My daughter, Anne, lived for 40 years: 25 as a caring, creative girl and woman; 15 as a disintegrating woman battling schizophrenia; she found peace by completing suicide.
Schizophrenia, bipolar 1 and severe affective disorders are incurable brain diseases and the most serious of mental illnesses. Anne’s schizophrenia caused psychosis, paranoia, delusions and reduced energy, creativity and motivation. About 550,000 Australians suffer these severe mental illnesses. Many can lead full productive lives, between crises, with treatment; the majority cannot.
Mental illness is underfunded, even though governments know this causes lives of deprivation and preventable deaths. The seriously mentally ill carry 13-14 per cent of the burden of disease. For years they were unjustly allocated 6-7 per cent of the health budget and many psychiatrists fought this disparity. In 2010 they received 2 per cent of the health budget; Ms Barbara Hocking OAM, director of SANE Australia, fittingly described this as “an act of patronising contempt”.
According to the World Health Organization (WHO), the seriously mentally ill complete 90 per cent of suicides. The Australian Bureau of Statistics (ABS) warns their statistics are incorrect because all states “under-enumerated” suicides. A Senior Counsel, 2005, wrote that suicide statistics in the Victorian Chief Psychiatrist’s reports have “serious flaws”. Last year Professor John Mendoza estimated published suicide numbers are under-reported by 30 per cent.
Numbers are under-reported. The WHO shows Australia’s 2008 suicide rate as 21.1 per 100,000 people, numbers presumably based on correct data from Canberra. With a population of 21,400,000 in 2008, this represents 4,304 suicides. The ABS reported 2,192 suicides in 2008, an under-reporting of almost 49 per cent. It seems possible the agencies providing accurate suicide rates to the WHO misrepresent suicide numbers within Australia. Such action is culpable; it bolsters the lack of political will to provide necessary funding and to try decrease the number of preventable deaths.
It is noteworthy that Australian road deaths, 2008, are eight per 100,000 while suicides are 21.1 per 100,000, yet funding is found and publicity is used in an attempt to decrease road deaths.
“Manner of suicide” reports are also under-enumerated. The ABS lists 61 persons in Australia as completing suicide in 2008 “by jumping or lying before a moving object”. Victoria alone has about 50 such deaths every year; nationally, there are possibly 200. Anne, in despair and after two previous attempts, chose this certain manner of death.
Accurate death rates are crucial for good health services, providing a benchmark for clinical and applied research. The Victorian Department of Human Services wrote (2006) that suicide prevention strategies, including Victoria’s, are not determined by sound evidence bases but “rely largely on assumed efficacy with little or no research”.
Assumed efficacy equals anecdotal evidence. No good health service relies on such superficiality to treat the severely ill; but Mental Health Systems do so routinely, to that minority of mentally ill who are fortunate enough to receive any treatment. The Mental Health Council of Australia (MHCA), 2009, said 65 per cent of mentally ill needing therapeutic care and/or hospital admission in Australia, are untreated and/or not admitted.
Victoria has some 115,000 seriously mentally ill. The Mental Health System treats 60,000 people, the private system 10,000 and 45,000 lack any specialist mental health care. These 45,000 lives vary from the most fortunate, cared for by a good general practitioner, to the most vulnerable and neglected, the untreated and homeless. The Council to the Homeless estimates there are 14,000 seriously mentally ill homeless in Victoria. The MHCA estimates 50,000 mentally ill homeless in Australia.
The Human Rights and Equal Opportunity Commission Report, 1993, said it is almost impossible for the seriously mentally ill to reach their full potential unless adequately and safely housed. All governments have ignored this. Deinstitutionalisation is still largely unfinished, since 1993. This was a helpful, positive policy if done sequentially. However, the second stage was done first and quickly; the sale of thousands of hectares of valuable land, with gardens and trees, and the destruction of stand-alone mental hospitals. The first stage, the provision of acute, sub-acute, rehabilitation beds and community care for those sent from treatment and shelter, remains largely unfinished by all states.
Tens of thousands seriously mentally ill remain inadequately housed, causing hundreds of premature natural deaths and suicides. No government entities collect these numbers. Housing of the mentally and/or physically disabled during the last 20 years in Victoria cries out for a Royal Commission.
The seriously mentally ill have a life expectancy 25 years lower than the national average: 55 years rather than 80 years. In 2010, Australia and New Zealand Health Policy published research which studied mental health-related mortality rates, specifically citing their implications for government policy.
The study used data from 1916 to 2004, concluding that the longevity of people with serious mental illness decreased through these years. It notes “excess mortality” associated with mental disorders and that natural and suicidal deaths increase premature mortality. More mentally ill are also dying from malignancies than to be expected. Very little attention is given to physical problems of the mentally ill. They are many, as this research illustrates. The study’s dire conclusion is that, for the seriously mentally ill, over these 88 years, “There have been no gains”.
The 20th century produced advances in all medical spheres, with healthier populations and higher life expectancy for all; except for these vulnerable and neglected. In 2016, six years hence, unless a miracle of justice occurs, Australia’s seriously mentally ill begin a second century of decline.