Newman Online

Weekly commentary by Dr Muriel Newman MP

Are sheltered villages the answer for our seriously mentally ill?

This week Newman Online looks at the whether sheltered villages are the answer to housing the deinstitutionalised mentally ill, who are at risk of harming themselves and others.

Back in 1996, one of my first tasks as a new Member of Parliament was to try to assist a mother whose son was threatening to kill her. He was mentally ill and refused to take his medication. As a result, the whole family including his sister and her children were living in fear and hiding.

Nine years on, it is difficult to know whether things in this area have improved much at all. Sure, there are more mental health hospital beds now than there were back then, but overcrowding is still a huge problem. Further, a very dangerous revolving door strategy has been established whereby patients who should really be kept in hospital for further treatment and supervision are turfed out because more urgent cases need to be admitted.

I recall visiting a group of advocates at the time, who were lobbying for urgent improvements to mental health services. Their particular concern was for those people who were seriously mentally ill, who before de-institutionalisation would have had twenty-four hour care, but who were then released into the community in a dangerously unwell state, often with little or no support.

One by one, they told me their stories: a mother whose son had threatened to kill her and her husband while they slept at night, who went on to burn down their house. A sister, whose brother suffered from violent delusions and wanted to stab the whole family to death in order to exorcise their demons. A father whose daughter refused assistance, preferring to live ‘independently’ in squalor, a victim of on-going rip offs and abuse by so-called ‘friends’. And so it went on, with each story just as horrific as the one before.

They had concluded that there was an urgent need in New Zealand for modern 24-hour residential care facilities for people assessed as severely mentally ill and prone to dangerous psychotic episodes. A place where they would be required to take their medication in an environment that would provide stability and safety for themselves, their family, and the rest of society. They called such a facility a ‘sheltered village’, similar to those in Britain and the United States, where quality living conditions for the severely mentally disabled would be provided, including opportunities for employment when people were well enough to work, as well as loosely supervised access to sporting and social events in the wider community, as appropriate.

As far as I’m aware their dream is still just a dream with the Ministry of Health apparently not being prepared to even consider funding such a project.

Meanwhile, dreadful crimes are committed by the seriously mentally ill: like Jesse Moore, who against the advice of police, walked free from a courtroom after attacking a workmate and leaving him for dead, only to breach his curfew that night in order to beat his father’s former partner to death with a rock; or Mark Burton, who stabbed his mother to death the day after being released from a hospital psychiatric unit; or Lloyd Alexander McIntosh, now released into the community with two full- time ‘minders’, whose horrific record includes the rape of a six year-old girl, the rape of a 23-month-old baby girl, and the assault of an intellectually handicapped woman while a guard was stationed outside the door.

Police warn that there is a significant danger to society from those people with serious mental illness and violent tendencies who are living free in the community. They say that if people really understood the threat from those who live unstable lives of crime, laced with drug use and psychotic episodes, they would demand that such people are no longer left unsupervised in their community but are required to be housed in the sort of care facility that the sheltered village concept offers.

The problem is extensive. Surveys show that some 10 percent of violent offenders in prison are seriously mentally ill. It is difficult – if not impossible – for these prisoners to get the medication and special care that mentally ill people need in a regular prison.

They should be in a forensic institution.

In fact prison managers have told me that if the 10 percent of prisoners who are mentally ill were moved into forensic establishments, and the 60 percent of the non-violent prisoners - who have been sentenced for white collar crime, driving offences and such - were moved into military-style prison camps where they engaged in work activities, that would leave prisons free for the 30 percent of prisoners who are seriously violent and dangerous. Such prison reform would free up some prisons for forensic purposes. It would solve the present prison over-crowding problem, and it would signal an end to the farce of home detention, whereby offenders sit on a benefit enjoying a life of leisure, while their families are forced to put up with them and their “attitude”, full-time with no respite.

Better dealing with the seriously mentally ill, who are a danger to themselves and society, is without a doubt, a challenging task. But surely it is time that we listened to the police who warn that with the failure of the health system to properly care for those in serious need - and with the increasing availability of mind-bending drugs like methamphetamine - the number of people in our communities who are considered dangerous is growing.

The reality is that while de-institutionalisation worked for many, it did not work for some. Surely it’s now time to firstly establish some sheltered villages along the lines that advocates have long called for as, and secondly ensure that proper forensic institutions are available for those prisoners who seriously mentally ill.

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