Answer is care, not fear, May 2013

Published in The Australian, 15 May 2013

COMING at the start of Schizophrenia Awareness Week, there were two disturbing articles in The Weekend Australian on May 11: Richard Guilliatt’s magazine feature “My meeting with madness” and the accompanying front-page article “Mentally ill more prone to violence”.

They’re disturbing because indiscriminate use of the term “mentally ill’, combined with a graphic depiction of a frightening attack and reference to an atypical cluster of violent episodes, will likely increase stigma. This then reduces the likelihood that people who need treatment will get it.

The dramatic impact of the articles conveys a message that we should be fearful of people with schizophrenia, period. This does not help people with schizophrenia nor protect them and the community from violence.

The articles also risk increasing the level of distress for the overwhelming majority of those with the illness who are not prone to violence. To extrapolate from a tendency within a small subgroup and apply it across the group as a whole is highly problematic, especially when dealing with an issue already steeped in misunderstanding. Many of them will be distressed by the articles and the increased stigma they may encounter because of them. Some may find the stigma more difficult to deal with than the illness.

As Guilliatt acknowledges, the vast majority of people with schizophrenia control their symptoms and live normal lives.

We need to change a situation in which as many as one in three people with a severe mental illness are not accessing services, and those who are cannot get effective treatment. The random attack described in The Weekend Australian is a case in point.

Effective treatment and support significantly reduce the likelihood of violence. So it is the lack of effective treatment that increases the risk of violence by a small minority of people with schizophrenia. Critical opportunities for early intervention are lost and so we get caught up in a vicious cycle.

As one woman living with schizophrenia said recently: “Whenever I hear of a murder in the news, I immediately say a prayer that it is not by a person with a severe mental illness, because it sets things back for the rest of us. Years of work campaigning hard to reduce stigma can be obliterated with individual incidents that are not covered in a responsible or balanced way. And we pay the price.”

At the same time, Guilliatt’s articles are provocative and we hope they lead to greater debate on the issue.

We cannot deny that a small subgroup of people with schizophrenia are more prone to violence when they don’t get adequate treatment and support. Such support does not exist in most parts of Australia. It is simplistic and wrong to say that the community mental health approach is at fault; we never want to return to the old lock-them-up approach.

Forensic psychiatry expert Paul Mullen advocates a “total immersion” approach involving a range of community mental health workers – in essence, a more effective form of community treatment.

We need to have a forthright and constructive conversation about how best to address the challenges created by schizophrenia and other forms of severe mental illness. We need well co-ordinated and continuing care. We also need to reduce the debilitating stigma around severe mental illness. And we need to examine whether delivering mental health services between the commonwealth and the states, including the resource mix between hospitalbased and community services, is giving us the best outcome. We spend billions of dollars each year on a mental health system that lacks integration and co-ordination.

And we must continue this dialogue beyond Schizophrenia Awareness Week.

Frank Quinlan is chief executive of the Mental Health Council of Australia, David Meldrum is executive director of Mental Illness Fellowship of Australia and Jack Heath is chief executive of SANE Australia.

Frank Quinlan - CEO, Mental Health Council of Australia
David Meldrum - Executive Director, Mental Illness Fellowship of Australia
Jack Heath - CEO, SANE Australia