Hello, Stacy34-ga!
I have chosen to research the topic you suggested in your
clarification:
"I am considering a study on the closure of mental health institutes
(in Australia) for financial reasons, leaving the mentally ill to fend
for themselves. This is a false economy as they then become involved
in the legal system at a much greater cost to the community both
economic and social.
This is certainly a large topic with many winding pathways that one
could follow! Therefore, I have narrowed it down to some specific
categories which should provide you with a good start.
Nonetheless, the research was fascinating and extremely enjoyable! I
learned quite a bit, and I thank you for the opportunity to assist
you!
===
The Closure of Psychiatric Facilities in Australia and the Consequent
Effects on the Community
Possible Reasons for Increase in Mental Illness within the Australian
Population
*******************************************************************************
According to "Another murder-suicide in Australia," by Linda
Tenenbaum. (10 August 1999) World Socialist Website.
http://www.wsws.org/articles/1999/aug1999/suic-a10.shtml, several
factors are contributing to the heightened occurrence of mental
illness in Australian communities.
Feelings of a loss of control:
"Last month (1999*) the Social Policy Research Centre at the
University of NSW reported findings from its national survey of
attitudes to social and economic change that almost one third of the
working population feel they have lost control of their lives and are
in constant fear of losing their jobs. Among those earning less than
$400 per week, the figure was just over 40 per cent."
Loss of jobs:
"In Australia, the old manufacturing industries have virtually
disappeared, and with them, hundreds of thousands of permanent,
full-time jobs. The processes of privatization and casualisation have
seen the tearing up of working conditions, the lengthening of the
working day, and a fall in the level of real wages."
Increased alcohol and drug abuse due to economic conditions.
Widening division between rich and poor.
Less government funding in the areas of education, health, recreation
and child-care.
===
Effect of Governmental Policies on Australian Communities
*********************************************************
The following excerpt is from the article, "Another murder-suicide in
Australia," by Linda Tenenbaum. (10 August 1999) World Socialist
Website. http://www.wsws.org/articles/1999/aug1999/suic-a10.shtml :
"...the last decade and a half has seen the full embrace of free
market policies in Australia, the UK and America. Unprecedented levels
of social inequality have been the result. Wealth, of almost
unimaginable proportions, has been amassed by a thin, privileged
layer, at the direct expense of the majority of the population.
In Australia, the old manufacturing industries have virtually
disappeared, and with them, hundreds of thousands of permanent,
full-time jobs. The processes of privatization and casualisation have
seen the tearing up of working conditions, the lengthening of the
working day, and a fall in the level of real wages.
The division between rich and poor is widening annually. For those not
in the wealthiest 20 per cent, economic insecurity permeates every
aspect of daily life. A general rule obtains: the more affordable the
housing, the higher the levels of unemployment in the surrounding
areas, the more intractable the social problems, and the fewer the
public facilities.
Welfare is under sustained attack. The "user-pays" principle is being
applied ever more widely, with the sick, the disabled, the unemployed
and the elderly increasingly being forced to rely on their own meagre
resources to survive or take low-wage jobs.
Accompanying the dismantling of the welfare state has been the
ideological offensive, waged first by Thatcher in Britain, then taken
up with gusto by Labor governments in Australia, Clinton in the US,
the National government in New Zealand, Blair in the UK and now the
Howard Liberal government, among others, aimed at stigmatising welfare
recipients, and promoting the concept of "individual (or "mutual")
responsibility."
Government, according to this line of thinking, is not in the business
of ameliorating poverty or providing social facilities. How one fares
in today's society is one's own (or family's) concern.
*****
Resolving social problems has become, in other words, an individual
responsibility, creating almost unbearable stress for working class
families. (AND a COMMUNITY RESPONSIBILITY, I might add!!!)
*****
Not only have governments washed their hands of the plight of ordinary
working people, so have the old workers' organisations - the Labor
Party and the trade unions. Literally no avenue exists through which
the interests and concerns of the working class can be articulated and
advanced.
===
Facility Closures and Effects on Community Crime Rate
*****************************************************
The Policy and Analysis Group of Australia conducted several studies
from 1999-2000 to determine the effects of deinstitutionalization on
the community in the areas of crime.
A very real consideration brought to light by their findings is the
increased financial burden that will be assumed by communities to
monitor and police the behaviors of the mentally disturbed general
population, and provide community treatment to help stem the increase
in substance abuse within the community.
Though studies reveal that crime has not necessarily increased due to
deinstitutionalization of the severely mentally ill - primarily
schizophrenics -and their re-entry into the community, the degree of
substance abuse among mentally ill citizens has indeed had an impact
on the crime rate.
Excerpts from "Policy and Analysis Group" at
http://www.mhri.edu.au/pag/ follow:
"The last 15 years in Victoria have seen dramatic changes in the
mental health services with closure of the old mental hospitals and
their replacement by general hospital units and community care. There
have been claims that as a result of the larger numbers of people with
serious mentally illness living in the community, the public has been
exposed to an increased risk of violent and criminal behaviour. In a
similar vein it has been asserted that people with mentally illness,
deprived of support and asylum, are appearing before the courts and
ending up in prison in increasing numbers.
In collaboration with Professor Paul Mullen of the Victorian Institute
of Forensic Mental Health, the Group examined the association between
the introduction of community care and rates of offending among
individuals with schizophrenia. Two large groups were examined, one
which were first admitted to treatment in 1975 - prior to
deinstitutionalisation; the second which began treatment after 1985 -
when community care was becoming the norm.
There was a modest increase in total offending in those admitted in
1985 compared to 1975, however, this was in line with increases in
criminal offending in community controls without schizophrenia. Rates
of violent offending showed no significant increase between the 1975
and 1985 groups.
Though they did not significantly increase with the shift to
deinstitutionalisation and community care, rates of offending were
higher in people with schizophrenia than in community controls for
every category of crime except sexual offending. There was evidence
from the study that this increased offending was associated with
substance abuse which is more common in those with schizophrenia -
particularly among young men with the disorder who account for much of
the offending.
Findings from the study suggests that the focus on violence and
offending among those with schizophrenia may be more to do with an
heightened awareness of the behaviours than any real increase.
Nevertheless, mental health services face a real challenge in reducing
the disturbed and sometimes criminal behaviour to which schizophrenia
can, on occasion, contribute. Turning back the clock on
deinstitutionalisation and returning to asylums is not the solution.
Rather there needs to be more support and intensive treatment in the
community for those at risk and more effective strategies for reducing
alcohol and drug abuse in this vulnerable group."
=====
Crime Rate and Policing
***********************
The lack of community mental health facilities combined with untreated
individuals requires added measures in community policing.
Read "A sign of despair in regional Australia: police siege ends in
suicide," by Mauricio Saavedra.
(6 November 1999) World Socialist Website.
http://www.wsws.org/articles/1999/nov1999/bend-n06.shtml
===
"The death of a man last month after a lengthy police siege in the
regional city of Bendigo has highlighted the increasingly desperate
situation for many young people in rural centres. The lack of jobs and
future prospects as well as the continuing deterioration of facilities
and services - in this case, psychiatric care - are putting
intolerable pressures on working class families."
While the community of Bendigo struggles with extremely high
unemployment.....The only service to grow markedly has been the
regional police force - with a jump of more than 16 percent in its
number since 1992. Patrols and surveillance are targeted in particular
at the large number of unemployed youth in the city."
http://www.wsws.org/articles/1999/nov1999/bend-n06.shtml
===
Couple high unemployment with a lack of psychiatric treatment
facilities, and a community can be overwhelmed!
===
"Wason's situation is what now faces many psychiatric patients in
Australia. After the Liberal Party came to power in 1992 in Victoria,
the state became a testing ground for the National Mental Health
Strategy drawn up under the federal Labor government aimed at cutting
the health budget through the closure of institutions, the axing of
jobs and the replacement of specialized services with "community based
services".
*****
As a result, responsibility was shifted from the government onto
families and the patients themselves, and the CATT team became a
stopgap to deal with emergency cases.
*****
Health Minister Marie Tehan announced plans to close 11 psychiatric
hospitals in Victoria, among them the Bendigo Psychiatric Hospital, as
part of a five-year plan. Many of the patients who were sent out into
the "community," ended up on the streets, and in a number of cases,
were killed during confrontations with police.
An Australian Institute of Criminology study of the period 1990-97
showed that of 222 deaths in police custody nationally, 75 people were
shot dead in confrontations with police - 41 by police and 33 died
from self-inflicted gunshot wounds. More than one third of those shot
by police were reported as being "depressed" or in need of psychiatric
treatment. Almost 70 percent of those, like Wason, who died from
self-inflicted wounds suffered from depression or had a history of
psychiatric illness requiring treatment.
Another study conducted by the government's own VicHealth found that
mental illness affects one in five people and is the third largest
category of serious illness after cancer and cardiovascular disease.
The study identified rural communities among the high-risk groups, and
social isolation and poverty as major contributing factors.
Yet everything that has been done over the last decade or so in
provincial cities like Bendigo - the closure of factories, and the
shutting of schools, hospitals, psychiatric facilities, childcare and
recreational centres, even banks and post offices - contributes to
growing social isolation and poverty. High levels of youth suicide,
drug abuse, and also psychiatric disorders, should therefore come as
no surprise."
http://www.wsws.org/articles/1999/nov1999/bend-n06.shtml
===
Suicide is on the Rise as Communities Grapple with the Lack of
Adequate Mental Health Services
********************************************************************************
How can communities take on the entire burden of coping with mental
health problems as staggering as those found in Australia?
The following statistics are from the article "Another murder-suicide
in Australia," by Linda Tenenbaum. (10 August 1999) World Socialist
Website.
http://www.wsws.org/articles/1999/aug1999/suic-a10.shtml
"In Western Australia itself, 24-hour counseling hotlines "receive a
staggering 380 calls a day - or one in every four minutes," according
to last week's Sunday Times.
And many vital counseling services are flat out and booked weeks ahead
as people become increasingly desperate and cry out for help.
The Samaritans' suicide counseling service in Perth received 25,800
calls and emails during 1998 - around 70 per day. This is in line with
a national trend, where suicides are increasing at an alarming rate,
particularly among young people. Between 1996 and 1997, the number of
suicides shot up by 14 per cent, with 2,723 people taking their lives.
Overall, suicides have increased continuously since 1988, and the
Australian youth suicide rate is now one of the highest in the world.
Drug overdoses, not counted in suicide statistics, are also at a
record high."
"A recent survey has concluded that one in five Australians suffer
clinical depression at some point in their lives. So widespread is the
problem that the premiers of the two most populous states, Victoria
and NSW, have advocated the urgent setting up of a national institute
to examine and treat depression.
** Several psychologists and counselors have pointed to the lack of
professional services available as one of the causes of the latest
spate of murder-suicides. **
=====
Current State of Community Mental Health Services in Australia and
Subsequent Financial Ramifications
********************************************************************************
Rise in cost of:
Direct treatment,
Disability
Pharmaceuticals
Disease Prevention strategies
"Out of Hospital, Out of Mind! A Review of Mental Health Services in
Australia -2003." Summary. Mental Health Council of Australia. (2003)
http://www.mhca.com.au/docs/Media%20Releases/MHCA%20Summary%20Document%20-%20Final%20April%207.pdf
A report by the Mental Health Council of Australia reports that
Community-based mental health services are failing to provide adequate
service, not due to a failure of the government policy in general, but
due to a "lack of ongoing government commitment to genuine reform and
failure to support the degree of community development required to
achieve high quality mental health care outside of institutional
settings."
Communities will continue to suffer if the government fails to commit
more money. Costs for treatment are expected to rise, demand for
services are expected to increase as those who have avoided treatment
begin to utilize services, and more young people are expected to enter
the mental health system.
*****
"If these young people are not treated adequately both direct
treatment and associated disability and unemployment costs will
increase. The costs of purchasing new pharmaceuticals, which will need
to be imported, and the need to establish broad population-based
disease prevention strategies, will both add new cost the mental
health budget."
*****
Despite the fact the national policy has moved to
deinstituionalization and community-based treatment, "the Commonwealth
and the States are unwilling to back widespread and systemic reforms
...."
Ten years after the National approach to mental health care was
implemented (1992), the adequacy of the system remains poor.
Communities are still ill-equipped to take over the overwhelming task
of providing for the mentally-ill.
"As a direct consequence of our lack of community understanding of
current treatments available for mental disorders and our poorly
resourced and poorly distributed service systems, the majority of
people with mental disorders receive either no treatment or treatment
that fails to meet current international standards for optimal care."
(Read the Summary in it's entirety to flesh out the above information.
It is quite interesting!)
===
Financial Commitment to Training Community Caregivers of all Types is
Necessary
================================================================================
The added burden placed upon Community Mental Health Nurses must be
realized and adequate financial and support provisions must be put
into place.
From "Community mental health care: Documenting the role of the
nurse." Contemporary Nurse. Volume 12, No. 2. (April 2002)
http://www.contemporarynurse.com/12-2p112.htm
Abstract:
"In Australia, the process of deinstitutionalisation has resulted in
the closure or downsizing of many large stand-alone psychiatric
hospitals. The aim of modern community mental health care is to
provide treatment and rehabilitation for people, who have a mental
illness, in their local community. This aim is supported by the
Australian National Mental Health Strategy that outlines the
importance of health professionals, carers, and consumers working
together to obtain the best therapeutic outcomes.
This study was undertaken to obtain information regarding the current
role of the community mental health nurse (CMHN). All community mental
health nurses working in the Adult Program at the Directorate of
Mental Health Services, Fremantle Hospital and Health Service in
Western Australia participated in the study. The study was completed
in November 2000. The results showed that the CMHNs' role focused on
six main areas. These areas included the day-to-day management of
clients, working with carers and their families; crisis work for both
existing and first time contacts; as well as liaison and advocacy
work.
The finding of this study demonstrate CMHN's work most often with
acutely ill and psychotic patients and their families. Therefore,
CMHN's play a pivotal role in promoting and sustaining the philosophy
of community mental health care. In addition, the liaison work within
the community completed by CMHN's is vital to address the mental
health needs of the community and to reduce the stigma associated with
mental illness. The documented findings of this study provide
challenges for the further expansion of the CMHN's role and the
development of best practice initiatives in community mental health
care."
===
Funding for Community Caregivers is still inadequate in most of
Australia.
According to the "Sane Mental Health Report 2002-2003."
http://www.sane.org/sanehealthreport.pdf : (may have trouble loading)
or
http://216.239.57.104/search?q=cache:8h-b9Xz_WxwC:www.sane.org/sanehealthreport.pdf+Australia+AND+closure+mental+hospitals&hl=en&ie=UTF-8
"The role of carers is now formally acknowledged by governments and
mental health services, through the Community Advisory Groups (CAGs)
and other bodies. Some services are even beginning to employ carer
consultants. Funding of carer support organizations has also increased
in line with the growth in NGO funding, but this started at such a low
base that it is still inadequate to the need. Generic organizations
such as the Carers Association are also starting to recognize the
needs of those caring for someone affected by mental illness."
"The acknowledgments and consultations are little more than lip
service, however, without provision of support for what is often a
very demanding role. Hardly any State ensures carer support by funding
it on a strategic regional basis. Hardly any State gives carers the
legal right to be included as part of the treatment team and have
relevant information shared. All too many psychiatrists still ignore
family concerns and do not refer them to support organizations.
Family-sensitive training (FaST) for health workers is practically
unknown outside Victoria and the ACT.
"Family group therapy barely exists in Australia yet there is strong
evidence that this reduces the frequency of psychotic episodes and *
saves mental health services money, * as well as helping the family."
====
Remote areas of Australia are usually without any trained caregivers.
Financial support and training is necessary so that mental health
treatment is available in all areas of Australia, rather than just the
larger communities.
From "Innovations for Mental Health Servicing in the Country."
http://www.hawkecentre.unisa.edu.au/institute/resources/Fuller.pdf
"Local health providers can provide a local responsiveness to needs
and they can coordinate services on the ground. If supported, they may
be able to see people with emotional problems or sponsor community
programs that reduce isolation. However, services in small towns that
we have spoken to expressed concern that they will be expected to pick
up more and more health problems * but without additional resources.*
If the local services are to provide such programs they require advice
and support from the Region and the specialists in the mental health
teams. Similarly, there needs to be contribution of resources and
skills from statewide organizations, such as drug & alcohol services
and the central units of the state health bureaucracy. However, when
the provision of mental health services involves local, regional and
statewide stakeholders, the process is slower and takes more effort."
Finances for "mental health training" for local service workers who
have an interest in providing help in rural areas must be made
available. Finances to establish a "network with other professionals"
is also necessary.
===
Cost of Stress and Increased Travel
====================================
The consequent medical cost of increased stress and the financial
burden of travel costs due to the lack of adequate mental health care
services in rural areas must also be considered.
From "Human rights in regional, rural and remote Australia." Address
by Chris Sidoti, Human Rights Commissioner to the South Australian
State Conference of the Country Women’s Association, Peterborough.
(24 September 1998)
http://www.hreoc.gov.au/speeches/human_rights/regional_rural_remote_australia.html
"One of the most urgent issues we have heard about, which is of
particular concern to older people, is the decline in health services
- including the basic minimum of hospital and ambulance services - not
to mention important psychiatric and specialist services."
"Yet in rural centres across Australia people are suffering from
reduced hospital, aged care and health services. A letter from NSW
stated:
".. we are experiencing massive changes and restructuring of our
hospitals, ancillary community services, abolition of dental services,
reclassification of hospital beds, hospital closures in smaller
centres, all of which cause financial hardship, stress, extra travel
costs because of State Government’s health economic rationalization."
The financial ramifications of business loss in rural areas when
adequate health care is not available
================================================================================
From "Human rights in regional, rural and remote Australia." Address
by Chris Sidoti, Human Rights Commissioner to the South Australian
State Conference of the Country Women’s Association, Peterborough.
(24 September 1998)
http://www.hreoc.gov.au/speeches/human_rights/regional_rural_remote_australia.html
"The reduction in services to rural Australia also seriously affects
the competitiveness and, ultimately, the survival of rural businesses.
Whether these are large beef or crop farms or the local post office,
many businesses are affected by the changes facing rural communities.
Yet support of and investment in small business and industry in rural
Australia are necessary to address the downward spiral of rural life.
During our consultations people have spoken repeatedly about their
concerns for telephone, postal and banking services."
"The closure of bank branches also affects the viability of other
services in the communities. When bank branches close people are
forced to travel greater distances to access bank services. When
people travel to larger centres they also conduct other business
there, reducing the viability of other local businesses and service
providers. This movement away from smaller centres puts the
sustainability of those communities at even greater risk. It is
another aspect of the "dying town syndrome".
==
Deinstitutionalization and increased Prison costs to deal with the
Mentally Ill Inmate and the Financial burden of training Police and
Prison Personnel?
===========================================================================
From "Community Care," by Dr Sabry Abdel Fattah. (2000)
http://sabryabdelfattah.tripod.com/docs/Comcare.htm
In Britain:
"There has been an increase in the number of cases of mental illness
in the prison system that seems to have paralleled the number of
patients discharged from the asylums."
==
From "The Criminal Justice System in Australia." The Schizophrenia
Fellowship of NSW. (Feb 2001)'
http://www.sfnsw.org.au/home/The%20Australian%20Criminal%20Justice%20System%20PDF.pdf
"The NSW Corrections Health Service Inmate Health Survey (Butler 1997)
reported that for people currently in gaol:
"50% of women and 33% of men had received some form of treatment or
undergone assessment for an emotional or mental problem by a
psychiatrist or psychologist."
"Of these, 36% of women and 34% of men had previously been admitted to
a psychiatric unit or hospital."
"26% of women and 12% of men had been diagnosed with some form of
psychiatric problem (including depression, anxiety disorder,
schizophrenia, eating disorder, alcohol problem or bipolar disorder)
prior to entering the correctional setting."
"5% of inmates were on ant psychotic or bi-polar medications."
"2.3% of women and 2.6% of men had a diagnosis of schizophrenia prior
to entering the correctional setting."
"A recent in house study found 60% of people coming into reception had
an active mental illness."
The strategies suggested to help cope with burgeoning mental health
population within the prison system, all of which assume a certain
degree of financing, include:
A comprehensive assessment of mentally-ill persons upon entrance to
the correctional facility, and possible protective custody if
necessary.
Available treatment services while in the prison setting.
Counseling, support groups, education and information about mental
illness should be available.
Continuity of care within the system if transfer occurs.
Specific training for corrective officers so they might recognize the
symptoms of mental illness and be trained in dealing with such
individuals.
The Schizophrenia Fellowship is also working to develop funding for
police training , and has already conducted training sessions for NSW
Magistrates and District Court Judges.
They are also seeking funding to conduct a Support and Information
group among female inmates with mental illness. Funding will be needed
to train, co-ordinate and provide travel expenses for volunteers and
the printing of information.
Funding for a comprehensive training program, and a liaison and advice
service for Corrective Service and Probation and Parole Officers is
also needed.
==
From "Managing difficult behaviours," by Bernadette Zimmermmann.
Police Journal Online (June 2001)
http://www.policejournalsa.org.au/0106/16b.html
"...sufferers of mental illness are very difficult people to deal with
and require almost specialist attention, not only for behaviour
management, but also for the dispensing of a complex line-up of
medications."
"It is probably no surprise that interest in out-sourcing the
custodial arrangements of police prisoners is back on the agenda.
There are arguments for and against. Some Australian states have
relinquished control of police prisoners, either partly or altogether.
** I would suspect much of this has to do with attempting to realize
short-term financial savings." **
"However, the experience gained by police - especially those in their
probationary term who witness and manage the various behaviours
associated with different forms of mental illness - is invaluable. At
least in the cells it is learned in a controlled environment. These
experiences can only assist members who will eventually attend the
numerous and potentially dangerous taskings involving mental illness."
"For police, the training is scant in how to deal with unpredictable
behaviours associated with these situations. Regrettably, the training
of our members who work in police lock-ups is virtually confined to
fingerprinting and photographing skills. The skill of effective
behaviour management is eventually achieved through on-the-job
experience. It shouldn't be left to occur like this. It should be
achieved through ongoing structured training programs."
"I am concerned that, with recent highly controversial incidents
between police and people suffering from mental illness, members are
being put at risk of serious injury. How many more of these
distressing events do members have to be confronted with before
appropriate training is offered?"
Additional References
*********************
Australia's 2nd National Mental Health Plan (July 1998)
http://www.mentalhealth.gov.au/mhinfo/nmhs/pdf/plan2.pdf
Evaluation of the 2nd National Mental Health Plan (2003)
http://www.mentalhealth.gov.au/mhinfo/nmhs/pdf/eval.pdf
(Allow some time for this to download, unless you have a very fast
computer!)
National Mental Health Report 2002
http://www.mentalhealth.gov.au/resources/reports/nmhrep2002.htm
You might be interested in the Differing Views on Mental Health Care
represented by each of New Zealand's Political Parties:
"Health - Mental Health. PolicyNet.NZ
http://www.policy.net.nz/hl-mental.shtml
"Mental Health in Rural Areas." Rural Health.
http://www.achse.org.au/ruralhealth/mental.html
==
The above information should provide you with ample background for
your study. There might be some other areas you wish to delve in to at
a later date. If so, I would love to be of assistance. If you want to
work with me futher, as suggested above, you can merely address your
further questions "to Umiat." If you choose to leave questions open
for another researcher, feel free to do that also!
If any of the information I have provided is unclear, or any of the
links fail to work, please let me know in a clarification. I will be
more than happy to help you!
umiat-ga
Google Search Strategy
Australia AND closure mental hospitals
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