Homelessness and mental health.

On a cold August night in Sydney 2001, I was walking up the steps that separate Parliament House from the State Library of New South Wales. As I reached the top of the stairs, I counted the number of homeless people resting under sheets of cardboard. Thirteen. I asked one of the men about accessing sheltered accommodation and if the shortage of beds was the reason why he and so many other people ended up sleeping on the streets. Several others joined the conversation. I asked about accommodation at Mathew Talbot Hostel in Woolloomooloo. They said they were enough beds at the hostel, but it was full of ex-psychiatric hospital patients and it was too dangerous to stay there because these 'psychos', as they called them, were un-medicated, un-supervised and had a habit of attacking people.

One gentleman related a story where he and three other friends where chased by one of these 'psychos' wielding a sharp kitchen knife. While he was lucky to escape, one of his friends ended up in hospital with stab wounds and slashes to arms, face and chest. As a result, they felt it was safer to sleep on the streets than to stay in shelters.

Later, while serving as a member of a parliamentary inquiry into the 'Increase in the Prisoner Population in NSW', it became clear that NSW prisons were becoming the new institutions for people with a mental illness who could not cope with living in the community. In December 2001, I managed to get the numbers to establish a parliamentary inquiry to look into mental health services. It was the first inquiry of its kind in 100 years.

The Richmond Report of 1983 had recommended that mentally ill people be taken out of institutions and integrated into the community. The report was based on the assumption that the community infrastructure would have the same resources as the institutions. Sadly, this was not the case. The resources were returned to Treasury, and there has been insufficient support for mentally ill people in the community. In particular, there was a lack of adequate money allocated for community-based support services.

Also, at the time of publication of the Richmond Report, conservative elements in the public health system argued that if the de-institutionalisation went ahead, funding for mental health services would be siphoned away to other areas of health. And they were right! Once money allocated for mental health services goes to an Area Health Service in NSW, it is almost impossible to track and the money ends up being spent elsewhere. The politics between various departments in any public hospital and the area health services are just as tough, byzantine and competitive as those of any parliament. Heads of departments for obstetrics, emergency or surgery compete and flex their muscle for additional funding.

The Select Committee's final report on Mental Health services (www.health.nsw.gov.au/pubs/g/pdf/inquiry_mhs.pdf) found that Australian health agencies allocate only seven percent of health spending to mental health, while most developed countries spend between ten to fourteen per cent according to the Organisation for Economic Co-operation and Development (OECD). New South Wales had the lowest number of psychiatric and acute care beds of any state, and the second lowest spending per capita in Australia on mental health services receiving only eight per cent of the $7.77 billion health budget.

The NSW Mental Health Inquiry has achieved some good. The State Government has made a formal response (that can be found at the same web address above) and the public had until 30 April this year to make a comment. Since October 2003, the NSW State Government has allocated a total of $318 million to go towards acute beds and community mental health services.

What is needed, however, is a deinstitutionalisation of society and a graded system of support in the community for people with metal health problems. The issue of how much information should be given to carers, when mentally ill people insist on confidentially, needs to be addressed and the question of who will deliver treatments and watch over people in the community is still sensitive. But there are models of community mental health teams and community treatment orders that can be followed, and if good voluntary care facilities exist, there is often less need for 'assertive' care later.

Policy makers and health professionals must avoid a 'one size fits all' approach to mental health. It is a complex issues that lays beyond the walls of our hospitals and effects one in five people at some stage of their lives. We must deinstitutionalise our thinking, look at caring for people in the community and only then think in terms of 'hospitals and beds' for those relatively short periods when people cannot cope.

Arthur Chesterfield-Evans is Democrat member of the NSW Legislative Council He is a medical doctor, an anti-tobacco activist and a former member of BUGAUP (Billboard Utilising Graffiti Artists Against Unethical Promotion).