In the run-up to the NSW state election, aspiring Premier Barry O’Farrell promised he’d appoint a Mental Health Commissioner, who would be “a champion for mental health within government so that sufferers get the best possible treatment”. The Commissioner will not start work until July 2012. But public housing tenants with mental illness in the Western suburbs of Sydney could well use such a champion right now.

A major investigation by the Australian Centre for Independent Journalism has found deep-rooted and systemic neglect by Housing NSW of some of its most vulnerable tenants. The ACIJ has interviewed a wide range of people with mental illness living in public housing, the health professionals who care for them, and the social workers, church welfare agencies and tenants groups who advocate on their behalf.

A clear and consistent picture emerges from their first-hand accounts. People with mental illness regularly experience harassment, victimization and bullying by neighbours. Some have received death threats. Yet their pleas for help go unheeded by the authorities. While the O’Farrell government’s new Mental Health Taskforce conducts yet another review of services for the mentally ill, desperate people are falling through the cracks of a health and housing bureaucracy in chronic gridlock.

Today Crikey begins a five-part series on a major public health issue — out of sight and out of mind in Western Sydney.

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It’s common for mentally ill people in the western suburbs to be living in squalid conditions, according to social worker and carer Linda Dickie.

Dickie worked for five years in public housing and says a typical housing unit or property is cockroach-infested or in a shambolic state.

“It’s not until you have worked with them in the community that you realise there are so many people with mental health issues living in these poor conditions,” she says. “It’s just existing. Not living. Just existing.”

Dickie adds that trying to improve these conditions is an uphill battle with bureaucracy.

“You can never get through to any department to help you out. They (Housing NSW) just gave me the run around. Everybody was throwing it on somebody else’s shoulders, which meant I had to go through department to department.

“You know those women you see on TV who have all that rubbish around their houses? Well they (Housing NSW) have been made aware of that for years and they don’t do anything about it. You just go through paperwork and people passing the buck. It’s ridiculous.”

Poor housing conditions are only part of the problem. Simon Besley, general operations manager of Uniting Care Mental Health Services Western Sydney, says that safety is the real issue for people living with mental health issues.

“It’s quite a common story for our clients to end up in hospital. Their houses are just completely burgled almost the moment they leave. I had this one lady whose mental state was very much affected by constant drug dealing and so forth occurring out the front of her house. The fact that they steal things off her the moment she’s not in her house was obviously not helping.”

Dickie has witnessed this first hand.

“I had one gentleman who lived in Lalor Park in an environment which was simply unsafe,” she says. “He was an alcoholic who had mental health issues as well as drug issues. He was routinely beaten up for his money and would end up in hospital.

“Him I wasn’t frightened of but the people hanging around just threw me over. I would have to park my car in another area and just come down with my keys on me in fear that they would take me over. We had to have two carers go in because of the safety in numbers.”

Dickie had a reason to be scared. On January 9 police found the remains of Dickie’s client, Daniel Sullivan, 59, in his housing unit. Two months later, on March 29, two men were charged for allegedly murdering the man and then lighting his housing unit on fire to cover the murder.

“It’s just that people know that they have disabilities, that they have money and so it’s easy to victimise them,” says Dickie.

The ghetto effect

Dickie believes problems such as this arise because the Department of Housing clumps people with mental illness together with others who have drug and alcohol issues.

“I find that they put them in areas where there is a great concentration of people with drug and substance abuse issues. They had this one guy in a block of units living in a dead-end street in a sort of semi-industrialised area where lots of other people would come and do drugs or you’d find a burnt-out car and things like that always in the area. They are always together and so there is very little positive impact on them wherever they were living.”

Besley agrees.

“Social housing in NSW is often on the fringes of western Sydney. There are a variety of socially disadvantaged groups that are housed together, often in areas with minimal infrastructure and so forth. In that mix, people often become very socially isolated, particularly those living with mental illnesses.” Besley adds that people with mental health issues have particular vulnerabilities.

“Those vulnerabilities have to be accounted for in their housing. They don’t need huge levels of anxiety and stress in their lives.”

However, Stephanie Brennan, manager of community services at Wentworth Community Housing, says community housing providers are aware of this and do all they can to avoid clustering.

“That’s something we definitely avoid. We have a critical assessment process and teams allocated in each of our local government areas who look at precisely some of the issues that might arise with people who have mental health issues.

“We have an extensive assessment and intake process where we try to match the property as far as we can to the person and avoid potential problems of putting people together, say in a block of units where there is potential for difficulties and potential for risk.”

But Linda Dickie says the stigma associated with clustered public housing makes it particularly difficult for young people with mental health issues.

“I was working with this young girl who had mental health issues as she was physically abused throughout her childhood. She went into transitional housing in Castle Hill. It was a big, beautiful house with 24-hour staff and she was very close to her carers. But as soon as she turned 18, they (Housing NSW) gave her no choice and allocated her to a housing unit in Granville all by herself. She was panicking and said to me ‘I don’t know anybody and I know I’m not going to be in a safe environment’. You just have to learn to survive don’t you?”

Mental health and accommodation support

What’s curious is that these problems are still occurring even though there is specialised support out there for people living with mental health issues.

One such support program is the Mental Health Housing Accommodation Support Initiative (HASI). This is a three-way partnership program between NSW Health, Housing NSW and non-government organisations (NGOs) and is designed to assist people with mental health issues requiring stable accommodation.

According to the Social Policy Research Centre’s Evaluation of the Mental Health Housing and Accommodation Support Initiative (HASI) Second Report dated March 2011, there are various packages available targeting people with low- to high-level psychiatric needs.

The report says HASI aims to enable people with mental illness to participate in the community, provide assistance with maintaining successful tenancies, improve their quality of life, and assist them in the process of recovery from their mental illness.

However, even though the evaluation report shows that people living with mental illness in public housing are typical candidates for the HASI program, there are still people falling through the cracks.

Uniting Care Mental Health Services is one NGO that provides HASI support packages for up to 140 people living in the western suburbs.

“There are already access issues for HASI. There is huge demand out there and our organisation has waiting lists,” Besley says.

Lack of funding and resources

According to Housing NSW’s budget commentary on the state budget 2009/10, only $1.04 million in funding was allocated to lease 86 units to accommodate people with mental illness under the HASI program. This represents only 3% of Housing NSW’s total budget for 2009/10 ($3.486 billion).

Yet figures from Housing NSW’s annual report for 2009/10 show that there are up to 41,800 people living in community housing and 245,800 living in public housing — and these figures apply across the whole state.

In other words, only a fraction of funding is allocated to housing and community health services to assist the mentally ill.

The bulk of funding goes to increase the supply of housing to anyone in need of social housing, irrespective of their mental health.

Pamela Rutledge, CEO of the Richmond Fellowship of NSW (RFNSW), which is also an NGO HASI provider, says more funding in community mental health services is required.

“The big level of under resourcing is in community mental health itself. NSW is behind other states in terms of its investment in community mental health and community-based support both in the health system and the not-for-profit sector. So it’s about increasing that level of investment so that more people can be reached and more people can get access to these resources.”

Brennan says the lack of investment in community mental health is at its worst in western Sydney.

“Western Sydney has the most concentrated pockets of disadvantage in the whole of Sydney and yet we have the least amount of resources in terms of community program. Therefore you have this great issue of need.”

What is happening with existing funds?

Rutledge says that despite the millions of dollars invested in housing and mental health initiatives, there tends to be a concentration of those funds and resources in acute care and clinical services (in other words, care provided during hospitalisation or by hospitals).

“Because community mental health resources are embedded in the mainstream health system, there is always a risk that those resources get pulled back into acute or physical health care. We’ve seen that dilution over many years of the resources that are intended for community mental health services within the health system getting dragged back into the acute mental health system.”

According to Rutledge, quarantining resources is one way to overcome the dilution of government funds in the complex array of government and non-government agencies, programs and initiatives.

“Since there is a risk that the resources are not protected, we think it’s a good idea to actually quarantine the resources for community mental health. Mental health is so important and so fundamental to people’s capacity to be in the community and contribute to the community that resources need to be quarantined and guarded.”

*Sathya Sivalohan is a reporter with the Australian Centre for Independent Journalism and is majoring in journalism at UTS. This is the first in a five-part series on a major public health issue — out of sight and out of mind in Western Sydney. Tomorrow: Facing down death threats: NSW Housing and tenants on different planets in Sydney’s West. This special investigation is published in collaboration with Reportage Online, the magazine of the Australian Centre for Independent Journalism.

Peter Fray

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