September 2019

The Nation Reviewed

Spiralling admissions

By Thornton McCamish
Victoria’s royal commission hears stories of a dysfunctional, under-resourced mental health system

Mary Pershall, a slight, softly spoken woman in a black jacket and floral print blouse, is telling the Royal Commission into Victoria’s Mental Health System the story of her daughter Anna’s lifelong struggle with mental illness. It begins with “a delightful little happy child” with a vivid imagination, who invented fantasies about the little spiders she would find in the school grounds; it reaches its tragic climax after two decades of spiralling ill health, addiction and psychosis, with the police phoning the family home. “For so long we’d expected a call to say that she was dead,” says Pershall, “but then we got a call instead to say that she’d killed someone else.”

That call came in November 2015, when Anna was 28. She was four months pregnant and had been doing her best to stay well, but the voices in her head were telling her “terrible things”, Pershall says. “She used marijuana and alcohol and also prescription medication to keep all those voices at bay … I think her brain just imploded.” Anna, who was never formally diagnosed until she went to prison, is currently serving a 17-year sentence for murder.

Pershall is one of 29 community witnesses addressing the royal commission. The hearings are being conducted on the second floor of the Melbourne Town Hall, in a stately function room with brass chandeliers, a coffered ceiling and walls lined with dark portraits of long-ago aldermen in their robes and chains. The commissioners’ bench, counsel and support staff take up about half the space; the rest is reserved for members of the public. As they shuffle in, a couple of women cheerfully warn a newcomer that the seats behind the counsel assisting are visible to the cameras live-streaming proceedings. She sits there anyway. The room is packed.

Pershall gives her evidence on a day devoted to the experiences of families and carers. One such witness, a middle-aged woman testifying under a pseudonym, tells counsel assisting Georgina Coghlan that she had been a carer for her parents and two brothers, all of whom suffered mental illness at different times, for most of her life. One brother took his own life in January, just days after he was discharged from a facility where he was undergoing psychiatric assessment. When she heard about the royal commission, the witness decided she needed to participate. “I really wanted to be able to talk about the experiences of my family in a way that contributes to changing the way we deal with mental health.”

Another witness, 25-year-old Jesse Morgan, tells the commissioners he was 14 when his single mother was diagnosed with a mental illness and he became primary carer for her and for his younger brother. Case managers supported his mother, but Morgan had to teach himself how to look after her and run a household. Every night for years he cobbled together basic pasta dinners – “pasta is banned at our place now” – and worked up to six days a week to provide for the family. He was scared to ask for help because he didn’t want people finding out how they were living. “We kind of lived in a constant fear of being separated from each other.”

Even to those with personal or anecdotal experience of it – which, statistically, is pretty much everyone – the sheer scale of the mental illness problem can be as bewildering as the variety of suffering it causes. One in five Australians aged 16 to 85 experiences some form of mental illness every year. In 2017, the last year for which figures are available, more than 3000 Australians took their own lives. In the past decade the number of people presenting to Victorian hospitals with a mental health crisis has increased by 60 per cent. The day before Pershall took the stand, Victoria Police assistant commissioner Glenn Weir told the inquiry that police now attend a mental health incident every 12 minutes.

Victoria will spend $705 million on mental health and addiction services over the next four years. Professor Patrick McGorry AO, chair of the inquiry’s expert advisory committee, has said this figure is patently inadequate – $1 billion a year would be closer to what’s needed.

The tone at the hearings is not inquisitorial. There are no cross-examinations about specific system failures or the mismanagement of individual cases, just testimony from experts and administrators in a system that too often fails to provide effective treatment, and stories of ordinary people’s struggles to get the help they need.

By the first two weeks of hearings a picture is already emerging of a dysfunctional, inflexible and under-resourced system that’s simply unable to cope with the demand. Witnesses have told the inquiry about not being able to access help because their condition is either too serious or not serious enough, and that patients often end up in a “revolving door” of treatment and relapse. They have described a severe shortage of clean and safe accommodation for high-needs patients, and an increasingly complex and poorly integrated network of supports that people in distress can find nightmarishly difficult to navigate. Pershall tells the inquiry that her daughter was “turned away from the mental institution because she abused drugs and she was turned away from drug rehabilitation because she was mentally ill”.

As counsel assisting Coghlan leads Pershall through her witness statement, she loses her composure only once, momentarily undone by the memory of the kindness of a police officer called to a violent episode at home. Pershall’s other daughter, Katie, leaves her seat in the front row to kneel at her side for support, remaining there as Pershall explains how Anna’s condition deteriorated as she became addicted to synthetic cannabis, then ice. The family found itself unable to cope with a series of escalating crises.

Once, Pershall says, they managed to persuade Anna to try detox, but were told they’d have to wait 10 days for an assessment. “Which was useless, ridiculous, because we had barely been able to keep her [at home] for 24 hours.” On another occasion, Anna was desperate for help, but afraid of retribution from her dealers if she contacted police directly. So she entered a service station in Footscray, politely asked if she could use the restroom, then stripped naked and stood in the door where customers could see her. Police took her to a psych ward. A week later, Anna discharged herself. The family was not informed or consulted.

Another admission to a psychiatric unit ended too soon because there were no beds available. “I went in and Anna was really distressed, crying,” Pershall says. “She knew she couldn’t look after herself, she knew that we couldn’t look after her, and she said, ‘I need the help that they’re giving.’ [But] the person in charge had said, ‘You can’t have a bed here just because you want it.’”

When Pershall begged for Anna to be allowed to stay, a staff member said, “Well, if you care so much about your daughter, why don’t you take her home?”

Asked what needs to change, Pershall says that more safe and supported crisis accommodation is crucial for people in Anna’s situation. Also, “it would be great if there could be a team approach, that families could be listened to”.

With the right support, Pershall says, someone like Anna could be an active, contributing member of our society. “And of course, it’s going to cost a lot of money. But it costs so much money to keep people in prison, and there’s more than just Anna who are in prison because of similar issues.”

The royal commission will deliver an interim report in November.
Lifeline: 13 11 14

Thornton McCamish

Thornton McCamish is a Melbourne-based journalist and author. His latest book is Our Man Elsewhere: In search of Alan Moorehead.

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