Bondi Junction attack inquest hears mental health sector needs reform

ABC NEWS (Australia)

Let's get some more now on the coronial inquest into the Bondi Junction stabbing attack and the state of mental health care in Australia. Professor of psychiatry Ian Hickie says the mental health sector needs to have more of a community focus.

Transcript

00:01We need to look at mental health really differently in Australia.

00:04It's interesting what you say about inquiries.

00:06We've probably had about 60 since the 1990s.

00:0960?

00:1060, 6-0 national and state inquiries into mental health services.

00:14Often precipitated by a tragedy, and I must say this is a real tragedy

00:17for all of the individuals, families and people concerned.

00:20So we've had coronal inquiries, state inquiries,

00:23human rights inquiries, government inquiries

00:25that have trouble getting to the heart of the problem.

00:27When you said preventative,

00:28what we're really saying is in the community,

00:30outside of hospitals, in the community,

00:32connecting particularly with those in greatest need.

00:35The real tragedy here was that the individual involved

00:38was effectively treated in Queensland and well,

00:41and a threat to nobody.

00:43The breakdown in that system, the move to New South Wales,

00:46the disconnection, the homelessness,

00:48and like many young men, I'm afraid to say,

00:50up and down the eastern seaboard of Australia,

00:52homeless, disconnected, and therefore not in contact

00:55with any effective services that might have prevented

00:58this particular tragedy.

01:00So you agree with this assessment that there's a serious lack

01:02of community-based treatment focused on chronic care needs?

01:06Yes.

01:07So those with most severe chronic and persisting needs,

01:10the reality is you've got to have a home address and be known.

01:13You have to have a home, not just a house, a home,

01:15where you're resident, where you're known,

01:17where people can take care of you, for our services to connect.

01:20The moment you don't, and given the housing affordability crisis,

01:24given the difficulty, particularly for single people,

01:26those who are without regular income,

01:28those without regular family support, to have a home,

01:31the chance that our services will find you is very low.

01:34You have to come to us.

01:36So that when you say preventive, what we would say is proactive,

01:39out there connecting with those who would benefit most

01:42from continuing clinical care, but also social care and support,

01:47housing support, employment support,

01:49those things that value you as a member of a community

01:52and connect you with effective care.

01:54There was a startling figure mentioned today.

01:57Back in 1991 in Sydney,

01:59there was something like 1,100 short-stay beds available

02:02in Sydney's four main shelters,

02:04and now there's fewer than 300 temporary beds available.

02:09Does that tally with what you know?

02:11Yes, tragically, what we've seen,

02:13because of housing affordability,

02:15many places where we had not just short-term accommodation,

02:18but short-term and longer-term rooms,

02:21availability, shared housing,

02:23because of the pressure on housing,

02:25have made this really difficult for the most marginalised.

02:27And if you travel up and down the eastern seaboard,

02:29you will see many men living out of their cars,

02:31living out of vans, who are disconnected.

02:34They've become disconnected through illness.

02:36They're no longer connected with their families.

02:38This is a well-known problem.

02:39But our services, if anything,

02:41have retreated back into hospitals and emergency departments.

02:43If there have been 60 enquiries over the years,

02:46how can that possibly be the case?

02:48Because we just don't really want to come to terms

02:50with the complexity here.

02:51You need clinical services, but you need homes,

02:54and you need proactive outreach services.

02:56New South Wales, in particular, was very famous in the 1980s

03:00for actually going out into the community.

03:02Largely since then, we've seen a retreat back into hospitals,

03:05concerns about staff safety, concerns about other sets of issues.

03:09It's easier to organise services.

03:11Another really important announcement today

03:12was by St Vincent's Healthcare saying,

03:14in the future, they're going to spend 50% of their money

03:16outside of hospitals.

03:18Get outside the hospital model again

03:20to really connect with people.

03:21And those with severe and enduring mental illness

03:23are one of the most important sources of that.

03:26We've got to go out and connect with people.

03:28They have to have homes.

03:29They have to have an address.

03:30They have to have a family who knows who they are

03:32so that services have a chance of providing effective care.

03:36And so, how do you effectively start turning the system around

03:40so it does cater to people that way?

03:42You cannot just operate at the national level,

03:44the federal level, the state level.

03:45We've just seen the Productivity Commission

03:47produce another report saying the last federal state agreement,

03:51just signed prior to the Morrison government,

03:53moving out of office, got nowhere.

03:55So the Productivity Commission said this in 2020.

03:57It said the current arrangements don't work.

03:59Because they don't get down to the regions.

04:02They don't get down to the places in which people live and operate.

04:05So state-funded regional health services

04:08have to work in the community in which you live.

04:10We have about 50 such communities in Australia,

04:12so the system has to work in each of those 50 communities.

04:15It's different in Bondi Junction, to the north coast,

04:18to far north Queensland.

04:19I've just been in south-west and western Australia.

04:21They're different, but they need to work with those communities,

04:24with housing, with social support,

04:26and effective clinical services for those most in need.

04:29Do you see any appetite for this from the current federal government?

04:33Yes. So the current minister, Mark Butler,

04:35has made it very clear in looking at reform of the NDIS

04:38and psychosocial support.

04:39He makes the comment,

04:40where we've really failed in many ways over the last 30 years,

04:43is providing the community support that we really need.

04:46So the federal government needs to not just say it.

04:49It needs to buy in,

04:50particularly in the housing affordability side,

04:52and through the national debisitability insurance system

04:54for the services.

04:55They're the so-called social services.

04:57The states, I'm afraid to say,

04:59have to provide the serious clinical services,

05:02not in their emergency departments,

05:04but in people's homes and where people are,

05:06including on the street, in cars, proactively,

05:10in trying to stabilise their illness

05:11and then stabilise those people

05:13as valuable parts of our communities.

05:15And have any of the states started taking that approach?

05:18The states find it hard,

05:19and we end up with where we are now,

05:20a fight about money, largely,

05:22between the Commonwealth and the states.

05:24Yes, it requires investment,

05:26but it really requires doing things differently,

05:28connecting with people where they are.

05:30So I'm afraid to say,

05:31we have to relearn what we learned in the 1980s,

05:33and unless you're out there doing that,

05:35the risk of tragedies like this repeating themselves continues.

05:39How does it feel for someone like you

05:41who's worked in the sector over the decades

05:43and you've seen these changes in policies

05:46and coming back around, like going full circle?

05:49Well, there's a great frustration at one level.

05:52I must say, the Australian community has changed a great deal.

05:54So in the 1980s, we had the philosophy,

05:56but we didn't have community support

05:58to implement that philosophy.

06:00Now I think the community has a much more positive view,

06:02but like other areas of healthcare,

06:04if you've got cancer, you've got heart disease,

06:06we expect the services to be there,

06:08and we expect them to be there in our state hospitals for everyone,

06:11not just for those who can afford the better care.

06:13And that's really where a lot of people

06:15with mental health problems miss out.

06:17They become poor, they become disconnected,

06:19they require much greater support from the state

06:22to be able to function as members of our community.

06:24So the pressure is on the states on the clinical side,

06:27but the pressure is on the Commonwealth,

06:29on the housing and the social support and the other services.

06:31And we've got to get our act together.

06:33The Productivity Commission is quite helpful.

06:34It says, get your act together and deliver it locally.

06:38That becomes harder at the political level,

06:40but I think the communities in Australia

06:42are on board for that approach.

06:44And are you optimistic there could be some momentum

06:47from the recommendations out of this?

06:49We have got to learn out of these tragedies.

06:51We've had tragedies,

06:52the risk is unless we really seriously deal with the problem,

06:55we will have further tragedies.

06:56But on the upside,

06:58we do know there are effective treatments for mental illness.

07:00The tragedy of this particular case,

07:02this man was effectively treated in public services in Queensland

07:06and was a threat to nobody.

07:08The breakdown in that system in Queensland

07:11and then the transfer to New South Wales happened.

07:13We've seen this before.

07:14I don't know if you remember Cornelia Rowell,

07:16very famously disappearing in far north Queensland

07:18and ending up in immigration detention in South Australia

07:20unrecognised with a similar illness.

07:22We've seen this before.

07:24Mick Palmer did an inquiry again 30 years ago saying exactly this.

07:28You can't lose people from one place to another

07:31and not expect bad things to happen.

07:33So we need to get down to the regional level.

07:35Productivity Commission says governments, get on with it.

07:38I think the community expectation is governments, get on with it.

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