Today’s thesis is that you can’t achieve worthwhile social outcomes if you focus simply on the cost of the process. Or, social initiatives too often ignore the real cost.
Is this a truism? What am I talking about?
I’m thinking specifically about care for the mentally ill, but more generally about how initiatives fail if they go solely by cost.
In 1983, the Richmond report was produced on behalf of the New South Wales government. In essence, it recommended deinstitutionalisation for the mentally ill. From what I’ve seen, this was a trend that was happening around the world at the time. Rather like economic rationalism (elsewhere known as Thatcherism, Reaganomics, Rogernomics, etc), certain ideas catch hold and spread through the western world like a plague.
Deinstitutionalisation in itself is not a bad thing at all. Nobody really benefits from having people locked away, except those who want to see everyone different… well, locked away.
However, the mentally ill were ‘released’ without sufficient support services and management plans. We saw the results of this anecdotally through the 80s and early 90s where the number of homeless people in Sydney jumped substantially. More people living and begging on the streets.
Yesterday in the SMH, Dr Michael Gliksman pointed out where another large cohort of releasees ended up: in jail. Since the Richmond report, the population of NSW jails has tripled. “Up to 75 percent of adult prisoners had a psychiatric disorder within the 12 months preceding their incarceration. Thirty percent have a significant history of self-harm” [my italics]. If nothing else, this specifically demonstrates that the mentally ill don’t receive the services they need. More largely writ, as Gliksman points out: this is reinstitutionalisation, and the Richmond report has simply resulted in shifting the cost. Possibly cheaper – if you only compare prison costs to psychiatric care costs – but certainly worse for everyone. They’re now locked up for crimes: personal or property damage to the general population.
I would then argue that the associated, unquantified costs – social and otherwise – render that deinstitutionalisation trend a scam. Gliksman points out jail costs around $75,000 per prisoner, but only about $35 – $50,000 to “properly house” each homeless mentally ill person.
The Richmond report was wrong, wrong wrong on all counts. Is this said with the benefit of hindsight? Well, I think it fairly intuitive that social solutions that focus only on the immediate costs will fail. Responsibility for this political expedience should fall on not just the politicians, but the professionals doing the analysis, accepting the recommendations – and all of us for not railing against stupidity.
If you think I’m stating the obvious, then… use your voice.