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

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6.3 QUEENSLAND

• 6.3.1 STANDARD 1: RIGHTS
• 6.3.2 STANDARD 2: SAFETY
• 6.3.3 STANDARD 3: CONSUMER AND CARER PARTICIPATION
• 6.3.4 STANDARD 4: PROMOTING COMMUNITY ACCEPTANCE
• 6.3.5 STANDARD 5: PRIVACY AND CONFIDENTIALITY
• 6.3.6 STANDARD 6: PREVENTION AND MENTAL HEALTH PROMOTION
• 6.3.7 STANDARD 7: CULTURAL AWARENESS
• 6.3.8 STANDARD 8: INTEGRATION
• 6.3.9 STANDARD 9: SERVICE DEVELOPMENT
• 6.3.10 STANDARD 10: DOCUMENTATION
• 6.3.11 STANDARD 11: DELIVERY OF CARE
• 6.3.12 STORIES OF HOMICIDE AND SUICIDE IN 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)