Saturday, March 2, 2013

New mental health act ignores social issues

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 significant 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’ 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 treating psychiatrist to simply ignore those directives and can 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 currently 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.

[This article by Barry Healy is from Green Left Weekly #956.]