Cornelia Rau: Catalyst for Mental Health Reform?

Cornelia Rau: Catalyst for Mental Health Reform?

The locking up of a mentally ill Australian citizen in an immigration detention centre may well be the catalyst to lasting reform on mental health according Tim Grau, Managing Director of Springboard Australia. The following article was first published in the international publication The Healthcare Lobbyist.

The ten month incarceration of mentally ill Australian citizen in a detention centre built to hold asylum seekers and “illegal” immigrants while awaiting processing has sparked more than a political storm.

The revelation that authorities had failed to establish the true identity of Cornelia Rau, whose family had reported her missing, was wrongfully detained in an immigration detention centre and her mental illness not diagnosed left many Australians wondering how a person with a mental illness can disappear without a trace.

The system failures in this case are now the subject of an official Government inquiry, but of perhaps greater significance is the ensuing public debate about mental health services throughout the country.

The one positive outcome of the disturbing Cornelia Rau incident has been a focus on the need to examine and improve the adequacy of the nation’s mental health services.

Following an initial flurry of finger pointing and blame shifting all political parties have now agreed to establish an extensive inquiry into Australia’s mental health services.

The Australian Senate has established an all party Select Committee on Mental Health that will receive submissions from interested organisations and individuals and will conduct a series of public hearings before reporting on October 6, 2005.

The extensive terms of reference provide health care providers, industry, consumers and carers an opportunity to ensure governments are delivering adequate services, regulations are appropriate and support is available.

As the Cornelia Rau case demonstrated, where she was first imprisoned in a State gaol before being transferred to a Federal Immigration Department detention centre, Australia’s Federal system of government can and does lead to inefficiencies, lack of coordination and duplication.

With a total of 9 governments – one Federal and eight State or Territories – responsible for the delivery of health services it is appropriate that the first term of reference for the Senate inquiry is to examine the National Mental Health Strategy, the resources committed to it and the division of responsibility for policy and funding between all levels of government.

It will also examine opportunities for improving coordination and delivery of funding and services at all levels of government to ensure appropriate and comprehensive care is provided.

As part of this study the Senate will look at the adequacy of data collection, outcome measures and quality control for monitoring and evaluating mental health services at all levels of government and opportunities to link funding with compliance with national standards.

Already some early speculation has suggested that the management of mental health issues may, by agreement, become solely the Federal Government’s responsibility.

Of particular interest to the health care and pharmaceutical industry will be the Committee’s examination of the current state of mental health research, the adequacy of its funding and the extent to which best practice is disseminated.

As will the investigation of the adequacy of various modes of care for people with a mental illness, in particular, prevention, early intervention, acute care, community care, after hours crisis services and respite care.

The Senate will also explore the appropriate role of the private and non-government sectors, including the potential for new modes of delivery of mental health care, including e-technology.

Though not explicit in its terms of reference, this may open the door for a further examination and recommendations on the adequacy of the nation’s Pharmaceutical Benefits Scheme where some mental health drug treatments are listed on the Scheme and therefore more readily available to consumers than other treatments.

The special needs of groups such as children, adolescents, the aged, Indigenous Australians, the socially and geographically isolated and of people with complex and co-morbid conditions and drug and alcohol dependence will also be a focus of the Inquiry.

Support services, education and training will be examined with particular reference to barriers to better mental health outcomes as a result of the unmet need in supported accommodation, employment, family and social support services.

The Committee will also inquire into the role and adequacy of training and support for primary carers in the treatment, recovery and support of people with a mental illness as well as the role of primary health care in promotion, prevention, early detection and chronic care management.

The new opportunities for reducing the effects of iatrogenesis and promoting recovery-focussed care through consumer involvement, peer support and education of the mental health workforce, and for services to be consumer-operated may also result from the Inquiry.

Mental health support groups will have an opportunity to make recommendations on the adequacy of education in de-stigmatising mental illness and disorders and in providing support service information to people affected by mental illness and their families and carers.

Finally, the Inquiry will also examine a range of associated issues such as the overrepresentation of people with a mental illness in the criminal justice system and in custody, the practice of detention and seclusion within mental health facilities and the proficiency and accountability of agencies, such as housing, employment, law enforcement and general health services, in dealing appropriately with people affected by mental illness.

This Australian Senate inquiry is unique in many respects, not least of which the incident and manner in which it was instigated.

But more importantly, unlike many Senate inquires it has bipartisan and minor party support.

For those working and interested in mental health, the inquiry, its submission-based approach, public hearings and subsequent report therefore does provide a real opportunity for them to shape the future of Australia’s mental health services, policy and environment.

Rather than the Cornelia Rau tragedy serving as a dreadful reminder of the all too common plight of the mentally ill it may just be the catalyst to lasting reform.