New mental health act ignores social issues

Issue 
Overuse of drugs and alcohol among fly-in, fly-out workers is putting strain on the health system.

In Western Australia, mental illness is the second-highest cause of disease for women and the fourth-highest cause for men.

Premier Colin Barnett has responded by publishing a green paper for public discussion for a new Mental Health Act. The proposed act contains provisions that would improve the rights of people subjected to a Compulsory Treatment Order (CTO). But it negates those same provisions by allowing the treating psychiatrist to simply ignore them.

WA authorities are trigger-happy when it comes to CTOs. Last year, there was a well-publicised scandal of a man who was incorrectly subjected to a CTO when police mistakenly confused him with someone else who suffered a mental illness.

The WA Mental Health Law Centre (MHLC) and a practicing psychiatrist told Green Left Weekly there are many such cases of CTOs based on mistaken identity in WA that receive no publicity.

A big cause of WA’s problems is the mining boom. A February 13 report by the federal Standing Committee on Regional Australia into fly in-fly out mining jobs found that there is growing evidence of binge drinking and self-destructive use of amphetamines and cocaine among young, cashed-up male mining workers.

Doctors and hospital emergency departments all over WA report that the drinking, drug use, boredom and exhaustion caused by the mining companies’ employment practices is producing a crop of crazed young men causing havoc in the health system.

Combining this with the 27% wage gap between men and women in WA — compared with 17% Australia-wide — and the reasons for WA’s mental health problems and its gender imbalance are clear.

When the Liberal government’s austerity and general hostility to social justice is added to the mix, it leads to a crisis. That is what grips the WA mental health system at the moment.

Having rejected demands for an independent inquiry for years, the Liberal government finally commissioned Professor Bryant Stokes in November 2011 to look into the system. What he reported was chilling: care in WA mental health hospitals is so appalling that a large number of patients commit suicide the same day that they are released from treatment.

The government sat on Stokes’s 107 recommendations, and the planned mental health act will make the situation worse.

People with mental illness can currently write directives during lucid periods, to guide health practitioners when the person needs care.

But Barnett’s planned changes will allow a treating psychiatrist to simply ignore those directives and decide on treatment. The patient would be unable to refuse.

The WA chief psychiatrist will supervise the treating psychiatrist. But that oversight can be delegated to the treating psychiatrist, making a mockery of the “supervision”.

The bill has provisions for the patients to name carers to look after their interests. But the treating psychiatrist can choose to exclude them at their whim.

There will be a Mental Health Tribunal to which the patient can appeal. However, there is no provision for the patient to be told of their rights and the treating psychiatrist can ignore tribunal treatment recommendations for up to eight weeks.

The MHLC said the treating psychiatrist can avoid review simply by temporarily changing the patient’s status from compulsory to voluntary the day before their case comes before the tribunal, without telling the patient. The tribunal then has no power and immediately afterwards the patient can be placed under a new CTO.

Second opinions for the treatment of patients under CTOs, which are already subject to abuse — a doctor at the same hospital can do a cursory examination — will be further weakened under the bill. If a patient under a CTO can obtain a proper second opinion there will be no mandatory requirement for the treating psychiatrist to respond.

The law would also remove the right of mental health advocates to visit and inspect mental health facilities.

The Director of Health and Disability Services, who is the last ditch option for a patient under a CTO to obtain an investigation into their treatment, will only have “conciliation” power under the new law.

The reports will also not be confidential, meaning that patients who complain about mistreatment may find themselves at the mercy of the staff who they have previously named if they ever find themselves back in the same wards.

Improving the situation for WA people with mental health problems will require a multi-pronged approach.

Firstly, the government needs to fund more community mental health teams to work with people in the community, alleviating the need for hospitalisation.

Spending on regional mental health facilities urgently needs to be ramped up. Kalgoorlie hospital, for example, survives by flying in psychiatrists from Perth on short-term arrangements.

The MHLC, a not-for-profit organisation that represents people subjected to CTOs and survives on a shoe-string budget, needs a substantial financial injection.

Beyond these immediate matters there are larger sociological issues needing attention.

The destructive nature of fly in-fly out employment practices in the resources industries needs to be ended. Forcing workers to work 12 hour shifts on rotating shift rosters, doing mind-numbing repetitive tasks is beyond the capability of a human being to cope.

Australian unions famously began the struggle for the eight-hour day in 1856. That struggle has to be refought and re-won. Alongside that there must be genuine gender pay equity to reduce women’s social oppression, which grinds on their mental well-being.

Finally, the power of Big Pharma must be broken. The drug companies promote their drugs as modern day shackles for mental health patients. The concept of control of patients has been substituted for the concept of recovery from illness.

Comments

You don't improve much with age, do you Barry? Not where mental health issues are concerned anyway. Ever since I have been campaigning, over the past few weeks, to goad (or shame) the WA Socialist Alliance, Perth Resistance, and the 'Green Left Weekly' newspaper in Sydney to get off their collective backside and do something to fight the Barnett government's draft WA Mental Health bill, I have focussed mainly on the threat that the proposed new Act will present to the civil liberties and democratic rights of the psychiatrically ill or disabled in WA, and more generally to the Western Australian community as a whole. The Socialist Alliance in WA had a creditable record in putting considerable resources into the fight to block the Barnett government's 'Stop and Search' laws a couple of years ago. Why don't we see the same diligence from SA when it is presented with what is possibly even more of an insidious piece of threatened legislation?

Barry Healy's meliorist approach to Barnett's Mental Health bill, as developed in the above article, is completely inappropriate. The bill should be totally scrapped, and a new one drawn up that enshrines the basic human rights of those who become caught up in the toils of the mental health system in WA. First and foremost, there must be included in any new Act the full right of appeal to an independent judicial tribunal (court) against the involuntary detention of anyone in a psychiatric institution in WA. As I understand the situation that prevails now, WA is one of the few jurisdictions, if not the only jurisdiction, in the world in which a person can be locked up in a mental hospital without any right of appeal against that incarceration to a court of law. This situation must be changed, and the Socialist Alliance, Resistance and 'Green Left Weekly' should be ashamed that they have not taken a firm position on this democratic demand.

It is completely unsatisfactory that the principle of the separation of powers, which is a foundation stone of democratic government, has been violated in the current WA Mental Health Act, under which the so-called 'mental health review tribunals' operate as a mockery of justice within the mental health system. These tribunals are part and parcel of the Mental Health Department (ie. of the executive branch of government). It is essential that anyone held involuntarily in a psychiatric institution has the right to appeal their incarceration to a court independent of the Executive. The WA Mental Health Act that was replaced by the currently- operating one in the mid-1990s did have a provision allowing for an appeal by an involuntarily-detained person to the WA Supreme Court. I do not know if this provision was ever utilised by anyone held against their will in a WA psychiatric institution: the court costs and the logistical problems of mounting a case would have been formidable, I should think. It is my belief that a civil case in the magistrate's courts would be more appropriate. The cost is minimal and no lawyers are allowed to be present at the hearing, as a general rule.

One point that has to be made clear here, in my view, is that professional psychiatrists are in our State allowed or awarded far greater prestige and status than they deserve, both under the terms of the WA Mental Health Act and also by the sycophants and toadies who pander to them in the community as a whole. These people (psychiatrists), are in my experience for the most part, in terms of their abilities, no more than profoundly-average, and often they are narrowly-focussed and narrow-minded. Sometimes they are uniquely stupid. These psychiatrists are, it is well to remember, nothing more than medical officers, and their opinions should be subject to independent judicial review just like anyone else's. We on the left at least should have by now heard and assimilated the meaning of the ironic dictum: 'Trust me: I'm a doctor!'

As I have indicated, Healy's article totally avoids the civil liberties issues connected with the draft WA Mental Health bill, The presently-operating Act clearly violates the provisions of the United Nations Charter of Human Rights prohibiting detention without trial, and the proposed newer version of the Act will perpetuate that situation. Further than that, the new bill proposes to extend powers to the mobile community staff of the Mental Health Department that will allow these people to assess the 'mental health' of anyone in the community and then, following liason with a psychiatrist over a mobile telephone, convey that person to a psychiatric institution and have them detained there indefinitely. There will of course be no possibility for the person detained of an independent judicial review under the proposals in the draft bill.

This is a disappointing effort, 'Green Left Weekly', but I must observe that your stance is pretty much par for the course for your outfit, at least where mental health issues are concerned.

- Graham Milner

I am disappointed in this article's cursory treatment of the issues surrounding involuntary hospitalisation and CTOs in Western Australia. For one thing, the author seems to believe that CTOs and involuntary hospitalisation are the same thing - they're not. Props to Graham Milner for providing a more detailed and respectful analysis of some of the human rights issues surrounding even the current Mental Health Act in Western Australia. There is a lot more wrong with the WA mental health system than "a crop of crazed young men causing havoc in the health system." As a Western Australian mental health consumer and member of the Socialist Alliance Perth branch, I am deeply disappointed by this article. I am saddened to read Milner's comments that this is "pretty much par for the course" for Green Left Weekly's stance on mental health issues and hope that this is improved in future.

"People with mental illness can currently write directives during lucid periods, to guide health practitioners when the person needs care.

But Barnett’s planned changes will allow a treating psychiatrist to simply ignore those directives and decide on treatment. The patient would be unable to refuse."

This issue has absolutely nothing to do with "Barnett's planned changes". Treating psychiatrists and hospitals can - and do - *already* ignore advance directives. I had a meeting with a medical negligence lawyer about this very issue recently, and was told that advance directives are in general not legally binding. I believe this applies across the spectrum of the health service and not just in mental health.

Recent changes to Mental Health Review Tribunal policies have impeded rights protection for people detained in hospital.NSWCCL is opposed to community treatment orders, believing that they are an unacceptable infringement of individual freedom and that the benefits do not outweigh the disadvantages.