Community mental health specialists say they fear for their patients' futures because of dwindling support to help people with chronic mental illness.
The desperate plea to deliver 'real' funding to public mental health units in the local health district has been exasperated by the Bondi Junction attacks where six people died at the hands of a man who was known to suffer from mental illness. Queenslander Joel Cauchi, 40, who was diagnosed with schizophrenia, stabbed people at a Westfield shopping centre on April 13. It was Australia's worst mass killing in years.
Following Sunday night's candlelight vigil for victims, Waratah Private Hospital Hurstville psychiatrist Adrian Keller, is urging the Federal Government to strengthen the capacity of community mental health support.
"If any good comes out of this, it should be that it shines a light on the woefully inadequate funding, particularly for community and public mental health services," Dr Keller said. "This unfortunate man would have been in the top 10 per cent of treatment resistant patients that we see, yet he was discharged. It shouldn't happen as often as it does, but there are simply not enough resources to continue to manage people who require ongoing, possibly lifelong care."
The pressure to discharge patients who cannot afford a private psychiatrist, back to a GP, was a growing concern, Dr Keller said. "Patients require the wraparound services of a team, not an individual in a private clinic," he said. "People are falling through the cracks. It's a nationwide problem. The Federal Government should take some leadership. I'm frankly appalled at the lack of governance and decision making to discharge patients who clearly should not be discharged."
He said the sheer volume of people seeking help, meant people who needed continuous care, were missing out. "They have to clear the back end to make room for the front. It's too easy to say that person didn't turn up for their appointment or they're not going to be followed up because that person is not interested. Well actually, they're the people who need to be followed up," Dr Keller said. "We've had no real increase in funding in community mental health in NSW for at least two decades - the real funding has diminished."
Combined with a lack of psychiatrists in the workforce, it is leading to an "avalanche" of mental health problems, he said. "We feel immense frustration. Referrals for the assessment of ADHD and autism have increased exponentially in the private sector, so where does that leave people with schizophrenia and bipolar disorder? They're struggling to get seen."
Dr Keller says some people with mental health issues in the community require help but do not seek it, or may actively avoid it. "We need to be providing involuntary treatment for a small number of people. Often their families are desperate but the patient is refusing. There are fully regulated, legislative provisions and community orders where mentally ill people who don't consent, can be given treatment," he said. "It has to be done in an ethical and humane way. We are leaving people to flounder because of this move away from involuntary treatment. It's wrong and it's causing a lot of people to be harmed."
But people who are struggling should feel confident they can access support, he said. It's the most at-risk, vulnerable groups - including people with severe schizophrenia, who need attention, Dr Keller emphasises. "Schizophrenia is a poorly understood condition in the general community. This perhaps isn't surprising because there is so much mythology around it. The reality of the more severe end of schizophrenia is that for many people they are withdrawn and avoidant. They may not be able to work, they might struggle to maintain relationships and might require support with accommodation."
Compassion for the innocent victims of the Bondi attacks is paramount, but demonising the perpetrator is unfortunate, Dr Keller said. "If only this man had the treatment he needed," he said. "His family, who would have tried everything, would be experiencing enormous shame and guilt. They are victims too."
The community should not fear people with mental illness, he said. "The risks to self are much higher than the risks to community - the rates of suicide are worryingly high," Dr Keller said.
"We're unlikely to witness a similar event in the short to medium term. We also need to be cautious when analysing unsubstantiated claims that link extremely rare events of multiple stranger homicide by a person suffering from psychosis, with increased risks to any specific groups within the community. If this man was suffering from a relapse of his chronic schizophrenia, as seems likely, he would have been aroused and agitated, and may have been acting under the influence of delusions and hallucinations. In such circumstances, I suspect it is less likely that this man was specifically targeting females."
But there are lessons to be learnt, he said. "The main risks relate to people suffering with chronic mental illness who remain untreated, are homeless and are not connected to services."
NSW Premier Chris Minns said the State Government's additional funding of up to $18 million to the Coroners Court, enabling an extensive inquest into the Bondi Junction attacks, will help direct policy changes and would provide clarity into whether the $2.7 billion spent by the government on mental health each year was enough, or adequately distributed.
Earlier this month, a Charles Sturt University-led research project secured $4.3 million in funding to investigate a specific therapy pathway for people with schizophrenia. The project will research how to implement and benefit from cognitive remediation therapy. Although it's a recommended treatment, access is limited. Research will be delivered across diverse mental health settings, including in South Eastern Sydney Local Health District and its community mental health services.
Support is available for those who may be distressed. Phone Lifeline 13 11 14; Mensline 1300 789 978; Kids Helpline 1800 551 800; beyondblue 1300 224 636; 1800-RESPECT 1800 737 732.
