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Category: Mental Health

03/01/2021

Veterans’ PTSD costs $241 million 3/1/21

Some time ago. I was driving through Western Sydney and saw a huge billboard for army recruitment. An interesting and challenging job, training for a trade etc. I then stopped in a supermarket and there was a much smaller ad for a charity that helped Veterans who were victims of Post-Traumatic Stress Disorder. I wondered why they needed a charity when the Dept. of Veterans’ Affairs has a much larger budget per patient than anyone else.

I asked a clinical psychologist friend of mine about this. The psychologist had a good practice and admitted that a lot of work came from ex-Veterans, commenting nervously that almost all the Veterans had PTSD, but that it was a closely guarded military secret. I was not surprised. I had read ‘Exit Wounds- One Australian’s War on Terror’ by John Cantwell, the ex-commander of the Australian forces in Afghanistan. He had PTSD and took himself off the short-list to be the chief of Australian defence to go into a psychiatric hospital for treatment. He wrote in 2013 that the war in Afghanistan could never be won and that every Australian life lost there was wasted. Troops are still there, presumably until the Americans all leave.

In 2019 I went to a pub dinner with a group I knew vaguely at a hotel in Kings Cross. I had arrived late from work and as I moved to the end of our table, a man sitting alone on the next table moved his pack so that I could get in. I nodded thanks. My group said a brief ‘hullo’ and went on with a conversation about people I did not know, so I remained a little detached. After a while the man on the next table stood up and asked me in a broad Scottish accent if I would mind looking after his pack while got another beer. He was unshaven and looked very dejected, perhaps in his early forties in age but his clothes were new. I moved his pack so that it was more directly in my line of sight, and noticed that it was a state of art pack, perhaps a military one. When he returned I asked him what part of Scotland he was from. (This is always a good opening line for Scots as they hate being asked what part of England). He said that he was a stonemason, who had lived with his single mother until she had become unwell with memory loss and needed institutional care. He wanted to get a ‘powder ticket’ so that he could have his own quarry. He could not afford this training so he had joined the British Army. Seemingly he learned his explosives quite well and was posted to Afghanistan. He had had to do ‘a job’ involving explosives and was praised by his commander as he had apparently done it well from a military point of view.

He did not elaborate much at this point as he choked back his tears, but he felt utterly worthless and had asked for an immediate discharge from the army. He had an elder brother in Australia from whom he had been estranged since his parents separated when he was young and he had in arrived in Australia this very morning to find his brother at the most recent address he had. He had no phone number or email. The brother had left the address, so he had stopped for a drink. He had no friends, no country and was very, very depressed.

As his tale unfolded, I was increasingly wondering what I could do, but in this case luck was with us both. One of the others on the table I was in theory still having dinner with had started to listen to our conversation. She was a counsellor in the Kings Cross area and joined in. She took over and found him accommodation, promising to get him some PTSD counselling when she finished a morning appointment the next day, and quite subtly got him to promise reciprocally not to commit suicide overnight.

I followed this up with the counsellor and she was apparently successful. He went with an Australian PTSD sufferer to a farm in the Central West where rehab is done for ex-Afghanistan veterans. Hopefully it was successful longer term.

But this story is largely luck, and success is not assured. Here was the real face of the foreign policy stupidity in the Middle East, and prevention is far better than any hoped-for cure.

The Vietnam war may have been ‘lost’ on the TV screens of America, but it is highly dubious that it could have been won anyway. Iraq, Libya, Syria and Afghanistan do not look like having any chance of the West winning. But since the Falklands war, journalists are embedded with the Army and so are on one side that gives them protection and restricts their information, so there is no peace movement of any political note to stop the foolish machinations of Australia in fawning to please the US in wars.

I am not sure that Veterans have ‘unlimited access’ to mental health services- if they did, why would there be charities appealing for support? My experience is that all funding bodies including Veterans Affairs try to deny the existence of a problem. It seems the concern of the article is the cost of the rehab. The answer of course is to stop the war.

The Buttery mentioned was the one of very few live-in addiction rehab programs that I could find when I was in Parliament. It was near Bangalow on the North Coast and had endless trouble getting funding. If it is now exclusively used by Veterans others will be missing out.

www.smh.com.au/politics/federal/bill-for-veterans-mental-health-care-reaches-241m-with-20-000-in-rehab-20201030-p56a9w.html

03/06/2020

Mental Illness and Stupidity 3/6/20

Quite early in my Parliamentary career I was approached and discovered 4 problems with mental health in NSW. A fellow medical student, now psychiatrist approached me and said that the system was far worse than formerly.

I had worked as an after hours call doctor in 1977 and 1983 and found that mental hospitals did not want patients sent to them, and would try to talk referring doctors out of sending them. At first they would say it was not in their catchment area, then that the patients were not really mentally ill and I did not actually know what I was talking about. Eventually I tired of this game, so I would call and tell them a brief history, my diagnosis and that the ambulance with or without police escort was on its way.

So when my psychiatrist friend said it was a lot worse I was surprised. She explained that Nick Greiner closed all the long-stay mental hospitals for a supposedly community-based service with supported accommodation, but the alternative was never funded, and the system had staggered on ever since.

Then I was in an inquiry into the rise in the NSW prison population and a government prison psychiatrist had found large numbers of mentally ill and developmentally delayed people falling foul of the law. He explained that if they became dysfunctional they could not pay for the electricity and rent so became homeless. They had no chance of getting through the complexities of Centrelink and getting money, so eventually they were caught shoplifting in order to eat and ended up in the Magistrate’s court, where, if he did not divert them, they went off to gaol. He had a pilot scheme in Sydney and ?Port Macquarie to divert them to supported accommodation at hugely reduced cost.

I went for a long weekend near Port Macquarie and met an older lady on the beach, who, hearing I was a politician said that this made me a cad and a bounder who was of no use in the major social problem which was mental health. Accustomed to this assumption about politicians, I remonstrated mildly, and she told me her story of her schizophrenic son, who had gone in and out of supported accommodation and prison for 30 years without getting much help.

Finally I want to a conference on homelessness where I met a community mental health nurse who described how after long weekends she would go to the parks and under the bridges to look for her homeless patients, to see if they were alive to take their medication. I asked that she write a summary in point form of the problems of NSW mental health. She did so, and her excellent report formed the terms of reference of the NSW Mental Health inquiry which I initiated. I asked Brian Pezutti to chair it. He was a Liberal, and had the credibility of having been an Assistant Health Minister. He was also a very thorough and meticulous anaesthetist, retiring at the next election, and keen to do something useful before he went.

The Labor government agreed to the Inquiry because I had the numbers in the upper house. The Inquiry came out in 2002 (NSW Health System Worst in Aust SMH 10/12/2002).

It resulted in a number of things. The budget the following year in NSW rose by $320 million, but mental health money was also quarantined so that it could not be siphoned off to fund Emergency Depts or ICUs further down the budget allocation tree. Most significantly it triggered a Democrat-initiated Federal Mental Health inquiry which put psychologists on Medicare and hugely increased the mental health workforce.

Needless to say, diversionary schemes were part of the recommendations, as without support, mentally ill and developmentally delayed people cannot do the functions that are needed to manage a life in society. There appeared to be some progress and the complaints from mental health workers for some time changed from, ‘we cannot afford staff’ to ‘we cannot fill our positions’.

As the time has passed, it seems that the situation has slipped back. The history of these inquiries is that there is a fuss, things improve for a while, then go back until another inquiry finds the same problems.

So I was discouraged to read that a program to divert mentally ill people from Gaol is to be axed, because some bean counter thinks it is too expensive. According to the Dept of Corrective Services it cost $181.85 per day to keep a prisoner in NSW gaols, which is $1,273 a week, or $66,375 a year. It is dubious that a support scheme could not be organised for less than this, but the idea that the only thing that matters is whether it saves money seems an appalling way to run society. Surely we should figure out what we want to do, workshop how to do it efficiently, and then work out how to fund it.

If a diversion plan is to be axed, let the NSW government tell us that there are good diversion schemes already working and prove it by having an independent body affirm that there is not an excess of mentally ill or developmentally delayed people in prisons. If such schemes existed, why was there this new one set up? There is a long history of ‘pilot schemes’ being set up to deal with a political problem, and then quietly dying when the political heat goes off.

www.smh.com.au/national/program-diverting-intellectually-impaired-people-from-nsw-prisons-faces-axe-20200527-p54wve.html

20/10/2019

Mental Health. Small wins, more needed.

20 October 2019 When I was in Parliament, 4 things happened in quite rapid succession. I was part of an inquiry into prisons and a Dept of Corrections psychiatrist who attended court to question accused people told the committee that it was much easier to get into Prison than the mental health system and that […]