My name is [ Type your name here ], I am a resident of New South Wales. I hereby submit my protest and register my objections with regards to the "Discussion Paper 2: The Mental Health Act 1990", recently released by the NSW Health Department. I agree with MP Peter Breen MLC’s submission dated 31 October 2004 (see MP's submission below). This proposed legislation is abhorrent and a blight on our health freedom and civil rights. Yours sincerely [ Type your name here ] [ Type your address here ] Discussion Paper 2: The Mental Health Act 1990 contains proposals that raise serious questions about potential abuses of fundamental human rights for mentally ill and mentally disordered people in New South Wales. Many of the issues canvassed in the paper relate to definitional and treatment issues surrounding mental health. In particular I express concern about the following aspects of the paper:- 1. Reducing the input of the legal system and promoting associated secrecy of the mental health system; 2. Forced medication and administration of drugs before stringent diagnosis; 3. Telephone assessments and expanding time frame for assessments; 4. Removing the right of appeal to the Supreme Court; 5. Removing safeguards on religion, philosophy, political opinion and sexual history; 6. Advocating usage of psychosurgery and electroshock treatment. **************************************************************** 1. Reducing the input of the legal system and promoting associated secrecy of the mental health system I have grave concerns about the way in which this discussion paper appears to minimise the role of the legal system in mental health. The paper proposes that the Mental Health Review Tribunal takes over the role previously held by magistrates' and consequently no magistrate or court representative will be involved in the process by which the mentally ill are detained. This proposal inappropriately seeks to allocate a judicial role to health department officials. Mental Health Tribunals should not replace the role of magistrates in courts in determining matters of a legal nature. Courts are crucial to maintaining impartiality in the mental health system. The discussion paper also suggests giving the Mental Health Tribunal the power to close hearings. The explanation given for proposing this power states: "Sometimes people coming before the Tribunal are not legally represented. In such situation their illness may impair their ability to identify situations where hearing the matter confidentially in a closed hearing may be to their benefit and may protect their privacy." There is no sound basis for allowing the Tribunal to have the power to close a hearing on its own motion against the wishes of the person being reviewed for thek mental state. If the Tribunal is concerned about a person without legal representation or then: privacy, then the Tribunal should arrange for a suitably qualified person to assist. Closing the hearing to the public will not assist a person who is not legally represented, it will simply allow the Tribunal to act in secrecy. Transparency and accountability are of the highest priority when dealing with persons who may be declared mentally ill or mentally disordered. 2. Forced medication and administration of drugs before stringent diagnosis; Currently the Community Treatment Orders (CTOs), imposed by a Mental Health Tribunal, can force a person to take prescribed mediation for a minimum period of 3 months. The discussion paper suggests that CTOs should be extended for 6-12 months before review, which could keep a person on psychiatric drugs indefinitely. The paper also proposes to extend forcible treatment to include mental disorders, not just mental illness, thereby increasing the circumstances under which treatment may be forced on a person. This could range from persons suffering from a personality disorder to anorexia sufferers. The paper also floats the idea that a person may be drugged and sedated immediately after an initial assessment and before they are transported to a hospital. This means forced medication to restrain a person, before a second opinion of the person's mental health has been completed in a hospital. This goes against the psychiatric code of practise, which advocates not drugging a person before they have been assessed in a hospital.If at any time restraint is necessary, then existing law should be applied as it would be in any other case and the police should be contacted. It would be unacceptable for a random person on the street to be forcibly medicated when they appear volatile and the same standard should be maintained for persons suspected of mental illness until a thorough examination is carried out in a hospital. 3.Telephone assessments and expanding time frame for assessments The notion of allowing an assessment of a person's mental health to be conducted over the phone in "emergency situations" is wholly unacceptable. As is the suggestion that medication could be authorised over the phone based on the advice of a nurse or police officer. It is neither appropriate nor justified to allow unqualified persons to consult on the administration of medication for suspected mentally ill or mentally disordered persons. The paper acknowledges there has been "strong criticism in a number of recent coronial and other cases over the practice of allowing often junior registrars to conduct examinations... In a number of these cases, discharge of the patient followed shortly thereafter by the patient's death or the death of a close family member.. .Similar concerns have also been raised by forensic psychiatrists who deal with people admitted via the Local Court." Currently a person who is taken into a mental health institution must be assessed within a 12 hour timeframe. The paper seeks to remove this provision based on the difficulty in accessing a "skilled professional in a relatively short time frame" thereby extending the period of time a person is held without assessment. Of significant concern is that the paper does not propose a replacement time frame in which a person must be assessed. By leaving this open, persons are vulnerable to being held indefinitely before assessment. 4.Removing the right of appeal to the Supreme Court The discussion paper further attempts to minimise the role of the legal system by proposing that appeals against detention under the Mental Health Act should not go before the Supreme Court. The paper suggests that the Administrative Decisions Tribunal is a more appropriate venue for persons to air grievances regarding their detention. Whether this may be the case or not, the option of a person requesting the direct intervention of the Supreme Court should be maintained. 5.Removing safeguards on religion, philosophy, political opinion and sexual historySection 11 has always provided safeguards to ensure that expressing a particular political or religious opinion, or philosophy or sexual preference cannot be used to indicate a person's mental health. The discussion paper seeks to remove this safeguard on the basis that some of the concerns it raises are no longer relevant.It is important to maintain the protections of Section 11 so that stringent conditions remain to determine whether or not a person is mentally ill or mentally disordered. It would be unthinkable to use a person's political, religious or sexual preference as a means to determine their mental health. 6. Advocating usage of psychosurgery and electroshock treatment The paper makes it clear that no psychosurgery has been carried out in NSW since 1994 due largely to the fact the Board was not reappointed when the members' terms of appointments expired in that year. Also, it is a fact that there appear to be no surgeons in NSW currently willing to perform these procedures - a clear indication of the professional opinion of this form of treatment. Nevertheless this the paper suggests that due to the renewed interest overseas in pursuing new forms of psychosurgery there is a need to retain some legislative base relating to this form of treatment. The paper also suggests replacing the word psychosurgery with neurosurgery to reduce stigmatisation, an issue that requires more detailed consideration before making any changes. In relation to the use of electroshock treatment, the paper suggests it as a means of possible treatment for people on Community Treatment Orders (CTOs). Currently a CTO allows a person to live in the community and forces them to take psychiatric drugs. Studies have shown that electroshock treatment can leave irreversible brain damage, permanent loss of memory and may result in death. Again, more work needs to be done before we go down this path. Conclusions There are serious implications for human rights abuses in the proposals outlined in Discussion Paper 2: The Mental Health Act 1990. On the whole, proposals in the paper serve to:- i. make persons more vulnerable to forced treatment, ii. fail to facilitate access to the legal system, iii. reduce transparency in hearings, iv. enable haphazard assessments and medication by persons who are not suitably qualified to assess mental illness or disorder, v. abolish safeguards on personal beliefs and opinions as categories for determining mental illness, and vi. pave the way for reintroducing psychotherapy and expanding the use of electroshock treatment Considerably more research psychosurgery and electroshock treatment would need to be conducted before any serious consideration to reintroduce them or have them regarded as legitimate mental health options.