Just the other day, we gave Paul* a week’s supply of medication, a bus ticket and sent him on his way. There was pressure for beds and Paul’s bed wouldn’t be unoccupied for long. He’s been in the psychiatric unit before and this wouldn’t be the last time, not by a long shot. But the crisis that lead to this admission, a few days earlier, has passed and Paul could be on his way.

Paul’s story makes for grim reading; too many drugs, too many scars, poor impulse control, and an unrelenting major mental illness. Oh, and through no fault of his own, his was a pretty ordinary childhood to boot.

In my twenty-five years working as a psychiatric nurse, it’s those crucial childhood years that serve as one of the main predisposing factor for the emergence of mental illness or chronic substance misuse. Philip Larkin’s bleak and famous “fucked up” families’ poem comes to mind. But I doubt Paul’s ever read it. And if he had, you can bet his shaven head would be nodding in vigorous agreement.

Paul has gone down for armed robberies, burgs and numerous drug-related crimes. Now past thirty, and not having worked for the past decade and recently out of jail, as he responded to the psychiatrist’s probing questions, he made all the right noises; like wanting to get back on a methadone program – so as to thwart his cravings and to stay off the gear. He volunteered he hadn’t been much of a father figure to his kids. And of course his own father wasn’t much chop either. But with all his mates still using, it’s hard to feel optimistic for Paul’s chances of success, and it’s difficult to believe he’ll be able to turn things around anytime soon.

As he sat with tears sliding down his cheeks, it was hard not to feel some of his pain and his sense of hopelessness and futility. But I also couldn’t help wondering what he’d do if I’d sprung him doing over my place. Would he even blink before using his knife or gun to make good his escape? And yet despite his bloody awful mishmash of tatts and missing teeth, and his forlorn demeanour, there was something likeable about Paul.

Paul is one of the many thousands of Australians who live with a mental illness and a serious substance abuse issue; that dual burden some people have to contend with as they move through life. Relying on a disability support pension to get by, Paul is unlikely ever to work again. His kids will grow up not knowing a father who has ever worked. Paul’s father also has a mental illness, and so the cycle continues.

Despite popular belief, tougher custodial sentences don’t deter people like Paul from engaging in crimes to procure drugs. Incarceration merely reinforces his sense of failure and alienation from society. Jail brutalises and embitters their sense of self. The high rates of recidivism speak for itself.

Medications like buprenorphine, methadone and suboxone – so called blockers that suppress cravings for opiates and other narcotics can be an effective treatment for some addicts. GPs and specialist clinics which are authorised and flexible in the services they provide are essential for such people. However, long waiting lists can spell disaster for punters who are ready to get on board the rehab programs. And yet they may well be all that serve to steer Paul and his cohorts away from cyclical pointless incarceration.

With an estimated 35,000 opiate dependent Australians and twice as many who are addicted to methamphetamines (like speed and ice) demand for such services has never been greater. While such medication also creates dependence, their dosage can be monitored and addicts know exactly what amount of stuff they have in their system.

But let’s take a step back from those scary statistics for a moment. Research shows that many drug dependent people often begin using in their early adolescence, sometimes as young as nine years of age. Heroin and cocaine are capable of inducing near permanent brain changes. And many of these young users go on to develop long term debilitating habits. You don’t need to be an Einstein to figure out that adequate community supports for vulnerable and struggling families must be of paramount importance in our society. If Melbourne is truly to be one of the world’s most liveable cities for everyone, the very least we can do is to put such supports in place.

And as for lenient sentencing, well it’s all a rather meaningless academic debate; the disgruntled horse has well and truly fled the stable.