The voices have ceased for now, but Shane Bell knows all too well the dangers of skipping his medication.

“It’s rather scary. You lose all contact with the reality of things,” Mr Bell said.

The 46-year-old has lived with schizophrenia for about 14 years, which included debilitating periods of psychosis.

“It’s mostly hearing voices and having hallucinations and strange thoughts, which are the distressing ones,” Mr Bell said.

“I’ve lost the mania and the anxiety and depression. All I’ve got is the schizophrenic component.”

Mr Bell is one of 230,000 Australians with the illness, though psychiatrists think many people hide the illness.

Schizophrenia attacks the prefrontal cortex of the brain, which psychiatrist Dr Robert Parker said essentially means it undermines a person’s ability to perceive reality and solve problems.

“People basically stop caring for themselves, and that’s the much more destructive part of the illness.

“The brain is the most remarkable organ in the human body. It’s a complex organ, which is why schizophrenia has a range of ways of manifesting itself,” Dr Parker said.

But medication and early intervention is helping make the disease more treatable.

“A number of years ago if you said the schizophrenia word to people it was like a life sentence, almost as bad as cancer. These days there’s a lot more hope because there’s much better treatments available,” Dr Parker said.

Services limited: health workers

Mental health workers are concerned schizophrenia treatments, beyond clinical services, are still limited.

“People with schizophrenia make up half the case loads of the public mental health services in most places,” said David Meldrum, the executive director of the Mental Illness Fellowship Australia (MIFA).

“They get a service, but they get a very basic service.

“Beyond basic medicine of dealing with medications you can’t rely on getting a range of other practical supports to get a life back,” he said.

Mr Meldrum has just started up workshops to teach schizophrenia patients and their carers how to lobby politicians to invest more in mental health services.

Federal funding for mental health has increased over the past seven years by about $1.5 billion.

Data from MIFA shows most OECD countries spend between 12 and 16 per cent of their health budget on mental health services, while Australia only spends eight per cent (see graph above).

“If you look at what’s called the burden of disease by the World Health Organisation, about 14 per cent of what gets dealt with by the health system is caused by mental illness,” Mr Meldrum said.

“And in Australia around about seven per cent of the health budget is dedicated to mental health. So that’s where the idea comes from. It’s only really getting half of what it should get.”

Mr Meldrum said it was not all about money but he hoped the federal budget would not decrease funding.

He said the latest national mental health review recommended more funding into community-based services.

“The number of beds we have in the psychiatric system in Australia is actually slightly ahead of international comparison,” Mr Meldrum said.

“Where we lack is decent community services to get to where people are living,” he said.

Remote communities suffering

Dr Parker said rates of schizophrenia among Aboriginal people in remote communities were three times higher than for non-Indigenous people living in cities.

“Low levels of education, exposure to trauma during childhood, and volatile substance abuse are all increasing the risk factors for psychosis,” Dr Parker said.

Compounding this is a lack of both clinical support and community services for remote areas.

“The recovery model looks at a range of issues in terms of housing, work, participation in society and education,” Dr Parker said.

“There’s no doubt we could develop programs to enhance that.”

Mr Meldrum said extending community-based services and support networks for carers to the bush was essential.

“If you want solutions to help people get a life you’ve got to go to where they live and work alongside them, not put them in an ambulance and take them several hundred kilometres away to a specialist unit.

“That may be necessary in moments of crisis, but it’s not going to get your life back,” Mr Meldrum said.

Shane Bell recoiled at the thought of living in a remote area.

He already finds it hard to get a job in Darwin despite being high-functioning, which means that despite his illness he is able to work and have a fulfilling life.

His visits the community service – the Top End Mental Illness Fellowship – as part of his therapy.

“It gets you out of the house and gets you going to a place during the day and meeting people and doing this together,” Mr Bell said.