Slipping through the Cracks

By Freedumb

It started with pinching.

On a cold September morning in 2004, Chloe Malcolm lay in numbed silence, pinching. First on her arms then on her legs shades of a morbid rainbow began to emerge, her skin punctuated with 20-cent-piece sized bruises from the day before. Staring at the ceiling as though she had never been asleep, in a room infiltrated with a crisp, cunning cold, she pinched. A chill crept beneath her pungent blankets, her neck stiff from the cement pillow, the mattress beneath her, stone-cold and rigid. Her fingers, like ice, clasped the edges of her blanket, holding on for dear life. It was coming; that awful vision that haunted her.

Heaving back her bedclothes and grimacing from the putrid stench that shot up her nostrils, she stumbled over piles of plates and mouldy food. Nausea washed over her, and suddenly as she caught a glimpse of her faded figure in the mirror hysteria gripped. It was like the Grim Reaper’s hand shooting out to clasp the neck of a dying man, violent and cold. She began to sweat, her blood boiled. The tension in the air was like a terrified gasp that never stopped; she felt the world was in a perpetual state of near death. Rotting. Derelict. Her head spun, her knees gave way. She rifled through drawers and piles of junk until she found it.

Chloe was surprised how hard it was to break skin. This wasn’t the first time; she’d tried the sharp edge of a medication packet, and then a pair of scissors before she found success with her craft razor.

A month earlier she had been discharged from the psychiatric ward of Lyell McEwin public hospital in Elizabeth Vale, South Australia.

For the 1 in 5 Australians who suffer from depression Chloe’s story is all too familiar. The battle for most does not stop with the illness itself, once diagnosed, sufferers find themselves navigating the wreck that is our public mental health system, looking for care that will never come, before finally falling through the cracks.

According to National Depression Initiative BeyondBlue, depression and suicide will be the second highest medical causes of death and disability globally by 2020. Affecting 20 per cent of Australians, research conducted by the Mental Health Council of Australia shows that the majority of people with a mental illness lead lives of poverty and isolation, shunned through misunderstanding and stigma in the community.

Yet despite an 80 per cent recovery rate, around half of those with mental illness will not be diagnosed as they will never seek help. For those who do, services and support are inadequate despite effective ongoing treatment being essential to minimize the risk of suicide.

When Chloe was discharged from hospital in July 2004, the only ongoing assistance provided to her was one appointment with the hospital’s psychiatrist three months later, in October of that year. Before even being discharged though, she had already started harming herself again.

The possibility dawned on her upon finding a pencil sharpener in the recreational room one morning and pocketing it. When bedtime came she huddled beneath her blankets and feverishly pulled the sharpener apart between the nurses night checks, using the blade on her upper thigh. No one noticed her injuries, she would change her sheets each morning and nothing would be said. Yet even if they had been noticed, such incidents were rarely managed or dealt with properly. It was not this disregard, however that Chloe found most frightening, but rather her drop kick into the outside world at the conclusion of her two-week stay. Upon release into the suburbs of Adelaide she received the phone number of a general practitioner and a curt wave at the door from a ward nurse, before catching the bus home.

“I felt so isolated,” she said, “I was terrified.”

“I was kicked out onto the street and left there with nothing to keep me from falling. I thought at least I would have some sort of regular contact with someone, anyone who would understand. I used to imagine cutting up my arms really badly and walking into the emergency department just so I could get help.”

Now, almost two years later, Chloe lives in a small one-bedroom unit in the Melbourne suburb of Ringwood. She and her boyfriend of 6 months scrape by on a disability pension and welfare payments. Money is short and the pair struggle to survive. With no means to pay for a psychologist or psychiatrist, Chloe and her boyfriend, Max make the trek to the nearest bulk-billing GP in Box Hill for medication. Understandably the service provided there doesn’t exactly cater to their needs.

On the day I come to see her, Max is in bed where he has been for four days. He hasn’t held down a job for five years on account of his severe depression, yet his doctor has not put him in contact with any services or community groups that can help him – possibly because there are none, or because the ones that do exist are inundated with cries for help. The house smells damp and mouldy, empty pizza boxes litter the floor and the paint on the awnings is dry and cracked.

Chloe has cleared a small space on the dining room table where bits of thread and scrap material are spread out.

“My splurge items for the month,” she says.

She tells me she didn’t use to live like this. Back in her hometown of Adelaide, she shared a three-bedroom house with her mother and younger brother in the leafy suburb of Magill. She had the luxury of a car to practise her driving on (she has a Learner’s permit) and was attending a private school when she could.

Despite being financially better off, adequate care was still hard to come across in Adelaide.

“The only thing that exists outside of busy doctors and hospital, really, are support groups,” said Chloe

“That’s just a group of depressed people sitting around talking about being depressed for an hour. In terms of helpfulness, it doesn’t really do much.”

So why the move to her new cash-strapped life?

“At least being here with Max, I have someone who cares for me and knows what I’m going through. Yes, it gets lonely, and a bit more money would help, but we have each other. Now I have someone to turn to. Before Max there was nothing. There’s no real community-based care, you are either sick enough to be in hospital or you don’t rate at all. Its all or nothing.”

Chloe is not the only one dissatisfied. Not For Service, a report into mental health care in Australia, launched by Minister for Health and Ageing, Mr Tony Abbott, unleashed a scathing attack on the degradation of a supposedly first world mental health system.

At the launch of Not For Service, chair of the Mental Health Council of Australia, Mr Keith Wilson, noted with disgust the broken and failing state of mental health care in Australia.

“We have an immoral disregard for the lives of Australians stricken, through no fault of their own, and stigmatised, and left out of our society,” said Mr Wilson

“We have failed people with mental illness in Australia. They are turning into the lepers of the 21st century”.

One would normally praise such recognition of flaws and calls for change, were it not twelve years after the first call and broken promise to tackle decades of neglect in the system were made by all Australian Governments in the National Mental Health Strategy of 1992.

In 1993, a year after the strategy’s implementation, the Human Rights Commissioner’s Burdekin Report noted human rights issues within the mental health system with overt abuse within institutions, and neglect in the wider community.

In 2002, after 10 years of supposed reform, the Mental Health Council of Australia reviewed whether substantial change had been achieved.

The findings were bleak.

“Australia continues to have an ineffective and inaccessible mental health care system, with apathy, lack of accountability and lack of commitment blocking real change,” reported the Not For Service review.

It noted that the inadequate pace of reform was condemning disadvantaged and ill members of the community to more years of abuse, neglect and poor mental and physical health.

So what went wrong?

The return of 50 million dollars to treasury that was allocated to the “Better Outcomes in Mental Health” project this year, suggests that perhaps it is poor leadership rather than a lack of financial resources that is the problem.

Executive Director of mental health charity, SANE Australia, Ms Barbara Hocking, agrees.

During an appearance on ABC’s Four Corners program she stated that national leadership was urgently needed to tackle the crisis in services for the mentally ill.

‘Both Federal and State governments share the responsibility,’ said Ms Hocking, addressing the blame game that had been unfolding between politicians upon release of Not for Service.

‘(The Government needs to) show leadership and negotiate funding for urgently needed services. With appropriate treatment most people with mental illness can make good levels of recovery. Without this, sadly and quite unnecessarily, too many Australians will end up on the street, missing, in prison or, most tragically of all, in a mortuary.’

And this is perhaps the greatest cause of heartbreak. For the 2500 Australian lives lost by suicide each year, each one was preventable. Depression, for all its angst and agony, is not terminal, at least not when proper care is provided. Research by the Mental Health Council of Australia has shown that with ongoing treatment and support most people with a mental illness recover well and are able to live rewarding lives in the community.

So is this a case of neglect on the part of the Federal and State governments, the medical profession or the community as a whole; or is it simply an idealist dream gone wrong? In a national crisis where we cannot see the forest for the trees, passing the buck seems to have extended itself into a nationwide contest where the burden of mental health care is passed from Federal government, to State government, to medical professionals, to police, to carers, to community groups, to families, to anywhere but here.

The band-aid solution for the moment seems to be to throw money at tangible yet useless initiatives such as BeyondBlue, which are little more than an advertising company, and high-security psychiatric wards such as that announced recently by the ACT Government for The Canberra Hospital. While services provided by counsellors and psychologists remain uncovered by Medicare, leaving patients thousands of dollars out-of-pocket.

Chief Executive of the Mental Health Council of Australia, Mr John Mendoza, says such action is not only backward, but also worthless.

“Putting more money into new buildings located at hospitals doesn’t help people with mental illness stay well in the community. There will be ribbons for the Minister to cut on new buildings but (they) will not make a real difference to mental health care,” Mr Mendoza said.

When I mention this to Chloe, the thought of more hospital beds makes her shudder.

“We wouldn’t even need them if there was adequate care in the community,” she says, stroking her grey cat, Mischief, her company keeper when Max is asleep and she needs comfort.

“What are the odds you’d be placed on a waiting list to get in there anyway? Its all needs based, but do I look sick to you? I brushed my hair this morning.”

Mischief purrs. I watch the steam rising from my cup of tea. Max stirs in the bedroom.

“But I’m not ok,” she says

“I’ve got this big black monster following me. I feel like a lonely spirit doomed to spend this cruel eternity alone, darkness devouring my soul, any joyful thought and any chance of love gone. I’ll never again spread my wings and fly.”

I watch Chloe’s frail figure, surrounded in piles of rubbish and clutter, stare blankly out the window, and I realise it is time to take leave. But as I turn the ignition and edge out the driveway, waving goodbye through the rear vision mirror, I too am haunted by an awful vision, of a black dog, sitting at her fence, menacing her peripheral, snarling and biting and merciless. And as I turn the corner and watch her reflection fade into the distance I think I see her slipping through the cracks.