Rau is only an extreme example - our prisons are full of mentally ill people
February 9, 2005

Services to support people with psychoses have been shamefully neglected, writes Allan Fels.

Over the past few days the tragic story of Cornelia Rau has unfolded to an increasingly incredulous public. How is it that for the past 10 months she has been held in prison and in a detention centre when her mental distress was so apparent to her fellow detainees and the Aboriginal people who discovered her?

Has the mental health system let her and her family down?

This case is of particular interest for me. Eight years ago my daughter Isabella, now 33, was diagnosed with schizophrenia after many years of bizarre behaviour. Not only has her illness had a major impact on her life, but it has also affected those who love her.

While she is a charming, intelligent, loving daughter and medication generally relieves her psychotic symptoms, she still has difficulties distinguishing reality and requires support with everyday living.

If Isabella had not been well treated medically and closely cared for, her life could have taken a similarly disastrous turn to that of Rau - who is now, at last, receiving psychiatric care at Glenside Hospital in Adelaide.

One of the most concerning aspects of Rau's situation is that she was clearly severely unwell, distressed and in need of care, yet was allowed to drift into the no-man's-land of an immigration detention centre - where she might still be languishing indefinitely but for the efforts of asylum-seeker support groups.

This is but one particularly flagrant example of how people affected by schizophrenia and other mental illnesses are neglected and allowed to drift into homelessness, neglect and, in many cases, prison or some other inappropriate institution.

While mental health services have been deinstitutionalised over recent years, there are disturbing signs that people affected by mental illness are effectively being "re-institutionalised" in prisons. In NSW - where the prison population has increased by 50 per cent in the past 10 years - 46 per cent of inmates at reception have a mental disorder and the prevalence of psychotic illnesses such as schizophrenia is 30 times greater than the norm.

People sometimes ask if deinstitutionalisation has gone too far. The truth is that it hasn't been given the chance to go anywhere. While the old psychiatric institutions have rightly been closed, community-based services have never been given sufficient resources to provide an adequate replacement - leaving the prison system (and in this case, the detention system) to act as a sump.

It is necessary to state the obvious: that adequate funding from federal and state governments is needed urgently to enable mental health services to provide treatment and care when it is needed - not long after, when a crisis develops and the person and their family have endured so much unnecessary distress.

We know that 1 per cent of Australians - 200,000 people - will experience schizophrenia and three quarters of those will develop it between the ages of 16 and 25. It is a treatable illness and the earlier it is treated the better.

With proper diagnosis and treatment, people with schizophrenia are no more likely to be violent than people being treated for any other illness such as cancer or heart disease.

Expert opinion is that people are born with a vulnerability to develop the illness which can be easily triggered by stress, injury or drug use. People do not develop schizophrenia because they are "weak-willed", nor because they have poor parenting.

Schizophrenia is a costly illness: in 2001 it cost $1.85 billion. More than a third of these costs were borne by people with the illness and their family carers. Many costs were a consequence of the illness going untreated.

It is clear that with the closing of the large psychiatric institutions governments grossly underestimated the number and range of community services that would be needed to provide humane and effective care.

Treatment should include access to good medications and psychological treatments, improved community-based supported accommodation, rehabilitation and recreation programs, help for families and other carers and an end to stigma.

This last point is critical. Stigma associated with schizophrenia means that people affected are thought to be less worthy than others and are treated less well as a result.

At the individual level it means that finding somewhere to live, study, work and play is made more difficult. At a government level it means mental health services are not funded equitably - mental health receives 8 per cent of the health budget, yet is responsible for 25 per cent of the illness burden.

Rau did not choose to be ill and this situation could have been averted by earlier diagnosis and effective treatment. For all our sakes we need to demand more from our governments.

Professor Allan Fels, AO, is dean of the Australia and New Zealand School of Government and an associate of SANE Australia, the national mental health charity. http://www.sane.org