Sunday, 15 February 2009

Community needs to understand mental health, before commenting on it

I direct you to the ABC Online article Community urged to weigh in on forced mental illness treatment.

The gist is that a parliamentary committee in Tasmania has heard that the community needs to debate when it is okay to force treatment on someone who has a mental illness.

Michelle Swallow from the Mental Health Council, which is an advocacy group, so therefore Michelle is someone who is paid to represent people with a mental illness and, in more basic language, be a shit-stirrer, thinks that the individual should be able to decide unless they are considered a threat to themselves or others.

Umm... Excuse me, but I thought that was what the law currently is anyway?

Most states have a two-tiered system for "forced" (which is called "involuntary") treatment of someone with a mental illness: An Involuntary Assessment Order, which is usually 48 hours during which the individual can be collected by police, taken to a secure facility and detained while a psychiatric assessment can be conducted upon them, and; An Involuntary Treatment Order, during the course of which they may either be in a secure facility or in the community, but have to take prescribed medication until such time as the order is revoked or not renewed.

It's a little bit more complicated than a GP deciding that someone with a case of depression needs to be locked up if they don't want to take their medications.

Michelle continues, to say that there is a gap in the law which does not require a GP to specify why they have ordered involuntary treatment.

Really? Now that would be interesting.

Let's have a look at the law in Tasmania, available from Austlii, here.

Section 15 states that a police officer or authorised person may, using their judgement, take someone into protective custody. Well, just about everything to do with the police involves judgement, so if there's a problem here, it's one of training and supervision of police officers.

Section 16 states that the person taken into custody must be taken ASAP to an authorised assessment centre, the assessment centre must be notified within 2 hours and the person must be assessed and either released or have an involuntary treatment order written up within 4 hours. Now, honestly, 4 hours? Try getting seen within 4 hours if you turn up to emergency with any condition less serious than haemorrhaging blood or developing cyanosis.

So how about treatment, then?

Sections 24 through 30 deal with involuntary admission to hospital.

Section 24 covers admission, and I'm going to copy it verbatim. Are you ready? Here we go:

"A person may be detained as an involuntary patient in an approved hospital if –
(a) the person appears to have a mental illness; and
(b) there is, in consequence, a significant risk of harm to the person or others; and
(c) the detention of the person as an involuntary patient is necessary to protect the person or others; and
(d) the approved hospital is properly equipped and staffed for the care or treatment of the person."
See? Criteria. Right there. Spelled out.

The people who may make this order are given in Section 25, and basically amount to an authorised officer, which means someone appointed by the Minister (and more detail than that I am, unfortunately, unable to give), or the ill person's guardian.

Interestingly, Section 26 states that a medical officer at the approved care facility has to approve the application for admission. An initial order has to specify all the whos and wheres, and, crucially, a statement against all the points covered in Section 24. You may like, at this point, to go back up and read those four points. An initial order for admission has to specify the who, the why there's a risk of harm, the why the detention is necessary, and that the nominated hospital can actually do so.

Well, that all makes sense, doesn't it? Would you care to clarify, Michelle?

I'm thinking, and this is only a guess, mind you, that there are two separate issues here:

One, this paperwork is often not explained to the patient, who rings the Mental Health Council with a complaint, or; two, this is just an excuse to get a debate happening because either liberties are being taken, or because that's the MHC's job.

In my experience, working in both Tasmania and Queensland, there are a lot of often quite worrying or even scary people wandering about who should be on an involuntary treatment order, preferrably in a lock-up, and that most people with a serious mental illness who come to the attention of services such as drop-in centres or the MHC, deny their illness and believe that they are being persecuted, or are part of a government experiment, or are being made worse, or.... Well, fill in the blank, really.

No system is perfect. Particularly with mental health, where all assessments are judgement calls and there is no testable pathology and all criteria are behavioural and either observed (massively open to interpretation) or reported (massively suspect, in far too many cases), no system ever can be perfect

Yes, sure, the community needs to have a say in law and policy. But leave medicine the hell alone, and let the doctors do their job until the law itself is changed. The community interfering in medical decisions is a road to nightmare. Measles epidemics, say, or the suicide of someone with schizophrenia who was denied treatment on religious grounds.

Link to the Mental Health Council of Tasmania
Link to the Mental Health Act (1996) for Tasmania, on Austlii.


Scara said...

Michelle Swallow is unlikely to be reflecting the interests and views of at least one of her constituencies, ARAFMI. The family of Cornelei Rau have some firm views about choosing to have treatment, or not.
As for doctors having right to impose treatment, complete bollocks. A patient who is detained cannot be treated without their consent unless authorised by the Guardianship Board. whether they can be detained is determined by another body, The Mental Health Tribunal.
It is troubling that someone as clueless as Ms Swallow has such influence.

Neuroskeptic said...

Great post. It's frustrating that it's always people like Swallow who get quoted in stories like this. Not that they never have anything useful to say, but it's not always clear that they have what amounts to a professional interest in making the situation look as bad as possible.

Hannah said...

This is Hannah Bevills, I am an editor with We are a medical publication whose focus is geared towards promoting awareness on hospitals, including information, news, and reviews on them. Given the relevance of what you are offering from your site and what our mission is, I feel we may be able to collaborate in some way or another, I look forward to your response regarding the matter. Thanks!

Hannah Bevills

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