Beyond reach

The phone on my desk was ringing. Restricted number. Damn, I hate that. I picked up the receiver with a vague sense of trepidation and said "hello".

There was no mistaking the voice that answered, although I had not heard it for more than two or three years. It filled me with a mixture of fear, anger, sorrow, guilt and frustration. It was my little brother.

Shane was diagnosed with acute paranoid schizophrenia in his late teens following a series of psychotic episodes. He suffers from delusions, sophisticated conspiracy theories and ongoing bouts of psychosis. It is a terrifying condition, made so much worse by his paranoid suspicion of his medication and the mental health system.

In less enlightened times we used to lock people like Shane away in institutions. More recently we have respected their freedom and left the mentally ill to live amongst the community.

In Shane's case, he had a family to live with and be cared for by. But the demands of caring for someone with a severe mental illness place a heavy burden on families and can take a high toll.

A lack of meaningful services and support to help people like Shane and their families cope with their condition only increases the difficulty of the situation. Instead we have a system geared to intervention and respite when a crisis situation develops, as it frequently does.

Eventually our family stopped coping. Following our mother's death, after years of bearing the brunt of Shane's volatile behaviour, it was left to our father to care for Shane. this soon became too much for him, and in his early twenties Shane moved out of home into supported independent accommodation.

Shane's paranoia soon created problems with the people around him, his social worker and doctors, and he left his government supplied unit and took to the road. Like many of the mentally ill he has wandered the country, drifting between rooming houses, hostels, sleeping on the street and psychiatric hospitals ever since.

We lost contact with Shane, occasionally hearing of his wherabouts when he'd run into trouble or was admitted to hospital. It's not easy to ignore the plight of a family member in need, but his erratic behaviour and extreme resistance to treatment leave little choice.

Seeing Shane again after several years, I'm quickly reminded that dealing with him is a high intensity and frustrating undertaking. He has escaped from hospital, convinced the nurses are seeking to control his mind for evil purposes. He is scared, confused and has no idea where to turn for help.

As a family member the sense of responsibility and the desire to help is overwhelming. Yet I know I do not have the skills to deal with this situation, and I also do not know where to turn for help.

I manage to convince Shane to return to hospital, but they have discharged him by now and don't care what happens to him next. His social worker finds him a place in a homeless shelter, but he checks himself out within 24 hours, convinced his fellow residents are out to get him.

Facing homelessness, and having exhausted his options within the system, Shane turns to his family once again. I give him enough money to stay the night in a backpackers hostel and we agree to talk the next day to try to work out something more permanent.

Shane doesn't call me again. Instead he disappears, moving beyond the reach of help once more.

There are thousands of people like Shane out there. Living on the margins of society, falling between the cracks of a system which falls far short of their needs. Scared, confused and with nowhere to go.

I think of Shane whenever I see a beggar on the street, knowing he is out there somewhere, beyond reach, yet somehow managing to survive. I am angry that I cannot do more to help him, and angry that our society has let him fall through the cracks.

Institutionalisation of the mentally ill may be an inhumane response to the problem. But leaving these people, and their families, to cope on their own, with inadequate support and little hope, is an abdication of our responsibility as a society to care for those in most need.