Posted: February 10, 2005

Systems failure and mental illness

The wrenching story of Cornelia Rau's 10 month incarceration in the Baxter Detention Centre points to critical failures within - and between - the health, justice and detention systems in the provision of care for the mentally ill. The Government's decision to conduct a private inquiry into Rau's treatment, as opposed to a public inquiry with full judicial powers, means we will learn less about the nature of systemic failures than we otherwise might. This is a great pity.

We do not need the Inquiry's recommendations to know that before we make policy changes that will impact on people with psychiatric illness we must guard against system failure. We have to think about how a particular policy shift will change the responsibilities and pressures on existing systems and whether new forms of integration and coordination will be required. So before the Federal Government reintroduces a Bill to change the assessment criteria for the Disability Support Pension (DSP) it has a hell of a lot of thinking to do.

In 2002-03 the Government introduced the Disability Reform Bill which proposed (among other things) a reduction in the qualification hours of the 'continuing inability to work test' from 30 to 15 hours per week. The legislation did not pass but the Prime Minister has signalled he will reintroduce the Bill when the Government gains control of the Senate from July 1.

The tighter eligibility criteria will see a significant number of people with psychiatric illness displaced from DSP to Newstart Allowance (NSA). In a paper titled A Job Guarantee for people with psychiatric illness the CofFEE research group examined how badly existing disability employment programs are working for those with mental illness, and the risks associated with the proposed changes. The following issues require urgent attention:

1. The contemporary labour market is not providing sufficient work opportunities and a safe working environment for people with psychiatric illness. This group experiences high levels of unemployment while short-term or precarious positions - in which workers have limited control over hours worked and limited opportunity to build confidence - may harm well being. The State must therefore provide the quantum of jobs required and ensure that the design of jobs is flexible enough to meet the individual and varying support needs of workers. We would argue that the effective integration of the Job Guarantee with mental health, rehabilitation and employment support services could achieve this goal.

2. If the Government passes the legislation (without accompanying measures to provide suitable work opportunities at a decent wage) it needs to consider how a worsening financial situation may effect people with mental illness. A single person receiving the maximum rate of DSP currently receives $75 per fortnight more than a single person receiving the maximum rate of NSA, and unlike NSA, DSP payments are tax exempt. In addition, DSP recipients receive a Pensioner Concession Card which entitles them to a broader range of benefits (including electricity and transport concessions) than are available under the Health Care Card issued to NSA recipients. What research has the Government done to establish that individuals with high medical and pharmaceutical costs who are shifted on to NSA will not be forced to cut essential treatments and/or medicines to make ends meet?

3. Individuals who would move from DSP to NSA under the tighter eligibility criteria would also be subject to activity testing in order to receive their payment. Penalties for breaching activity test requirements pose particular risks for people with psychiatric illness. Penalties range from an 18 per cent reduction in payment for 26 weeks for the first breach to no payment for 8 weeks for the third and subsequent penalties. Research conducted by the National Welfare Rights Centre suggests that among those most affected by the penalties are people with mental illness and/or drug and alcohol related problems.

I am conscious as I write this of not 'using' Cornelia Rau's obscene experience to draw attention to an issue of interest to CofFEE. The motivation to respond comes from the research done for a recent CofFEE working paper on employment and psychiatric illness. In 1993 the Report of the National Inquiry into the Human Rights of People with Mental Illness (known as the Burdekin Report) identified a deeply flawed system and provided detailed recommendations to address systemic failures. Ten years on, the progress has been microscopic. As a researcher, the Burdekin Report underlined the importance of thinking about the implications for those with mental health problems whenever one is waxing on about public policy. Obviously this blog might be interpreted as manipulative but that is not its intent.

Blog entry posted by Sally