This week a family holidaying here from Victoria were sitting at an outdoor setting of a cafe near Central rail station when a homeless man walked up and punched their eighteen month old daughter in the face as she sat in her stroller. He ran off - chased by the father - and was later arrested by police. The little girl received a bloody nose and was treated by Paramedics, but fortunately suffered no permanent damage.
The twenty-eight year old homeless man appeared before a magistrate and it was learned that he suffers a severe mental disorder. On May 5 he became an involuntary patient admitted to St Vincents mental health unit - and on May 11 he was given unescorted day leave - from which he never returned. The magistrate ordered that he undergo a further mental health assessment and he was returned to St Vincents hospital.
The unanswered question is - where do we go from here ? It seems that mental health is a revolving door treatment. No doubt the doctors will determine a drug regimen that will at least ensure a partial return to normal and once again the patient will either be discharged or will walk out the door and refuse further treatment. We simply lack the facilities for long term treatment of our mentally ill.
We have just had a chilling example of what is possible when the mentally ill go to extremes. There seems no doubt that the man who took customers of the Lindt cafe in Martin Place hostage and brought about the death of two people in the siege that followed was suffering a mental illness. The problem is that it is almost impossible to to spot that dividing line between "harmless " and " homicidal " - and after the event we always have 20-20 vision !
Now just suppose that the Lindt cafe gunman had survived the siege and no deaths had occurred. Without doubt he would have faced court and been sentenced to a long term in a prison cell. That seems to be the only answer available to the long term mentally ill. We wait until they do something extreme and then we use the prison system as our defacto mental hospital.
It is fairly easy to predict what will happen with that homeless man who irrationally walked up and punched a child in the face. He will again be an involuntary patient for a few days until a drug regimen is determined and he responds. When that happens, he will probably again be allowed unescorted day leave and the hospital will lose control. He will probably disappear amongst those living on the streets and he will probably discontinue taking whatever medicine that has been prescribed. There is an obvious limit to how long a public hospital can have a mentally ill person taking up one of their desperately needed beds.
The frightening thing is that there are vast numbers of people roaming the community with varying degrees of mental illness. We tend to treat them with disdain. Most suburbs have their resident " Weirdo " which children are told to avoid. Bondi has a family that collects rubbish and stacks it in and around their home, causing a horrible stink and reducing the appeal of nearby properties - but are otherwise harmless. In some cases, mental illness is labelled "eccentricity " and the person afflicted is seen a a " character ". Perhaps even treated with good humour.
A century ago we had "lunatic asylums " for the mentally ill but these fell into disfavour. They were closed and it became the custom to treat mental disease in the community. There were promises of long term treatment facilities, but these never eventuated. The cost factor was always the issue inhibiting their provision - and that is unlikely to change.
So ! We have a young man who shows aggression by punching an innocent child in the face and there is every prospect that he will soon be again roaming the community. Hopefully, the medics at St Vincents hospital may perform a miracle and give him a cure, but there is also a good chance that he will again grace the evening news and appear in our newspapers.
The next time he comes to public attention it is likely that officialdom will go to the next level of mental health control - and he will serve a period of incarceration. There is little provision of mental health management in our prison system, but at least it solves the "out of sight and out of mind " problem.
Such is the enigma of mental health treatment !
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