Sarah Krasnostein on Australia’s mental health crisis

Mar 22, 2022 • 14m 15s

For a long time, we’ve known Australia’s mental health system is overwhelmed and under-resourced. As a result, those who need help can end up trapped in the criminal justice system. But these outcomes aren’t new; they can be traced back to colonisation. Today, Sarah Krasnostein on how Australia’s history of incarceration and shame informs the current crisis.



Sarah Krasnostein on Australia’s mental health crisis

656 • Mar 22, 2022

Sarah Krasnostein on Australia’s mental health crisis

[Theme Music Starts]


From Schwartz Media, I’m Ruby Jones, This is 7am.

For a long time, we’ve known Australia’s mental health system is overwhelmed and under-resourced.

As a result, those who need help can end up trapped in the criminal justice system.

These outcomes aren’t new - they can be traced back to colonisation.

Today - author of a new Quarterly Essay on the mental health system Sarah Krasnostein on how Australia’s history of incarceration and shame informs the current crisis.

It’s Tuesday, March 22.

[Theme Music Ends]


Sarah, your Quarterly Essay is about Australia's mental health system. Can I ask, why did you want to write about this, what brought you to this place?


So with my background in criminal law, I'd been seeing time and again how people with mental health issues were ending up in the criminal justice system and not the health system. And that played out repeatedly to compound distress across a range of marginalised groups in our society.

So I knew from that aspect how the mental health system in Australia had been catastrophically failing long before the pandemic to provide timely and adequate treatment and support to those who needed it.

But it has felt long, urgent to me that we address the longstanding failures failures of will when it comes to implementing necessary equitable reform of this mental health system in Australia, as well as the stigma that surrounds mental illness. And and I think the greater question of what our history of resistance to change in this area says about us collectively as a nation.


Let’s talk about that then, about this country’s history of resistance to change. In your piece you go back to colonisation, to the way that national identity and mental unwellness were intertwined at that moment. So can you talk to me about your ideas around that?


Yeah, I mean, um the more kind of I went back to the start of colonisation and white settlement in Australia. I was shocked to see, you know, medical histories characterising many of the earliest convicts as mentally ill. Which, you know, when you think about it does make sense, given their desperation that often led to offending as well as social isolation.

And the experience of a death sentence being imposed then commuted to transportation to some place none of them had seen before.

Archival Tape -- Documentary Presenter:

“150 thousand transported convicts formed the basis of European settlement in Australia..”


So there was the extreme violence of settlement, the precarity of life under a still forming government at the edge of empire

Archival Tape -- Documentary Presenter:

“The British considered themselves world leaders in what was seen as the science of punishing and reforming criminals. They had refined techniques of segregating prisoners from society…”


And the state and territory mental health institutions are older than the states and territories themselves. There are amongst the first, permanent structures built.

Archival Tape -- Documentary Presenter on the Port Arthur Prison and Asylum:

“Stories abounded, some closer to the truth than others about savage floggings, long weeks and dark cells and brutal treatment in work gangs”.


So when you have a deep knowledge of that part of our history, you start to see very uncomfortable commonalities between where we were then and where we are now.

So if you think of the phrases that are embroidered into our daily lives, still, “she'll be right.” “Pretty ordinary.” “Toughen up.” “Get over it.” It suddenly starts to take on a different weight.


Hmm. Yeah. And I suppose when you speak about the history here, there are these two things that emerge and one is this idea of stigma and shame, and the other is the idea of incarceration as a direct response to mental unwellness.

And I just wonder if you look at the situation we're in today, to what extent you think that those responses are still the main kind of responses to mental unwellness?


Well I think that it looks very different today, how we are trying to provide mental health care, what we conceive of as criminal justice, what we conceive of, as mental and physical health care. But there are very disturbing commonalities.

There is a cohort of people caught in the criminal justice system of our states and territories who, for lack of anywhere else to put them, have been imprisoned.

So to see whether these this has been to see whether these historical patterns continue to play out in the present, I looked at three cases of women who had mental health issues and whose treatment by the system while they were at their lowest made them worse.

Two of those concerned the incarceration of women with severe mental illness or disorder.

And one of those women was Rebecca.


We’ll be back after this.



Sarah, part of your approach to investigating Australia’s mental health crisis is to follow specific stories of people who have first hand experiences within the mental health system. One of those people is a woman you call Rebecca. Are you able to just tell me a little bit about her, and what happened to her?


Yeah, sure. So Rebecca is a client of the Victorian public advocate, and she was in her late 30s when she was the subject of a report by the ombudsman. So Rebecca and we're calling her Rebecca, that's not her real name - was profoundly impaired, but clinicians had disagreed since she was a child on her official diagnosis, whether it was a mental illness or disorder or an intellectual disability.

Because of her complex disabilities, she had certain behavioural patterns, which her elderly parents really struggled to cope with. They took out an intervention order, which it's unclear whether she understood and which resulted in her being physically removed from the family home by police on a number of occasions and charged with breach of the order.

So she was incarcerated repeatedly and eventually it was less because of that behaviour or any criminality, moral blame, worthiness, culpability attached to it and more because as a society, we had no alternative accommodation for her, and she ended up being imprisoned for 18 months, locked in her cell for the better part of each day, and she remained there because there was no other place for her to go. Had she pleaded guilty, she would have spent less time in prison than she ended up serving.

And she is representative of a group of people in the correctional system who are not on remand for an offence or they've been found unfit to be tried. And yet, because of multiple disabilities, they have not been released and they fall through a gap in our sectors and our services. No data is kept on how many, how many of these people there are, and I found that a very distressing but eloquent absence of concern.


Mm hmm. Yeah. So she's, I suppose, one of one of the people in Australia who, when there is nowhere else for them to be, ends up in jail. That's kind of the only place that we have in society that is reserved for her.


Yes, that's right, what I heard again and again, whether I was talking to people with lived experience themselves or legal advocates, lawyers, judges, GPs from around the country - what I was hearing was that we have a particular conception of who the country belongs to, who has a place in it.

And it's not just that we have a malignant lack of empathy for people that are suffering because of their mental health, It's very much a lack of self-compassion. Our repeated patterns of reviling the difference that we associate mental illness with happening with them and never us. That starts if you look at it through a psychoanalytical lens, it starts to look like fear and shame about our own potential vulnerability, our own need for others and reliance on others in times of stress and weakness.

And I found that kind of inability to show that softness or that vulnerability or perceived weakness to be a common thread throughout the last 200 years.


Hmm. OK. And so after speaking to all of the people that you did for this essay and looking at stories like Rebecca's story, do you have much hope then about any kind of reform within the mental health care system?


Yeah, I mean, I would give a very heavily qualified yes, I'm I'm hopeful, but many things have to change before we get to that point.

We have great blueprints for blueprints for what it should look like if it is properly funded. The Victorian Royal Commission into Mental Health has a wonderful blueprint for reform. It would look like a more holistic approach to good mental health and wellbeing across the community. It would look like shifting the focal point of service provision away from emergency departments and further up and further further back in time to community based services.

It also looks like housing support and parenting support and equal payment for single parents, often single mothers. So again, when we talk about mental illness, we're talking about all of these other areas of society, We're talking about the public institutions that need to shift in concert, how they focus on the people who are coming to them in need. And so yes, the answer is I hope that because these harms were co-created, that they can be solved.


And another thing that struck me in your essay - along with these solutions - was the point you make about vulnerability, about the power of people being honest about their own mental health.


I mean, it's not an easy it's not an easy thing to admit our own areas of. Again, I say perceived weakness because I think that vulnerability is the source of our greatest strength because it's the thing that connects us and into relationships that get things done in our personal and collective lives.

The thing that I learnt by talking to an enormous range of people over the 14 months from December 2020 until February 2022 was an exemplary willingness of each of them to share not just their professional knowledge, but their personal drive to do the work that they did.

So these were higher court judges. They were GPs from remote and regional areas all around the nation, psychiatric nurses, psychiatrists, psychologists, people with lived experience of psychotic illness, borderline personality disorder and anxiety and depression. And each of them in the context of sharing with me their professional experience willingly shared their personal experience.

And I think that was the most inspiring and heartening part of doing this work was seeing that personal change, which is the precondition for any national change.

And that is very much alive in the people who are, you know, on the frontline of dealing with the current crisis, which is in every Australian jurisdiction when it comes to mental health care.


Sarah, thank you so much for your time.


Thank you for having me.


Sarah Krasnostein’s Quarterly Essay on mental illness and vulnerability is called “Not Waving, Drowing.” It’s out now.



Also in the news today,

Russian forces have escalated their attack on the Ukrainian port city of Mariupol, with more reports of shelling and heavy fighting reaching the city’s centre.

Ukraine rejected a Russian demand to surrender the city by five am on Monday morning.

Meanwhile the US President Joe Biden has announced he will be visiting Poland, as part of diplomatic efforts in Europe this week.

Biden will also travel to Brussels - where he will discuss Ukraine with leaders from the G7, NATO and the E.U.


And a funeral has been held for Labor Senator Kimberley Kitching.

Kitching died suddenly of a suspected heart attack on 10 March.

She was 52.

I’m Ruby Jones, this is 7am, see you tomorrow.

For a long time, we’ve known Australia’s mental health system is overwhelmed and under-resourced.

As a result, those who need help can end up trapped in the criminal justice system.

These outcomes aren’t new; they can be traced back to colonisation.

Today, author of a new Quarterly Essay on the mental health system Sarah Krasnostein on how Australia’s history of incarceration and shame informs the current crisis.

Guest: Writer and criminal lawyer, Sarah Krasnostein.

Listen and subscribe in your favourite podcast app (it's free).

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7am is a daily show from The Monthly and The Saturday Paper. It’s produced by Elle Marsh, Kara Jensen-Mackinnon, Anu Hasbold and Alex Gow.

Our senior producer is Ruby Schwartz and our technical producer is Atticus Bastow.

Brian Campeau mixes the show. Erik Jensen is our editor-in-chief.

Our theme music is by Ned Beckley and Josh Hogan of Envelope Audio.

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656: Sarah Krasnostein on Australia’s mental health crisis