More on Mental Health

Posted on September 23, 2005. Filed under: Health |

How very easy it is for governments to sweep the problem of mental health under the carpet. After all, many people with mental illness do not want to take advantage of the service. All you need is a good strong dose of paranoid schizophrenia, and, when unwell, you’ll stay well away and avoid that medication. All of which saves our government millions of dollars a year.

Additionally, society would really prefer the mentally ill to just disappear and not bother them (the “not in my neighbourhood�? syndrome), so its easy for them not to notice that money is not being spent in nearly adequate amounts for the care of those who need it. Notice I am not saying “the care of those who want it�?. Those who want it often have a wonderful ability to mobilise many resources and supports which the others cannot or will not, because of their illness. And, in the case of our very busy Community Mental health team, those who want it are getting it, at the expense of those who need it but are avoiding it. We simply do not have the resources any longer.

Its no longer safe to do our job alone. What sane community nurse will walk into a house where there is someone holding a knife or gun, or a lump of timber. Of course we don’t know for sure that this is going to happen. But it has happened often enough for us to know that theres a strong possibility that it could. So we go visiting in twos. At least one will have a mobile phone to call for help and that one remains close to a door and escape at all times. Two-up visits are not always an efficient was of dealing with our customers, but under the circumstances, the only sane thing to do. Our top level managers will not provide us with a proper alternative.

The community at large complains about the number of mentally ill people who end up in gaol. I wonder where they want us to put them, because the government keeps closing hospital beds. We don’t have the luxury of a longstay ward… anywhere… in this state. Other services like the Sallies and St Vinnies and Richmond Fellowship and Centacare and New Horizons and many more who popped out of the woodwork and said “oh we’ll take ‘em�? have been given some money to look after those chronically ill people who cannot manage in mainstream society. Of course those services don’t actually employ people who are qualified… like (god forbid) psychiatric nurses (it would cost too much out of the $$$ per person that some of them get every year) and so our state run service STILL has to manage, without proper funding, alongside those NGOs.

All I can see is total, unmitigated mismanagement. The government has got it wrong and its just throwing good money after bad.

Total mainstreaming of mental health is both dangerous and stupid.


2 Responses to “More on Mental Health”

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My mother was a psychiatric nurse and we lived close to a “mental hospital” in a regional town.

This is a subject worthy of more mainstream discussion, so thanks for raising it.

I work for a multi-purpose health agency and one of the most common issues I come across is case management of people needing care in the community. It doesn’t matter if this is acute, mental or aged.

Too often there are many different people and agencies involved when there should be a single point of contact.

If we’re going to treat and care for people in their home environment, which is a noble objective, we need to have proper systems in place. I don’t think that’s the case in many instances.

Stupidity in mental health management! I agree. Ironic, isn’t it?

Right on the money, Michael, with the issues of multiple agencies.

I have no problem with NGOs taking over the care of our chronically mentally unwell clients… but they need to do it all, and not expect that we will still have the same level of input as before. The way I see it is, either they manage the client, or they don’t. And if they don’t, the funding must return to those who do. I am talking about general care here, I certainly do not expect them to cope in times of crisis, thats what our team is for.  Day to day management, though, should be done by the agency thats being funded for it.
There was a case recently where one NGO was being given $500k a year to look after one particularly unwell person. The person was so unwell that that particular agency was *not* able to care for him. They did not have properly qualified staff. So the community mental health team was still doing the work, but the funding was going to the NGO. This is one extreme case, but it highlights one of the problems. In having said this I do not want to detract from the wonderful work that these NGOs do in other areas. The 4 Corners episode on Monday illustrated that in spades.
Its just that I believe that the government is expecting (and some NGOs are claiming) that they can do the same job as qualified psych staff. I say they cannot.
However, even within the government run agencies, there are services being fragmented. We have a clear example of that in this region, and alas I cannot be too specific, but suffice to say that, in the end, there are parts of the government agencies who have become so specialised that they perform a very limited service for a limited number of people, and the ones who really need a service cannot get what they need.
Its nothing short of criminal.

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