"The process had gone too far" Professor Paul MullenLEADING psychiatrists have admitted that a 20-year policy of treating mental patients in the community has failed.
The psychiatrists are demanding a radical review of mental healthcare, claiming prisons have replaced asylums as holding centres for the mentally ill.
Those calling for a new approach include many of the architects of the current policy of deinstitutionalisation, which led to the closure of psychiatric wards and institutions around the country.
High on their list of priorities is the reopening of secure psychiatric wards and an increase in the number of medium and long-term beds for the mentally ill to take the pressure off prisons, which are ill-equipped to deal with the number of mentally ill inmates.
In the two decades since the influential Richmond Report recommended deinstitutionalising mental healthcare, the number of patients in psychiatric institutions has more than halved, from about 15,000 to 6000. The prison population more than doubled between 1986 and 2001 to more than 24,000 and now includes a high proportion of mentally ill prisoners.
A recent study by Corrections Health Service found that 74per cent of prisoners in NSW suffered from a psychiatric disorder, with almost 10 per cent suffering symptoms of psychosis.
Former NSW corrective services commissioner Tony Vinson said, "The consistent testimony of frontline workers in corrections is that, increasingly, court proceedings and jail cells have replaced the longer-term mental healthcare of 30 years ago."
David Richmond, the author of the 1983 Richmond Report said, "that a new model" was needed.
"Fundamentally the planning and precepts of the 1980s were for a different kind of community," Professor Richmond said.
He called for more acute beds and supported accommodation, because his report had not taken into account radical changes in population growth, housing and employment structures in Australia, or the impact of illicit drugs.
A damning report from the Mental Health Council of Australia and the Human Rights and Equal Opportunity Commission, to be released in coming months, will expose "serious problems" and "failures of care" in facilities around the country.
In the past six years there have been at least 30 murders committed by mentally ill people and between 1999 and 2002 at least 20 people charged with murder were found not guilty in the Supreme Court on the grounds of mental illness.
In a Senate inquiry submission that pre-empts the report, the council says underfunding "undermined the (deinstitutionalisation) strategy from the beginning".
"(There are) serious concerns that, while the (psychiatric) institutions themselves have closed, institutionalisation of people with a mental illness has in fact been transferred to prison and detention systems or replaced with isolation within the community, for example through homelessness," the council says.
According to one NSW Health report, 12 per cent of prisoners are psychotic, 30 times the rate in the general community.
University of NSW head of psychiatry Philip Mitchell is planning NSW's response to the call for reform. He said a new secure hospital being built alongside Long Bay jail would take some seriously ill psychiatric patients out of the prison system.
"In NSW there is a process to open up more acute beds and sub-acute beds," he said.
"We're now recognising we've created some new problems with deinstitutionalisation."
One of Australia's foremost defenders of deinstitutionalisation, Monash University psychiatry professor Paul Mullen, said the process had gone too far.
"It was a well-meaning enthusiasm, an overenthusiasm, which shoved the whole thing to an extreme point," Professor Mullen said. "It's not a good thing that there are no locks and bolts now."
The push for reform of mental healthcare in Australia has been given added weight by the findings of the Palmer Inquiry into the wrongful detention of mentally ill Australian resident Cornelia Rau, which was released on Thursday. The report found the prisons system, the South Australian Health system and immigration detention centres failed to deal properly with psychiatric patients such as Ms Rau.
The calls for reform follow recent moves in the US to open new mental facilities after decades of deinstitutionalisation.
NSW chairwoman of the Royal Australian and New Zealand College of Psychiatrists Louise Newman said there was consensus among mental health experts there needed to be a limited reopening of new psychiatric institutions, but not a return to traditional asylums.
"We're seeing more drug-affected and mentally ill people presenting at hospitals. There's a real need for a place to keep them secure and safe and protect the community," she said.
Both Dr Newman and Professor Mullen said bed shortages for psychiatric patients were chronic.
Australian Bureau of Statistics census data shows a rapid drop in institutionalisation from the mid-1980s. On census night in 1986 there were 14,855 patients in psychiatric hospitals or institutions, by 1996 this had dropped to 11,745 and by 2001 to 6092.
"Some people simply need long-term stable and supportive living arrangements if they are to keep out of harm's way and avoid being pushed, for want of other options, into lock-ups and jails."
The NSW Justice Health Service's latest figures on prison admissions show that more than one-third (38 per cent) of inmates sentenced suffer a mental disorder.
An Australian-first study by Professor Mullen, published in the American Journal of Psychiatry last year, found sufferers of schizophrenia were more than twice as likely to be convicted of violent crime than the general population.
The Mental Health Council's unpublished report found 1000 NSW prisoners had a serious mental illness.
"We have all the indications of a serious crisis in this area," council chief executive John Mendoza said. "There is a case for clinical care in long-term residential settings for those with a chronic mental illness."
States such as Victoria and Western Australia are leading the way by building residential care facilities.
By Simon Kearney and Adam Cresswell 16 July 05
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