Don’t go down the road to Gatton

The excellent documentary film The Road to Guantanamo is the story of a group of British boys on a holiday that evolves into a bizarre and unfortunate adventure.

As with the road to Guantanamo, so with the road to Gatton: the whirlwinds of war and schizophrenia sweep innocents into prisons. What I find surprising is the equanimity with which survivors from both groups accept their prison experiences: what doesn’t destroy you can strengthen you.

It is time to call a halt to the blaming, shaming and punishing of the most marginalised members of our society. Mainstream Queensland community correction officers will calmly say that prison is where certain young men with schizophrenia will spend most of their 20s. Queensland community forensic mental health officers calmly state that having 600 high needs clients in prison is what they are budgeting for. Hello! The prisons are a high cost alternative to the mental health system; and one that is highly inappropriate.

How is this happening to good people? Suddenly, with their lives in full swing, they find themselves in a chaotic situation. Amid turmoil and confusion, they are bundled in with all types of other people. And indeed some of those other people are really not at all nice. But the advice to hand is what they follow. The Guantanamo boys were told to say they were Pakistani: the local lads are told to say they are guilty.

Subsequent to discovering the relative asylum offered by prison, people with schizophrenia often make a choice between homelessness and the prison system. From their point of view, it is a choice that I can understand. However from a different point of view, I do not understand how we can be so complacent about giving them only two options. This is a human rights issue that is under our noses.

The emptying of the asylums into a community that lacked the necessary infrastructure was, of course, doomed. Project 500 was that costly effort that began over ten years ago in Queensland and which is now known as P300. Most P300 clients have serious disability as a result of schizophrenia. However the tide of reinstitutionalisation has overtaken this minuscule work; such that on average there are 600 people with serious mental disorders back in prison institutions in a worse state than when the project started.

Today, mainstream prisons are the default mental health system for many high-needs clients. The prevalence of joblessness, homelessness and incarceration for people with schizophrenia or other psychotic disorders tells us there are holes in the fabric of our society: so what would a community-based mental health system look like?

Recent and current research at Queensland University of Technology into joblessness has revealed that the issues are complex, often interrelated, and not amenable to quick-fix solutions. New definitions are necessary. Joblessness (or homelessness or incarceration) might be better understood as a state in which various linkages are missing.

The research has shown that strengths-based learning in a peer-mentoring environment can assist some people to move towards more productive and satisfying lives. However that recovery process can require months or years of personal mending before it gains a forward momentum.

Unfortunately, non-clinical support in the community is not the focus for increased spending in Queensland’s 2007 mental health budget. Moreover, a much better model than P300 is the HASI (Mental Health Housing and Accommodation Support Initiative) (NSW), which has been trialled and assessed by the University of New South Wales. The Princess Alexandra and Royal Brisbane Women’s Hospital transition pilot project is based on HASI; but the Queensland version does not have the capacity to offer continuing care (so higher-needs clients are screened out).

We are presently waiting on a report requested by Disability Services Queensland and auspiced by Schizophrenia Fellowship Queensland on community based options. Initial findings are that isolating people within the community can leave them lonely and vulnerable to predators.

Some simplistic approaches to non-clinical service provision are limited to giving individuals and/or families long lists of agencies. An improvement on this involves an interview and two or three recommended contacts. It is clear that these types of approach might be appropriate for someone who is functioning fairly well, but for higher-needs clients they fail abysmally.