Mental health: Lack of support pushes fragile parents to the limit
Kylie Fowler killed her three children and then herself while she was suffering a psychotic episode. The children of parents with serious mental health problems are all too often the victims when the care of those ill parents falls through the cracks of the health system.
Kylie Fowler killed her three children and then herself while she was suffering a psychotic episode. The children of parents with serious mental health problems are all too often the victims when the care of those ill parents falls through the cracks of the health system.
By JOCELYN WRIGHT
Siblings Matthew, 11, Melanie, 13, and Samantha, 18, were the subject of no fewer than 20 reports to the Child Protection Service during their tragically short lives.
On January 9, 2011, their mother, Kylie Fowler, 36, stabbed her eldest daughter 23 times to the back of the head, and her youngest son 20 times.
She then barred entry to her small Heidelberg Heights home and ignited accelerants that tore through house.
The initial 000 calls reported an unknown victim bleeding at the address, but it quickly escalated to reports of a house fire, attended tragically too late by police, firefighters and ambulances.
The murder-suicide came at the end of what is believed to have been a prolonged psychotic episode.
Three years on, there are tribute pages on Facebook for the children which are strewn with messages of grief and disbelief from family and loved ones.
“The fact that you are gone absolutely haunts me every day,” reads a message from Samantha’s boyfriend at the time, James Elks, who posts regularly.
Family and friends continue to mark birthdays, holidays and anniversaries. Last year Samantha was wished a happy 21st, and her sister Melanie a sweet 16th.
In March, four coroner’s reports were released detailing the deaths of Kylie and Samantha Fowler, and Melanie and Matthew Maher.
The inquest found that Kylie Fowler was responsible for inflicting the stab wounds on two of her three children and causing the fire, while suffering a prolonged psychotic episode.
The inquests detail that Kylie Fowler had an 18-year history of episodic schizophrenia.
After her last involuntary inpatient care, she was placed with a community case management team.
When she was discharged from that group, she never established contact with her nominated GP.
In the inquest brief prepared for Coroner Ian Grey, Det Sen-Constable Mick Cashman said Kylie’s case “simply fell through the cracks of the mental health systems, including primary care services, and had done so for nearly 20 years.”
He recommended that people with a serious mental illness who had at least three involuntary admissions to psychiatric units be placed on a lifetime registry with the Department of Human Services to monitor their condition and movements and make sure they continue necessary care.
Just one week after the findings of the Fowler family were released, the Herald Sun obtained a DHS quarterly report calculating that close to 40,000 child protection reports were made in a six-month period in 2013 to the Department of Human Services.
That report said the DHS was failing to meet its targets in allocating cases and was under increasing pressure with 15 per cent of child protection workers quitting their jobs in that six-month period.
On the front line
Julie Sharrock is a mental health nurse and consultant liaison officer with psychiatry services at St Vincent’s Hospital.
She has worked in mental health for 27 years and says child protection and mental health services are two of the most under-resourced systems of care in Victoria.
“I think when terrible things like this happen, it’s usually generally a series of gaps, not just one gap. Generally there is more than one thing in the system that falls down,” Ms Sharrock said.
“GPs, for example, they book people in for a 10-minute appointment, 20-minute appointment – how do you identify which ones are the ones you really have to worry about? If they don’t turn up, who follows it up?
“They really don’t have the resources. There are checks and balances that might be put in place but, again, these are under-resourced systems trying to respond to a devastating event, probably not getting any more resourced to do it,” she said.
New Victorian research has also revealed that many parents who kill their children have experienced depression and therefore are likely to come into contact with GPs or mental health services.
The research also revealed that in such cases the warning signs were present but were not passed on to relevant agencies.
Ms Sharrock said these incidents should trigger meaningful rather than reactionary conversations around what checks and balances should be put in place in our systems of care.
She said that while we need to recognise it’s a person’s right to be treated in the least restrictive way possible, it’s also their right to be protected from the devastating effects of their illness.
“This lady, did she have a right to be protected from murdering her children and killing herself?” she asked.
“When horrible incidents like this occur we should look at our systems and our communications. And there’s no doubt that our communications and our assessments are rushed, our systems of care can be quite fragmented.”
Failures in the system
In South Australia in late 2009 Duke Hadley, 2, was killed by his mother, who was suffering an acute psychotic episode.
Coroner Mark Johns found significant failures in the mental health system which echo Kylie Fowler’s case. After inpatient treatment, follow-up care ceased and Rachel Hadley slipped through the cracks, with disastrous consequences.
“It is not unreasonable to speculate that had Ms Hadley been afforded proper and appropriate psychiatric care, she may not have relapsed and deteriorated to the point of the acute psychotic condition she suffered at the time of Duke's death,” he said.
The coroner made several recommendations for reforms to the mental health system in SA.
“The mental health system as currently structured does not ensure continuity of care and ... this should be addressed as a matter of priority,” he said.
The issues considered by Victorian coroner Judge Gray regarding Ms Fowler and her three children raise issues, not only of child protection, but whether the provision of education, information and counselling to the children of those suffering mental illness would have influenced a different outcome and evaded tragedy.
Section 81 of the Coroner’s findings detail that Ms Fowler had an 18-year history of episodic schizophrenia, and that a better understanding of her illness might have helped her children.
“Her symptomatology was severe enough to require involuntary admission to an acute psychiatric unit on five occasions and to have periods of extended community based case management. During that time, there is minimal evidence any of the children received information to improve their understanding of their mother’s mental illness,” Judge Gray said.
Recommendations from the inquest suggest the pilot program Families where a Parent has a Mental Illness (FaPMI) be rolled out across public mental health services and extended to include all regions of Victoria to improve mental health literacy for children and young adults who have a parent with a mental illness.
Continuity of care
However it was the failure of communication between mental health clinics and GP services that came under heavy scrutiny in the coronial inquests.
Kirsty Barger works as a clinician for a public mental health service. Her role is to assess people as they come into contact with a service for the first time, assess their mental state, conduct a risk assessment, and co-ordinate a response appropriate to the case.
She acknowledges there is a gap in follow-up where continuity of care is not always achieved, and that the policy around ensuring engagement after case management to a local service provider such as a GP has since changed.
But she also identifies the enormous pressure service providers are under to “fit the number”.
“There’s an extraordinary amount of pressure for people coming into acute inpatient unit. The Victorian Government key performance indicator of an acute admission is 12 days. There was one man who I’d worked with that had been in the hospital for almost 10 months – there was huge pressure to fit that number,” she said.
“When you’re talking about transferring people from inpatient to outpatient, do they leave hospital too soon?”
In her work, Ms Barger has found the FaPMI program to be beneficial to clinicians and clients, as it endorses a more holistic approach to mental health services.
“It’s a program around literacy, to acknowledge that patients are parents as well. Particularly when they come into hospital, clinicians must consider the implications of patients coming into hospital. There are trials and tribulations in living with a parent with a mental illness,” she said.
“All data was indicative that as a pilot program, this ought to be ongoing as it was found to be helpful, as not many clinicians would ask people when they were being admitted whether they had children.”
High toll of children
Each year, an average of 27 Australian children die at the hands of their parents.
The deaths of Luke Batty, Darcey Freeman, Brad Lees, and Yazmina Acar, along with Jai, Tyler and Bailey Farquharson, are etched in our consciousness as victims of filicide.
The deaths of sisters Savannah and Indianna Mihayo in Watsonia on Easter Sunday this year ignited an outpouring of public anger and mourning.
While those children were killed by their father, that is not necessarily the rule in such deaths.
Recent research from Domestic Violence Resource Centre in Victoria indicates women are almost as likely as men to commit filicide, and were 20 per cent more likely than the father to suicide after they killed their child.
Dr Deborah Kirkwood, a researcher with the centre, examined the motivations of men and women who killed their children, analysing case studies and 11 years of data gathered by the Australian Institute of Criminology's National Homicide Monitoring Program.
About 10 per cent of homicide victims in Australia are children and in 62 per cent of cases, their parents are the killers.
Between July 1997 and June 2008, there were 239 incidents where a child was killed by one or both of their parents.
These incidents involved a total of 291 child victims, and in 39 cases there were multiple child victims.
While the numbers horrific, they represent a small percentage of the total number of children who go through the Family Courts, have parents who separate or who are the subject of child protection reports, making it difficult to pinpoint the particular pressures that lead to these incidents.
Dr Kirkwood’s report suggests steering clear of labeling filicide as an ‘inexplicable’ tragedy, instead advocating for more effective ways to identify those children who are at risk of falling victim to their parent.
On July 1, the new Mental Health Act 2014 came into effect, which updates 30-year-old laws governing treatment of mental health and “promotes strong communication between practitioners, patients and their families and carers”, the state Mental Health Minister Mary Wooldridge said in July. A Mental Health Complaints Commissioner has been appointed.
People seeking support and information about suicide prevention can contact Lifeline on 13 11 14 or Suicide Call Back Service 1300 659 467 or follow @LifelineAust @OntheLineAus @kidshelp @beyondblue @headspace_aus @ReachOut_AUS on Twitter.
See other stories in mojo's series on mental health:
