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Royal Commission into Victoria's Mental Health System

Charlotte's story*

"Death is not an acceptable outcome for those suffering acute mental illness. And yet, with the current system, death is an ever-present fear for these patients and their carers.

It is not acceptable that gaol is the de-facto “care” institution for those suffering acute mental illness. But with our current system, incarceration is the default way to deal with these patients, only because nobody in the system seems prepared to do anything else.

I have over 20 years of experience dealing with the mental health system in Victoria. Over that time nothing has improved. Nothing. I am caring for a son diagnosed with schizophrenia. There seems to be amazingly little expertise or knowledge about this disease among mental health workers at all levels. I have had to deal with CAT teams that just left after briefly being told that my son would not come out of his room. They just went. There was no follow up or longer-term plan presented to us.

Much more needs to be offered before a crisis is the only way an unwell person and their family can get help. Expert mobile intensive support teams are essential to work with families throughout this difficult time.

There needs to be more research, education and assessment of schizophrenia and the impact it has on patients, carers and society in general. Mental health care workers need to be trained and educated on all aspects of acute mental illness and especially schizophrenia.

The physical health of acute mental illness patients can be addressed if the government takes a few practical steps. Better awareness and expertise in this area among mental health workers and GPs is needed. My son developed a life-threatening infection because of the positive and negative symptoms and cognitive impairment associated with psychosis. It could have been prevented if we had expert community mental health services to help us all.

Carers like me have to “case manage”, write letters to those in authority, be proactive, become strong advocates, simply to get the health care our loved ones need. This is unacceptable. Mental health care should be equally offered as it is for those in our physical health care system.

What is really needed is a community mental health hub or centre staffed with highly skilled teams who are specialists in acute mental illness and have negotiation skills to deal with patients who are often not rational and have no insight or understanding into their own condition. There needs to be a bi-partisan political effort in Victoria so that things will actually be done to improve our mental health system. Mental health should not be a political football.

Two other measures should be put in place in hospitals. First there should be a complete physical examination and assessment carried out on mental health patients at their first hospital admission. This should include a plan for their long-term care and include such items as accommodation and the financial and personal situation for their carers. There should also be a psychiatrist on call 24/7 who can oversee admissions and sign off on discharge. There should not be long waits for this as there is currently.

There needs to be a much greater emphasis on long term follow up and long-term planning of care that includes housing and supported independent living. This is where the plan drawn up at initial diagnosis and admission could be a good first start. At the moment, the policy is for short term care management. This is dangerous and also counterproductive.

Police need much more education and training around how to deal with mental health patients. They need to be able to recognize symptoms and to negotiate with mental health patients in a more effective and respectful fashion. They also need to be trained in how to gather information from carers and other family members and how to use this information in their dealings with patients.

Carers themselves bear immense and cumulative stress that must affect their own mental and physical health. The cost of this to our health system must be enormous. It makes good economic sense to support carers more and give them more support and education and help and recognize their central role in mental health care."


* Names and places have been changed to protect individuals.

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