3rd National Conference on Human Rights and Mental Health

Thursday 8 September Parliament House Canberra Dr Sev Ozdowski OAM Human Rights Commissioner and Acting Disability Discrimination Commissioner

Acknowledgements

Thank you for the opportunity to speak today.

My best congratulations to the organisers - it takes plenty of effort and good planning to organise such a conference.

I would like to acknowledge the Ngunnawal People , the traditional owners of the land on which we stand, and pay my respects to their elders past and present.

I make this acknowledgment at any function where I speak in order to

• Pay my respects to the oldest continuous culture in the world
• Demonstrate that we aspire to a just and fair Australia for all, and
• Stress that Australia is a diverse society and that the First Australians are an important part of this diversity.

I also acknowledge Members and Senators present, my fellow speakers and other distinguished guests who have worked to champion the rights of people affected by mental illness.

Mental health is a human rights issue

It is very appropriate to be having a conference that highlights mental health as a human rights issue.

Australia has signed and ratified important human rights treaties which explicitly recognise the right of everyone to the highest possible mental health care.

For example, the International Covenant on Economic Social and Cultural Rights , Article 12, states:

The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.  

The Convention on the Rights of the Child , Article 24, states

States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.

We have also the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care (United Nations General Assembly, 1991) which reinforce the rights enshrined in the International Covenants and provide valuable guidance as to how those rights ought to apply to people with mental illness.

• Principle 8(1) makes clear that people with mental illness have the right to the same standard of health care as other ill persons.
• Principle 14 states that mental health facilities should have the same level of resources as any other health facility.
• Additionally, Principle 7 emphasises the right to be treated and cared for as far as possible in the community.

The Australian Government was closely involved in the negotiation of the human rights treaties I have mentioned, and of the Mental Illness Principles.

Treaties and international declarations of principles, however, do not implement themselves. They require appropriate action within each country.

Supporters and opponents alike of the role of the United Nations in human rights often speak as if the main point of human rights law is as a commitment to the international community.

But really the point of the Australian government subscribing to human rights treaties and supporting international declarations on human rights issues is as a commitment to the people of Australia .

Delivering on that commitment and keeping faith with the people requires accountability.

One way which Australia and other countries have tried to promote accountability on human rights issues is by establishing human rights commissions.

It is important to remember though that human rights is not only the job of a human rights commission. Human rights is everybody's business. All parts of the political and legal system and indeed organisations beyond that in the private and community sector, also have to play their part if human rights are to be realities.

Human Rights Commission's activities in the area of mental health

The Human Rights and Equal Opportunity Commission has a proud record of long standing involvement with mental health issues.

In 1993 the Commission released the report of its National Inquiry into the Human Rights of People with a Mental Illness. It is widely known as the Burdekin report, in honour of the massive contribution by its Chairman, my predecessor as Commissioner Brian Burdekin.

In summary form, the Inquiry found that the care and support provided by the Australian health care system at that time contravened the basic human rights of our mentally ill.

• In general the money saved by deinstitutionalization had not been redirected into mental health and related services in the community.
• Health services and other services which would enable people with a mental illness to live effectively in the community were found to be seriously under funded or in some areas just not available at all.
• Governments were found to be relying increasingly on NGOs to provide services but to be treating NGOs as peripheral in the allocation of funds.
• Accommodation for people with a mental illness was found to be particularly inadequate, with government housing support programs either excluding people with mental illnesses or failing to address their specific needs. The absence of suitable supported accommodation was the single biggest obstacle to recovery and effective rehabilitation.
• In the employment area, people affected by a mental illness were found to be disadvantaged by negative attitudes, a lack of awareness of means of accommodating employees with a psychiatric disability, and by inadequate vocational and rehabilitation services.
• Families and carers were found to be badly overstretched and insufficiently supported.
• The Inquiry found that mentally ill people detained by the criminal justice system are frequently denied effective health care and human rights protection. Procedures for detecting and treating mental illness and disorder in the Australian criminal justice system were found inadequate in all jurisdictions.

Unfortunately, I expect that most of that sounds all too familiar to you, not as decade old history but as current affairs.

CIDI inquiry

More recently I conducted a National Inquiry into Children in Immigration Detention "A last resort" which continued exploration of the mental health themes.

During the inquiry it became painfully obviously that long term detention is associated in some cases with serious deterioration of mental health. However, the most serious finding of the detention inquiry was the failure of DIMIA to implement the recommendations from mental health professionals that certain children and families mental health problems cannot be treated in detention and that they should be released for appropriate treatment.

The recommendation read as follows:

"Furthermore, the Government's failure to implement repeated recommendations by mental health professionals to remove children with their parents from detention amounted to "cruel, inhumane and degrading treatment".

Let me briefly give you one case study from the report to add a little flesh to the dry bones of that 'finding' and I refer now to the case of a 13 year old child who had been seriously mentally ill since May 2002.

This boy had regularly self-harmed . In February 2003 a psychiatrist examining the boy wrote the following:

"When I asked if there was anything I could do to help him, he told me that I could bring a razor or knife so that he could cut himself more effectively than with the plastic knives that are available."

The most disturbing fact is that there had been approximately 20 recommendations from mental health professionals saying that he should be released from detention with his family. Some said that removal from detention was a matter of urgency.

When finally released, (after 3 years detention, and 2 years after mental illness diagnosis) as refugees, following an RRT finding, into the Adelaide community, all members of the family were severely mentally traumatized; prescribed heavy, daily medication, too ill to work and requiring extensive community support and assistance.

In other words, we locked them up, we traumatised them and now as they join the Australian family, we are going to have to pay a price for that treatment.

I acknowledge the recent actions of government in removing children and parents from detention. But the first recommendation of this inquiry has not yet been implemented: legislation on minimum standards in relation to detention.

When the report of the Children in Immigration Detention inquiry was released it was criticised by some as backward looking. But it now looks rather prophetic in the light of the revelations the of treatment of two mentally ill women, namely Cornelia Rau and Vivian Solon-Alvares, by DIMIA and other areas of government.

These issues should concern every one of  us.

20 per cent or more of Australians may have some mental health problem. At least 25 per cent of those can be expected to have been born overseas.  

Apply those figures to a population of 20 million, and I get a number of one million Australians.

More than a million is more likely, if we consider the effects on mental health of

• social isolation that comes from language difficulties particularly for  older people;
• the experiences that people are fleeing from when they come to us as refugees;
• the process of detention itself for asylum seekers.

So - even if we restrict our consideration further, to those who experience a more serious mental health episode - it is really not at all extraordinary to be an Australian citizen who has both a mental health issue and some foreign element to their identity.

Are human rights adequately protected?

The detention of Cornelia Rau although wrong appears to have occurred through the operation of our laws providing for mandatory detention.

The deportation of Vivian Alvarez appears to have been quite simply unlawful.

It is often claimed that Australia does not need a Bill of Rights because the common law and a democratic Parliament are sufficient protection - even though every other democratic common law country does have a Bill of Rights.

For me at least, the history of these two matters gives little cause to believe that parliamentary accountability and ministerial responsibility alone provide sufficient safeguard for human rights.

In these matters, compliance with human rights involves only the relatively simple requirement that government avoid exercising its powers unlawfully or arbitrarily.

Even this however requires more than good intentions. It requires that legal and administrative systems are in place to ensure accountability.

Mental health and positive rights

The role of government in relation to human rights is not limited, however, to refraining from arbitrary or illegal actions which infringe human rights - actions such as wrongful detention or illegal deportation, to pick a couple of examples out of the air.

We also look to governments to take positive actions to secure human rights. Those actions can require the application of very substantial resources. You cannot have the basic rights to a fair trial and equal protection of the law without investing in independent judges, impartial and uncorrupted prosecutors and police and other features of a justice system. Equally you cannot have the right to the highest attainable standard of mental health without investing in the medical and community facilities to ensure that people who need it have access to treatment and supports.

In the context of our inquiry into immigration detention, when we started looking at what sorts of treatment are available, a whole new picture of human rights concerns emerged from the shadows.

Mental health consultations

This in addition ever-increasing concerns expressed to me about mental health services by community members on an ongoing basis throughout my term as Human Rights Commissioner lead me to embark last year on national mental health consultations in co-operation with the Mental Health Council of Australia (MHCA) and the Brain and Mind Research Institute (BMRI).

Methodology of the mental health consultations

To start with, MHCA and HREOC issued an invitation to all those interested in mental health issues to provide us with written submissions. By now we have received over 360 submissions.

Then we conducted open community forums in each State and Territory from 05 July - 14 October 2004 (approx 20 forums were held; approximately 1,200 people came to talk to us):

• consumers
• carers
• general members of the community
• clinicians
• advocates
• service providers (eg. Mental health, general health, accommodation providers)
• emergency personnel (eg. Police)
• academics and
• administrators.

We also conducted individual meetings with specific community, professional and non-government groups as well as meetings with various members of State and Federal governments.

Key points from the consultations

I am pleased to indicate that our Report " Not for Service " will be launched shortly. When I accepted the invitation to speak today I hoped that we would have this report publicly available.  Unfortunately that is not yet the case.  The later than planned date for release of this report has not been due to any lack of effort.  It has rather been because the amount of input we received, and which we need to do justice to, was simply far greater than expected.  

The following are the key points raised with us during the consultations:

• Resources provided are simply inadequate to match the level of unmet needs and ensure access to treatment and services when they are needed. Accountability for money allocated to mental health services is seriously lacking.
• The most frequently mentioned gap in mental health services was the absence of early intervention and other specialist services for young people. All too often people are being told, in effect, to come back when they are really ill. It is a good time to look at prevention and early intervention, rather than face the high cost of the treatment, in the future. Australia leads the way in development of early intervention programs for mentally ill. They are being implemented overseas, but not in Australia .
• Despite increasing evidence of links between drug use and mental illness we still lack adequate mental health facilities to cope where a person also has an addiction - or other forms of dual diagnosis
• In all States I received reports of children and young people being admitted to inappropriate adult facilities.
• Emergency services are overburdened and often inaccessible.
• Acute care services are too often simply missing, especially in regional Australia . This results in preventable death.
• Community supports likewise are seriously overburdened and unable to cope with the existing demand.
• Those with a mental illness are still being blamed for being sick.

These consultations confirm other reports

To be perfectly honest, all the concerns that were mentioned to us are in fact well known for a considerable period of time.

For example, the evaluation of the Second National Mental Health Plan published by the Department of Health and Ageing in March 2003, stated that:

"progress has been constrained by the level of resources available for mental health and by varying commitment to mental health care reform. While the aims of the Second Plan have been an appropriate guide to change, what has been lacking is effective implementation. The failures have not been due to lack of clear and appropriate directions, but rather to failures in investment and commitment."

A shorter way of saying that might be that governments have not sufficiently matched their words with dollars.

Very similar conclusions can be found in the "Out of Hospital Out of Mind" report released by the Mental Health Council of Australia (MHCA) in April 2003 in the lead up to the Third National Mental Health Plan.

To sum up, the failure of adequate funding for mental health services, the failure by governments to address the issue and the resulting human right breaches and suffering of people with mental health problems and their carers are well known for a number of years.

Now it is a time for action.

I am proud of the work that I have done with the Mental Health Council and as I have said the report of those consultations will be available very shortly.

I also look forward to the results of the Senate select committee inquiry on mental health services.

But frankly, our greatest need is not for more inquiries and reports. We need our governments to act and ensure that our mental health services in Australia are up to the first world standard.

To achieve this we need to involve our civil society. We need opinion makers, media, average Australians to publicise the issues associated with mental health shortages. We need new NGOs established and working for a change. The fact that we have got children with their parents out of immigration detention centres is a testimony to the strength of an Australian civil society movement.

Future directions

Our consultations on mental health services painted a very depressing picture and it is true that there is a long way to go before Australia 's mentally ill can truly enjoy the highest attainable standard of mental health as the human rights treaties require.

The voices we heard in our national consultations seem to me to be saying that the needs above all are for better accountability and for significantly more resources.

There must be more money put on the table.  The money is needed for research, innovation and better services. For example, we were frequently told that more money is needed for research on links between drugs and mental illness in young people.

Australia currently spends only about 7% of its health budget on mental health.

By comparison, as many of you would be only too aware, other first world economies are spending between 10-14% of their health budgets on mental health.   New Zealand now spends twice as much per capita compared with this country.

The Federal government, in the election context, committed an additional $110m to mental health. But I did note the strong view of the AMA that on mental health the budget was a major disappointment in relation to the level of needs.

I hope that we may see further commitments this year from all Australian governments in terms of resources and particularly from the Federal Government on the leadership which it its role to provide.

The good news is that we are starting to get statements from political leaders who are placing mental health reform high on their agenda. For example our newest State Premier, Mr Iemma in NSW said in his inaugural speech that mental health would be one of his top priorities.

And of course there are politicians here from all sides today. My role is and must be a non partisan one so let me just say that we need champions on all sides to lead the way.

Australia and people with mental illness need you.