2020 Vision

A doctor writes:

I've been in psychiatry now for around 20 years — since the millennium in fact. I was just finishing my specialist registrar training in 2001, as the Dome was being finished off.

Things were really bad back then. I remember we had people with schizophrenia living in the community. I mean — how naive can you get. There was a reason the asylums were built in the first place. There was a run of murders, people with schizophrenia killing innocent members of the public, the same public that had been selflessly trying to help them integrate back into the community, giving them jobs and self-respect.

Well, enough was enough. Back to zero tolerance. There was this myth that people with schizophrenia were not responsible for their offences. Some psychiatrists, even then, would fall over backwards trying to stop people with mental illness being charged, convicted and imprisoned for their offences. The nurses on the wards were being assaulted and the police couldn't do anything. The argument went that they were on a Section 3 anyway so what difference would a Section 37 make?

The courts had had enough of psychiatrists trying to get their patients off. The politicians saw the problem and responded, thank goodness, with decisive skill. We already had the basis of treatment in the community. It was called the supervised discharge order. The only problem was it lacked teeth. All we could do back then was to wait for someone to get unwell and bring them back to the hospital. The really silly thing was that, even then, you couldn't insist on giving them their injection. So they got worse. Next thing, you would see them on the front of a newspaper. Well, who could be blamed but ourselves, the psychiatric profession.

We lobbied for change and got it. Now we don't have to wait for people to become dangerously ill before we treat them. If people default on follow-up, we take them to a treatment centre. There were criticisms initially from the bleeding-heart liberals, but that soon dried up. I think the public are just happy to know that these people are being cared for so they can walk the streets in peace.

Since the prison population started to fall we've managed to take over some of the prisons. Really, with minimal capital investment, we've removed all trace of the fact they were ever penal institutions. Sure, the doors still lock, but how else could we ensure the nurses' safety?

I actually think the patients appreciate the feeling of containment. They're like little communities. Lots of things to do — industrial workshops, gardening projects — a chance for our patients to be themselves.

Over the past few years we've been collecting data on the patients we've been treating who are dependent on drugs that we've been treating. Of course, I haven't seen the results yet, but the Minister for Health has hinted that it is as successful as treatment under the Alcohol Hygiene Act. It's so very encouraging — so much so that there is even a rumour that we may be asked to treat sexual deviants. Really, I don't understand why this hasn't been thought of before.

A patient writes:

It's been 20 years since I told the doctor about my violent fantasies. I had a tough time as a kid — you know the usual stuff, pissed father, he beat me — and an uncle — well, I still have nightmares about that.

I was angry. Wouldn't you be? I got drunk a lot, even when I was at school. Got in with the wrong crowd. That's when I started to get into trouble, nicking cars, that sort of thing. Later we turned over some houses. I was with my mate once, we'd done some drugs, speed I think, turns out this woman was in. Well my mate decides to have some fun so I joined in too. Stupid really, she wasn't meant to be there. Next thing I know I get done — my mate grassed me up. Six years I get. I couldn't cope with all those nonses, I mean I know what I'm in for, but I'm really not one of them perverts. I sorted a couple of them, got a bit of a reputation on the block. So I see this shrink, told him my story and how I still thought of killing my uncle. He said I was a psychopath. Turns out I needed treatment. So I get fraggled off to hospital. It's where all the nutters used to be before they were placed in the treatment centres — I did time in some of them. There aren't many nurses here, lots of screw types though.

Now I get thinking about this, too much time on my hands. If they reckon I need treatment, I must be ill. If I'm ill then what I did can't be my fault. So I go to the mental health review tribunal (that's what they call the parole board now) and say that I recognise now that it was not my fault because I was ill at the time. So they think about this and send me back to the prison so I can get some therapy.

I don't know when I'm going to get out, the doctor says he can't be sure I won't kill my uncle. I've said I won't but that does not seem to convince them. Still, the therapy is going well — I'm starting to be able to think about my problems. Maybe I'm not psychopathic any more. Oddly, that worries me, because if I still want to kill my uncle and I'm not psychopathic, doesn't that just mean it's human nature?

Can they treat that?