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When Andrew celebrated his 30th birthday recently he didn’t get any presents. At the boarding house where he couch surfs, he and a few others got through a few long necks, shared some bongs and everyone had a hit of smack. For once, no-one called the cops and when I caught up with Andrew a few days later, he still looked worse for wear but was already scrounging for his next hit.

Andrew has schizophrenia so I can’t tell you his real name. I can tell you he started going off the rails when he was thirteen. Like many people who have schizophrenia, he refuses to accept his diagnosis. And like many people experiencing a psychiatric illness has also has a serious drug problem. He’s lived in group homes and in psychosocial rehabilitation centres, been in and out of psychiatrists units, done several stints in jail and still he continues on his merry destructive path.

His psychiatric medication’s efficacy is limited by the amount of illicit drugs and alcohol substance he has on board at any given time. With debts to pay, and dealers to placate, his pension is gone within an hour. The rest of the fortnight is then one long scrounging for food, smokes, alcohol and drugs.

Andrew’s showing no signs of slowing down. He’s isn’t concerned about the parlous state of his liver. Age hasn’t wearied him. He could’ve scripted Amy Winehouse’s single Rehab. But he’s never been interested in any detox programs. Of course there are drug and alcohol treatment options available to Andrew. Most services have a waiting list, but with a little persistence, those genuinely seeking treatment will get a guernsey.

Over the years I’ve worked with him, I haven’t made any headway. It’s not from a lack of trying. Cajoling, encouraging him, and at times even suggesting a spell in the local psychiatric ward hasn’t gotten anywhere. Recovery (the latest buzz word in psychiatry) and Andrew just don’t fit into the same sentence. He doesn’t do appointments and he barely tolerates my visits. Occasionally if he has too much gear on board, he resorts to intimidating behaviour. When stoned he’s mellow, but when he’s iced up he’s downright scary.

Andrew will likely continue on his destructive trajectory – for how long, who knows? I can’t see that he will ever be able to turn his life around. He is emphatically unemployable. The $2.2 billion the Federal Government is allocating to mental health over the next few years will make no difference at all to his situation.

Andrew’s lifestyle choices throw up an interesting challenge. After all he is choosing to maintain his drug-seeking behaviour. He relies on the generosity of his mates for shelter. Practically all his pension goes on alcohol and drugs. His GP is unable to get him to accept treatment for his deteriorating liver.

For the Andrews of our world, I have to admit, little can be done. He and his cohorts are in the proverbial too hard basket. A gloomy conclusion I know, but there is little mental health professionals like myself can do if the client is unwilling or unable to take that first step.

There has always been a certain per cent of society who have been dealt a wrong hand – often through no fault of their own, and sometimes through their own self-destructive urges. In a minority of cases people somehow manage to turn their lives around. For some, it’s a spiritual awakening or good fortune, for others, reasons that they themselves cannot comprehend.

It isn’t Andrew’s fault that he has schizophrenia. He hasn’t done himself any favours by continuing to do drugs. It would be judgmental of me to blame him for his choice. I don’t know what I’d resort to doing if I had schizophrenia.

At the mental health clinic where I worked, until recently Andrew generated an array of responses from the staff. Some make no secret about their intense dislike of him. One receptionist hated him with a passion: frequently muttering that he should’ve been in jail, that his pension should’ve been cut off, that he’s an oxygen thief: the list goes on.

Maybe it’s saying something positive about our society that Andrew’s dysfunctional ways have been accommodated for so long. But there’s no neat ending to Andrew’s situation. I can’t or won’t put a positive spin on his story. I’m sure he’s still out there right now, harassing his mother for money, calling in favours, hustling for his next hit, in the hope of experiencing a brief period of sheer bliss – when he can forget about his squalor, his hunger, and his awful reality.

And, what gives me, or anyone else, the right to judge him or, for that matter?