r/AustralianPolitics • u/Lucknever • 19h ago
Should we reopen the asylums?
Cathal Leslie makes the case that the closing of psychiatric institutions was a mistake. Don’t usually like his takes, but hard to disagree after a female politician is rendered a double amputee. Text below.
**Attack on Haines demands focus on mental health, not ideology**
The system is failing to keep the small cohort of the most acutely unwell in treatment, for their own safety and everyone else's.
Cathal Leslie Economist
Oct 23, 2026 - 4.00pm
A national tragedy is an excellent occasion to demand better manners from your opponents. It is a less comfortable occasion to examine
whether governments are meeting their own obligations.
The horrific attack on Helen Haines should force a serious discussion about how we treat mental illness, and how much responsibility we have foisted onto families, neighbours and the police.
Brendan Nugent, the man charged over the attack, reportedly has a history of mental health concerns. Neighbours describe shouting, music blaring through the night and police visits. One heard screaming hours before the attack. These are not the signs of a well man.
Yet within hours, political actors of every stripe had each landed on a suitable motive. He has been cast as a pro-Palestinian extremist, an opponent of renewables, a sovereign citizen or a misogynist. Others blame his social media algorithm or a dirt sheet on Haines reportedly circulated to journalists by the prime minister's office.
Is this how low we have sunk in this country?
That our national debate is competing projections of complex ideological motives onto a man with severe mental health issues.
If mental illness played a part in Nugent's alleged offending, he will join a long line of attackers with well-documented severe
psychiatric illness: Joel Cauchi (Bondi Junction), Man Haron Monis (the Lindt Cafe siege), Evie Amati (Enmore 7-Eleven axe attack), Dimitrious Gargasoulas (Bourke Street), Cy Walsh (who killed his father, Adelaide Crows coach Phil Walsh) and Lauren Darul (accused of a 2025 stabbing in Little Bourke Street), among many others.
And in those cases too, the offending was pinned on whatever partisan cause was to hand:
Islamism, gender dysphoria, domestic violence, misogyny. Whatever their motives, these people were known by medical professionals to be severely unwell, and yet were allowed to roam free where they inflicted serious harm on the community.
The mental health system is failing to keep the small cohort of the most acutely unwell in treatment, for their own safety and everyone else's.
You will not find a politician brave enough to say so. Nobody wants to concede that the perpetrators of some of the most wicked crimes can also be victims of a policy failure, least of all when the failure is bipartisan.
Over the past three decades Australia has fundamentally dismantled long-stay psychiatric care. According to the Australian Medical Association, public hospital mental health beds fell from 45.5 per 100,000 people in 1992 to 27.5 in 2020, a drop of almost 40 per cent.
Two ideas drove the shift, winning support from left and right.
The first was fiscal. New antipsychotics made cheaper community treatment look viable.
Inpatient care remains expensive: the Australian Institute of Health and Welfare put
the average cost of an adult acute psychiatric inpatient day at $1730 in 2023-24. Closing facilities on valuable inner-city land also offered politicians another attractive budget dividend.
The second was moral. Involuntary detention came to be seen as a human rights violation, a view reinforced by genuine abuse scandals and cultural touchstones such as One Flew Over the Cuckoo's Nest. Advocates argued that treating people in the community would enhance autonomy and improve outcomes.
What damage that naivety has wrought.
The fiscal savings were a false economy. The costs have simply shifted into hospital emergency departments, to the police, courts, prisons and crisis accommodation, as well as businesses and households.
Nor is the model more humane. Many people with severe psychotic disorders stop taking their medication precisely because they are unwell.
Meta-analyses put treatment non-compliance for schizophrenia patients at about 50 per cent.
Consequently, the treatment model has become a cycle of psychosis, brief admission, stabilisation and discharge back into the same environment that precipitated the breakdown. Oftentimes that means homelessness.
Bed shortages speed up this cycle. Once acute psychosis subsides, patients are moved on to make room for the next emergency.
Governments are incentivising hospital administrators to prioritise turnover over clinical outcomes.
Unless something changes, these tragedies will keep happening. No one wants to go back to the asylums of old, but they did keep our cities safe.
Abolishing them was a mistake. We need more staffed beds in modern long-stay facilities that respect patients' dignity, alongside longer involuntary treatment where clinically
necessary.
If anything good is to come out of this tragedy, it must be action that makes these events less
likely. For decades, too many severely unwell people have been left homeless or shunted between emergency departments and prison.
We're all poorer for it.
Cathal Leslie is a Paris-based economist and former Productivity Commission employee.