CO-MORBIDITY

The Hon. K.L. VINCENT (16:11): By leave, I move my motion in an amended form:

That the Social Development Committee inquire into and report on the issue of co-morbidity, which here refers to a dual diagnosis of both intellectual disability and mental illness, viz:

1. Facilities in South Australia currently treating people with a dual diagnosis with particular reference to the Margaret Tobin Centre and James Nash House;

2. The possibility of establishing a new forensic facility similar to James Nash House in South Australia to deal specifically with offenders with intellectual disability;

3. The level of training offered to general practitioners, psychologists, psychiatrists and other relevant professional in the area of dual diagnosis and possible measures to enhance that training;

4. Information given to individuals and carers on how to manage a dual diagnosis;

5. Supports to aid individuals and carers in managing and living with a dual diagnosis; and

6. Any other related matter.

I am moving this motion hoping that we can make some progress in an area which has been little discussed and attracted little interest but which, nonetheless, represents a great hurdle in the lives of many people with disabilities.

Mental illness is between three and four times more likely to occur if a person has an intellectual disability. Despite this, in South Australia and across much of the country there are almost no dedicated facilities or supports offered to help people with this dual diagnosis or co-morbidity, as it is more commonly known nowadays.

I understand that it may not be immediately obvious to members why the existing structures which deal separately with disability and mental illness are not adequate, so I would like to explain how this issue has unfurled for me—that way you can all see things the way I see them.

I was contacted recently by two families whose loved ones have both an intellectual disability and a mental illness of some form. The stories these families have told me about the treatment their family members have been subjected to are nothing short of horrific. While every experience has varied greatly in its context and actions, there is a common theme in all of them. That theme is ignorance, often augmented by a lack of empathy.

When I met with the families, I heard a great many examples of misunderstanding. One story involved a teacher who clearly thought the child in question was deliberately badly behaved. Her solution to this behavioural issue was to lock him in a cupboard. This particular boy was trying to deal with the world through a prism of an autism spectrum disorder while also having a mood disorder. His mother says that, with effort to accommodate his needs, he is little trouble. Clearly, the teacher in this case was not interested in examining the causes of his behaviour; rather, she just wanted it to stop. This teacher was ignorant and disinterested.

While I am sure you all acknowledge that this story is indeed tragic, perhaps you are thinking that some teachers do not have an in-depth understanding of intellectual disability or mental illness, and that is not too surprising. What is surprising is how far this level of ignorance permeates into the professions of psychology and psychiatry.

As an example, here's another incident recounted to me by one of the families. The loved one with an intellectual disability and mental illness had been institutionalised for a brief period during an episode when their mental illness was more severe than usual. After a few days at the facility, the mother was speaking to his treating doctor and attempting to explain the issues her child might face when conventional mental illness treatments were used. Due to his disability, for example, this man has a fear of large, noisy spaces. Also due to his disability, he requires a bit of extra and lateral explanation when communication is taking place.

The doctor, however, simply was not interested. Instead of taking the comments on board, he simply said, 'I'm not here to treat his disability, I'm here to treat his mental illness.' But of course, as most rational people would know, you cannot treat one without at least acknowledging the other. To me, that is like saying that I can get treatment for a migraine but only if I get out of my wheelchair and walk over to pick up the appropriate medications. It is almost inconceivably stupid.

Having heard these stories, and many others, I set about trying to find out if they were the normal state of affairs. I must thank the Royal Australian and New Zealand College of Psychiatrists for helping me a great deal with my research in this area. However, what I found out was no cause for thanks. While there are pockets of expertise in the treatment of intellectual disability and mental illness around the world, there remains an enormous gap in expertise in South Australia.

The UK seems to have some of the best practices and knowledge in the area, and there are a few locals in South Australia who have trained there and have brought this knowledge back with them. However, there are absolutely no systematic methods by which this knowledge is spread.

Registrars training in psychiatry are not exposed to disability, except perhaps through a few lectures which mention it. For professionals operating in institutions like the Margaret Tobin Centre, one of our main mental health destinations, there is no expectation that you will have a level of knowledge about disability, either.

This shows an attitude of apathy toward disability, but also reflects the level of ignorance our society still has around mental health, more generally. It is proof that we are still not considering mental health as a part of a whole person. We looking at it as if it were some kind of alien disease which can be extracted with the simple swallow of a pill.

Mental health is like any other illness, it has its causes and many of them are buried within the person themselves. This must be recognised. When left unrecognised, we end up with people who could be active and engaged with life that are instead pushed to the fringes. That is why part of my motion focuses on forensic facilities, because many people with intellectual disability and mental illness end up being so alienated from society that they are picked up in the justice system.

I hope this inquiry can unearth information about better treatment, and also provide us with ideas about the best and fairest way to deal with offenders who have a dual diagnosis, because I assure you that they are not being given a chance at the moment. I do not think I need to draw a picture for you of what might, and does, happen to someone with an intellectual disability and mental illness when incarcerated in a mainstream prison.

So, this is a snapshot of what I have found out so far, but I realise that there is much more we need to know so that we can tackle this problem fully. I am not, in this instance, attempting to attack the government or anyone else by making these statements. What I hope I have done is convince all of you that this area is a significant disaster at the moment, but with some good information and good policy frameworks it could be transformed, which would simultaneously transform the lives of South Australians, and their families, with a dual diagnosis.

Debate adjourned on motion of Hon. I.K. Hunter.