Katie Horneshaw: My sister never should have been allowed to kill

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As Anna (right) grew up, she began hearing voices in her head.
As Anna (right) grew up, she began hearing voices in her head.

A couple of months ago, I opened my news page to see a headline that made me want to pass out.

"Melbourne woman murders man for cigarettes" it read. That "Melbourne woman" is my little sister.

I watched my sister succumb to the torture of mental illness and addiction. I watched as her ability to perform even the most menial of life's persistent tasks was stolen by the demons who gnashed their teeth inside her broken mind. And as I watched, my friends reassured me.

"Don't worry," said Elsje, "if your family can't take care of her anymore, the government will have to find somewhere for her. They can't just leave her to the streets."

We found out the hard way that this isn't the case.

Anna found the requirements of childhood perplexing. Returning home from primary school, she would cry because no one wanted to be her friend.

My parents and I thought she was quirky and clever, and we always wanted to fix everything for her.

We couldn't, though, and when she left the older boyfriend who had supported her throughout her early 20s, she fell head first into alcoholism. This marked the beginning of a period of her life which always seemed like it couldn't get any worse. But then, somehow, it always did.

Living with mum and dad, Anna fell into a ritual of rising late, traipsing out to the far reaches of the overgrown backyard, and smoking bong after bong. She drank, too; crouched in her room with the door shut, she'd skull a bottle of vodka to get a "good buzz going".

Often she'd top off this cocktail with heavy sedatives, and I was constantly terrified that she'd stop breathing. But challenging her wasn't an option. "Well I suppose you're just perfect then, you self-righteous bitch!" she'd spit, disdain spreading across her face. Later she'd cry and tell me she loved me, and I knew it wasn't her who'd said those things.

To Anna, you were either good or bad. The risk of being expelled to the bad category was enough to keep all of our mouths shut, and we would tip toe around her, laughing at her manic jokes, agreeing with her rants, desperate to avoid a collision.

Anna had voices in her head. They told her that her room had been broken into and her DVD player reprogrammed, they told her that the old neighbour had been murdered and left to rot, and they made her believe she had been possessed by spirits. Mum brought the priest over to bless Anna's room, and gave her a cross to wear.

Eventually the voices told Anna that mum and dad had bad intentions, and I became the last thread of hope that she may be convinced to seek help. The weight of this was paralysing, and it never worked. Most of my time was spent pleading with Anna to stop excoriating mum behind her back, to see that mum was not evil.

She would disappear for days on end. At the beginning I was naive enough to think that the cops would look for her. "She's not capable of looking after herself!" I cried at the local station. There was nothing they could do.

We were always waiting for the phone call. Every day, mum and dad and I were distracted, petrified each time the phone would ring that we'd hear a solemn voice on the other end - "I'm so sorry ..."

On one occasion she came home with wild eyes and cigarette burns. She was hysterical, terrified that a man had followed her home. It emerged that she'd met him on the train and gone back to his place. She'd "escaped", but only just.

Katie (left) remembers vividly the day she learned her sister (right) was a killer.
Katie (left) remembers vividly the day she learned her sister (right) was a killer.

Mum and I panicked, for Anna's safety and our own, and we spent the night desperately trying to convince a hyper-aroused Anna to get help. After hours of back-and-forth and several attempts from Anna to run back to the abuser's house, she said yes.

I began to cry. Mum and I hugged. She'd said yes! We thought this was it, we would bring her to a rehab facility the next day. This is how ignorant we were back then.

At the GP the next day, we were given the number for the public detox unit, and mum called, trembling. I was sitting at a cafe with Anna, staring at mum's back, watching her shoulders twitch, then slump. She turned around: "They can't even do an intake interview for a month."

That day marked the beginning of our relentless and increasingly desperate search for a residential facility which could take care of Anna.

Mum and dad no longer felt capable of keeping her alive.

Anna had initiated a reign of terror over the house, under the threat of killing herself by various horrific means, and there was only so many times that dad could get up to agonised wailing in the middle of the night and talk his daughter down, bribing her with Valium that could itself stop her halted breath.

But she "wasn't bad enough for the psych ward", according to the CAT team who came to visit after the day at the GP. This was supposed to be the team for the mentally ill who were at crisis point, but their services relied on Anna being at home for an appointment.

"Is she not here again?" one of the workers asked in frustration upon their second visit, and I actually laughed. Anna was out there with her mind peeling away in pieces around her feet and the "swat team of the mental illness world" were shuffling their paper work and lamenting her poor punctuality.

At my parents' house, Anna hobbled from one suicide attempt to the next, and mum wrote to her family back in the States, telling them she didn't think her funny little girl had much time left.

When Anna took the kitchen knife and plunged it toward her chest, and dad used every ounce of his strength to tackle her to the floor and hold back her shaking hand, mum called the police.

She was admitted to hospital for a psychiatric assessment. We thought this would finally be it: she would be put in the psych ward. But Anna, always articulate even drunk or on ice, convinced the doctors she was OK. Mum's desperate pleas were dismissed as an over-reaction, and Anna was sent home.

This became a pattern: find Anna unconscious in a mess of pills and bottles, call the ambulance, go to hospital, be told that Anna was not 'acute' enough for admission, and sent home.

Even on the day that it took nine medical professionals to wrestle Anna into her hospital bed, a day when she still managed to bite a nurse, she was sent home with her horrified parents.

Anna was now taking ice whenever she could get it: Going home with random people from the train. She would return in the full throes of psychosis, terrified that she was being recorded and followed. She brought ice users back to the house. She told me she thought Dad was "not who he says he is".

Dad was fearful for our lives, and so he told his little girl that she had to leave.

I was consumed by anger at the system. We had been brought to this: Kicking out a person in unimaginable mental turmoil, a person who had no capability whatsoever of looking after herself. We felt abandoned, that Anna had been left for dead.

She found a dirty house with three older men to stay at. The tenant, Johnny, an ageing alcoholic, was protective toward Anna and we were grateful for this.

It was there that her violent and erratic behaviour escalated to the point that she was finally admitted to the psych ward. Anna herself begged to stay, but they discharged her six days later with just a follow up appointment at an outreach centre.

She was picked up again and again for increasingly bizarre behaviour, sometimes admitted to the psych ward, but always discharged, despite our futile pleas.

Then, one day, the phone call came.

It was mum, her voice broken by sobs on the other end of the line. "Anna's killed Johnny! She's killed her friend!"

This didn't have to happen.

But it does happen, over and over again, all over Australia. People with acute mental illness do terrible things and wind up in prison, because they fall through the cracks of the woefully inadequate mental health supports on the outside.

When people ask me about my sister, I say she's in an institution. It's not a lie, but I know what they are picturing: A long term, involuntary residential facility. What they don't realise is, these places do not exist. If they did, I believe Johnny could have avoided his horrible fate.

The system we do have, meant to replace the problematic institutions which once housed the mentally ill, is called community-based care. Theoretically, it is a wide ranging network of community supports for families charged with caring for the mentally ill.

In practice, and according to our own parliament, the system is "randomly implemented", woefully underfunded, and lacks any integration or communication between service-providers. For Anna, this meant that each one of her "incidents" was viewed in isolation: the pattern of instability and violence which was clearly emerging to her family wasn't evident to those treating her.

In place of a streamlined system, a random assortment of NGO's, churches and government-affiliates operate a mishmash of outreach services. Even the "crisis" subset of the system; the CAT team and home-visit psychiatrist; require active engagement from the patient.

Some small residential facilities do exist, but they are voluntary, have strict behaviour codes and months-long waiting lists.

This is a system which may be helpful to those who are still in command of their faculties. But for people as tormented as Anna, it all amounts to nothing because they lack the time to wait or the capability to participate.

And so, the non-functioning mentally ill end up in one of three places: with desperate and exhausted families who are provided no training to accommodate their sick children, on the streets, or in prison.

The girls in Anna's prison are so acutely aware that this is the safest place for them that they often confide to Anna that they are frightened to leave. They know they won't be taken care of on the outside.

Parents of "frequent-flyers"- the mentally ill girls who bounce in and out of the prison in an endless cycle- breathe an enormous sigh of relief when their daughter is admitted afresh, knowing at least that they will, for a time, be safe.

Anna has made vast improvements in prison. She could have made these same improvements if she was in a comparable long-term, involuntary residential facility on the outside. This is the case for thousands of severely mentally ill prisoners.

I don't advocate for these facilities lightly. And of course I believe that they should be an absolute last-resort. But if they had existed when we were begging nurses and doctors and anyone who would listen to put Anna somewhere where she would be safe, Johnny might still be alive.

• I am donating my fee for this article to the Luke Batty Foundation.
• I hope that before allocating the money which has been earmarked for mental health in the upcoming budget, the government will consult with families like mine.
• My unending condolences to Johnny's family - I hope that things can change so other families don't have to suffer the fate you did.

- news.com.au

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