Dialogue: Secrecy in mental health an insult to people who care

By CARMEL CERVIN*

Last year, Malcolm Beggs was murdered by his flatmate, Lachlan Jones, who then apparently committed suicide. Lachlan Jones was a mental health patient who had recently discharged himself from Waitemata Health's acute psychiatric unit.

In a Dialogue page article, Dwayne Crombie, of Waitemata Health, discussed issues surrounding this preventable tragedy. He raised three arguments.

First, he said that information should only be divulged to "clear" caregivers and not to other people living with a mentally ill person. Thus, even after Malcolm Beggs' death, Waitemata Health's chief executive believes that Malcolm had no right to know about his flatmate's illness.

Secondly, he said the public must be less judgmental of mental health professionals if it wants them to improve their service, and not expect individuals to be made accountable.

Finally, he argued that to obtain the truth in Waitemata Health's inquiry, the findings must remain secret.

I disagree strongly with all three arguments.

People with a mental illness need the support of those with whom they live. These people may not be formal caregivers. In Malcolm Beggs' case, Waitemata Health used him as a de facto caregiver by handing Lachlan Jones' medication to him. At the same time, Waitemata Health chose not to inform him that Lachlan Jones needed to take this medication because he suffered a serious psychotic disorder. There is no evidence that they even asked Lachlan if they could inform Malcolm Beggs.

It is unacceptable to use those living with a mentally ill person without their consent. A shortage of beds is not an excuse to use members of the public without their knowledge. Nor is it in the best interests of the person with a mental illness to be living in an environment in which their needs are kept secret.

Community care can only work if those living with a person with a mental illness are fully informed. Without this, how can the community provide care and support? Malcolm Beggs was never given the choice or opportunity to assist with the care Lachlan Jones clearly needed.

Moreover, mental health professionals need to know what is happening in a patient's life. People living with a mentally ill person are an important source of information and help. Malcolm Beggs was very concerned with Lachlan Jones' behaviour, but was not aware that mental health professionals should be informed.

Those living with a mentally ill person also have a right to a safe home. I had not long been going out with Malcolm when he was murdered. From the time Lachlan moved into Malcolm's house (about two weeks before he killed him), Malcolm began coming to my house. I never again went to Malcolm's house while he was alive. At the time, I had no idea how significant this was. Malcolm was afraid. He protected me by always coming to my flat. But he had no protection; he was afraid in his own home but there was nothing he could do.

It is recognised that with psychotic disorders there is an increased risk of self-harm or harm to others. Therefore, it is important that flatmates and family living with a person with a psychotic disorder are informed.

We inform people who are in close proximity to those who suffer from a contagious disease so they know the risk. Surely, steps to protect the public's safety should also be taken when someone suffers a mental illness.

These steps are not to disadvantage mentally ill people, but to ensure that those who live with them are safe. Mental health professionals themselves concede that there is a grey area in assessing risk. Given this uncertainty, it is surely safer to err on the side of caution and to inform.

Mental health professionals are concerned that their patients will be discriminated against. Public education is the most effective way to break down discrimination.

Providing information is an important part of this. If the public are aware how they can help, and of the warning signs for when professional help is needed, fear and discrimination can be broken down. While mental illness is kept secret, ignorance and suspicion will continue.

Unfortunately, many mental health professionals continue to rely on secrecy to "protect" their clients. This, in turn, leads to ignorance of what is happening, which only increases the possibility of a tragedy occurring, particularly suicide.

Another point made by Dr Crombie is that the public must be less judgmental of mental health professionals if it wants them to improve their services. It is deeply concerning that the response to public pressure for improved services is to blame the public.

Dr Crombie also argues that only systems should be criticised and suggests that the public should not expect individuals to be held to account.

It is little wonder that Waitemata Health has found no one accountable for the many failures in the care (or lack of it) that Lachlan Jones received. It must be disheartening for dedicated professionals to see those who fail in their duties get away without so much as a reprimand.

Obviously, when things go badly wrong, the public should see both systems and individuals held to account. When a death occurs in a private workplace, Occupational Safety and Health holds an inquiry which considers accountability. Surely, when a tragedy occurs within our public services, there should also be public accountability. After all, the public funds these services. There is little pressure to avoid mistakes when those responsible are not held accountable.

Dr Crombie's final argument, that the inquiry into Lachlan Jones' death should be secret, is also extraordinary. Put simply, justice must be seen to be done. Secrecy never serves the public interest; it only protects those with something to hide. Transparency and accountability, both individual and systemic, are not only expectations of a democracy, they are among its fundamental principles.

It is an insult to the professionals concerned that Waitemata Health believes they will only tell the truth in secret. The inquiry into the deaths of Malcolm Beggs and Lachlan Jones would normally have been carried out under the Mental Health Act, which allows for a more transparent and open process. The secret inquiry reeks of arrogance.

Finally, it is obscene that, having lost so much, the Beggs family must now battle for justice and accountability. Waitemata Health's apology is meaningless without accountability. The family and friends of Malcolm want to know that others will not face a similar tragedy.

A fundamental shift in the ethos of mental health professionals is required. They must start using their power to inform and protect the public. Only by informing those living with a mentally ill person can community care become a reality. How can the community care if it is not informed of who needs care?

* Carmel Cervin is doing a PhD in social policy at Massey University, Albany.