacy and support while in prison and the lack of transition planning were highlighted as critical areas of concern that suggest that the rights of prisoners with mental illness are not being promoted or protected while in prison or immediately post release.

The core issue is Housing. Corrective Services assumes, wrongly, that prisoners take up where they left off before incarceration. Many have no family support or any friends. With nowhere to go, prisoners supply an address for release that is not a long-term housing option and may not even be a short-term option. Because his place of living is uncertain, my son has asked to be supplied with a prescription for antipsychotic medication, as no connection can be established with a mental health clinic until a place of residence is given. As far as I know, it is not accepted policy to supply prisoners with scripts, but this request does highlight that, having been through the revolving door, he knows about the problems he will face.

(Anonymous, Queensland, Submission #67)

Compliance with medication and having secure, stable and affordable housing are the fundamentals of mental health management for people with serious disorders. Intensive post-release support is necessary until community links and support networks are established, and anxiety levels are reduced.

(Anonymous, Queensland, Submission #67)

The current release and management practices almost guarantee poor release outcomes. Furthermore my efforts to initiate transition planning are not encouraged by staff working for Health within Corrections. It would appear that the policy of Partnerships - which I see mention of in numerous letters and documents - has no meaning in the working lives of many public servants. Many prisoners have no support or advocacy. A dedicated support team in the prison working with a community support team could provide for better release outcomes.

(Anonymous, Queensland, Submission #67)

6.3.11.4.A Community living

The MHS provides consumers with access to a range of treatment and support programs which maximise the consumer's quality of community living.

Under this Standard, submissions and presentations indicate concerns about:

  • lack of treatment and support services for consumers to live in the community without their health deteriorating;
  • the lack of support for carers; and
  • lack of family centred-approaches to treatment and support.
6.3.11.4.A.1 Lack of treatment and support services for consumers to live in the community without their health deteriorating

Reports were received describing the incredible strain that has been placed on families due to the lack of adequate treatment and support services for consumers and their families. One account in particular demonstrated the failure to provide consumer with the 'opportunity to strengthen their valued relationships through the treatment and support effected by the MHS'. It would also appear there is a lack of access to family-centred approaches to treatment and support (as stated in Standard 11.4.A.12). A report of the success of Project 300 indicates that positive outcomes can be achieved with adequate treatment and support in the community and integrated and coordinated care between agencies.

However since the system in Queensland has been de-institutionalised our family, my mother's parents and I, has born the brunt of having to care for her. She lived with myself and her parents on and off, when her delusions became too strong and she became violent we were left with no course of action but to take her to the hospital, where she would remain for a few months, sometimes only a few days before she would be released into our care again. More than half of the time within 48 hours, to a week, of her release we would be back at the emergency room when the medication had worn off and the delusions had returned full force and often she had lashed out at myself or my grandparents.

(Anonymous, Queensland, Submission #82)

The failure of the health care system in not treating people with mental health problems results in carers giving up on all treatments, programs and the health care system it self.

(Carer, Queensland, Submission #109)

We cannot leave him home by himself more than a couple of days, as he cannot be trusted to remember to take the medication. Mostly he does, but not always. There is also the worry that he will decide as he did earlier this year, that he had been well and out of hospital so long this time, he is obviously cured, and didn't need to take the medication anymore Luckily I managed to convince him to cut it down gradually, and that is what we did, but not anywhere near as far down as he intended. He is more aware, and active on the lower medication, but still not up to doing anything other than basic chores.

(Carer, Mother, Queensland, Submission #228)

The advent of Project 300 (a program that assisted people to move from long-stay psychiatric institutions into the community) provided the foundation for sector development. Despite some inherent problems, Project 300 was an extremely successful de-institutionalisation project. Much of this success was due to the central role of the non-government sector and the provision of public housing. Project 300 demonstrated that people could live high quality lives in the community provided that appropriate supports were in place and that there was a balance between the provision of clinical and psychosocial supports, and housing.

(Queensland Alliance of Mental Illness and Psychiatric Disability Groups, Queensland, Submission #218)
6.3.11.4.A.2 Lack of support for carers

One clinician also raised concern about the lack of support for carers of people with mental illness and felt this group of carers is discriminated against with regard to the amount and type of support received compared with carers of people with physical illness.

Carers of people with a mental illness lack support. There is such a disparity between how the system deals with carers of people with a physical disability and carers of people with a psychiatric disability.

(Clinician, Queensland, Brisbane Forum #23)
6.3.11.4.A.3 Lack of family centred approaches to treatment and support

As reported throughout this Report, concern was expressed about the incredible strain that has been placed on families as a result of an inability to access treatment and support at the earliest possible stage of onset of illness. For families, this was often further compounded by the lack of housing and accommodation options available for their family members.

Reports received also indicate a lack of family-centred approaches to treatment and support. Standard 11.4.A.12 states: 'the MHS ensures that the consumer and their family have access to a range of family-centred approaches to treatment and support' and Standard 11.4.A.11 states: 'The consumer has the opportunity to strengthen their valued relationships through the treatment and support effected by the MHS'.

The lack of access to other support services (e.g. respite, leisure, recreation, education, training, work, employment, respite, home and community care) also contributed to this strain for consumers and their families. Strain was also seen to emanate from discriminatory remarks made from members in the community towards family members, a general lack of community acceptance and increasing social isolation (family and individual).

He lives downstairs, and we live up ... But we are getting older, and won't be able to do this for ever. His brothers will be unable to take him into their homes, and it would be nice for us to have a little freedom before we are too old to be able to enjoy it. My husband has just retired, but we will be virtually stuck at home, full time.

(Carer, Mother, Queensland, Submission #228)

Respondent F. cried, "The system sucks!" All nine respondents [family members] reported failed experiences with the Mental Health System. Lack of information about the nature of their relatives' diagnosis, lack of access to clinical and counselling support and community programs and minimal inclusion in care planning and treatment options were identified as major barriers to coping with their relatives' illness ...

(Carer, Wife & Mother, Queensland, Submission #157)

To obtain a comprehensive narrative, the author conducted a small research project focusing on the impact on nine family members of persons living with mental illness. The project identified a significant number of traumatic physical, mental and emotional impacts, which had a disabling effect on these relatives. Listening to the stories of spouses, parents, children and siblings it became obvious that all respondents felt the mental health 'system' had failed them and their relative living and/or dying with mental illness.

(Carer, Wife & Mother, Queensland, Submission #157)

6.3.11.4.B Supported accommodation

Supported accommodation is provided and / or supported in a manner which promotes choice, safety, and maximum possible quality of life for the consumer.

My son had schizophrenia ... I'm a nurse and I understand why he wasn't kept in hospital - you can't just keep people like him in hospital. What he needed was a halfway house. We need more money spent on after care and pre care - something staged that people can access when they don't necessarily need to be in hospital.

(Carer, Mother, Queensland, Rockhampton Forum #9)

Under this Standard, submissions and presentations indicate concerns about:

  • the lack of available supported accommodation; and
  • the lack of support for homeless people with mental illness.
6.3.11.4.B.1 Lack of available supported accommodation

Most people don't expect our loved ones to be wrapped up in cotton wool - what we would like is some sort of place where they could go after hospital and get support.

(Carer, Female, Queensland, Rockhampton Forum #16)

As noted previously in this Report (8.3 Integration), the lack of housing and accommodation options, and supported accommodation options in particular, for people with mental illness is of serious barrier to consumers attaining the 'maximum possible quality of life' and integrating and contributing to the community. Of particular concern was the reported lack of accommodation for youth with mental illness or mental health problems. The scarcity of services for this age group and inability for clinicians to intervene as early as possible, often has serious long term consequences. Not only were concerns raised with regard to lack of available places, but also with regard to lack of resources and staff to adequately provide such services.

There's a real lack of supported accommodation here in this town. We have 23 beds in our intensive unit but a very large geographic area to service - the difficulty is in finding accommodation for these people ... We also have a number of hostels in town here

(Clinician, Queensland, Rockhampton Forum #7)

Since early 1996 my mother has been living in privately managed care facilities ... somewhat decreasing the burden which has been placed on her parents and myself to care for her. However, this facility is not perfect, and is understaffed and without the resources and trained assistants to fully care for all of its residents. I have been told by the management of this facility that my mother is one of the most mentally ill people living there, and were her condition to worsen, in any way, they would no longer have the resources to care for her and she would have to return to us. I have to ask if these people, who are infinitely more skilled and better trained than either myself or my octogenarian grandparents, cannot care for my mother, then how can we? The only answer people have had for us, is that well, there isn't anyone else.

(Anonymous, Queensland, Submission #82)

Childers backpacker fire has forced closure of beds in hostels. 35% of people in this case have a mental illness but they haven't got access to appropriate medical care and housing.

(Supported Accommodation and Assistance Program Service Provider, Queensland, Brisbane Forum #2)

...issues that are regularly presented to our offices ...People being kept in patent care longer than necessary because of lack of housing; Discharge planning - shunted into supported accommodation and hostels; Access to SAAP [Support Accommodation Assistance Program] services.

(Office of the Public Advocate worker, Queensland, Brisbane Forum #14)

Many families, particularly elderly parents / carers, are being placed under a lot of stress because of the severe shortage of suitable assisted accommodation for their mentally ill adult children who are unable to manage on their own. Most of them are worried sick about what will happen to their children when the carer dies. Will the consumer end up on the streets? This is the biggest fear for the parents of these consumers. Many of these consumers COULD manage their own home IF they had the ongoing support of a case manager. And I mean a case manager who visits a minimum of once per week. So the problem of eliminating case managers also affects the ability of consumers to live in society independently of their family. (author's emphasis)

(Carer, Mother, Queensland, Submission #10)

The Report of the National Inquiry concerning the Human Rights of people with a mental illness in 1993 found;

People affected by mental illness face a critical shortage of appropriate and affordable housing. The absence of suitable supported accommodation is the single biggest obstacle to recovery and effective rehabilitation.

This is still the case; in fact I feel the problem has increased.

(NGO Service Provider, Queensland , Submission #40)

Homeless shelters, refuges and boarding houses are now functioning, defacto, as a major component of the accommodation provided by our society for thousands of Australians affected by Mental illness. This is completely unacceptable. It must have been acceptable because it has not changed. Homeless shelters are receiving more referrals from Acute Psychiatric Units to supply accommodation for their patients then ever before.

(NGO Service Provider, Queensland, Submission #40)

It was recommended that Supported accommodation for people with psychiatric disability must be established in all major metropolitan and regional centres. This should include crisis, medium-term and long term accommodation.

(NGO Service Provider, Queensland, Submission #40)

In September 2003, The National Council of Women Queensland took the following resolution to the National Council of Women Australia triennial conference in Perth :

Accommodation options for mental health clients. That NCWA requests all Australian governments to increase funding to provide a range of accommodation options for mental health clients, including supervised accommodation, so that wellness is facilitated. Accommodation, together with case management and transition planning, should be addressed as matters of great urgency.

(Carer, Mother, Queensland , Submission #228)

A couple of years ago I tried to find somewhere he could live, where there would be some support to make sure he took his medication, remind him to have a bath regularly, and have his hair cut etc. Nothing was available, but he was not worried. He is quite happy to stay at home. "You are good for another 20 years yet mum." For the last 3 years I have been suffering from Polymyalgia Rheumatica, and am not sure that I will be. My current symptoms are in my feet, making it very painful to walk.

(Carer, Mother, Queensland, Submission #228)

As he had been assessed / worked with by CCU for 13 months .... I felt he had declined or showed no signs of progress in several areas and there are bound to be others: personal hygiene; financial responsibility; personal motivation; awareness - again I question his hearing ability; level of restlessness / pacing; raised level of smoking - in heath and cost terms needs addressed. From what I understand - he would not be a good candidate for living alone, although I believe an application has been raised with the Housing Dept for a flat? ... [Z] expressed concern that they were unable to find ways to stimulate [X] and seemed to be waiting for [X] to "pull himself together". I doubt, having seen [X] that this approach can produce the potential results we all want.

(Carers, Parents, Queensland, Submission #150)
6.3.11.4.B.2 Lack of support for homeless people with mental illness

Concern was also expressed for one of the most marginalised groups in society, the homeless with mental illness. Concerns included the lack of organised treatment and support services for these consumers and the lack of options that can be exercised to protect them from self-harm.

Also, for 10 years I worked as a Welfare Worker in a Hostel for the Homeless, and was astounded that Mackay Mental Health could not institutionalise those who were totally incapable of living in society, not even in a home for the homeless.

(Carer, Mother, Queensland, Submission #91)

I had a lady staying with me and she had a mental illness and I took her home and she had nowhere to go. I went on a holiday and when I came back she had killed herself. Her case worker and I tried to get someone - but no one would take her.

(Anonymous, Queensland, Rockhampton Forum #10)

6.3.11.4.C Medication and other medical technologies

Medication and other medical technologies are provided in a manner which promotes choice, safety and maximum possible quality of life for the consumer.

Under this Standard, submissions and presentations indicate concerns about:

  • the emphasis on medication.
6.3.11.4.C.1 Emphasis on medication

Reports were received expressing concern about the major emphasis of treatment for mental illness being a reliance on medication without regard to side-effects, overall well-being or other treatment options.

I'm also concerned that many people are treated for mental illness when the main treatment seems to be to whack them on large doses of medication - there aren't enough reviews of medication.

(Consumer, Queensland, Brisbane Forum #11)

Regulated patients in the community a disguised form of "enforceable" medication. Australia's high rate of medication by injection - forced compliance - "why so different in Europe?"

(Anonymous, Queensland, Submission #49)

Use of medication - most have severe side effects (impotence, constipation, weight gain (diabetes), thyroid damage, facial tichs) - medication given apparently without a regular review unless obvious damage is being done, little or no thought given to reducing doses of medication to see if the patient can function without symptoms on a smaller dose - power of the drug companies undisclosed risks (present scandal on anti-depressants) - respiridone the drug of choice in qld hospitals? "it's the cheapest & we don't know which one is going to work now do we?"

(Anonymous, Queensland, Submission #49)

By this time, [X] seemed as if he felt he didn't really need to attend the unit as Dr [Y] had provided him with a script with seven repeats! I didn't even think this was possible. Dr [Y] apparently also increased the dosage. This meant that [X] was not being seen by anyone at Mental Health so his deterioration was going undetected.

(Carer, Wife and Mother, Queensland, Submission #52)

6.3.11.4.D Therapies

The consumer and consumer's family / carer have access to a range of safe and effective therapies

Under this Standard, submissions indicate concerns about:

  • lack of access to a range of accepted therapies.
6.3.11.4.D.1 Lack of access to a range of accepted therapies

According to Standard 11.4.D.2: 'The MHS provides access to a range of accepted therapies according to the needs of the consumer and their carers'. However, concern was expressed that access to such therapies in the public mental health system is difficult. These concerns further support the claims that there is an over reliance on medication as the preferred treatment of choice by clinicians in the public mental health system.

What talking therapies are available in the public system to be used instead of or in conjunction with medication?

(Anonymous, Queensland, Submission #49)

It is almost impossible to see a psychologist or psychotherapist in the public mental health sector these days. This is a disaster. Where have they all gone and why? Why do those of us who desperately need counselling and other talking therapies always seem to come last?

(Consumer, Queensland, Submission #204)

During the years I have been involved with the Rockhamptom Mental Health Unit the only option offered to consumers seems to be by way of medication. There is a real need for other options to be available instead of / or in conjunction with the use of medications.

(Carer, Wife and Mother, Queensland, Submission #52)

However, one consumer reported an ability to access non-medication based therapy:

What helped me in reclaiming my life ... Starting a course of antidepressants (let me qualify: this helped with bearing the load - they don't cure anything); ... Seeing a psychologist and undertaking Cognitive Behaviour Therapy (which is a very effective treatment for depression).

(Consumer, Queensland, Submission #313)

6.3.11.4.E Inpatient care

The MHS ensures access to high quality, safe and comfortable inpatient care for consumers.

I was admitted to hospital one night I had a serious overdose on drugs, trying to commit suicide, I explained this to the nurses in the Logan Hospital, they left me in a room by myself all night and released me at 6am the following morning and told me I was fine.

(Consumer, Queensland, Submission #73)

Under this Standard, submissions and presentations indicate concerns about:

  • the lack of beds; and
  • appropriate treatment and support not being provided in inpatient units.
6.3.11.4.E.1 Lack of beds

Treatment is typically brief and often people are released the next day; they are just kept in over night. This type of care is no good - it creates a revolving door - people just get sick again because they have been discharged early so the figures look good and someone else can have their bed. This is not good care.

(NGO worker, Queensland, Brisbane Forum #3)

The lack of available beds for acute care was also cited as a serious concern. Patients requiring admission were generally in desperate need of medical care, often life-saving medical care. It appears that the demand far exceeds the number of beds available which results in a whole series of other decisions which jeopardise the safety and rights of consumers: non-admission and returned 'home', admission and someone else who is still unwell is discharged to vacate a bed, admission to another ward, or, as indicated below, admission to child and adolescent facilities.

On a number of occasions I have sought admission for young female patients with life threatening eating disorders only to find that acute private care is almost unattainable. I have been advised by a leading eating disorder specialist that beds are so difficult in units that can handle this type of disorder that patients must be within imminent danger of death within less than seven days to meet their criteria for admission.

(Dr Bruce Flegg MP, General Practitioner and Liberal Shadow Minister for Health,
Queensland, Submission #39)

Perhaps even more acute however is the difficulty in accessing in-patient beds. Let me focus on one particular area where services in Queensland are particularly lacking and that is in the area of eating disorders.

(Dr Bruce Flegg MP, General Practitioner and Liberal Shadow Minister for Health,
Queensland, Submission #39)

In the public system it is even worse. Essentially patients are taken in to the public system at the point that they require to be admitted to intensive care. Clearly these patients need beds in a general hospital setting with psychiatric capabilities and sadly this is diminishing. The recent closure of the Wesley Hospital's mental health ward has further exacerbated an ongoing shortage of mental health beds in general hospitals and given the nature of eating disorders there is the need for a socialised unit within the public system that has the capability of assisting the mental health issue whilst providing general life saving medical care.

(Dr Bruce Flegg MP, General Practitioner and Liberal Shadow Minister for Health,
Queensland, Submission #39)

We have four units with a total of 60 beds. Eight days is the average length of stay. 10 beds for dual diagnosis at Mater Hospital and we take referrals from across the State. The overflow is dealt with by child and youth mental health services.

(Clinician, Queensland, Brisbane Forum #10)

These admissions are never without drama, and it can take 6-8 hours in the waiting room before he is seen, and a few more hours to find a bed. The worry is that someone else who was not really ready to go home, might have gone to make room for him ...

(Carer, Mother, Queensland, Submission #228)

In 2000 he was in Wacol hospital, and went walkabout. The voices told him to swim the river. He had already done that a number of times, and said so. So they said 'OK jump off this bridge'. "Stupid voices, they should have waited until the tide came in". He jumped 6 meters onto rocks under 18inches of water. Smashed both heels and a bone in one leg. He couldn't get out of the creek, and although he spoke to someone, they ignored him. He wasn't found until 28 hours later, during which time he had spent a night in the creek, wet and cold.

(Carer, Mother, Queensland, Submission #228)

After years of depression, on and off, Mum was finally Hospitalised in January this year ... It was only towards the end of her stay in the Hospital I found out the Doctor there was the Resident Doctor. The whole time Mum was in Hospital she never saw a Psychiatrist once. When I queried this I was told the Doctor was working in consultation with the Specialist, but the Hospital system didn't have the funds to have a Specialist there all the time ... She has now been taken off this wonder drug and there is talk of sending her home. I'm confused as to what the future now holds for my Mum as we go along with the Medical people on trust because we have no option. Mum hasn't seen a Psychiatrist since being in Hospital again this time, but what do I do? ... I am telling this story because it's just one more person on the merry-go-round of mental health and I don't know where to get off and get more help for Mum.

(Carer, Daughter, Queensland, Submission #93)

A submission from Queensland Health discusses bed number and distribution. The submission notes that overall bed numbers have not declined since deinstitutionalisation was implemented in 1996.

All acute inpatient beds are now mainstreamed within general hospitals. The development of new services and the redistribution of existing services have resulted in improved access and continuity of care for mental health consumers across the state. Queensland Health currently provides facilities across a range of clinical program areas including inpatient services for adults (603); older people (35); children and adolescents (76); and extended treatment services in the areas of Dual-Diagnosis and Extended Treatment and Rehabilitation (348); Acquired Brain Injury (62); Psychogeriatrics (138); and Medium (99) and High Secure (71). Since the commencement of the reform process under the 10 year Mental Health Strategy (1996), Queensland has not reduced the overall number of inpatient beds in the State, which now number 1432. Queensland has, however, decentralised the beds from its large stand-alone mental health facilities at The Park, Baillie Henderson Hospital and Mosman Hall Hospital to other regional sites ensuring extended care services are provided closer to where people live and closer to their natural support networks.

(Mental Health Unit, Queensland Health, Queensland, Submission #311)
6.3.11.4.E.2 Appropriate treatment and support not being provided in inpatient units

Concern was expressed by carers that appropriate treatment and support was not being provided to their relatives while they were receiving treatment in hospital-based settings. Concerns ranged from short and non-helpful stays, without appropriate planning prior to discharge, and the lack of required aggressive treatment. Standard 11.4.E.1 states: 'The MHS offers less restrictive alternatives to inpatient treatment and support provided that it adds value to the consumer's life and with consideration being given to the consumer's preference, demands on carers, availability of support and safety of those involved'. One carer suggested that interpretation of 'less restrictive alternatives' needs to be considered in the spirit intended 'provided that it adds value to the consumer's life and with consideration being given to the consumer's preference, demand on carers, availability of support and safety of those involved' (Standard 11.4.E.1). In this instance, the family member achieved the best results when admitted to a secure ward and given 'aggressive treatment'.

On one of my mother's brief stays, my mum told dad that one doctor said to her what are you doing back here? As if to say, she was wasting his time. The result of this first class care was that in approximately twelve days mum was back there as a result of drinking Weed Killer, for yet another short and non helpful stay, and the Drug Addicts are still there. Yet again mum was sent back to her family's expert care.

(Carer, Son, Queensland, Submission #184)

My son then had to drive him from Logan to PA with a letter of admission. He was registered as an involuntary patient and 5 minutes after going through locked doors he was outside the hospital behind my son who had admitted him. We went through months of absolute trauma because he wasn't kept locked up and given aggressive treatment when he needed it. It wasn't until I started sending emails to people at the top that we got any action.

(Carer, Mother, Queensland, Submission #168)

6.3.11.5 Planning for exit

Consumers are assisted to plan for their exit from the MHS to ensure that ongoing follow-up is available if required.

Under this Standard, submissions and presentations indicate concerns about:

  • inadequate planning prior to discharge
  • planning for exit on the basis of need to vacate beds; and
  • discharge occurring while consumers are still very ill.
6.3.11.5.1 Inadequate planning prior to discharge

One submission raised serious concerns about the inadequacy of discharge plans, and that sometimes they are not even instigated. Specifically, the allegation suggests that discharge plans have not been developed in collaboration with the consumer (Standard 11.5.2), that understandable information about the range of relevant services and supports have not been provided (Standard 11.5.4) and that consumers have not established contact with the service providers prior to exit (Standard 11.5.6).

There are very rarely discharge plans upheld or even instigated. A recent admission reported filling out her name and nothing else on the discharge plan and this was accepted as her plan. She was told she was to be discharged after a two-night stay, with very little contact and no one contacted her for 5 days. This person was drinking or taking excessive medication, cutting, then reportedly blacking out, each night. Their response was 'it's her choice'. Her obsessional thoughts were severe and constant and related to a service provider. She was told she could control them and why doesn't she go and talk to the person she is obsessed with ... she had apparently threatened to kill the service provider, knew her phone number and where she lived, wrote poetry about the person and so on.

(Anonymous, Queensland, Submission #113)
6.3.11.5.2 Planning for exit on the basis of need to vacate beds

Concerns were expressed that discharge was not occurring to an agreed exit plan or health status of the consumer but rather according to the need to vacate beds for new admissions. Such exits could jeopardise the safety of the consumer, especially as entry is almost always on the basis of risk of actual self-harm or harm to others, and frequently results in almost immediate readmission. According to Standard 11.5.2: 'The exit plan is reviewed in collaboration with the consumer, and with the consumer's informed consent, their carer's at each contact and as part of each review of the individual care plan'. Also, according to Standard 11.3.18, a review should be conducted when the consumer is going to exit the MHS, presumably to ensure that exit is occurring at an appropriate stage of the recovery process.

Nurses told me when a patient is in emergency needing a bed, they do "eenie, meenie, miny, mo" around the ward and decide who can be discharged - whether or not they are well. On one occasion during the 6 month period my son was ill he was discharged and threatening staff while we were still standing in the ward waiting for his medication.

(Carer, Mother, Queensland, Submission #168)
6.3.11.5.3 Discharge while still very ill

Concerns were expressed that discharge was occurring without staff reviewing the outcomes of treatment and support (Standard 6.1). One carer reported that her son was discharged while very ill, which indicates that that an individual care plan had not been devised, and an exit plan (Standard 11.5.1) and clinical review of the consumer had not been conducted prior to discharge (Standard 11.3.18).

I was amazed on one of my visits to see my mother so distressed that after two days they were sending her home to us the family to give the care she had not received in the Hospital. May I add also that this particular incident occurred after her third attempt on life. She was so frightened because she knew she was not any better.

(Carer, Son, Queensland, Submission #184)

Then he was discharged while still obviously very psychotic, and 14 hours later his brother sat in an emergency room at the hospital for another 5 hours to have him re-admitted.

(Carer, Mother, Queensland, Submission #168)

6.3.11.6 Exit and re-entry

The MHS assists consumers to exit the service and ensures re-entry according to the consumer's needs.

Under this Standard, submissions and presentations indicate concerns about:

  • inadequate or no follow-up; and
  • suicide immediately after discharge.
6.3.11.6.1 Inadequate or no follow-up

Concerns were also expressed about the lack of follow-up, even if plans were arranged.

...people weren't followed up.

(Anonymous, Queensland, Rockhampton Forum #8)

It is very difficult to be admitted to the facility and in many cases there is no follow up and/or case management is kept to a minimum. But this is not always the case, some people are taken up or case managed long-term that are far less ill than others.

(Anonymous, Queensland, Submission #113)

[X] was in hospital for ten days (a long time by this unit's standards - they are usually sent home after only two or three days treatment almost as unwell as when they were admitted). He was discharged with one week's medication and was to see Dr [Y] in one week for a follow-up and to get scripts. Later in the week when I realised [X] was not given the time of the appointment, I called in at Mental Health to find out the actual time. Typically, no appointment had been made. After much difficulty, the earliest appointment for Dr [Y] was not until Thursday - [X] only had enough medications to do till Monday morning! When I pointed out this fact, I was introduced to a person from the Acute Care Team for advice - which was 'just see how [X] goes and if he has any trouble contact the AC Team'. I couldn't believe I was hearing this! I said 'of course he will have trouble, as soon as he misses a day's medication he will have trouble and what happens if this trouble occurs after 9pm when the AC Team has left?' It was only when I made it clear that I would not leave without the problem being resolved, that a doctor was called and a script was provided.

(Carer, Wife and Mother, Queensland, Submission #52)

I do believe that there has to be more follow up contact with people to make sure there [sic] on the right track from the acute care team or mental health workers.

(Consumer, Queensland, Submission #192)
6.3.11.6.2 Suicide immediately after discharge

As noted above, concerns have been expressed about the inappropriate discharge of consumers when they are still unwell. Such concerns are reinforced by the report below from a carer whose son died within 48 hours of discharge. When discharged, both the son and family raised concerns that he was still unwell.

My 23 year old son, [X] who suffered from schizophrenia for a period of about 7 years took his own life within 48 hours of being released from an acute psychiatric unit. [X] was released from hospital on the 1st June 2004 and died on 3rd June, 2004. [X] told medical staff at the hospital he was not well enough to leave but they insisted on discharging him. I felt he was not well enough to be discharged and knew there was no way they would keep him in hospital any longer. A nurse told me if patients do not leave the hospital when told, medical staff can have security guards remove them (patients). I believe the mental health system failed my son in a number of ways. They did not care to acknowledge that my son was still psychotic and he was released from hospital too early. Staff at the hospital were not willing to listen to our family about [X] and his illness.

(Carer, Mother, Queensland, Submission #117)

6.3.12 STORIES OF HOMICIDE AND SUICIDE IN QUEENSLAND

[X] was on medication and her father apparently had been going to the [Rockhampton Mental Health] Unit advising them of the changes in [X] but they (M.H.U) ignored her father's concerns. On [date] 2003 [X] went to the mental health unit seeking help as she was hearing voices. They turned her away (this has been confirmed by the Rockhampton Police). Approximately 4pm on [date] 2003 [X] (after returning home) stabbed her nephew [Z] aged 3 yrs 11 months approximately 6 times in the chest (I have since been advised [X] did exactly the same thing to [X] as she did to her own child 5 years ago). [Z] died not long after.

(Family Member, Queensland, Submission #43)

My son committed suicide 2 years ago. There are a lot of deaths here amongst indigenous youth. Before he killed himself my son went to the mental health unit and they told me he was suffering from behaviour problems - the perception was that because he was an indigenous young man that he was 'sloshed out'. We were told that he wasn't suicidal.

(Carer, Mother, Queensland, Rockhampton Forum #3)

I lost my son a few months ago. My son was a drug addict - he was popping pills all the time. Trying to rehabilitate. On the 19th August last year he had an appointment at the mental health service. The doctor changed his medication and gave him 4 prescriptions of methadone 20 tablets (10mg) - putting that prescription in his hand was like putting a loaded gun or a syringe of heroin in his hand - after that he had mood swings, other symptoms came back in a number of days. On the 23rd August, at 6am I found my son dead - he had taken half the box of methadone. I thought Methadone was a controlled substance. Why was my son given this prescription?

(Carer, Mother, Rockhampton Forum #4)

A cousin who worked for the blue nurses in NSW was looking for work. She couldn't get work any more because of her mental illness she ended up killing herself.

(Anonymous, Queensland, Rockhampton Forum #5)

My son had schizophrenia and he's now dead as well - he committed suicide. The community didn't understand and when people found out he had a mental illness they dropped him like a hot potato.

(Carer, Mother, Queensland, Rockhampton Forum #9)

I had a lady staying with me and she had a mental illness and I took her home and she had nowhere to go. I went on a holiday and when I came back she had killed herself. Her case worker and I tried to get someone - but no one would take her.

(Anonymous, Queensland, Rockhampton Forum #10)

Two consumers died at Xmas one who self harmed and took it too far - we referred him to the service as he was very distressed and out of control he was assessed by a case manager as ok but died within the following week; The second went to the service begging to go into the unit as he knew that when he got this depressed he was at risk - this was our experience in the past and he was hospitalised and kept safe; they refused on this occasion - he took his own life a couple of days later.

(Anonymous, Queensland, Submission #113)

Six years ago my husband took his own life after being released from Brisbane Hospital when staff knew that the previous evening he had attempted suicide. I could get no support or answers for his four children - even after writing to the Brisbane hospital ombudsman, the Brisbane Police, the coroner's office for an autopsy report. I engaged a lawyer ... to no avail. I dropped the search for answers when the lawyer told me it was too hard. For years my children and I have had to carry the weight of their father's suicide with the only answer being that it was sad but too bad, there was nothing anyone could do. Well the Sunday program has raised all my angry again at the indifference of the Medical community of Queensland at the time and I still want answers for my children as to why the system failed their father.

(Carer, Wife, Queensland Submission #85)

My son [X], aged 19, and 5 and a half months prior to his death was diagnosed with schizophrenia, paranoia and severe depression. During this period we found lack of services, lack of treatment and no understanding by the wider community. During this period [X] tried to kill himself twice in one day. First by connecting the hose to the exhaust pipe of his car, and the second by taking an overdose of prescribed medication. [X] was rushed to the emergency of mental health by an ambulance however he still was not taken seriously by doctors and psychiatrists and allowed to leave after a short few days even though we his family and [X] himself insisted that he was not well enough to leave. [X] finally lost all hope and on the 29th of May 1999 he laid himself on a train track.

(Carer, Mother, Queensland, Submission #81)

The suicide caused some reflection on my part. The 24-year-old was a troubled woman. I saw her 19 times over a two year period. She strode out of our final consultation, angry that I wouldn't prescribe strong sleeping tablets. She threatened to do something that would shock me. We both knew what she meant. Luckily for my own stress levels this episode took place months before her actual suicide. The clinic's nurse was less fortunate, having much more recently experienced a similar interaction over a different issue. My patient had rapid severe mood swings and tendency to self-harm. She met the criteria for borderline personality disorder. There is increasing evidence that, rather than a wicked soul, dysfunction of the brain's limbic system underlies this condition. This dysfunction is often associated with past emotional trauma. Among my female patients, a history of childhood sexual abuse is common. This already disturbed young woman had problems dealing with the murder of a friend and I sought psychiatric help for her. She told me that community mental health service said she didn't have a mental illness. She was also assessed at a public hospital psychiatric unit and apparently told that she didn't need a psychiatrist. None of this surprised me, and I'm not blaming the clinicians who assessed her. Like most health care problems, the fault does not lie with individuals. They were merely following their training and, of course, to a degree restrained by the resources allocated to the public system. There was certainly nothing unique about the failure to achieve psychiatric support for this woman and I have been down this same path many times with many patients in many locations.

(Clinician, Queensland, Submission #42)

At this stage of my wonderful mother's sad story, it was having a huge affect on the whole family. The answer to my question to the doctor about how many attempts would be enough. Apparently the answer to that question as found out was five. Because on the fifth occasion, at approximately 1:30pm on the 15th October 2003, my mum decided to douse herself in petrol and set herself alight.

(Carer, Son, Queensland, Submission #184)

6.3.12.1 Case scenarios outlined by White Wreath Association:

Son 19 years of age attempted suicide. Rushed to hospital. Released after a few days. Threatened to kill himself on several occasions after being released. Family tried to seek help. Discovered no services in place what so ever. Family pleas for help ignored. Found dead 2 months later.

Male aged 33 attempted to kill himself with overdose of Alcohol / medication. Found and rushed to hospital. Released 2 days later. Found dead 1 week later.

Male 42 years of age. Attempted to kill himself and two children. Found in act. Taken to hospital. Released 3 to 4 days later. Found dead 2 weeks later.

Woman rang concerned about her daughter. Daughter has a two-year-old child and is constantly talking of killing herself and her two-year-old. Tried to intervene by seeking help for this woman.

1st Phone call was informed the psychiatrist's only works Monday, Wednesday Morning and Friday.
2 nd
Phone call there is nothing we can do unless she is assessed.
3rd
Phone call because a family member did not ring we can't help you. Ask woman to contact us.
4th Phone call, office hours closed after 5PM please ring this number .... Case history of woman: - Brother suicided, Auntie Suicided, her own mother suffers severe depression and has attempted suicide. NO QUESTIONS EVER ASKED OF HER MENTAL STATE OR FAMILY HISTORY. (author's emphasis)

(White Wreath Association Inc, Queensland , Submission #81)
© Mental Health Council of Australia 2005. Last updated 29 August 2005.
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