HANSARD
SITTING CALENDAR
SEARCH
LIVE BROADCAST
Hansard Dynamic Member Index
Legislative Council - Fifty-First Parliament, Third Session (51-3)
2009-04-08 Daily Xml
Contents
Pdf Xml

MENTAL HEALTH BILL

Second Reading

Adjourned debate on second reading.

(Continued from 26 March 2009. Page 1781.)

The Hon. A. BRESSINGTON (21:50): I warn members in advance this is quite lengthy—I have culled it—and if I seek leave to conclude, you all know why. I rise to speak to this most important bill, the Mental Health Bill 2008. This bill states that this is for an act to make provision for the treatment, care and rehabilitation of persons with serious mental illness with the goal of bringing about their recovery as far as is possible; to confer powers to make orders for community treatment, or detention and treatment, of such persons where required; to provide protections of the freedom and legal rights of mentally ill persons; to repeal the Mental Health Act 1993; and other purposes.

I have researched the aims and objectives of this bill and compared it with science, and I must say I have some serious reservations about what is being proposed; what has been amended from the 1993 bill; and also the medical premises that have been used to put into legislation how mentally ill individuals could be treated under this law. The most disturbing part for me is that we will now include children under the age of 16 in the Mental Health Act. Time and again, we are told in this place that we must look to the evidence, yet when evidence is produced and is contrary to the intention of the state, the evidence seems to be ignored. The evidence shows that early intervention produces the best results. The evidence shows that the least invasive form of treatment will often produce better outcomes for those with a mental illness. The evidence shows that a community visitors' program is also effective and is best delivered by the non-government sector.

I notice that these matters are not dealt with in the bill and I am concerned that there is little differentiation between a person who is at serious risk, as opposed to a person who is perhaps a little eccentric and who can be placed on a community order at the request of a family member, with no compelling directive to ensure that adequate legal representation is provided to the person whose mental capability is being questioned. It is fair to say that a society can be judged by how it treats its most vulnerable—and that is the second time I have mentioned that tonight.

After we debate this bill, we should be able to feel as though the best interest of the individuals has been served by the deliberations of this parliament. If shortfalls are identified, then this bill should be the tool with which we are able to address these shortfalls so that fewer people fall through the cracks. We should be taking steps to ensure that those who are at serious risk to themselves and others receive appropriate intervention, support and treatment, and if detention is necessary for the safety and wellbeing of those individuals, that a safe and secure environment is provided for them. Those who do not require detention should still be able to rely on the services being funded appropriately and adequately so as to allow them to live within the community, and they should be encouraged to be as independent as possible, but also have access to intervention and support when things go pear shaped for them.

We cannot promise that now. In fact, community confidence in government run operations such as this is at an all time low. One only has to take a trip to Semaphore and sit outside with a cuppa to see just how many times they are approached for money and cigarettes—and the locals know that the people doing this are part of the mental health system and that they are floundering. These are people who have been put out into the community to live independently and who, for the most part, have been left to their own devices. I cannot help but wonder, if the non-government sector were financed sufficiently and the many services that already exist were able to extend their services for practical support, counselling and the biosocial aspect of mental health needs, how much different our current landscape would look.

At this point I would like to include the recommendations of the Office of the Public Advocate in the record. The paper was released on 1 May 2006 in relation to developing a community visitors' program, the same as programs implemented in other states and specifically in relation to the program in Victoria that has seen many successes in ensuring that Victoria's mentally ill are receiving an appropriate level of care and that their rights are respected.

In November 1995, Judy Clisby, a student of the School of Social Work and Policy, University of South Australia, as part of the parliamentary internship scheme under the supervision of the Hon. Robert Lawson MLC produced a research report 'Community Visitors in South Australia: A strategy for ensuring high standards of care and protecting the human rights of people with mental illness'. The research strongly recommended as follows:

Recommendation 1: that a community visitors program be set up in South Australia to monitor standards of care and protection of rights in public and private sector institutions offering psychiatric in-patient services. Features of the community visitors program must incorporate functions of monitoring, investigation of complaints, advocacy and support, independence from funding bodies and service providers, a statutory basis, annual reports to both houses of parliament, regular meetings with key officials in health and with the Minister for Health; adequate resources with secure funding that does not detract from existing funding for services, and appropriate criteria for the recruitment, training and support of volunteers;

Recommendation 2: that a working party be established to consult extensively with consumers, consumer groups and service providers to develop a model suited to unique South Australian conditions, to ensure that consumer focus is the primary consideration governing the program, to investigate the target population services of the program, linkages between the community visitors program, community advocacy agencies, commonwealth funded schemes for nursing homes and hostels, and the supported residential facility scheme; and

Recommendation 3: that the working party report in sufficient time for its recommendations to be incorporated into the review of the Mental Health Act 1993, the Guardianship and Administration Act 1993, and the Supported Residential Facilities Act 1992.

In this same report the location of the service was canvassed between the Office of the Public Advocate, Health Advice and Complaints, and the Ombudsman, and concern was raised about the lack of advocacy provisions for monitoring standards of care and protection of rights for government, non-government and private services, except under the provisions of the Office of the Public Advocate.

The Clisby report supported the Office of the Public Advocate as the most appropriate location for a community visitors scheme in South Australia, and the Public Advocate at the time saw it as augmenting the functions of the office under section 21 of the Guardianship and Administration Act 1993 and providing an external system of monitoring standards of care and right to protection in both the public and private sectors. The most compelling factor in choice of location was the independence of the auspicing agency. A significant proportion of respondents recommended the Attorney-General's Department with its dual advantage of independence and access to legal advice. Those are the main points of the study; I will not read out the rest because it is late.

The area of mental health is one that is of wide concern not only to those who need to be provided with effective services but also to those who treat the mentally ill, those who care for them and those in the community who, for whatever reason, are impacted by decisions made in the delivery of those services. It concerns medical practitioners, people who care for those with mental illness issues (both professional and family carers), as well as members of the wider community who are concerned themselves, because of misperceptions surrounding those whose mental health is not all we would hope it would be.

The interesting thing about mental illness is that there is no true measure to detect it. It depends greatly on the interpretation of behaviours as being abnormal, and this is where I see a problem with diagnosis, because there is more to mental illness than the demonstration of eccentric or even bizarre behaviours. There is no medical examination, there is no genetic test to show a predisposition or risk of incurring a mental illness. Some very well-known psychiatrists have jumped ship on the practices of modern psychiatry because they say that psychiatrists are nothing more than the distributors of legal drugs to the unsuspecting.

Thomas Szasz is Emeritus Professor of Psychiatry at the State University of New York Health Science Centre, and is internationally acclaimed as one of the most important writers in present-day psychiatry. In 2002 he stated:

There is no blood or other biological test to ascertain the presence or absence of a mental illness, as there is for most bodily diseases. If such a test were developed, then the condition would cease to be a mental illness and would be classified, instead, as a symptom of a bodily disease.

The aim of that statement by Professor Szasz was to point out that there are a number of contributing factors to why an individual may experience a psychotic break, or even why a person may suddenly appear to be less psychologically functional. The causes can range from allergies to certain preservatives found in our food to brain tumours and hormone imbalances. In fact, recent science has revealed that that the very medications we use to treat low-level mental disorders such as depression and sleep disorders can themselves contribute to the illness and hurl a person into a full-blown suicidal ideational episode.

An article from Medical News Today reveals that a test is now available to determine whether or not a person's genetic make-up would be a contraindication to the use of a certain antidepressant medication. NeuroMark (a Boulder, Colorado company) has announced the immediate availability of a genetic test to identify people at risk of suicidal ideation (thoughts of committing suicide) when prescribed an antidepressant drug. The test, called the Mark-C test, is expected to help restore public confidence in antidepressant medication and help to reduce a recently announced spike in suicide rates amongst US youth. Kim Bechthold, NeuroMark's CEO, said:

This is an exciting example of the power of genetics to address a critical need and make important drugs safer for patients worldwide.

In September 2007, the Centre for Disease Control (CDC) announced that, in 2004, there was an 8 per cent rise in suicide rates among 10 to 19 year olds—the year the FDA issued public health warnings linking antidepressant drugs with suicidal ideation and behaviour. The largest percentage increase in rates from 2003 to 2004 was among females aged 10 to 14 at 75.9 per cent, followed by females aged 15 to 19 at 32.3 per cent, and males aged 15 to 19 years at 9 per cent, according to the CDC. In a statement the company said:

We feel a sense of responsibility, given the current climate, to provide the test to physicians immediately so that they may identify patients who would benefit from closer monitoring or even a change in therapy. It is our hope that this early test will encourage more people to consider an antidepressant drug treatment who would benefit from it.

It is interesting that, during the trial of that test, some 37 per cent of people showed an adverse reaction to this drug, which is one of the most widely prescribed antidepressants in the western world. About 37 per cent of people who were tested for the genetic contraindication for this drug developed symptoms such as suicidal ideation and attempts at suicide and, when they were taken off the drug, those particular side-effects abated, and it was put down to the fact that it causes brain inflammation and it also has serious physical side-effects for them.

We have become a nation looking for quick fixes, and those quick fixes are usually in the form of medications. Knowing that this test now exists I think should be a compelling argument for this country—particularly, this state—to enter into research into this test. It would make a physician's job far easier when they are prescribing these drugs for their patients to know that they are genetically compatible with them and that the risk of their patients 'going off' and trying to commit suicide would be greatly reduced, and that means that the people who are compatible with antidepressants will get the help they need and, for the people who are not, we can look for other sorts of treatment for them, whether that be another kind of antidepressant or another kind of therapy altogether.

It could be argued that a person should be administered medication only when all other therapies have failed and the person's condition either does not improve or deteriorates to the point where they are at risk of serious harm to themselves and others. While I am no expert on mental health, I have seen some situations that raise concerns as to how mental health treatment in the first instance has become almost entirely medication based and how a person's life experiences and emotional state are pondered little, if at all, by some in the field of psychiatry. Indeed, for state governments, the prescribing of medications could be seen as a cost shifting exercise, because those medications are almost always made available on the federally funded pharmaceutical benefits scheme.

It is a sad state of affairs indeed when people who are prescribed heavy duty medications become addicted to them and are then left to their own devices. I have seen this happen many times, and I have seen the human tragedy of a system that resorts to medication as a first, second and last port of call. It is true that getting to the core emotions of an individual is a time-consuming and labour-intensive exercise and, again, the issue of a duty of care to those in the mental health system does come into question.

We have seen a shift away from institutionalised care and a move towards encouraging independent living within the community. As the best care scenario, we would all choose the latter where and when possible. Unfortunately, with the noble ideal of independent living, there is an expected increase in responsibility for government to ensure that those who are placed in the community have an acceptable quality of life, which would also eliminate the risk of exploitation, violence and discrimination against them.

This would mean that those who have been netted into the mental health system and live independently still require a level of monitoring and support to assist them to be the very best they can be. Sadly, I see no moves in the bill before us to identify that there are a variety of persons who need a variety of support mechanisms. This, of course, applies not only to those who will be detained but also to those who roam the streets and are unable to make decisions in their own best interests, for whatever reason.

Our body is a complex piece of work, and it is regulated by our psychological wellbeing and our emotional status at any given moment. Of course, all of this is determined by the chemical stability of our central nervous system. The brain and its functions are the least understood, and the connection between our brain and our emotional wellbeing is influenced by many factors. Stress and trauma reduce our resilience to cope, and this in itself creates a situation where our body will produce a number of hormones in an effort to counter the emotional, physical and psychological effects of that stress and trauma.

Of course, early intervention and support at the onset of stress and trauma would be desirable, and such interventions should include counselling and various kinds of practical assistance and mechanisms that would see a problem solved or at least a solution realised, but that does not happen in most cases. In fact, the age at which our children are being introduced to quick fixes is as disturbing as the number of adults on medications. Antidepressants and anti-anxiety medications are prescribed like lollies, and for our young people this can create a lifetime of problems. I seek leave to have inserted in Hansard a one-page statistical table without my reading it.

Leave granted.

Attachment A

Table 1. Number of patients who had at least one prescription filled for a PBS/RPBS listed antidepressant drug in the 2007-08 year, by age and State/Territory.


Patient Age State²
NSW VlC OLD SA WA TAS NT ACT Australia
0 to 1 years 12 16 12 * 8 * * 48
2 years 22 13 14 6 8 6 * * 69
3 years 38 11 18 7 10 * * * 84
4 years 33 18 37 5 9 11 * * 113
5 years 73 46 69 19 18 14 * * 239
6 years 102 68 117 25 21 14 * * 347
7 to 10 years 901 512 1,007 192 188 122 21 40 2,983
11 to 15 years 3,130 1,882 2,818 563 775 324 53 142 9,687
16 to 18 years 5,206 4,100 4,047 1,255 1,582 620 46 280 17,136
19 years and over 447,927 360,853 308,515 128,707 143,778 43,892 5,891 19,178 1,458,741
Age unknown¹ 161 95 86 39 50 9 * 8 448
TOTALS 457,605 367,614 316,740 130,818 146,447 45,012 6,011 19,648 1,489,895

¹ 'Age unknown' is where the Departments administrative systems do not contain enough information to accurately determine a patient's age.

² Patient State/Territory is the first State/Territory of the patient in the year. If a patient moves within a year then the data reflects their initial State/Territory.

* indicates that a table cell was 3 or less and has been suppressed for confidentiality reasons. Suppressed cell values have not been included in totals.

Table 2 contains information by generic drug name, As patients may have received more than one of the indicated drugs within the year, the individual drug totals will not add to the total number of patients.

Table 2. Number of patients who had at least one prescription filled for a PBS/RPBS listed antidepressant drug in the 2007-08 year, by generic drug name, age and State/Territory.

Drug name Patient age State
AMITRIPTYLlNE HYDROCHLORlDE NSW VlC OLD SA WA TAS NT ACT Australia
0 to 1 years * * * * * * * * *
2 years * * * * * 5 * * 5
3 years 5 * 9 * * * * * 14
4 years 5 * 18 * * 10 * * 33
5 years 10 6 28 11 5 9 * * 69
6 years 19 * 48 10 * 13 * * 90
7 to 10 years 138 47 321 62 19 65 * 6 658
11 to 15 years 294 126 503 123 74 64 * 10 1,194
16 to 18 years 248 185 222 109 107 49 * 7 927
19 years + 59,999 40,145 38,775 20,874 19,688 7,360 854 1,698 189,393
Age unknown 26 13 11 5 6 1 62
AMITRIPTYLlNE HYDROCHLORlDE Total 60,744 40,522 39,935 21,194 19,899 7,576 854 1,721 192,445
CITALOPRAM HYDROBROMIDE 0 to 1 years * * * * * * * * *
2 years * * * * * * * * *
3 years * * * * * * * * *
4 years * * * * * * * * *
5 years 5 * * * * * * * 5


The Hon. A. BRESSINGTON: The table outlines how many of our young, state to state, are on antidepressants of one kind or another, and it is a staggering figure indeed. Antidepressants were never meant to be used long term, yet I know many people who have been prescribed these medications for decades where the original cause was never identified. We may have a grasp on the minimum mechanical functions of the major organs, but there is still a lot to be discovered about the intricate crossover of systems that keep our body and mind healthy. What fascinates me about the entire topic of mental health is that the emotional experience of an individual is skipped over as if of no consequence to our emotional state and how that impacts on us physically and mentally.

We all remember some years ago when the medical profession was disputing the addictive properties of Valium and Serapax and, after many thousands of women had been prescribed 'mother's little helpers', as they were called, it was discovered that they were, in fact, highly addictive and were being widely abused. These particular medications remain a problem for many, and the effect those medications have had on the body's regulatory systems of hormones, etc., has been devastating.

At the drug rehab centre where I used to work, 90 per cent of our clients last year were middle-aged housewives who had been battling with an addiction to Valium and Serapax for decades. Those women had been on those medications for most of their adult life, and they are only now realising the effect that has had on their ability to function day to day. These people have a great struggle ahead of them when coming off these medications. None of them could remember why they were actually put on them in the first place—they were not sleeping, they were new mums, and all they needed was some sort of social support network to get them through some difficult periods in their life that were new to them.

Many of our generation remember the saying, 'Have a Bex, a cuppa and a lie down.' For so many years, as a society we greatly underestimated the side-effects of medications. At the same time, our mental health services rely heavily on the use of drugs as treatment, when in actual fact the compliance rate of drugs to treat, say, schizophrenia and bipolar is sometimes as low as 15 per cent. Despite the low compliance with mediaeval treatments, we seem to ignore the ever-increasing research showing that bio/psycho/social approaches, such as cognitive behavioural therapy, and others that target a person's adverse life experiences, often produce better long-term results than any medication.

I make it clear that I am not advocating total abstinence for those who have been diagnosed with a true mental illness. I am advocating that the one-size-fits-all approach we currently have in the name of treatment needs serious revision.

Renée Garfinkel, who wrote an article called Marketing Mental Illness: The way to sell drugs is to sell psychiatric illness, made the comment that 'disorders to be included in psychiatry's diagnostic and statistical manual of mental disorders (DSM), published by the American Psychiatric Association, are chosen by a majority vote of APA members and is on the same scientific level as you would choose a restaurant'. She also states:

When the American Psychiatric Association published the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952, the book contained only 112 entries. That figure has more than tripled over the past 50 years. The disorders listed in today's DSM and the mental disorders section of the World Health Organisation's International Classification of Diseases include: reading disorder, disruptive behaviour disorder, disorder of written expression, mathematics disorder, caffeine intoxication and nicotine withdrawal disorder.

These are all now classified mental illnesses. These publications comprise a grab-bag of billing terms for the mental health industry. This also accounts for the growth in the number of disorders contained in the DSM. Some believe it has been motivated by purely economic principles.

The first increase took place in 1968, coincident with US government insurance becoming available to the mental health industry. That year, the number of disorders in the DSM jumped from 112 to 163. By 1980, the DSM-III edition added another 61 disorders, for a total of 224. With the publication of the DSM-III-R in 1987, mental disorders increased to 253. In 1994, the total had risen again, this time to 374. But the money trail goes deeper.

A study published in April 2006 by public health researchers from the University of Massachusetts and Tufts University in Boston disclosed that every psychiatrist expert involved in the development of the mood disorders listed in the DSM-IV had financial ties with drug companies before or after the book was published. This report was the first to officially document the wide-ranging and incestuous monetary relationship between the pharmaceutical companies, psychiatrists and other mental health industry personnel responsible for the manual.

Depicted as diagnostic tools, the DSM and the International Classification of Diseases (ICD) mental disorders sections are used not only to diagnose mental illness and prescribe treatment but also to resolve child custody battles, discrimination cases based on alleged psychiatric disability, to support court testimony, to modify education and much more. All this, and yet there is no science to this diagnosis system, and insurance companies estimate that the cost of treatment for disorders that cannot be physically proven is two times greater than for general medical conditions.

In 1995, after more than $6 billion of taxpayer funds had been poured into psychiatric research, psychiatrist Rex Cowdrey, Director of the NIMH, admitted:

We do not know the causes of mental illness. We don't have methods of curing these illnesses yet.

Psychiatrist Colin Ross points out:

The way things get into the DSM is not based on blood test or brain scan or physical findings. It is based on descriptions of behaviour, and that's what the whole psychiatric system is.

I have long been sceptical of some of the mythology used to diagnose mental illness, especially with individuals who have a known history of substance abuse. I do not believe that enough attention has been paid to the signs and symptoms of addiction. I also know that the mental health system and the drug and alcohol system do not talk to each other and do not work cooperatively together, and this bill will not improve that situation. In fact, in conjunction with federal initiatives, this bill will see most drug addicted people referred, by their treatment providers, to mental health services for assessment. I guarantee that those drug and alcohol services will not see those clients again.

I have heard the statistics about drug users and the high level of comorbidity. The question is: if those in the mental health industry were trained adequately in the effects of drugs on an individual, they would also be able to better distinguish between a person who is truly mentally ill and a person who is caught in the grip of addiction, and there would be a clear and definite difference in how they were treated.

Anyone who knows addiction knows addicts exhibit some quite bizarre behaviours while using mind altering drugs. That is actually why they are called 'mind altering drugs'. I have personally seen many people of various age groups, the youngest being 14 at the time and the oldest 57, who were misdiagnosed with schizophrenia and bipolar, or manic depression, as it used to be known. When I say misdiagnosed, the impact that this misdiagnosis has had on the individuals and their families should be realised.

Being caught in the mental health system is not a flash in the pan experience, and for some the long-term physical effects of misdiagnosis is as devastating as the decline in their quality of life. I am not sure how psychiatry became the profession that was considered to be the supreme power, but I will state for the record that I have seen more harm done to some by the policies that are driven by psychiatry.

The reliance of this profession on medication is profound. Probably the one that stands out most is a 37 year old man, who was a methamphetamine addict, who was literally trapped in a psychotic state for five long years. His psychosis would ease when he did not use meth multiple times during the day, but he would slip into psychosis when he would be able to afford to use more regularly.

He was married, with four young children, and his wife did not know that he was using drugs. This man, husband and father of four had been able to hide his drug use, and his wife put his odd behaviour down to stress, overwork and his consumption of alcohol, which, by her own admission, was less than one stubby per day. She believed that the combination of all of these things was responsible for his odd and erratic behaviour and his mood swings.

He gradually became worse over time and, eventually, his psychosis became so obvious that over the period of four years he spent time in and out of Glenside, where he was put on medication, detained for a short period of time, and released into the care of his wife. He would cease his medication because it would make him feel too dopey, and within days his merry-go-round would begin again because he would start using his illicit drug.

His behaviour became more frequently erratic, and his admissions to Glenside became more frequent for longer periods, but nothing had changed—nothing—in how he was handled. Even though absolutely no progress was being made, in fact, if we were to be honest, his behaviour had deteriorated with more frequent psychotic episodes lasting longer; but the treatment never varied.

Eventually, this man became more and more violent until he ended up on the wrong side of the law after five years. When he went to gaol his family approached DrugBeat and me, and the program manager and I went to visit him in Yatala. He admitted that he had been using methamphetamine and smoking dope and that he had been a recreational drug user since the age of 12. Now he was looking at a lengthy stint in gaol. Isn't it just a little peculiar to members here, as it is to me, that a question was never asked, that a drug test was never taken, and that he was prescribed heavy duty anti-psych medication in hospital and also as an outpatient, without ever being tested for the presence of drugs known to induce psychosis?

I guess it is the lack of imagination that staggers me in this case. We managed to negotiate home detention for this man under court order to attend the program for 15 months. He has now been drug-free, alcohol-free and psychosis-free for three years. I have left out a lot of the detail of his five-year reign of terror on his wife and children. However, just as an example, on one occasion he was sure his wife was having an affair and that her lover was living in their wardrobe. He removed and burnt all the clothes from the wardrobe because he believed that this lover of his wife was also wearing his clothes when he was not home. He removed the doors from the wardrobes and would not sleep with the light out.

His wife was not allowed to sleep in another room and he would sit and watch her all night to make sure she did not leave the room. If she needed to go to the bathroom he would follow her. He became so obsessed with this lover that he erected a glass shed in his backyard so that he could see everything and everyone who went through the house. He controlled the electricity from the shed and he would run secret missions during this time at home to plant what he believed were microphones all through the house and randomly turn the electricity on and off during meal times and while the kids were watching TV, and their life was absolute mayhem.

He also believed that his wife had put a tracking device in his telephone so that she would know when he was coming home and she could hide her lover in the wardrobe. He threatened his wife with an axe and had her pinned down in the backyard in front of his children. This went on for almost all the five years and the only relief was when he would be admitted to the hospital for a couple of days.

That entire family was traumatised by his drug-induced psychosis, and his family could not get the help they needed. He would stop taking his medication because it made him dopey and he was even more aggressive on the medication once he started to come down from it. The wife made many inquiries of the treating psychiatrist and she stated to me that she felt as though he thought she was just making all this up in order to get her husband admitted.

This man was coming closer and closer to hurting someone and the family was held to ransom. When things got really bad and Families SA stepped in, guess what was required? He was required to go to anger management classes and the mother was required to go to parenting classes because her children were acting out in day care and at school. That was the total sum of assistance and, if things did not improve, the department was going to take out an order on their four children. No-one questioned why his behaviour was so bizarre; no-one offered to have him drug tested and put into a program.

This family, as well as the extended family, were isolated and devastated. When he was released on a court order to attend, he was placed on medication, which he did not take for the entire time. He made good progress over the 15 months and went regularly to visit his psychiatrist, who put his progress down to his medication—and just remember, he was not taking his medication at all. Not once did the treating psychiatrist ask me, the program manager or this person what therapy was being used, nor did he ask the client how it was working for him. At the end of 15 months of detention and after showing numerous clear drug tests, he was taken off home detention and resumed his normal working hours.

He went back to the psychiatrist for his final visit and asked how long he would need to be on the medication that had been prescribed for him, and he was told, 'We will see about reducing it in about 12 months but it is my recommendation that you stay on that medication for quite some time yet.' When he informed the psychiatrist that he had not been taking the medication at all and that what had helped him to get his life together was the various programs that he had undertaken, was the psychiatrist curious as to what had assisted his client? No; he was not. Did he inquire as to what the client thought had been useful for him in particular in that 15 month period? No, he did not. What he did say was, 'I could have had you thrown back in gaol for not taking that medication,' that being included in the court order, 'and I have a good mind to report you.'

This is not an isolated case study of people who have been diagnosed with a mental illness while under the influence of illicit drugs and who have had their recovery complicated by taking antipsychotic drugs that were not necessary after they had stopped taking their drug or drugs of choice. I often wonder whether in fact that is why the non-compliance rate is so high. I do not want to sound cynical, but surely these practices need revision and evaluation.

I discussed these matters with the minister in the hope that some guidelines could be put in place but was told by her that the medical profession would laugh at us for trying to direct medical experts in the area of treatment.

My argument is that we could significantly reduce the number of people in the mental health system with some commonsense expectations that a diagnosis is carried out on individuals who are not under the influence of substances that by their very nature can affect their psychology and behaviour. This measure, along with the implementation of the test mentioned earlier, could see better outcomes for individuals who struggle to keep their head above water because the system drags them down rather than assisting them to rise above it.

This man, his wife, his mother, his father, his two sisters, his brothers-in-law and his children lived every day in fear of what might happen for five long years, and it took his getting arrested for anyone to find the core issue behind his repeated psychotic episodes. And, as I said, it is not an isolated case. Both the program manager and I tried on numerous occasions to meet with the psychiatrist to discuss the process of recovery that this man had undertaken and perhaps set up a link with him and his practice. However, no interest was shown. So, eventually, we just accepted that we have a system in place that is content sometimes to do more harm than good. It seems that we have two treatment options for people with substance abuse issues and what appears to be mental illness: gaol if they commit an offence or medication.

I would also like to draw the attention of members to at least three cases where members of the public have been put at risk. The first is the case of the two men who were attacked by their neighbour and stabbed numerous times. Their neighbour knocked on their door and then proceeded to viciously attack them with a knife, telling them, 'The pain will be gone soon. Soon you will be dead.' The perpetrator was a person with a history of substance abuse who was also involved in the mental health system.

Another was the case of the young man who attacked his elderly next door neighbour in the backyard with a hammer and killed him. He was also a known drug user. I had many conversations with this young man's mother, and she was beside herself. She could get no assistance for this young man, and he ended up killing his elderly next door neighbour. He was also involved in the mental health system.

Even more recently, there was the case in Davoren Park, where a man stabbed his two year old son to death, attacked his 15 day old baby and then stabbed himself to death. This man, according to his neighbours, had a long history of substance abuse and was also involved in the mental health system. I implore members and the minister to recognise what is the common denominator here.

In 2002, Dr John Anderson of the neuroscience clinic at Westmead spoke of the correlation between the use of antidepressants, marijuana, suicidal tendencies and psychosis. His studies revealed that a person using marijuana who was also being prescribed antidepressants had a 75 per cent increased chance of tipping over the edge because of the chemical interaction between marijuana and prescription medications. He also stated that a person using marijuana should only be prescribed doses of medications at around 25 per cent of the usual dose. If that applies to antidepressants and marijuana, surely it is not a long bow to draw to understand that the chemical interaction between amphetamines and antipsychotic drugs needs close attention.

People with a genuine mental illness are rarely a threat to others. They may have odd behaviours and they may make some people feel a little uncomfortable, but the behaviours that are being exhibited by some labelled as mentally ill are giving mental illness a bad reputation. Frances Nelson QC went public with the fact that she had notified the mental health system on five occasions of the risk that the man at Davoren Park posed. She also stated that she knew of about 150 people who also concerned her as being a risk to themselves and others. The Attorney-General, the Hon. Michael Atkinson, stated on radio at approximately 9.15 am that what she said made sense and that legislation could be passed within two weeks to address her concerns.

I know that applied to the Parole Board, but these people are diagnosed with mental illness and, according to my information, also have a history of substance abuse. If the Hon. Frances Nelson QC can see they have correlation that they are a risk to themselves and others, and we are doing nothing about it, this bill in its entirety is not going to solve this problem.

Obviously what we are doing is not working and, if we are not prepared to up the ante and change our approach, then more tragedies like that I have already mentioned will continue to occur and I believe the number will increase to a point where the government cannot ignore the signs any longer.

The questions we need to ask are: what is the difference between true mental illness and drug induced psychosis? How can an accurate diagnosis be made if a person's mind is altered by either licit or illicit drugs at the time of assessment? How long will it take for our mental health and health systems to collapse under the pressure while we ignore what to many are just common sense action steps?

Over a 12-year period I learnt a great deal about addiction, mental illness and about the systems in place, and over the years I became more and more disgusted that millions of taxpayer dollars literally are used to churn over an industry of human misery. It is like a machine that chews them up and spits them out, and the people in that machine are like drones. They have come to rely fully on medication, whether or not it works. I have waited for three years for an opportunity to tell this truth in this place, and this speech has actually been that long in the making.

I have here a paper that I would like to table for members to look over, if there is any slight interest in how this bill would be used. It is called 'Infectious Agents in Schizophrenia and Bipolar Disorder', written by Dr Robert H. Yolken, MD and E. Fulle Torrey, MD. I read this study probably six or seven weeks ago and it was quite revealing. It states:

The idea that schizophrenia and bipolar disorder might be caused by infection is not new. This was a prominent hypothesis in the early years of the last century. For example, an article entitled 'Is insanity due to a microbe?' was published in Scientific American as early as 1896. Research to test this hypothesis by identifying causative viruses was already being conducted by the 1930s, when data were reported from experiments in which cerebrospinal fluid (CSF) from patients with schizophrenia was injected into rabbit brains.

New research in the field continues, aided increasingly by impressive technologic advances in microbiology and virology. As recently as the past decade, reports documented the presence of influenza virus, rubella virus, bovine disease virus, and other infectious agents in patients with schizophrenia and bipolar disorder, as well as the presence of other infectious agents in childhood paediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) and obsessive-compulsive disorder.

In this article we briefly highlight the background of this research; discuss our own research on Toxoplasma gondii, herpes simplex virus (HSV)...

Background and rationale

Why should we look for infectious agents in schizophrenia and bipolar disorder? Such a hypothesis is consistent with the known genetic contributions to these disorders. Indeed, a genetic predisposition is well established for most chronic infectious diseases, including tuberculosis, malaria, polio, AIDS and peptic ulcers caused by Helicobacter pylori. The hypothesis is consistent with the role of neurotransmitter abnormalities in schizophrenia and bipolar disorder, because specific infectious agents have been shown to alter dopermine, serotonin, glutamate, amino butric acid and acetyl coline in animal models. The hypothesis is also consistent with neurodevelopmental models of schizophrenia and bipolar disorder.

This goes on to say that there are, in fact, a number of viruses that a person can have and can contract that would lead to signs and symptoms of schizophrenia that may not manifest until their early teens, and rarely are these viruses tested for.

People start to show these symptoms of schizophrenia or bipolar, are diagnosed on their behaviour rather than on the pathology, are then put on medication and those medications can actually aggravate the condition and make them far worse, physically and mentally, and make them quite psychiatric, and that could be a permanent condition, whereas a simple antibiotic, if these things are traced, could actually remove those signs and symptoms within weeks and they could be restored to full mental and physical health in no time at all, but we do not do these tests.

An additional important reason to look for infectious agents in schizophrenia and bipolar disorder is that CNS infection by specific pathogens frequently mimics the clinical symptoms of primary psychiatric diseases, for example, Carofen College reviewed 108 cases of psychiatric disorders resulting from suspected or confirmed CNS viral infections. In 62 cases a specific virus was implicated, including HIV, HSV1, HSV2, Epstein-Barr and CMV, and measles, mumps, coccidia and influenza viruses. Among bacteria, the fact that the spirochaete of syphilis can cause the symptoms of schizophrenia was well known to psychiatric commissions of an earlier era. More recently, infection with the spirochaetal organism borrelia—

The Hon. P. Holloway interjecting:

The Hon. A. BRESSINGTON: Just let me get through this word first—borrelia burgdorferi has also been associated with schizophrenia-like symptoms in some persons.

The Hon. P. Holloway interjecting:

The Hon. A. BRESSINGTON: Mr President, I do have quite a bit more to go. I know this is probably boring for most, but it is—

An honourable member interjecting:

The Hon. A. BRESSINGTON: Well, you know, I am seeking leave to conclude because I do want to read the rest of this onto the record because I think it is very important to the debate. If we are debating a mental health bill then we should actually be knowing what we are dealing with, or what we could be dealing with. I seek leave to conclude my remarks later.

Leave granted; debate adjourned


At 10:38 the council adjourned until 28 April 2009 at 14:15.


PARLIAMENTARY BUSINESS
MEMBERS
GET INVOLVED
ABOUT PARLIAMENT
VISIT
LEGISLATIVE COUNCIL
HOUSE OF ASSEMBLY
CONTACT