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Wednesday, 13 November 2002
Page: 6216


Senator TIERNEY (1:47 PM) —I rise today to speak on the mental health crisis in New South Wales. This came home to me very dramatically a few weeks ago when my wife and I, together with two of our adult children, left the performance of Cabaret at the State Theatre in Sydney and headed along George Street for coffee. Coming from the glamour and decadence of Cabaret's pre-Nazi Berlin, we were suddenly confronted on the streets of Sydney by the dispossessed of our society—a group of about 10 people who were aimless, destitute, dirty, drunk and probably homeless. The statistics tell us that in that situation probably 75 per cent of them would have a mental illness—although my wife's experience as a senior officer in the Department of Community Services told her that in the group before us there was probably closer to a 100 per cent chance of them having some form of mental illness. Many showed signs of brain damage as they clutched their bottles of wine in brown paper bags, swaying and singing along to the music of the evangelist who was at that time trying to save their souls. They were harmless enough and we stopped to talk to some of them in the heart of Sydney, on a balmy spring night within a few hundred metres of five-star hotels and financial centre skyscrapers which denote opulence and success in our society.

Yet the mark of how civilised our society is can be judged by how we treat these really forgotten people. How do we measure up in the state of New South Wales in the care of people with a mental illness? Recently, the Select Committee on Mental Health in New South Wales brought down its interim report. The committee was headed by Dr Brian Pezzutti. I want to draw out of this report one crucial point. The Pezzutti inquiry is the first parliamentary inquiry specifically into mental health in New South Wales since 1877. That is 125 years ago. In 1877, the inquiry identified 11 significant problems with the mental health program at that time. One hundred and twenty-five years later, seven of these 11 problems have not been dealt with properly. Why?

When the latest report was published two months ago, it drew some media comment. Four Corners screeneda program which laid bare the run-down in psychiatric services in New South Wales, particularly over the last six years. Two days later, the media moved on to other issues. Contrast this with February 1999, when on the front page of the Daily Telegraph appeared a photograph, taken in a back lane in Redfern, of an older boy showing a younger boy how to shoot up heroin. Quite rightly, there was public outrage. The issue rolled on in the press for many weeks. Quite rightly, the government responded and hundreds of millions of dollars were allocated in a four-pronged attack on the drug problem. The mental health issue raised by the Select Committee on Mental Health died in two days as a media issue. And we are still waiting for Bob Carr to commit one extra cent, even when expenditure on mental health in New South Wales is right at the bottom of the class—sixth out of six, across Australia. Bob Carr probably thinks he can get away with this—


The ACTING DEPUTY PRESIDENT (Senator Knowles)—Senator Tierney, may I correct you. It is `Mr Carr'.


Senator TIERNEY —Mr Carr probably thinks he can get away with this because voters do not seem to put mental health very high up the `important election issue' scale. Health is certainly an important issue with the community, but the concern is about access to hospital beds and waiting lists for operations. So I ask: if mental health does not register as a matter that affects voters, how will the lot of people with a mental illness ever improve?

The lack of engagement by the public on this issue is curious when you consider how widespread mental health conditions are, such as depression, anxiety disorders, substance abuse, personality disorders and, to a much lesser extent, psychoses. As for how many people are affected, I note that around 23 per cent of the population have a diagnosable mental illness each year. One-third of these suffer mild episodes and recover without treatment, one-third suffer moderately severe episodes and should have treatment and one-third suffer severe and/or chronic episodes and need treatment.

Who is affected? Sadly, the worst affected group is the 12- to 17-year-olds—at 20.6 per cent. Of the hope of our future, one in five will suffer a mental health episode. The most shocking result is for the under-one-year-olds. Of this group 5.8 per cent have a mental illness, mainly because of abuse, neglect or mothers suffering severe postnatal depression. So, if you have a 20 per cent chance of having a mental health episode and almost a 100 per cent chance of this happening to someone in you family, what are your chances of receiving professional help?

The answer is not good, particularly if you live in New South Wales. Only 35 per cent of people with a mental illness in New South Wales receive treatment. Most treatment— for 75 per cent of those treated—is provided by general practitioners. Of those treated for anxiety and depression, 55 per cent do not receive effective treatments. All of this raises a number of key questions. Why is such a widespread and disabling health problem occurring in such a wealthy society as ours and why is it so poorly diagnosed, under-resourced and largely untreated? Why don't the public register mental illness as a major concern and demand that more resources be allocated to this area?

In our culture people do not really want to know; they switch off. We have to ask why. Possibly, it is because there is a great deal of misunderstanding and misplaced fear of people who have a mental illness. Dr Patrick Corrigan, author of Don't Call Me Nuts, talks about the silent stigma of mental illness when he lists four myths that might explain the public disengagement from mental health issues. Myth 1 is that people with a mental illness are dangerous, unpredictable and out of control and that as a result they can become homicidal maniacs. The fact is that for the most part research suggests that people with mental illnesses are no more dangerous than the rest of the population, except when they use street drugs or are paranoid. Fewer than one in 1,000 people with a mental illness will commit a dangerous act in their life.

Myth 2 is that depression and mania in particular represent a weakness that most members of the population avoid because they have stronger characters. The fact is that serious mental illness is a biological disorder; it is a disease. People no more choose to have depression or schizophrenia than they choose to have diabetes or breast cancer. Myth 3 is that people with mental illness are not capable of living independent lives outside of institutions. The fact is that the vast majority of people with the severest of mental illnesses—schizophrenia, mania and major depression, to name a few—rarely see the inside of a hospital or need institutional care. Myth 4 is that if people with a mental illness are capable of work it is only in menial jobs. The fact is that, like the rest of the population, a small percentage of people with mental illness work as doctors, lawyers and entrepreneurs. Also, mental illness does not necessarily preclude someone from completing schooling or skills training.

Finally, how can we improve what we do for people with a mental illness? There are three key strategies. Firstly, we must increase the mental health literacy of the community. Rotary is to be congratulated on their Australia-wide community forums and support for research into mental illness. Secondly, we must ensure that health practitioners are better able to detect mental illness and provide treatment that works. To achieve this goal there needs to be a large boost in expenditure on mental health, particularly directed at GPs, with training programs and backup resources to make this happen. Thirdly, we need to reorganise mental health services to better provide treatments and forms of support that work in a timely manner—let me emphasise `in a timely manner'.

As a society which believes in the self-reliance of the individual, have we struck the right balance between that tenet—and all that it brings as a mainspring of wealth creation and economic growth—and our responsibility in a civilised society to look after those who cannot rely on themselves? Clearly, particularly in New South Wales, the answer is no. Brian Pezzutti's upper house committee is to be congratulated on exposing the disgraceful state of mental health in New South Wales. Jillian Skinner has made an excellent start with the mental health policy she released recently. We must now establish plans to ensure that the really forgotten people, the mentally ill, receive the level of care and treatment that should be expected in a civilised society.


The ACTING DEPUTY PRESI-DENT —Order! The time for the debate has expired.