Poor mental health services perpetuate poverty

On a crisp autumn morning, sunlight began to bathe the cold concrete floor of the car park. There, solitary figures sat smoking long cigarettes, the signs of another restless night showing on their faces.

It was Good Friday eve, and inside the walls of The Big Issue’s Brisbane Headquarters, Easter was humbly celebrated by wearing rabbit-ear headbands and drinking hot coffee. Cindy Chatters’ smile was palpable, yet she couldn’t hide her demons.

“I was deemed not bad enough for them, so I slipped through the cracks,” she said. “I never had the support I needed because I was deemed functional enough.”

Diagnosed with depression as a teen, Ms Chatters became homeless as a result of personal and family issues, and walked away from community housing after becoming increasingly distressed with her situation. She’s been on and off the streets in Adelaide and Brisbane ever since, and believes a lack of mental health support has been a major contributor to her troubles.

“Even though it was my choice, if I had the support I would have never been homeless,” Ms Chatters said.

Her story is not uncommon.

While awareness of mental health issues has grown immensely over the past decade, the most vulnerable continue to find it difficult to gain access to treatment, and evidence is building of the connection between mental illness, socio-economic disadvantage and homelessness.

In 2005, Mission Australia found three quarters of job-seekers had a diagnosed mental health issue, and a 2007 Salvation Army report estimated over 50 per cent of homeless suffer from some kind of mental health condition. Additionally, an RMIT survey from 2009 found 31 per cent of respondents had a diagnosed mental illness, with 79 per cent of this group having experienced long-term homelessness.

Yet tangible data on the subject remains scarce, and it’s difficult to judge the true scale of the problem when the most disenfranchised often don’t report. In 2012, Homelessness Australia suggested the prevalence of mental health conditions in the homeless population could actually be as high as 85 per cent.

Dr Cameron Parsell from the Institute of Social Sciences Research believes greater support for those with mental illnesses is required.

“We need to seriously take into account what people’s mental health is and how it may act as a barrier for them to access housing and job opportunities, and also how it may undermine their capacity to sustain that,” he said.

The fragmentation of services between government and non-government organisations, where there is no centralised information about clients, is a particular concern.

“There’s some real ideological differences in how these agencies and organisations even see people, so in order for them to collaborate, it’s difficult when they view the problems of the world in very different ways,” said Dr Parsell.

This state of affairs is all too familiar to Dr Dan Siskind from the Queensland Centre for Mental Health Research.

“Fragmentation of services makes it very challenging for consumers who are already cognitively impaired, paranoid or having auditory hallucinations to navigate a system where you’ve got multiple doors of entry,” he said.

During the last 2 weeks of March, bright-eyed volunteers were hitting the pavements of Brisbane well before the sun had the chance reveal itself. Micah Projects’ 500 Lives 500 Homes campaign, supported by the Queensland Government, aims to house 500 of the most vulnerable and in the process is collecting valuable data. Of 725 people surveyed, 357 reported mental health problems.

Project Worker, Maria Leebeek, thinks community housing works best when individually tailored help is provided.

“Without that stability it’s very hard to do the other things, but we’re not going to house people without the support if that’s what they’re requiring because they’ll fail, or they may not fail, but it could be a lot more difficult for them to sustain their housing and we acknowledge that,” Ms Leebeek said.

Perhaps 500 Lives 500 Homes’ greatest coup is the close cooperation between partner organisations. Even for those who aren’t lucky enough to be housed, participating in the survey means greater support will be available in the future and, if there’s consent, their information can be shared across various government and non-government organisations.

For those with mental conditions who are still wary of seeking help, Dr Siskind sees the Housing First approach of the United States and Canada as a way of engaging the most disenfranchised.

“Housing First said, ‘let’s just give people a house, that way they might feel more comfortable and more engaged, and if they’re feeling more engaged then they might seek mental health services’. It’s been incredibly successful,” he said.

Early intervention remains an elusive dream for stretched and underfunded mental health services, but for those who slip between the cracks, a housing solution could indeed be the first step to curing a health problem.

Back in the car park of The Big Issue, Trevor Maxwell waited, his hands shaking with an anxious desire to tell his story. He knows all too well how important it is to talk about mental illness, and how close he came to losing not just his home, but much, much more.

Trevor Maxwell - Phillip Wells

Trevor Maxwell

“I had a mental breakdown. I gave up my job. I was calling out for help, but no one was listening. I came very close to committing suicide,” he said.

Mr Maxwell was eventually admitted to hospital late last year, and with their help, and that of The Big Issue, is looking to get his life back on track. Like Cindy Chatters, he nearly walked away from his community home, but was lucky enough to keep a roof over his head, and thankfully his life. This fine line between life and death, having a home and not having a home, has convinced Mr Maxwell that earlier intervention is vital.

“They have to go out there in the community instead of expecting people to go to them. People might be too scared to go out,” he said.

There are varied and complex reasons why people become homeless or lose their job, but there’s no doubt that those who are mentally ill are far more likely to end up in such a situation, and those who end up in such a situation, in turn, are far more likely to develop a mental illness.

Left unchecked, a cycle of disadvantage is perpetuated, yet mental health services still struggle to meet demand.