Tertiary Initiatives for People with a Disability

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PSYCHIATRIC DISABILITY AND UNIVERSITY STUDY: WHO COPES?

Report of a Forum held at The Club House, St Lucia Golf Links, Brisbane on 24 May 1996

The following is the HTML version of the above 40 page document.

Psychiatric Disability and University Study: Who Copes?

CONTENTS

Foreword

 

Program

• Biographical Details of Contributors

Keynote Address

• Overview of Psychiatric Disabilities: Indicators and Functional Impact
• Video: One in Five

Panel Presentation of Life Experiences

• The Impact of a Psychiatric Disability on University Study and University Life
• Recognising the Indicators of a Psychiatric Disability and Taking Some Action: Duty of Care
• Pressures Caused by University Study; Coping Strategies and Seeking Support
• Implications of the Disability Discrimination Act

Support at University

Community Support Services

Summary of the Issues Emerging during the Forum

Appendix A

Appendix B

Appendix C

Appendix D

Appendix E

 

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ABBREVIATIONS

• AHMAC Australian Health Ministers Advisory Council
• ARAFMI Association of Relatives and Friends of the Mentally Ill
• CIT Computing and Information Technology
• CRS Commonwealth Rehabilitation Service
• DDA Disability Discrimination Act
• GU Griffith University
• HACC Home and Community Care
• HECS Higher Education Contribution Scheme
• ITAA Income Taxation Assessment Act
• NSW New South Wales
• QADA Queensland Anti-discrimination Act
• QUT Queensland University of Technology
• SA Student Adviser
• TAFE Technical and Further Education
• THEMHS The Mental Health Services
• TIPD Tertiary Initiatives for People with Disabilities
• UQ University of Queensland

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Foreword

Equity initiatives to increase the enrolments of academically qualified students with disabilities in tertiary education have been under the spotlight since the beginning of the 'nineties, stimulated by government policies and special funding and encouraged by advocates for people with disabilities who work within the sector. In large measure, universities have responded well to the challenge as can readily be seen by the increasing visibility of people with disabilities participating in campus life.

However, there are also many people with essentially hidden disabilities who face their own particular challenges in entering university, particularly those with psychiatric disabilities. They must decide, for example, if they can succeed without seeking assistance and, if they believe they need it, whether they can trust "the system" to provide such assistance with dignity, respect and genuine understanding. While staff in universities are gaining greater understanding of students and colleagues with disabilities in their midst, they too are challenged, to put aside former prejudices and inaccurate stereotypes as they come face to face with daily experiences that contradict earlier misunderstandings. Staff development activities can also support this process, as the present Forum demonstrates.

The Forum was organised by the Tertiary Initiatives for People with Disabilities Project to raise awareness of the challenges of university study for people with psychiatric disabilities and to focus on the functional impact of such disability on university study and university life more generally.

The report of the proceedings is based on notes taken during the Forum, or where possible, on copies of papers provided by contributors.

Judging by the attendance and the quality of discussion on the day, the response to this event was most encouraging. Among the 150 who participated were people with psychiatric disabilities and family members, workers from associated agencies, secondary school guidance officers, advisory visiting teachers, academic and service staff from universities and TAFE institutes.

The TIPD Management Committee is indebted to many people for the success of the Forum:

Members of the working party who planned and implemented the program:

• Ms Di Paez, Australian Catholic University (Convener)
• Ms Glenda Page, TIPD Project Manager
• Mr Mike Nelson, Rehabilitation Counsellor, CRS
• Ms Helen Glover, Consumer Network Officer, Caboolture Mental Health Service
• Ms Denise Woodhouse, Disability Officer, University of Queensland

TIPD office staff:

• Catherine Spencer, Julie Elliot and Margaret Smith

The staff at The Club House St Lucia Golf Links for their fine hospitality and excellent organisation.

Professor John O'Gorman from Griffith University not only provided an excellent summary at the conclusion of the Forum but also has prepared a detailed summary of the sessions in this report.

To all these people and to the participants who made the Forum such a worthwhile event, we thank you for your contributions. This report will be distributed to the Forum participants, and more widely to tertiary education institutions throughout Queensland and interstate.

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PROGRAM

9.00 am	Welcome and Introductions
9.05 am	Presenter: Dr Harvey Whiteford, Qld Director of Mental Health Overview of psychiatric difficulties; indicators, and their functional impact Video: One in Five
10.30 - 10.50 am	Morning Tea
11.00 - 12.30 pm	PANEL PRESENTATION OF LIFE EXPERIENCES Students: Ms Ganya Kordas Ms Helen Glover Ms Shirley Bennett Ms Melanie Scott The impact of psychiatric disability on university study and university life Lecturers: Ms Ricky Anthony Dr Monica Cuskelly Recognising the indicators of a psychiatric disability and taking some action: duty of care Families: Ms Jan McIntyre Pressures caused by university study; coping strategies and seeking support
12.30 pm	Lunch
1.30 pm	Presenter: Mr Chris Ayres, Human Rights and Equal Opportunity Commission Implications of the Disability Discrimination Act
2.00 pm	SUPPORT AT UNIVERSITY Mr Bruce Tills, Associate Director, Counselling & Employment, UQ Dr Barbara Tooth, Senior Lecturer, School of Nursing, QUT Ms Rhonda Watson, Disability Officer, UQ Ms Sophie Ridd-Doherty, Student Guild, QUT
2.30 - 3.30 pm	COMMUNITY SUPPORT Dr Kalyanasundaram, Clinical Director of Mental Health Services, Southern Sector, Caboolture Community Mental Health; also Senior Lecturer in Psychiatry, UQ Mr Mike Nelson, Rehabilitation Counsellor, CRS Mr Ted Crouch, Schizophrenia Fellowship Mr Michael McGrath, Field Worker, GROW Ms Jan McIntyre, ARAFMI Ms Karen Sullivan, Stepping Stone
3.30 pm	Issues: Professor John O'Gorman, Dean, Faculty of Health and Behavioural Sciences, GU Summary of the issues that emerged during the forum

Biographical Details of Presenters

Ricky Anthony

Ricky has a Bachelor of Business (Marketing) and is currently studying toward a PhD. She has freelanced for several years with University of Queensland, Queensland University of Technology, Griffith University, and University of Southern Queensland. Ricky has taught communication across a number of faculties, having set up Griffith University's course Communication and Clear Thinking she is now a lecturer at the University. Her research interests include, strategic marketing, information systems, problem based learning, reflective practice, improving teaching practice and maximising student outcomes.

Chris Ayres

Chris is an Education Officer with the Queensland Anti-Discrimination Commission. Prior to commencing this position he was a solicitor in Townsville. Chris is a solicitor of the High Court of Australia and the Supreme Courts of New South Wales and Queensland. Having teacher registration in Queensland and New South Wales, Chris' qualifications include: BAHons, GDipLegal Prac, MA, MEdHons, LLB

Shirley Bennett

Shirley is currently studying at The University of Queensland in a part time capacity. She has overcome many difficulties to be studying but can share with us her achievements as well as the required support networks she uses to participate in university life. Despite her illness, Shirley has a wide social network and participates in life in a very full capacity.

Ted Crouch

Ted Crouch has worked for Queensland Rail and has studied Arts and Law at Queensland University. In 1975 he was hospitalised for 13 weeks with a psychotic illness.

Monica Cuskelly PhD

Monica Cuskelly is a lecturer at the Fred and Eleanor Schonell Special Education Research Centre, Graduate School of Education at The University of Queensland. She is the Director of the education psychology programs which are offered jointly by the Graduate School of Education and the Psychology Department. Prior to joining the university staff she worked as a psychologist in schools and hospitals. Her research interests include the development of individuals with Down syndrome, the way in which families and their individual members respond to having a child with Down syndrome in the family, and families' connections to their communities.

Helen Glover

Helen has successfully completed a Bachelor of Social Work through The University of Queensland. She has a personal experience of living with a mental illness and shares with us the experiences of support required for this to have occurred. Helen currently works as the Consumer Network Officer for Caboolture Mental Health Service. In addition Helen joins Melanie in working for the psychiatric disability therapy field as a freelance consultant.

Dr Kalyanasundaram

Dr Kalyanasundaram is Clinical Director of Mental Health Services, Southern Sector at the Caboolture Community Mental Health. He is also Senior Lecturer in Psychiatry at The University of Queensland.

Ganya Kordas

Ganya is currently studying a Bachelor of Arts part time at The University of Queensland. Ganya is an active participant in the consumer movement in Queensland. She brings to this panel an experience of studying while living with a mental illness. Ganya is actively involved as a consumer adviser and is participating in the planning of The Mental Health Services Conference of Australia and New Zealand to be held in Brisbane in September.

Michael McGrath

Michael McGrath has worked for GROW for 20 years, in particular in the north of Brisbane.

Jan McIntyre

Jan has been State Coordinator/Field Worker for ARAFMI Brisbane Inc since 1994. Prior to this appointment, she was a telephone counsellor for Lifeline Brisbane. Currently enrolled in a Certificate in Community Services Management course, run jointly by Australian Institute of Management and HACC. Jan has five children aged between 12 and 27. One daughter has Bipolar, another has personality disorder. Jan's mother also has Bipolar and her deceased father had a personality disorder.

Mike Nelson

Mike is currently a Rehabilitation Counsellor at Commonwealth Rehabilitation Service.

John O'Gorman PhD

John O'Gorman is Professor of Psychology at Griffith University and Dean of the Faculty of Health and Behavioural Sciences.

Sophie Ridd-Doherty

Sophie is working with the QUT Student Guild as the Director of the Women's Department. She is currently studying a Bachelor of Arts in Drama.

Melanie Scott

Melanie is a key player in the consumer movement and currently is the co-convener for the 1996 The Mental Health Services Conference of Australia and New Zealand. Melanie is planning to return to University next year and is currently planning her course of study keeping in mind that she experiences a mental illness. She can share with us the hopes and dreams that she has for her future university life. Melanie works in Training and Development on issues pertaining to psychiatric disability and is active in many non-government organisations.

Karen Sullivan

Karen is a social work student on field placement at Stepping Stone Clubhouse.

Bruce Tills

Bruce is currently Associate Director of the Careers and Counselling Service, The University of Queensland, responsible for Counselling and Employment. He is a Psychologist and has worked in TAFE and universities as a counsellor since 1984. Bruce has also worked in prisons and as a family services youth worker.

Barbara Tooth PhD

Barbara Tooth is a Registered Nurse with a PhD in Clinical Psychology and is Senior Lecturer at the QUT School of Nursing. She has worked in integrated Mental Health Services in Wollongong, NSW before joining QUT. For four years she taught Mental Health at undergraduate and postgraduate levels and now is Co-ordinator of the Post-Graduate Mental Health Nursing Course. Her research includes Recovery from Schizophrenia: A consumer perspective. She is interested in finding out from people who have serious mental illness what helps and is useful.

Rhonda Watson

Rhonda Watson has been Disability Adviser at The University of Queensland since 1987. She was instrumental in the establishment of the Higher Education Disability Network in Queensland in 1990 and has been involved as The University of Queensland representative in the TIPD project since it commenced in 1991. She originally trained as an occupational therapist and then completed a Graduate Diploma in Counselling in 1984. She worked for many years as an occupational therapist in psychiatric hospitals and in the area of drug and alcohol rehabilitation.

Dr Harvey Whiteford

Dr Whiteford trained in medicine and psychiatry in Queensland before undertaking postdoctoral studies at Stanford University in California. He is currently the Director of Mental Health, Queensland Health, and is responsible for the State's mental health policy and planning and the monitoring of mental health programs delivered by the Queensland public health sector. Dr Whiteford has been involved for the past seven years in the development of the National Mental Health Policy and the National Plan to reform Australia's mental health services. He is the Chair of a number of national committees, including the Australian Health Ministers Advisory Council (AHMAC) National Mental Health Working Group which is overseeing the national mental health reforms.

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KEYNOTE ADDRESS

Overview of Psychiatric Disabilities; Indicators and their Functional Impact

Dr Harvey Whiteford, Director of Mental Health, Queensland Health

Dr Whiteford began by thanking the organisers of the Forum for the invitation to speak and noted that it was particularly appropriate that he should do so in what was Schizophrenia Awareness Week, which, like the Forum, is an attempt to raise community awareness about mental illness. He went on to point out that clinical and disability services had historically been separated and that the Forum's focus on psychiatric disability raises the need to bring those two sets of services into greater harmony. He also noted that when he was an undergraduate it would have been unthinkable for a person with a psychiatric disorder to be a university student (there may well have been such students but they were never identified) and that the recognition of psychiatric disability, ie., the functional difficulties that flow from a psychiatric disorder, is particularly timely.

Dr Whiteford then made a series of remarks about a number of the more common psychiatric disorders and the functional difficulties that they might give rise to in the university context.

Schizophrenia

Dr Whiteford told of his participation in research in the 1980's at Stanford University in the U.S.A. that examined the functioning of the frontal lobes of the brain in people with schizophrenia. The research made use of techniques for forming images of blood flow and metabolic activity in the brain while the patient performed various psychological tests including one, termed the Wisconsin Card Sort, particularly appropriate for studying decision making. Volunteers who were not suffering from schizophrenia showed clear patterns of activation of the frontal lobes of the brain while completing the Wisconsin Card Test ; the images of their brain activity literally showed the frontal lobes "lighting up" as they performed the test. Schizophrenic patients by comparison showed much less activation in that part of the brain while completing the test; their brains simply did not "light up" in the same way. The findings of this research are consistent with the view that schizophrenia is a biologically based disorder. Many of the difficulties that those who suffer from this disorder have in living in the community are a consequence of faulty brain function.

Dr Whiteford considered it was important to recognise that schizophrenia had a biological basis and was not the result of poor mothering, child abuse, dysfunctional families or one of the other environmental causes once proposed. If correctly understood, approaches to treatment and intervention are more likely to be effective. In this regard, he pointed out that neither institutionalisation nor release into the community unaided is the correct approach.

In pointing to some of the functional implications of the disorder, he noted that symptoms could occur episodically, with periods of normal functioning intervening, or could appear as a chronic illness, with some symptoms always present. Which form the disorder would take was not predictable at the time of onset. This meant that the particular form of support required for any one person suffering with the disorder could well vary from that required for any other and that traditional models of disability support, such as those developed in working with people with intellectual or sensory disabilities, could not be readily applied to those with psychiatric disorder such as schizophrenia. In terms of their academic performance, it would be reasonable to expect some impairment of cognitive functioning that would wax and wane in intensity and that could follow a cycle of days, weeks, or months.

Anxiety Disorders

Dr Whiteford noted a number of particular disorders under this heading including panic attacks, agoraphobia, and obsessive-compulsive disorder. These all occasioned great distress but were usually hidden from staff and fellow students.

Eating Disorders

Conditions such as anorexia nervosa were more frequent in some student groups than others. For example, the incidence was found to be higher in female dancers and athletes.

Substance Abuse

Abuse of various drugs was known to trigger psychiatric disorder in some individuals. Alternatively, substance abuse can mask psychiatric disorder, with symptoms that would alert observers to psychiatric disorder being attributed incorrectly to drug use. Chronic cannabis use, far from being harmless, was known to impair brain functioning and would as a result impact on academic progress.

Dr Whiteford noted that a peak time for onset of psychiatric disorders was late adolescence and early adulthood, the age when many students are beginning university studies. Beginning life at university might, for those who are vulnerable, trigger psychiatric disorder.

In considering the functional implications of psychiatric disorder, it was important to recognise that there was a double jeopardy for those so affected: there were the impairments of cognitive and emotional functioning that the disorder brought and there were the reactions by society to the disorder. These reactions were usually highly stigmatising and discriminatory.

Dr Whiteford went on to discuss reactions to the recent mass killings at Port Arthur in Tasmania and the effects that the press coverage had had on some individuals suffering from schizophrenia. Although there was no factual evidence to support it, a comment by a police officer to the effect that to do such thing a person would have to be schizophrenic had been seized on by reporters and turned into the claim that the person charged with the murders must be a schizophrenic and rapidly into routine references to the 'schizophrenic gunman'. Although the research evidence indicates that schizophrenic patients are more likely to be victims of violence than perpetrators, the popular imagination sees it otherwise and the media are quick to play on this, for example, by using sensational headlines that often are contradicted by the content of the stories that they introduce. In the case of the attribution of schizophrenia to the person charged with the offence in Tasmania, the result had been the suicide of some patients with schizophrenia who, apparently from reports prior to their deaths, were concerned that they might commit mass murder.

Dr Whiteford concluded with a plea to members of society to change their attitudes to schizophrenia and other psychiatric disorders, and to be more tolerant and accepting so that those suffering from these disabilities do not have to deal with the disability that flows from the stigma as well as the disability that flows from the disorders themselves.

VIDEO: One in Five

The video was the story of Steven, told by himself, of the onset of his schizophrenia, of the difficulties he faced, and of his adjustment to his illness. He was 21 at the time, completing a Bachelor of Education. He had noticed that his thought processes had not been clear for some time. He developed ideas that people were following him, that there were plots against him, and he began to hear voices. There was little sign of his difficulties to his friends, other than he became quieter. He stopped going to university and shut himself away. He came to believe that his thoughts were being monitored and that simple household appliances were being used for this purpose. He found some peace by going to the beach because there he could calm down and get things into perspective.

He was worried about being labelled and for this reason did not seek help early enough. He knew what he would think about people who heard voices and he assumed other people would think that way about him. His mother, who had been overseas when the illness began to develop, got him to see a general practitioner who referred him to a psychiatrist who recommended a period of hospitalisation. He was very upset when admitted to hospital. He had seen the motion picture 'One Flew over the Cuckoo's Nest' and imagined that a similar fate was his. He found hospital very trying at first, completing psychological tests and answering the same questions being put by four different professionals. The turning point came when a nurse quietly but firmly got Steven listening to him rather than to the voices in his head. He now looks back on the hospitalisation as a positive experience.

He went back to university and finished his degree but he did not let it be widely known that he had been hospitalised for schizophrenia. One member of the academic staff in whom he confided disputed that he could in fact have schizophrenia because if he had he could not be successfully completing his studies. As a result of his illness he became interested in studying psychology, but found that he would not be accepted into a Master of Clinical Psychology because of his illness. He also experienced discrimination from some employers when he sought work, although he had since found a job suited to his ability and qualifications.

His illness comes and goes. Sometimes he feels as if he is about to lose control. This happened once on a tram and his distress was so intense that he had to get off and walk. He walked for a long time and then asked two policemen in a parked police car for help but they told him to go away. Finally he walked into a private home and the woman there sat down with him and talked quietly with him until he calmed down. When he is not well he is inclined to misinterpret what people say and to become highly suspicious of their motives. He has found that stress is likely to bring on symptoms and that he will become tense and his tenseness can make him aggressive.

He now knows that mental illness is just that, an illness and not a weakness. Coping with his illness has meant some changes to his lifestyle but he has accepted the changes, seeing them as necessary in order to grow.

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QUESTION TIME

Questioner 1. The workplace is becoming increasingly stressful. How can people like Steven be expected to cope with this?

Dr Whiteford. People with a psychiatric disorder need to identify what are sources of stress for them and strategies, such as relaxation, that will help them deal with stress. The best approach is not to lock themselves away from society, wrap themselves in cotton wool as it were, but to learn how to deal with the world as it is.

Questioner 2. In your account of the various types of psychiatric disorder, Dr Whiteford, you did not mention depression.

Dr Whiteford. Yes, I should have said something about depression as it is more common than schizophrenia. Depression ranges from mild mood instability, much as we all might feel at some time in our lives, to major depression. It affects the person's attention, concentration, and memory. When severe it cannot be shifted by any effort of will on the part of the person suffering it, nor does it respond to positive changes in the person's environment alone.

Questioner 2. What happens when it doesn't go away for 12 to 14 years?

Dr Whiteford. Then I would say there are likely to be two conditions involved. One is an underlying dysthymic condition on which is superimposed bouts of depression.

Questioner 3. What is your preferred terminology? Mental illness, mental disorder, psychiatric handicap, psychologically challenged?

Dr Whiteford. After long thought about this and discussion with a variety of people involved in this area, including importantly consumers, I think it is better to confront it and use a term like mental illness or psychiatric disorder. If we find a term that does not have the same current degree of stigma attached to it and begin using that term, we will find that in time the stigma will come and we will need to move on to another term. It is better to accept the condition for what it is and work on the stigma attached to the label. As for psychiatric disability, there is no good definition of this. It embodies the functional implications of having a psychiatric disorder.

Questioner 4: Where do the personality disorders fit into all of this?

Dr Whiteford: This is a very good question. What I have been talking about are psychiatric disorders that happen to people. Just like any physical illness they strike the person living a normal life, although that person might have some genetic vulnerability for the condition. The personality disorders, by contrast, arise from the way the individual has developed, from the sort of person they are. They can be exaggerations of traits which are normal personality traits. For example, a certain degree of obsessionality can be useful, particularly in the life of a university student, but when this goes to the lengths that the person must constantly rewrite their assignments because they are not up to standard, with the result that they never submit their work for assessment, then we have an exaggeration of a normal trait into a handicapping disorder. We do not know as much about the personality disorders and we need to pay them more attention.

Questioner 5. You spoke of the aftermath of the Port Arthur killings and the distress suffered by schizophrenic patients made to think that such an outcome was to be expected of people who suffer this illness. What is being done for them and for their relatives?

Dr Whiteford. We made a number of observations on the gun control debate, among which was that the evidence indicated that 84% of those committing multiple homicides (more than 4 people killed) in Australia and New Zealand over the period 1987 to 1993 had a firearm licence and 86% had no history of mental illness.

Questioner 6. Could you offer some advice to those staff at university who have to deal with students with psychiatric conditions, without clear guidelines on students rights or of what can be done for them? [The questioner went on to outline a particular case of a student who was creating considerable difficulty for staff.]

Dr Whiteford. From the case outlined, I think we are back to the earlier questioner about personality disorders. Where we have relatively clear symptoms, such as for schizophrenia, and we have a known treatment, then we have a relatively straightforward situation where we can offer clear advice. Where we are dealing with a personality disorder the situation is not straightforward and often many forms of treatment do not help. I do not have the answers for clear guidelines in these situations. It is a case by case assessment.

Questioner 6. But what can we do as a system for this student?

Dr Whiteford: If the student is impinging on the rights of other students or staff, then the student needs to be confronted with their actions and its effects and asked firmly to modify their behaviour.

Questioner 7. What of the stigmas attaching to the term 'personality disorder'? Is there an alternative?

Dr Whiteford. You could use character disorder, but it is better to keep the term personality disorder and tackle the stigma.

Questioner 8. Can high schools prepare students for university and can they identify the precursors to a mental illness at university?

Dr Whiteford: One of the things that high schools can do is to encourage students to talk openly about the topic of psychiatric illness. Teenagers are often far more willing to talk about depression, eating disorders and the like than teachers. Allowing high schools students to talk about these conditions takes away some of their [the conditions'] menace. Beginning with high school students, we might make it okay for society to talk about mental illness and its effects.

Questioner 9. There are not enough support services in the community for people with mental illness. We might be able to identify a student in need but it might be three weeks or more before the service can see that person.

Dr Whiteford. The problem is that mental health competes for the health dollar along with all other health needs. Currently, of the $2.7 billion spent on health by the State Government, only $170 million goes to mental health. Politicians respond to what the community wants.

Questioner 10. What feedback are you getting from patients to help you revamp health services?

Dr Whiteford. I have to be honest and say that consumers do not think I have made an impact yet, but the program is still in its infancy and we need to wait for the mid-term to assess its effectiveness. The process is gradual and legislation will not alter community thinking. But programs do work eventually, as we have seen with the change in the community's appreciation of intellectual disability.

Questioner 11. Have you considered retraining for those who are the first point of contact for people with psychiatric illness?

Dr Whiteford. Yes, we have and we are doing something on this front but the fact remains that some of our staff have old-fashioned attitudes.

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PANEL PRESENTATION OF LIFE EXPERIENCES

Students, University Lecturers, Families

Student Perspectives: The Impact of a Psychiatric Disability on University Study and University Life

Ganya Kordas

People with a psychiatric illness in our society are not considered as valuable as those without such illness. I have battled through at The University of Queensland with good support from counsellors and staff. I want to work in mental health. One of my major problems has been my concentration level and the effects of medication on this. I might seem lazy at times, but this is a result of my medication which helps keep my thinking straight. A second major difficulty is the lack of scholarships or other financial support for people like me. I get $60 a fortnight from Austudy. I am a mature age student without a family support network and I have, in addition to the expenses that other students have, the expenses of medication and medical fees. I have a determination to succeed and will 'hang-in' there but I need support.

Shirley Bennett

I suffered a near-fatal car accident that left me unconscious for 10 days and with serious head injuries. I recovered after three months with rehabilitation. I had to teach myself a number of things all over again, like typing. My planning wasn't good and I could not keep a job. Finally I was given the diagnosis of manic depression. In 1994 I went back to university. I had, before the accident, completed a degree in music and administration. I began again with psychology but found that my mathematical skills had deserted me and the statistics component of the course frightened me. I dropped psychology and took up English. The staff kept giving me extensions and I finished with a 5. I commenced again with sociology but now have changed to German. I was sick for a period and missed the conversation classes but finished with 38/60 which I was happy with. What I have learned is the need to accept my limitations and lower my standards accordingly. I plan to do some French and then Spanish and some music for pure enjoyment. I know that there will be another depression in a few weeks but I will ride through that.

Melanie Scott

I was at university before my illness, which is bipolar disorder, and remember the stress and I am a bit fearful of that because stress triggers my illness. I concentrate on recognising my symptoms and taking action early. I know the importance of building a good support network including my family and friends and recognise the need to reach out to them. One of the issues facing me is whether or not I should disclose my illness to those at university. In general, I have been quite straight about this until now, because if I have 'hang-ups' about being honest about my illness what can I expect of others. One of my major concerns about disclosure is that staff might give me special consideration all the time and this will minimise my achievements. I am as good as anybody else but I do need help. If I do not disclose it may become evident when say I am on a high in the middle of a tutorial and then I will be labelled as 'that crazy person'. People are becoming more enlightened. Don't lower your expectations of what people with mental illness can do.

Helen Glover

I completed Social Work at The University of Queensland. I entered the course when I was very ill and completed 75% of it from my hospital bed. I was supported by a strong peer support network. I experienced stigma and discrimination from staff, although not all of them. The basis of this was fear. People used my need for special consideration to limit my opportunities. Some, however, respected my ability and allowed me to learn in my own way. I remember that to fill in my Queensland Tertiary Admission Form I had to ask to be released from my restraints. I was not encouraged by the doctors treating me and they became concerned when I told them I planned to use my degree. They set all sorts of limits on what I should do. I am now working with Dr Kalyanasundaram at Caboolture. I suffer daily from my illness. As to the question to disclose or not, there is certainly a big risk in disclosure. If you do, don't play the victim; take responsibility for yourself. The episodic nature of your illness will put you at a disadvantage as you may have to go to hospital for periods and this will interrupt your work. Psychotropic medication makes you sleepy and affects concentration and memory. My memory is short term. University study involves reading a great deal and synthesising. I had to learn to make notes to compensate for my memory difficulties. Examinations are stressful and extra time is not the only or the best way to cope with this. As a general rule, it is of most assistance if you help people with psychiatric illness to plan. Listen to them rather than tell them what you can do for them.

University Lecturer Perspectives:

Recognising the Indicators of Psychiatric Disability and Taking Some Action: Duty of Care

Dr Monica Cuskelly

Dr Cuskelly introduced her presentation by pointing out that she was basing her remarks on her personal experience rather than on any research she had conducted. As she saw it there were four main issues that needed to be addressed.

Identification: In her experience, students were identified as having a psychiatric disability primarily as a result of self disclosure. She works with small classes of postgraduate students and this might be a factor; self disclosure may be less likely in large first year classes. In some cases, a colleague may tell you. In others, you might ask questions that lead to disclosure, but in general if the student does not disclose the staff member will not know. There are currently no guidelines to assist staff to answer such questions as: Should I act on the information provided by another staff member or wait until the student discloses to me? If I suspect on the basis of my observations of a student's behaviour that there might be a problem, should I confront the student or ignore the behaviour? What, if any, obligations do I have to refer a student experiencing psychiatric problems? To where can I refer such a student, as information about the services available is likely to be quite limited for staff outside allied health programs? What is the proper role relationship with such a student - supportive teacher or counsellor, particularly if the relationship with the student is a good one?

Confidentiality: If a student has confided in a staff member, should the information be passed on? Who, within the hierarchy of the university, should receive the information - that is, without the student's consent? If the person confided in has little authority within the system, what should be done to provide help? How much information should be released to placement supervisors in the interests of protecting the student?

Accommodations: These have to do with variations to the course to ensure the student's success. These variations should not reduce the quality of the work required but allow the student's capacity to be shown other than in standard ways. One problem here is that accommodations can make the student's situation known to other students who may not otherwise have known, and may lead to resentment on the part of other students who consider the accommodations being made are unfair. A typical response might be - 'I suffer from stress too, why can't I get an extension?' A difficult judgement for the staff member arises where the assessment item is likely to generate performance anxiety in the student. The task being assessed may be performed well outside the assessment context, but within that context anxiety impairs performance quite markedly. Can the staff member make allowance for that or must they take the view that all they can legitimately base their judgement on is the assessed performance of the student?

Duty of Care: To whom do we owe a duty of care as academic staff, particularly those involved in professional training? To the student ? To the adults and children whom the graduate will be working with? In the case of my own professional area, educational psychology, there is a problem in that the educational psychologist is an itinerant, travelling between schools and spending insufficient time in each to build up much contact with other staff. Hence, if he or she becomes ill, there may not be anyone in the work situation who will notice that possibly for some time. This is a difficult issue. In the video we watched, Steven noted that he felt discriminated against when he was not admitted to a postgraduate program in clinical psychology, but then went on to say that during the periods of his illness he did not interpret people's reactions correctly. Interpreting other people's behaviour would seem to be a significant aspect of the work of a clinical psychologist. Were those who denied Steven a place properly exercising a duty of care? There is a further complication: A person may not disclose their condition and gain admission to a course, graduate and go on to be a useful professional. Had they disclosed they might not have been admitted. Thus disclosure can result in inequalities in the way students are treated.

Ricky Anthony

Ms Anthony outlined the features of the first year subject she teaches in Communication and Clear Thinking. The subject is a full year subject taken by students in the School of Computing and Information Technology at Griffith University. Approximately 80% of the class are 18 year-old Australian males, with the remainder being overseas or mature age students. She is advised by the University if a student in her class has a vision or hearing disability, but she is not advised if a student has a psychiatric disability. The problem here is 'How do I not set off their buttons if I don't know they have a problem?' The general approach taken in the subject is that students want outcomes, they want results, but they have their problems in obtaining those outcomes. The teacher is there to help them get those outcomes by assisting with their problems. The model is an educational one rather than a psycho-counselling one. Students know what their needs and problems are and you need to take the time to listen and to be there for them. All materials for the course are provided at the outset on the World Wide Web. The pressure points in the subject are known and the coordinator is watchful for the signs of stress: attention difficulties, mood swings, medication related side effects, fatigue, concentration difficulties, lack of self-confidence, short term memory loss. This oversight is provided to all students and those with psychiatric disabilities are therefore included. A major factor in the success of the approach is considered to be the genuine interest in the students taken by the coordinator and her availability to them. If the approach were applied to students with psychiatric problems in other universities, coordinators would need to be provided to help with the students educational needs and parents should be included as an essential part of the approach. (Refer Appendix A)

Family Perspectives:

Pressures caused by University Study: Coping Strategies and Seeking Support

Jan McIntyre [as provided by Ms McIntyre]
Daughter 26; Bipolar; works full-time; studies part-time

Along with the usual stresses involved with commencing university study, my daughter had to deal with her highs, anxiety states and depression. She was living independently at the time as she had done for seven years. However a few months into the term she returned to live with me and is still doing so.

I had learnt years ago to let her take care of her own affairs. Her insight into her illness had led her to seek psychiatric help years before her family even knew what the problem was. The memories of how difficult living together had been back then still worried me and I was on eggshells for the first few months. As time went on I relaxed and was filled with admiration for the way she handled the ups and downs.

The worst times were, understandably, when assignments were being assessed. I knew if she received a 6 instead of a 7 she would be devastated.

So, what helped her to cope? Having a psychiatrist who relies heavily on counselling with his patients and resorts to medication only when necessary; one who makes an appointment for her at 9 pm and spends an hour with her. This doctor has, over the last seven years, helped her to maintain employment, ride out the break up of a long-term relationship and come through highs which would otherwise have seen her burn out.

Another resource for her was the support of her family, once we knew what the heck was going on. Actually being told the diagnosis and then learning about the illness made a tremendous difference to our family unit. This is often an area overlooked by professionals and it can be years before the carers are taken into the picture and given the support they need.

For my daughter, her illness has not been a disability. A challenge, certainly, but it has not stopped her from achieving her goals and setting new ones.

QUESTION TIME

In the question time that followed, a number of members of the audience spoke from the floor. It was difficult to record this session as a series of questions to particular members of the panel and their responses to those questions. Instead a brief synopsis of the central issues is provided.

Determination on the part of the student to succeed is a major factor. Assistance must foster student control and not erode it. That is, services for students with psychiatric disabilities must respond to the needs identified by the students and must not create a false situation for them in which, as it were, the world revolved around them. Service delivery, whether they want it or not, is counterproductive.

Students need to assert themselves, because they often experience being devalued because of their condition. They are not just passive recipients of services but users of services who can make sensible decisions for themselves.

Disclosure is a matter for the student. Few disclose because of the fear of the consequences. In the case of students with depression, staff have to understand that one of the symptoms in a student who discloses might be difficulty in trusting others and the belief that everyone is against them.

Models of assistance need to recognise that not all students have families to support them.

Services for people with psychiatric disorder are not very responsive. That is, their response time seldom matches the peak need of the person with a psychiatric disorder. One way of dealing with this is to have a network of support and not simply rely on one disability officer.

The community needs to talk more about mental illness and its consequences. An honest, factual approach to it at school would be a good start.

IMPLICATIONS OF THE DISABILITY DISCRIMINATION ACT

Chris Ayers

'In failing to accommodate the needs of students with psychiatric disabilities, do HECS, AUSTUDY and University enrolment policies contravene the Disabilities Discrimination Act?'

1. An Overview of Anti-Discrimination Legislation

1.1 Why Two Acts?

Commonwealth legislation is limited under the Constitution to specific powers;

State law complements this legislation.

The definitions of 'educational institution' under the Queensland Anti-discrimination Act 1991. (QADA)1and the Disability Discrimination Act. 1992 (DDA) encompass universities.

The DDA is specific legislation dedicated to reducing discrimination against people with disabilities; the QADA incorporates thirteen attributes of which impairment is one.

Thus both Acts have application. The DDA has direct application in regard to Commonwealth laws and programs funded or administered by Commonwealth legislation as well as a general application.

1.2 What is discrimination?

Discrimination occurs when one person treats another person less favourably because that person has a disability3 or an impairment.

Under both Acts, discrimination may be direct or indirect.

Direct Discrimination

This is discrimination on the basis of disability (DDA) or one of the attributes listed (QADA). It happens when one person treats or intends to treat, another person who has one of these attributes, less favourably than they would have treated a person without that attribute in similar circumstances.

Direct discrimination on the basis of an attribute happens if a person treats, or proposes to treat, a person with an attribute less favourably than another person without the attribute is or would be treated in circumstances that are the same or not materially different.

Indirect Discrimination

Indirect discrimination may be said to occur where an unreasonable rule, requirement, condition, practice or company policy disadvantages a particular group of people more than others.

eg. Scott v Telstra Corporation, Human Rights and Equal Opportunity Commission, No H 94/34.

2. Disability Discrimination

2.1 Psychiatric disability and impairment under State and Commonwealth Law.

Psychiatric disability is covered by the definition given in the Disability Discrimination Act. 1992 (DDA)

(f) a disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction; or

(g) a disorder, illness or disease that affects a person's thought processes, perception of reality, emotions or judgement or that results in disturbed behaviour;

Psychiatric disability is included as an 'impairment' under the Queensland Anti-discrimination Act 1991 (QADA).

2.2 What exemptions apply to enrolment policies of education institutions?

The DDA renders it unlawful for an educational authority to discriminate against a person or a student on the ground of disability unless the educational institution is one which is wholly or partly established for students with a particular disability or where a defence of unjustifiable hardship can be established.

The QADA prohibits discrimination by an educational institution in the student area unless special services or facilities are required which would impose unjustifiable hardship on the educational authority.

2.3 What is meant by 'justifiable hardship'?

Unjustifiable hardship is defined in both the DDA and the QADA. Under the DDA, an educational institution is meant to make 'reasonable adjustment' to accommodate students with disabilities. However, where the burden of providing such adjustments is high, then the institution may argue such adjustments impose unjustifiable hardship.

2.4 Higher Education Contribution Scheme:

The QADA has no application since the HECS Tax is Federal legislation and therefore attracts the jurisdiction of the DDA.

Income Tax Assessment Act 1936 - HECS provisions make no special allowances for people with disabilities. The meaning of discrimination lies with the treatment by one person (the discriminator) of another person (the aggrieved person) less favourable.

There is no discrimination application to the DDA - all students are HECS liable under the relevant provisions of the ITAA. The Australian Taxation Office does have various discretionary powers that are applied in certain circumstances. If a person with an intellectual impairment was unable to comply with the requirements of the ITAA specifically because of their disability, then they may, depending on the circumstances and with each case looked at individually on its merits, be able to argue, for exemption from HECS. It is not my purpose to examine this since it is a matter of Taxation law rather than anti-discrimination law.

2.4 Austudy

Any benefit under Social Security Act 1991 becomes a policy matter.

Commonwealth Rehabilitation Service (CRS) and certain other Commonwealth departments offer programs to assist people with disabilities. An important issue is often over carer hours. Specific programs fail to provide the type of assistance and support required, particularly where there may be a combination of psychiatric and physical disability.

Funding - or the inadequacy of it - is a major human rights issue. The Report on the National Inquiry into Human Rights of People with Mental Illness found "people with psychiatric disabilities have never received the same level of funding and access to vocational services as other disability groupings". In 1991, for example, programs for people affected with mental illness receive just 2.2% of long term funding.

Whether or not an AUSTUDY benefit discriminated against a student would once again depend on the individual, each case being considered on its merits.

3.1 A Right to Work

There is compelling evidence of the beneficial effect of employment on people with psychiatric disabilities. However, for employment to be meaningful and relevant to the particular person with the psychiatric disability, then proper and equitable access to education is essential. University enrolment policies should reflect this need.

3.2 A Right to Study

This may require putting in place systemic changes to broaden assessment and evaluation processes where people with psychiatric disabilities are concerned. Such changes may need to address the way students with psychiatric disabilities are taught and assessed as well as the availability of support services and learning aids. People with certain manifestations of psychiatric disability may achieve lower levels of educational achievement because of difficulties in study skills or communication skills. 'Reasonable adjustment', under the DDA and the QADA would anticipate flexibility to allow fair comparison between students with psychiatric disabilities and those without. This clearly poses a challenge for institutions of higher education.

3.3 Part of the Problem or part of the solution?

The Report on the National Inquiry into Human Rights of People with Mental Illness found that tertiary institutions were highly inadequate in providing support services for people with mental illnesses.

At present no university appears to include mental illness as part of a disability support program and some universities have stated they do not wish to include mental illness as part of their disability support program. Students having a breakdown in health are often not given or advised what their options are.

There appears to be significant room for improvement if universities are to meet the needs of students with disabilities once they have been enrolled.

3.4 Guidelines for Special Arrangements.

Each student should be considered individually. Established examination procedures may need to be reconsidered. Flexibility rather than rigidity of thinking is a key requirement.

Enrolment at university is merely the first hurdle for a person with a psychiatric disability. The student will continue to be disadvantaged unless reasonable adjustments are made to provide access to learning facilities appropriate to the needs of the student. Such reasonable adjustments may be applied in courses taught at the university.

3.5 Towards a solution

Universities may need to develop a range of support services. The report on the National Inquiry into Human Rights of People with Mental Illness notes "(the concept of 'the least restrictive environment' should be the guiding principle in determining the type of special educational programs and services which people with mental illness should receive".

However, a broad approach may be needed to satisfy the reasonable adjustments required under the DDA and QADA. This would apply not merely to admission procedures but to teaching methodology, assessment and evaluation techniques as well as the provision of appropriate support services.

In making these efforts to accommodate the needs of students with psychiatric disability, not only will a fairer enrolment and pedagogical structure be put in place, but the risk of contravening discrimination legislation will be significantly reduced.

Bibliography

Australian Bureau of Statistics, 1991 Census of Disability Services (AGB Australia, 1991.)

Commonwealth Rehabilitation Service, Vocational Rehabilitation for People with Psychiatric Disabilities, AGPS, Canberra 1991, p1.

Hayes, R, and Hayes S. Mental Retardation - Law, Policy and Administration Law Book Company, Sydney 1982.

National Health Strategy, Enough to make you Sick, Research Paper No.1 AGPS Canberra 1992.

Report on the National Inquiry into Human Rights of People with Mental Illness, Human Rights and Mental Illness, Human Rights and Equal Opportunity Commission, Victoria. December 1995.

Report on the National Inquiry into Human Rights of People with Mental Illness, Human Rights and Mental Illness, Vol 1 Human 'Rights and Equal Opportunity Commission, AGPS 1993, p.410.

Webster, I, "Health Costs of Unemployment" Mental Health in Australia Vol 1, No 12, pp 17-23.

QUESTION TIME

Questioner 1. Who makes a complaint? Who sues whom?

Mr Ayers. An action would be brought by the student against the university.

Questioner 2. At least one university in this city includes a question on the enrolment form asking whether or not the student has a disability. If a student does not indicate in completing the form that he or she has a disability, could the university subsequently plead that it did not know of the disability if an action for discrimination were brought by the student.?

Mr Ayers. There is a real problem about confidentiality and invasion of privacy in asking such a question. The only justification for it is that the answer will help the student providing it. It is not good enough to say that the answers will be collated and used to gain funding from the government or for some other administrative purpose.

Questioner 3. The question needs to be a more refined one than simply 'Do you have a disability?' and should seek to determine how any such disability might affect the student's study.

Mr Ayers: The student does not have to disclose the nature of the disability.

Questioner 4: At my university students are told exactly how the information is going to be used.

Mr Ayers: Answering any such question must be on a voluntary basis.

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SUPPORT AT UNIVERSITY

Bruce Tills (Counselling)

Mr Tills began by distributing a pamphlet outlining the services provided by his unit and then went on to make the following remarks.

There has traditionally been a separation of disability and counselling services in universities. This does not recognise that consumers often require a range of services. One-to-one services are the standard for most counselling units but this may not necessarily be the best service provision. For example, working with groups to help members learn stress management might be more effective.

Resources for service provision are currently under threat. This, coupled with the fact that the consumer movement is currently working its way into universities, means that counselling services need to ask users in a systematic way what services they want and how they want them delivered. Briefer services that are more readily available may be really what users want, even though this might be hard for the service providers to accept.

The separation between counselling services and disability services will need to be broken down if effective support for students with psychiatric disabilities is to be provided. There are no clear boundaries between psychiatric, psychological, and emotional difficulties. It is, however, easier to work with a client with a 'labelable' disorder in terms of advocating for them to the university.

Barbara Tooth (Health)

Dr Tooth outlined the health services provided at her university. She noted that staff of the health service on each of the campuses might be called out to deal with suicidal students, anxiety problems arising in examinations, or might see stress related disorders. They operate a referral service. They also do some health education work, but nothing is currently being done for schizophrenia. Given the current level of demand on the service it would be difficult for it to collaborate with other services.

Dr Tooth went on to talk about research being conducted by Dr Kalyanasundaram and Helen Glover which is directed at understanding, from the consumers' viewpoint, what helps in recovery from schizophrenia. The essential finding is that what helps most is to be a normal person in society, eg., to have a job. She noted that many consumers interviewed would not disclose their condition because of the discrimination they would suffer. Nursing academics show this discrimination and use the duty of care argument to support it. Hospital staffing policies discriminate against nurses with psychiatric disabilities. (Refer Appendix B)

Rhonda Watson (Disability Officer)

Our approach is that students are responsible adults. We offer a service and students choose to use it or not. Approximately 40% of the students we see have identified themselves to the university as having a disability.

Students with a disability receive the same degree as any other student and they must feel that they have earned that degree. We seek to provide reasonable accommodations but ones that do not alter the standard of what is required for the degree.

Every student is an individual and they know what their needs are. The service must be tailored to the needs of the individual student.

A range of accommodations can be made, including modifications to the timetable, providing rest pauses in examinations or surrogate borrowers for students with agoraphobia, and alternative forms of assessment.

We provide general support and encouragement for students but recognise that we work within a system and that not all staff have the same attitude to students with disabilities.

The need to respect confidences often limits what can be done. (Refer Appendix C)

Sophie Ridd-Doherty (Student Union)

Ms Ridd-Doherty spoke of the experience of the Student Union with students with psychiatric disability. (Her notes were prepared by Sue Greig.) The first point of contact for students wanting access to Guild services is the Student Information Officers. A survey of these officers indicated that no student had disclosed a psychiatric disability to them. The Education Office had noted that students, on occasion, did not seem to be acting rationally or had ideas that they were being persecuted, but whether any of these instances resulted from psychiatric illness was not a judgement that the Education Officer could make. The Women's Officer in 1995 had been approached by a student seeking help with an eating disorder. Some other students appeared to have such a disorder. The Welfare Officer sometimes sees students with what appear to be problems of a psychiatric nature. In general, the Union is willing to support all students and will refer students who approach it for help, but officers of the Union have no expertise that allows them to assess students' mental health and they do not attempt to do this.

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COMMUNITY SUPPORT SERVICES

Dr Kalyanasundaram (Community Mental Health)

The Commonwealth Government is coming to recognise that psychiatric disorder can give rise to disability. Likewise there has been some improvement in the State government's funding for mental health. There is still, however, a large gap between the services provided and the needs of those with psychiatric illnesses. One statistic illustrating this is that 45% of people with psychiatric disorders do not use the services that are provided. This has a lot to do with a reductionist approach to illness, which is to identify the problem and then fix it. A more relevant approach is to ask what does it take to have a person with a psychiatric disorder live in the community with dignity.

Dr Kalyanasundaram went on to describe the service that he had developed in Caboolture over recent years and to contrast it with the traditional approach. The vision statement for this service proposed that the rights, options, and opportunities of those with mental illness are the same as those of any other citizen. He stressed that, while he could as a doctor provide illness management and could attempt to facilitate recovery, rehabilitation was a matter for the community. For that reason he had been involved in the development of a mental health network of Caboolture and Kilcoy which had proved effective. (Refer Appendix D, Framework for Support)

Dr Kalyanasundaram pointed out that we needed to change our attitudes to those with mental illness and appreciate their citizenship and recognise that there was much to learn from people who had suffered through their illness. We have to recognise that there are choices that can be made and that people with a mental illness should be allowed to make and not simply be regulated and forced into hospital or consigned to psychiatric communities which are nothing better than ghettos. People with psychiatric disorders need meaningful human interaction and respect and support for their citizenhood.

Mike Nelson (CRS)

The Commonwealth Rehabilitation Service (CRS) provides short term rehabilitation for clients through a package of services directed to client need. Eligibility for use of the service is broad based and can be accessed through self-referral or by referral by a professional. CRS asks: Can we provide the service wanted and, if we can, will there be a gain for the client through the provision of the service? If the answers to these questions are positive, a program for the client is designed which may include a range of activities such as on-the-job training, work experience, counselling, or job search skills.

The CRS unit in Anzac Square in Brisbane is a specialist unit for people with psychiatric disorders. It applies a model of empowerment or enablement, which sees the Unit as a resource that can be drawn on by the client to help them with the problems in their lives.

It is not clear what implications the Commonwealth Government's spending cuts will have for the services that can be provided or the policy framework in which they will be delivered.

Ted Crouch (Schizophrenia Fellowship)

The Schizophrenia Fellowship currently does not have a special program for tertiary students who may suffer from the disorder. It does provide assistance through its existing network, that can be contacted through its office at 95 Arthur Street , Fortitude Valley in Brisbane. It provides advice to families, engages in community action aimed at fighting the stigma of schizophrenia, and supports research into the illness. (Refer Appendix E)

Karen Sullivan (Stepping Stones)

Stepping Stone uses a club-house model. Members are responsible for the running of the club, which provides a place where they can go that is stress-free and where they can discuss their problems. It can help people to learn that there is life after hospitalisation, help them to develop social skills, and to identify achievable goals. It also negotiates job placement for members and provides a guarantee to the employer that the member will be supported in the job when necessary.

Michael McGrath (GROW)

GROW was formed 39 years ago by people who had been hospitalised for their illness and who found that after hospital there was no support. There are now 650 GROW groups in 6 countries. GROW has a 12 step plan that can assist but only if people are prepared to put effort into the program.

Jan McIntyre (ARAFMI)

ARAFMI (Association for the Relatives and Friends of the Mentally Ill) is a community organisation that focuses on those who care for people with psychiatric disabilities. It is not for people with mental illness but for those who look after them. If provides an opportunity for carers to talk openly and honestly about their experiences and difficulties in what they call their 'sharing and caring' meetings. Through these they provide people who are willing to listen and importantly people with first-hand experience of what is being talked about.

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SUMMARY OF ISSUES EMERGING DURING THE FORUM

Professor John O'Gorman

The Forum, through the contributions of speakers and the active participation from the floor, has raised a number of issues, each of which warrants greater discussion than has been possible in one day. Summarising the central issues is no easy task, and I trust my attempt is not too idiosyncratic. I have identified six issues or sets of issues, and in what follows I discuss each in turn.

1. Talking about psychiatric disability

What is the most appropriate language to use in talking about psychiatric disability? We need an agreed set of terms to communicate about any subject, but some words have powerful effects because they act as 'advance organisers' for ways of thinking and feeling which may have no basis in fact. Schizophrenia is just such a word as, we were reminded in the Forum, journalists know only too well. The word evokes in the popular mind a stereotype of a crazy, dangerous person and this stereotype is offered as an instant explanation, most recently for the disaster that was Port Arthur. People who suffer schizophrenia thus carry a double burden: the effects on their thinking and emotional life that the disorder brings and the beliefs about them that the term itself engenders.

There is thus a dilemma: we need to communicate but we need to avoid stereotyping. To have no terms creates difficulties as Bruce Tills pointed out in his presentation. Rightly or wrongly, it is easier to advocate for university students who have conditions with labels than for those who do not. To use a fresh set of labels provides a temporary solution at best, as the process of stereotyping is delayed but not arrested.

The solution, proposed by Harvey Whiteford in his remarks, is to use the terms about which there is a consensus among professionals and consumer representatives, but at the same time work to remove their stigmatising effects. Thus, 'psychiatric disability' is the term to describe the functional impairment that accompanies or follows a psychiatric disorder. 'Psychiatric disorder' refers to mental illness, which like physical illness has a recognisable pattern of symptoms and a preferred method of treatment, and personality disorder, in which behaviour and experience deviate markedly from normal expectations, for reasons that are not well-understood.

Stripping terms such as psychiatric disorder, mental illness, and personality disorder of their stereotypes requires honest and factual discussion in the community of the conditions that these terms signify. High schools were suggested as the best places to begin the process, as young people are likely to be more open to the facts and more willing to take up the challenge of social inequity that existing stereotypes create.

More generally, the Forum has raised the need to talk more about psychiatric disorder, to communicate a better understanding of it, and to free it of the emotional baggage that makes life for people who suffer from it far more difficult than it need be.

2. Recognising the diversity of psychiatric disability

Disability arising from whatever source does not have uniform effects on those who live with it, but the diversity of effects is likely to be greater in the case of psychiatric disability than in many others. Partly this has do with the number of psychiatric disorders that are recognised, each giving rise to particular and somewhat different impacts. Those we heard something about in the Forum include schizophrenia, bipolar depression, the anxiety disorders, substance abuse, eating disorders, and the personality disorders.

The functional effects of these disorders can manifest themselves in a variety of ways. The cognitive functioning of the individual can be affected. For example, there may be difficulties in concentration, either as a direct effect of the condition or as a result of the medication used to treat the condition. Given the importance of concentrating for long periods for success in university work, a problem with concentration can be quite disabling in itself, but can also be misinterpreted by staff and fellow students as a lack of motivation, as Ganya Kordas noted in her presentation, which in turn may mean they are less willing to support and assist. Related to attention difficulties, there may be problems with memory and with planning, as Helen Glover noted, which too are of major significance in a university environment.

As well as effects on cognitive functioning, psychiatric conditions may impact on the emotional life of the individual, leading to mood swings or high levels of anxiety. They may impact too on the way in which the person interacts with others, including staff and fellow students. Steven in the video presentation spoke of how he could become aggressive when he felt tense. One of the participants in question time pointed out that, for her, bouts of depression were accompanied by suspiciousness and unwillingness to trust those trying to help her.

Cognitive, emotional, and interpersonal difficulties are likely to undermine self-esteem and self-confidence. We know the importance of self-confidence in choosing particular courses of action, such as enrolling at university in the first place, and in persevering with that course of action in adversity, such as continuing in the face of a failed assignment or a failed subject. Impacts on self-confidence are likely therefore to be particularly damaging.

The diversity of functional effects that arise with psychiatric disorder has at least two implications. The first is that support services in a university setting need to be tailored to the particular needs of the student. Although this is likely to be a guiding principle for all disability services working with their clients, in the case of clients with psychiatric disabilities models of service delivery will prove more complex than for most other types of clients. One reason for this is that psychiatric disorders may cycle in severity, at times taking the person out of the university altogether and at others leaving the person symptom free. Second, the range of functional effects is likely to be better addressed by counselling and disability services working in tandem, a need alluded to by both Harvey Whiteford and Bruce Tills in their presentations. Closer links between different services will maximise opportunities for clients, but, as Barbara Tooth noted, these links may be difficult to forge at a time when all services are under-resourced for their current purposes.

3. Service availability, access, and responsiveness

Several speakers at the Forum indicated that not enough is being done to provide adequate support services for those with psychiatric disabilities in our community. Given the recent recognition of the problem in universities, it is unlikely that provision on campus is much better. The CRS, as we heard in the afternoon session, provides a service but funding cuts currently loom over it. There are as well a number of self-help groups and we heard something of the differences in their approach this afternoon. In general, however, more needs to be done.

Mental health is not a high priority for governments in allocating funding for health, and this in turn reflects the politicians' reading of community priorities. Dr Kalyanasundaram in his presentation suggested a possible reason for this. We, members of the community and politicians alike, think of illness as a problem to be fixed. The health budget is thus most easily spent, and that spending most easily defended, by identifying the problems that need to be fixed and fixing them. Psychiatric disorder and the disability that it can bring does not fit that formula at all well, and until we, as a community, begin to engage in some more subtle thinking about mental health, service availability is likely to continue to be a problem.

The appropriateness of the services currently provided is a further issue. Dr Kalyanasundaram in his presentation pointed out that almost half of those with a psychiatric disorder do not use the available services. Bruce Tills in his presentation noted that service providers have a view about the type of service they should, perhaps want, to provide, and have been reluctant in the past to seek the views of consumers about the services consumers need or want. Until there is a better match of services with client needs, the funding that is available, albeit inadequate, will not be used to its best effect.

Responsiveness is a special case of the more general problems of availability and access. Speakers from the floor during the Forum spoke of long waiting periods to access services and of the less than helpful attitudes of staff who are the first point of contact for users of these services. Although acknowledged by those with some responsibility for service delivery, effective solutions to these problems are still awaited.

Universities are microcosms of the communities they serve. Although their staff and students are likely to be better educated than the community at large, the attitudes and opinions of staff and their prejudices and fears are likely to be broadly representative of the community. The issues of availability, access, and responsiveness of services for those with psychiatric disabilities are therefore likely to be as challenging for university communities as they are for the broader community.

4. Educating university staff about disability

As Chris Ayers remarked in the Forum, psychiatric disability, unlike a number of physical disabilities, is largely invisible. It was not so long ago, as Harvey Whiteford pointed out, that it was unthinkable that people with psychiatric disorders would attend university. Steven, in the video presentation, noted that one of the academic staff he encountered on returning to university after the acute stage of his illness refused to accept that he suffered from schizophrenia. It was an exercise in (faulty) logic, as Steven related it, that had taken the staff member to that position: if you have a mental illness you cannot cope with university; you are coping with university; therefore, you do not have a mental illness.

Invisibility and denial, significant as they are, are not universal in the university community. Academic and administrative staff from time to time work with students with psychiatric disabilities, but, as both Monica Cuskelly in her presentation and a questioner from the floor in the morning session made clear, there is no advice or guidelines available to assist staff in working with these students. How to balance the pastoral role of an academic member of staff against the counselling role of a professional; how to set the limits on interaction with a student, with perhaps understandable interpersonal difficulties stemming from a psychiatric condition, so as to ensure the rights of other students and staff are respected; how to assist a student and not introduce inequities into the way other students are treated; these are the sorts of questions for which there is currently no adequate preparation of academic and administrative staff in universities.

Universities over the past 10 years have shown a capacity to accept and adapt to the social changes that the community, through its politicians, has indicated are necessary for its continued support. Greater access for disadvantaged groups in the society and more attention to adding value for the students who enrol are just two examples of the priorities universities are responding to (although, some might say, yet with sufficient vigour). These priorities can be used to drive better education of university staff about the realities of university study for students with psychiatric disabilities.

Some staff will be sympathetic to such efforts, some will not. But attitudes can be changed in the long term with concerted education campaigns, and in the shorter term those staff who are wanting to help, but are currently without direction, can be assisted to sort out the issues that working with their students currently pose. When administrative staff face their psychiatrically disabled students with the same degree of confidence that they face all the other members of their client group, and when academic staff write in their teaching portfolios of the ways they have adapted their teaching methods to accommodate their disabled students, including the psychiatrically disabled, then we might consider that education of university staff is beginning to have an effect.

5. Disclosure, discrimination, and duty of care

It is clear that, for those with psychiatric illnesses attending or planning to attend university, whether or not to disclose an illness to members of the teaching and administrative staff or fellow students is a major concern. On the one hand, disclosure is the principal way in which staff can know about the particular problems for the student that the disorder brings, and be in a position to help or secure the resources of the university to help. On the other hand, disclosure opens the person to the potential for discrimination, fear and resentment, and, perhaps most damaging or all, the belief that any success they have at university is due to the special consideration they have been extended and not to their own efforts and abilities.

Discrimination, as Chris Ayers pointed out, contravenes both State and Federal legislation. Denying enrolment to a psychiatrically disabled student when all other criteria for admission have been met, or not making reasonable adjustments for that person's study, or setting assessment requirements in such a way that the student cannot comply with them, all constitute discrimination and are grounds for the person so affected to bring an action against the university. Even asking a person about psychiatric disability may contravene privacy legislation and requiring a person to answer such a question certainly does, which reinforces the point that self-disclosure is necessary if university support is to be recruited.

University management practices in the area of social policy increasingly rely on project based funding in which objectives and targets are specified and effectiveness assessed in terms of performance against those objectives or targets. It follows that a university wanting to target psychiatric disability as an area warranting special attention from its support services would need to be able to identify students with such a disability. Unless students self-disclose, the extent of the need, or the effectiveness of dealing with it, cannot be evaluated and, in all probability, cannot be specially funded.

From the student's point of view, however, the dangers in self-disclosure are very real because the university community, as noted above, is unlikely to be any more enlightened in responding to psychiatric disability than any other section of society. Academic staff who teach in faculties or schools that train the so-called helping professions are no exception. We heard during the Forum of staff in social work, psychology, and nursing who responded negatively to students with psychiatric disability, a circumstance confirmed by my own experience. A reason or rationalisation typically offered is the responsibility staff owe to the profession or community.

Monica Cuskelly focused this issue in her presentation when she pointed out that Steven, the student in the video who had been denied a place in a postgraduate program in clinical psychology, had said that at times he misinterpreted the behaviour of others. Monica noted that this would pose a real difficulty for someone working as a clinical psychologist. Universities as providers of professional education have a responsibility to the community and the professions to ensure fitness of the student to practice, but as educational institutions they have a primary responsibility to the students who enrol with them to maximise their development. It is not the duty of universities to act as gate-keepers for the professions. This issue requires a lot more discussion from all the parties, not just universities and the professions, involved.

6. Acknowledging 'citizenhood' and the right to self-determination

As one speaker from the floor put it during the Forum 'Because you cannot think straight at times does not mean that you cannot exercise control over your own life'. Accepting the right of those with psychiatric disabilities to determine how they will live their lives is fundamental to resolving any of the other issues raised in the Forum. This became quite clear in the session before lunch when this theme recurred in the comments of speakers from the floor.

Dr Kalyanasundaram later in the day used the term 'citizenhood' to capture the appropriate community response to those who have suffered or are suffering from psychiatric disorder. The community and its support services need to extend to the psychiatrically disabled the full measure of rights, responsibilities, and opportunities they would to any other citizen. Such an approach would seem not only a moral imperative in a liberal democracy such as we have in this country, but is also, from research we heard briefly about in the Forum, most likely to aid in the rehabilitation of those with psychiatric disorders.

One could not help but be impressed by those who spoke in the Forum from first-hand experience of a psychiatric disability, by their courage and tenacity in overcoming obstacles, in one case physical restraint, and in facing the future with optimism. As Shirley Bennett put it , 'I know there will be another depression in a few weeks but I will ride through that'. Even at a more concrete level they showed a capacity for coping with the difficulties of university study, by setting realistic goals for themselves, drawing satisfaction from achieving those goals, monitoring their physical and mental health and taking steps to maintain their equilibrium, and building support networks that have depth and breadth. It is not surprising that more than one speaker, who did not have a psychiatric disorder but who had lived or worked closely with those who had, offered the view that these are people to be admired and learned from.

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Appendix A

LIFE EXPERIENCES

University Lecturer Perspective ­ Ms Ricky Anthony

The impact of psychiatric disability and university study

Recognising the indicators of a psychiatric disability and taking some action: duty of care

Maximising psychiatrically disabled students' educational outcomes - a first line exploratory approach.

Rather than focus on the recent horrors of Port Arthur with its emphasis on schizophrenia, I'd like to emphasise the positive outcomes and concentrate on the success stories.

Today I'll be talking about a two-pronged approach used at Griffith University's Faculty of Science and Technology, and more specifically, within the School of Computing and Information Technology (CIT). I am here to tell you how we at Griffith University approach this issue of maximising educational outcomes.

The research indicates the following attitudes towards students with psychiatric disabilities:

The Students:

Unger (1992) states that "many students feel they do not need a psycho-counselling model but an educational model."

Cato (1988) argues that these students are "unique, capable of reasoning, controlling and understanding their illness and their needs".

The Academics:

Academics, on the other hand, according to research feel that students with psychiatric disabilities are "disruptive and violent" (Gething 1992) and that the "service needs of these students are different" (Unger 1992).

Few academics have the experience of dealing with students with psychiatric disabilities as few students choose to disclose for fear of being treated differently.

Life at university is like a pressure cooker. You add all the ingredients: the students, the academic system and its deadlines, students' perceptions and expectations of themselves, their hope for results and expectations and these are often negatively influenced by parents' expectations.

So you have a system that automatically creates PRESSURE. Once the temperature starts to rise as deadlines start to emerge and stress compounds, the pressure valve starts to rock and hiss. While it is acknowledged that the Disabilities Office does a wonderful job, and I have worked with them on numerous cases of disabilities, usually hearing impairment or vision impairments of varying degrees, it is these "hidden students" that we aim to cater for at Griffith School of CIT through the role of the Student Adviser (SA). Through this role we take a relationship approach to our students and endeavour to build up a long-term, personal relationship which provides a means of releasing the pressure before it becomes too harmful to the students and their expected outcomes.

I am in a fairly unique position at CIT. I lecture into a full year subject in first year. This gives me the opportunity to develop a long-term relationship with students as I also teach into second year and am a Project Adviser for all the third year project teams. With a Communication subject that incorporates a large group component, any difficulties are easy to spot early on. All students are advised that for any difficulties they may be experiencing with anything - stress, anxiety, personal problems, depression, performance anxiety, etc that the Student Adviser is available. The SA's service is free, confidential and available to all students, regardless. We at CIT do not discriminate against any student. This SA role is part of my official role at CIT and I receive teaching relief in my workload.

Yes, my office is pretty busy as assignments come around and as exams draw near - in fact - most of the time. All students know they can drop in for a "chat", cup of coffee, walk to the common room, or whatever is needed. They know that I care for them and their progress through the degree and I offer them confidentiality, loyalty and support.

The things I usually see are:

• attention difficulties
• mood swings
• medication side effects
• fatigue
• lack of self confidence
• short term memory loss
• anxiety, panic attacks
• depression
• schizophrenia

These are all present in students at one time or another. Through the nature of my course I am able to, if you like, take students' collective pulse on a daily basis to monitor their stress levels. CIT has a very informal, friendly, "open door" approach to its students and lecturers chatting and having coffee with students is the norm. We aim for long term rapport. I see the students on a daily basis. I know what they did yesterday and who has just come off a midnight to dawn shift at McDonalds and is tired in tutes. I can feel the pressure building up in the student body and in individual students. The degree's emphasis on group work means that networking and student support of each other is encouraged. This further helps to identify potential problems and students who are not coping.

I have the added advantage of coming from a family who have been professionally involved in mental health for over 40 years as well as my personal experience dealing with large numbers of students over many years - mostly large numbers of first years. To this I also bring my personal experiences of friends with psychiatric disorders - manic depression, depression, schizophrenia, bi-polar disorder, psychosis and panic disorders.

Within the SA role I have the opportunity to be proactive rather than reactive to situations. I am able to say "I think you should see your doctor - I don't think your medication level is holding you".

I do not as mentioned previously, take a pseudo-counsellor role. If students are having problems with say anxiety or medication side effects I can sit down with that student and have a look at their past performance over subjects, their workload for the semester, the behavioural effects caused, and examine the student's wished/hoped for outcomes. With my inside knowledge of the "weight" or "degree of difficulty" in each of the subjects I can often offer a variety of optional courses of action to ensure that the student completes studies successfully.

In my experience, these students do not want to be treated any differently. What they need when their behaviours start to go out of whack, is flexibility. Time to get themselves back on track. I have found that if you give them this flexibility they have the time to sort themselves out, get whatever professional help they need for as long as they need jeopardising their chance of success in their studies.

The system does work. I recently had a student come into my office and break down into tears and tell me he had a problem. It took him 18 months to get to know and trust me but he came. We were able to work out a course of action for him to make sure he makes it through his degree. I was able to work out a similar program for a student suffering from mental disabilities brought on through a car accident. He was experiencing enormous medication side effects when his doctor switched his medications. Knowing the student's abilities, the semester workload, etc, we were able to work out extended deadlines, extra exam time, and copies of overheads, and taped lectures to enable him to get the most out of his time when he could get his brain around study.

One student had a panic attack on hearing that she was required to do a full blown business prevention of 20 minutes duration in front of her class. Her anxiety level had been higher than was the norm and I noticed when she started missing classes. Through her group, we taped all her lectures, copied all overhead transparencies, and copies of other students' notes and put them through her mailbox. We contacted her family. And we got her back. But it needed someone to realise that she was missing!

This brings me to the "forgotten element" in all of this - the parents. When their sons/daughters enter university all parents feel rather removed and isolated. They can no longer chat to their friends or ring the headmaster to find out how their student is coping. University does not work that way. Any difficulties the students are having tends to be hidden. At Griffith University, the Student Adviser attends the Orientation Week Parents and students sessions. It is made known that if students need help with anything that that service is available to them. We usually find that caring parents will come up and ask and, much to their student's embarrassment, tell me what the particular difficulty is.

So in conclusion, the system is working. We have the results of people who are making it successfully through university with psychiatric disabilities. I help them in any way I can.

Ricky Anthony
Lecturer and Student Adviser (SA)
Griffith University, Faculty of Science and Technology
School of Computing and Information Systems

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Appendix B

SUPPORT AT UNIVERSITY

Health Services - Dr Barbara Tooth

I have been invited today to talk about health services available within the University environment and to also share with you something of the research in which I am currently involved. Along the way some comments on important issues raised for lecturers in teaching people with a psychiatric disability will be highlighted.

Health Services

At QUT health services are provided across three campuses. At Garden's Point and Kelvin Grove campuses, there are two General Practitioners and two nurses. At Carseldine Campus there is one General Practitioner and one nurse. These staff are available Monday to Friday from 9-5 and provides the wide range of services typically seen in any general practice setting. The service caters for both students and staff of the University who can just walk in at anytime for a consultation with a nurse. Appointments are usually necessary for the medical practitioners.

The health service, and in particular the nurses, are usually the first point of contact for students. Following assessment by the nurses they will then be referred onto the counselling centre or to the general practitioners or to outside services. The health service has a signification focus on prevention and conducts a wide variety of health promotion activities. They have a display of all the Department of Health brochures, including those on mental health problems. The service also conducts a range of group programs aimed at promoting general health. For example, during heart week they will focus on raising awareness of heart problems, conduct blood pressure and cholesterol screening etc. Unfortunately, they do not appear to engage in mental health promotion activities or conduct activities for events such as "Schizophrenia Week". However, they do focus on alcohol and drug abuse and provide a needle exchange program which incorporates counselling services. The promotion of mental health appears to fall upon the counselling services at University.

The coordinator of the Health Service reported a significant number of students who attended were seeking assistance with stress related problems. She reported being called out for a number of stress incidents, particularly at exam time. They are also called to see students who are suicidal. It would be an understatement to say these services stretched to the limit. Each nurse sees on average at least 20 students per day.

Current Research

Dr Kalyanasundaram, Helen Glover and myself are currently involved in research which is exploring recovery from schizophrenia from a consumer perspective. I shall talk about this here today because it has particular relevance to a number of issues being raised today.

We are particularly interested in hearing from consumers, who identify themselves as "in recovery" from schizophrenia. We hope they can tell us what it is that has helped them the most or least in their journey with this disorder. This information will give us a better understanding of the coping mechanisms that people use which are presently poorly understood.

We know that traditionally people who have schizophrenia have been discouraged from working or studying because it is "too stressful". However, from our experience we know that work and studying can be very important aspects of a person's journey of recovery. Hopefully, we can identify strategies that help people continue their study and later in their work life.

Issues from the research project

• It is not an uncommon occurrence for people who are studying and then develop a mental health problem to be told to forgo their study due to the stress it will incur. It is also common for those anticipating study to be discouraged, the assumption being that stress will exacerbate their symptomatology. This raises issues of paternalism, and the general lack of awareness of how damaging such a position can be. It highlights the ignorance of some mental health professionals and academic staff. I would like to caution people who talk about "duty of care" to the public in relation to students who have a mental illness undertaking field placements. This is a thorny issue that needs more discussion because it is potentially discriminatory.

 

• During the research project we have encountered people who have completed university studies but given up their career for fear of the stress that continuation will incur.

 

• We need to find out what helps some people continue study, work etc whilst other people with similar levels of disability abandon their career paths.
• Some people just refuse to become a slave to the illness.

 

• Stripping of hope form people with a mental illness is a major problem in our society.

 

• Consumers have the same basic right to education as everyone else in the community.

 

• Our role is to find ways of supporting people with such problems in their chosen career paths.

 

• In an interview with a participant who has a diagnosis of schizophrenia and is currently in the final year of a degree, I was informed that he has not told anyone at University about his illness due to his fear of stigmatisation. He remembered hearing once that if it was known that you have a mental illness then this can stop you form entering certain professions. Whilst this is discriminatory, I know many health professionals who have heard this same story.

Issues for teaching staff

The following is a list of some issues raised for teaching staff when working with students who have a psychiatric disability.

• One of the biggest problems is knowing what to do or where to go.

 

• Another problem is that students usually do not tell teaching staff of their disability for a variety of reasons. In my experience this is common and unfortunately understandable.

 

• It is often difficult to refer students to the counselling centre or to suggest that they need to see a psychiatrist.

 

• Taking concern for students and referring them to the medical centre can be a useful option for teachers.

 

• Unfortunately, teaching staff can have the same biases and stereotypes and may stigmatise people in the same way as the general public, resulting in students being typecast and pigeonholed.

 

• The strategies used by teachers can vary from confrontation through to maternalistic responses. There needs to be discussion and raising awareness of this issue.

 

• A particular problem for me is being an academic who teaches mental health, but also has significant clinical experience in mental health. It can be difficult to draw the line.

 

• Perhaps one other important issue that is often not discussed is that there are teaching staff who also have a psychiatric disability. This raises another set of issues that are related to the overall lack of acceptance and stigmatisation that occurs in the general community.

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Appendix C

SUPPORT AT UNIVERSITY

Disability Adviser - Ms Rhonda Watson

In this address I will be speaking mainly about service provision at The University of Queensland but having spoken with all the Disability Officers of the other universities in Queensland I understand that each university provides very similar services.

In provision of services to all students with disabilities, regardless of their disability, an attitude of regard for the student as a competent adult is the basis from which the service operates and as such students' decisions regarding the utilisation (or non-utilisation) of services and recommendations offered is respected. The Disability Officer will help a student identify their needs in undertaking studies given the effects of their illness and their medication on their ability to study and the specific requirements of their course. Most Disability Officers will acknowledge that it is usually the case that it is the students themselves who are best able to identify their specific needs as they are most acutely aware of the specific limitations imposed by their disability.

Given the episodic nature of psychiatric illness, a longer term plan of action given changes in a student's condition throughout the semester is usually developed.

The following examples of assistance are those that have been provided to students in the past and should not be seen as a "menu" of options.

Given that two of the major difficulties experienced by students with a psychiatric disability are reduced ability to concentrate and increased susceptibility to stress the following procedural variations have been provided:

• recommendation that part-time study be undertaken;
• use of notetakers in lectures to overcome difficulties associated with reduced concentration;
• negotiations to extend deadlines for assignments;
• additional time in examinations;
• rest pauses in examination to implement stress management strategies;
• specific examination needs such as separate room, close to toilets, small room for agoraphobic etc;
• timetabling of exams to suit effects of medication (i.e. may function better in afternoon than morning);
• use of a scribe in exams;
• extensions on library loans in certain circumstances.

Other services include:

• alternative arrangements to access the library catalogue from home if the student's condition prevents them from utilising the library;
• alternative borrowing arrangements (eg surrogate borrowers) for library loans for those unable to come on campus;
• general supportive counselling;
• referral to other services on campus such as learning skills; personnel counselling; Health Services and attending psychiatric services.

If the student experiences a deterioration in their condition during the semester, then assistance may involve:

• preparation of an appeal for withdrawal without penalty from subject(s);
• organisation of extensions for due dates for assignments;
• rescheduling of examinations (usually to the postponed supplementary examination period);
• organisation for the subject to be "carried over" and completed during the following semester.

These are still unresolved issues and much is to be learned in this area in terms of provision of services. One of the major issues is that of attitudes of staff and students within the university community towards those with a psychiatric disability. Ongoing education and provision of information and positive role models will, it is hoped, gradually see a change. Until then the issue of the student's rights to confidentiality within the service (which is respected) can often create difficulties when there may be a need for academics to be aware of difficulties experienced by students in order to provide appropriate flexibility in course presentation and requirements.

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Appendix D

CABOOLTURE FRAMEWORK FOR SUPPORT

This document is in portable document format (PDF)

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Appendix E

COMMUNITY SUPPORT

Schizophrenia Fellowship of South Qld Inc ­ Ted Crouch

The Schizophrenia Fellowship does not at present have a program for directly supporting tertiary students suffering from schizophrenia.

This particular group of consumers is indirectly supported through the services The Schizophrenia Fellowship provides to carers and consumers at large.

The Schizophrenia Fellowship is currently involved in setting up a system of support groups for carers and consumers throughout South Queensland. Branches such as Gold Coast, Bundaberg, Outer South Brisbane, Dalby, Toowoomba and others are already in place while new groups are developing at Noosa, Warwick and Chermside.

These groups allow consumers and carers to discuss their problems, receive information and be educated about dealing with schizophrenia.

The main offices of the Schizophrenia Fellowship are at 95 Arthur Street, Fortitude Valley. Here information in the form of a newsletter, library/resource centre and telephone is disseminated to its members in the support groups. Sometimes the telephone service is the first contact for families experiencing schizophrenia.

Other avenues the Schizophrenia Fellowship is pursuing are accommodation for people with schizophrenia, fighting the stigma associated with the disease and encouraging research into the causes and treatment of schizophrenia.

The Schizophrenia Fellowship advocates for the needs and rights of people with schizophrenia and their families to the different levels of government and in the community. It encourages, supports and implements activities aimed at rehabilitation of people disabled by schizophrenia, e.g. setting up a centre based on the clubhouse model pioneered in America.

The Schizophrenia Fellowship also offers social integration through leisure activities, e.g. camps and BBQs, as well as supporting a social club for consumers.

This page last updated: 1 September, 1999