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Royal Commission into Victoria’s Mental Health System

Personal story:

Michael Silva

Michael* and his family have been providing care and support to Michael’s 55‑year‑old brother, Alan,* for more than 30 years. Alan has a diagnosis of bipolar disorder, including psychotic episodes, and experiences addiction to alcohol and other drugs.

Michael reflected that in his role as a carer he has not been able to find integrated treatment, care and support for Alan in the mental health system.

We have never had an experience in the public mental health system of Alan being treated in an integrated way with respect to his dual diagnosis. Alan has eventually moved over to the private health sector, but even in the private health sector it’s still only mental health and not integrated treatment.

Michael said he thought the mental health system was not equipped to respond to Alan’s needs and found it ‘rigid and inconsistent’.

Alan’s dual diagnosis meant that it was difficult for him to receive support. For example, we were once trying to give an explanation of Alan’s dual diagnosis to a CAT [Crisis, Assessment and Treatment] Team. Their response was, ‘We’re not concerned about what the cause is. We just deal with the symptoms’.

Michael speaks of a stigma in the mental health system that Alan experienced because of his addiction and felt that he had to justify the need for Alan to be given mental health support.

We felt that the mention of his use of illicit substances affected how people responded to the crisis. It was a situation of, ‘Well, this is not really our domain. This is a drug and alcohol issue’.

The lack of integrated support for Alan has been an ongoing issue for Michael and his family. Michael said this has affected their own mental health.

There is a lot of responsibility on the carers. My mother was not coping herself. For her, Alan’s situation was a tragedy.

There was a domino effect. It would start with Alan, and then my mother would become unwell herself, due to the stresses that she had. Then it would come through to me.

Michael believes access to a system providing integrated treatment, care and support would have been of great benefit to Alan and in turn help Michael and his family in their role as carers. Michael would like to see mental health and alcohol and other drug services more closely aligned.

I think integrated treatment would give the family, us, something that we could work within … I feel that someone in a clinical role with training in dual diagnosis may have resonated with Alan.

In the ideal world, there would be the one person, who understands both sides of the coin, working with a dual‑diagnosis client.

Source: Witness statement of Michael Silva, 22 June 2020.

Note: *Names have been changed in accordance with an order made by the Commission.