“MENTAL ILLNESS AND BOARDING HOUSES”

“Taking advantage of the most vulnerable in our society, is one of the most lowest acts anyone con commit”-Melissa Ryan

Hospitals should not be an alternative accommodation industry, yet there is no alternative provided by the Government. The choice is a privately run hostel...where people may be exploited — or the streets.

Boarding houses have undergone a major change from their original purpose — as a temporary but nonetheless respectable form of housing for people visiting the city for work or on holiday. As the housing market changed and the policy of deinstitutionalising the mentally ill was implemented.

An expert witness in NSW told the Inquiry that in the 1960s, at the beginning of deinstitutionalisation, the psychiatric hospitals continued to provide some support for their patients who went to live in boarding houses. But that support has dropped away and, from the evidence presented to the Inquiry, has rarely been replaced.

While it is rarely stated publicly, this 'evolution' in the role of boarding houses means they have become a de facto part of the mental health system, housing a large number of that system's clients. The advantage of this situation for boarding house owners is that it provides a generally docile clientele who are easily controlled and prepared to accept minimal standards; it also guarantee a reliable regular income generated by pensions and benefits. But the evidence indicates that boarding houses have failed to fulfil the accompanying expectation that they would contribute in some way to community care.

Boarding houses provide accommodation and some residential services — often cleaning, laundry and three meals per day. Generally some level of 'super- vision' is inherent in their operation. However, unlike ordinary private tenants, boarding house residents have no lease, no security of tenure and no right to exclude the landlord from the rooms they rent.

Many thousands of mentally ill Australians live in boarding houses. According to an Adelaide outreach team working with people in boarding houses, about 70 percent of its client population have a psychiatric disability. The single most prevalent disability is schizophrenia.

Some boarding houses are run by caring people who make a conscientious attempt to provide a decent 'home' for their residents. But the conditions in many are a national disgrace.

The evidence presented to the Inquiry in all States indicated that the physical conditions in many boarding houses are depersonalising, depressing and completely conducive to any dignified normal life. Many boarding houses have no living space appropriate for any form of leisure activity. Security is poor: rooms often have no locks on the doors. Many rooms are dark, cramped, crowded, dirty, unsafe and poorly maintained. The decor tends to be sparse, without plants or pictures on the walls to make the environment homelike.

Living with so little personal space makes many residents feel aggressively territorial; the lack of privacy also produces sexual frustration. These factors contribute to erosion of self esteem and loss of dignity, and result in a level of tension between residents which sometimes erupts into conflict. This atmosphere would be difficult for anyone to live in; for someone with a mental illness it is especially destructive.

Many people affected by mental illness live in boarding houses because they are cheap. However, evidence was presented that mentally ill individuals are frequently discharged from psychiatric wards directly to a boarding house, without having any choice in the matter.

For many people with a mental illness, living in boarding houses or hostels is effectively a form of scaled-down re-institutionalisation. Boarding houses share some of the main drawbacks of psychiatric hospitals: an abnormal environment, strict rules and very little control by residents over their lives. However, boarding houses also lack the major advantage of hospitals — the provision of treatment.

Another way in which boarding house life exacerbates disability is by fostering substance dependency. Over-use of alcohol and aminobenzoic drugs is rife; residents' legitimate medications are sometimes stolen by other residents. There is an obvious need for 'dry' boarding houses, for people who have beaten their drug or alcohol addictions. But as far as the Inquiry could ascertain relatively few of these exist.

It appears that some boarding houses have arrangements with particular doctors, giving them exclusive visiting rights. This means residents are virtually compelled to adopt the boarding house doctor as their regular GP. A boarding house clientele can provide a lucrative 'franchise' for a doctor, with the danger of exploiting both the patients and (through over servicing) the taxpayers. Even if the mentally ill do receive primary health care from the boarding houses' GPs, those doctors generally do not have adequate professional training to treat a serious mental illness.

The management practices in some boarding houses clearly amount to exploitation of the residents. One practice, for example, is to press residents into unpaid work.

Other practices also constitute clear breaches of basic human rights. For example, the Inquiry heard evidence of a person whose incontinence was managed 'by a regime that is akin to a deprivation of liberty': the manager simply did not allow the resident to leave the boarding house.

In many boarding houses the manager controls all the residents' money —because their pensions are simply paid into accounts which the manager operates. Residents are frequently subject to a form of debt bondage based on cigarette and coffee tabs. Most people in boarding houses are heavy smokers and are also poor; the management provides cigarettes and coffee on credit, sometimes beyond the residents' capacity to pay.

Some boarding house practices reported to the Inquiry are clearly dangerous for people with a psychiatric disability — for example inappropriate allocation of room-mates (a recovering alcoholic being assigned to share a room with an active substance abuser). Danger also arises from managers hoarding residents' medication or dispensing it inappropriately.

For mentally ill women, boarding houses are a particularly inappropriate form of accommodation. Sexual abuse by managers or other residents was cited in several States in evidence to the Inquiry, and sexual harassment is such a significant problem that some emergency housing agencies will no longer refer female clients to boarding houses. Most boarding houses do not accept children, but some mothers, desperate for accommodation (and homelessness is an increasingly common problem), lie and hide their children in their rooms.

Evidence to the Inquiry from most States showed that people living in boarding houses generally pay 85-90 percent of their pensions for room and board. This leaves them very little money to buy anything else they need or want.

Since many residents tend to be extremely passive (and some are incapable of looking after their own finances), boarding house managers often convince them to hand over control of their bank accounts. The resident's pension is paid into the account, the manager deducts the rent and gives the resident an allowance from the remainder. This ensures the rent is always paid, but it forces residents to ask the manager for money whenever they want to buy anything for themselves.

This practice is obviously open to abuse. Boarding house proprietors set their own fees, so sometimes residents receive no change from their pensions at all. Instead they may be paid in kind, for example with a packet of cigarettes or with toiletries. Not surprisingly, there have been reports of proprietors simply plundering clients' accounts. Clearly, the likelihood of exploitation increases when residents are in such a dependent position.