By Dawn Joyce
First published at On Line Opinion , 25 July 2007

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.

There has been a proliferation of responses to the alarming signs of societal dysfunction. Thirty-seven years ago, a coffee brigade began in Brisbane for the homeless. Today there are dozens of agencies and even regular soccer matches on offer. It is heart-warming to know that there is no shortage of food for the homeless in Brisbane: they are even given a bed-roll. The root causes of homelessness, however, require somewhat more thoughtful analysis.

Incarceration of people with psychotic disorders is often associated with earlier states of homelessness. Evidence based research has shown that incarceration functions as respite, particularly in cold weather. With warmth, food and medication, a few months in prison are equivalent to a few months in hospital. At $161.40 per resident per day (Report on Government Services 2007), this is a cheaper short-term option than hospital for our public coffers. A community-based alternative of peer mentoring in a supportive environment would be less expensive in both dollar and in human costs.

Following a community campaign that dates from the 90s, Richmond Fellowship was granted the tender from Queensland Health in February 2006 to begin the provision of transition assistance for a small number of our many high-needs forensic mental health clients. Transition to community is a challenging task and it is hoped that the research on homelessness will help inform this important work. Although the tender was announced a year and a half ago, unfortunately this work has not as yet begun.

The first of four rounds of federal FACSIA funds for peer mentoring in the community has been announced. Auspicing bodies for the initial roll-out of the PHaMs program are: Open Minds in Brisbane; Youth and family services at Logan; Ozcare at Townsville and on the Sunshine Coast; and the Mental Illness Fellowship of Victoria (via SFQ) on the Gold Coast. It is hoped that exclusion of high-needs clients - a hallmark of some previous work - will gradually lessen as better mutual understandings are gained.

These initiatives show that there are tentative steps that would lead Queensland out of this Dickensian darkness. Such initiatives need to be monitored; fine-tuned; and they need to be better funded.

I find the Gatton option unwise and unacceptable. We already know that appropriate case management produces radically different outcomes. Spending $2.2 billion on housing and $35,370,800 per year on support in the community is a much better path to follow.

First published (prior to On Line Opinion) in Qletter in December 2006 and in the SFQ newsletter in the February 2007 edition. This article is an updated and extended version.

Dawn Joyce BA BSc is a Mental health management researcher and Convenor for INPSIGHT team.