EITHERhen he headed each psychiatric unit, before starting work, he took a Valium, beta-blockers (to rest his heart rate), and kept a few cigarettes handy. Being an advocate for people with mandatory treatment orders in most metropolitan psychiatric units was a terrifying experience, but not for the reasons you’ve been taught to believe.
Violence permeates mental health units. But unlike what you’ve been told in the media, most of it is done a people with lived experience of mental health challenges.
All Australian states and territories allow the use of mandatory mental health treatment and restrictive practices, including the use of forced medication, forced electroconvulsive treatment, and the use of seclusion (solitary confinement) and restraint (by human force or mechanical instruments). . This is despite what consumers tell us this is violenceand despite the fact that international authorities consider it to be contrary to international human rights law.
Even within the parameters of mandatory mental health treatment, there are safeguards designed to protect people’s rights and involve them in their treatment decisions.
“But we have no rights.” It’s something I hear regularly as an advocate working in Victoria’s mental health system. He was telling people their rights under mental health law and they told me he was wrong. We would tell his psychiatrist and a room full of doctors (something I found incredibly intimidating, so you can only imagine a person’s experience when in detention) about their legal obligations and they would ignore them.
Later, colleagues and I published recommendations which revealed that violations of mental health laws were so common as to make people’s rights illusory. The law was used against people with mental health problems, but their rights and protections were out of reach or ineffective.
Victoria’s royal commission into the mental health system, which is reported in 2021, signaled an opportunity to chart a new course. Built on a real recognition of the socioeconomic drivers of distress, a new mental health system would be one that maintains the use of medical or psychiatric care but shifts the balance to give fair consideration to the other types of supports that people seek : talk therapies, art, connection with mental health professionals who work from their shared experience of distress (called coworkers). Importantly, the system would be attractive and culturally safe enough to entice people into voluntary adoption, rather than so rigid and unappealing as to require force.
The presentation of Victoria’s Mental Health and Wellbeing Bill to the state parliament on Wednesday represents a step in this direction. Replacement of the previous Mental Health Law, the bill creates new principles to inform care, such as the protection of rights, and introduces changes in the way people can communicate their needs in advance.
But despite the commitment to eliminate the isolation and restriction within 10 years, they remain in force and practically without changes in this legislation. After the resistance of the peak psychiatric collegethe Victorian government has left the criteria for compulsory treatment unchanged and deferred it until a new review process.
It means that beyond the headlines, changes in people’s lived experience of the system remain uncertain. Indeed, the executive director of the Victorian Mental Illness Awareness Council, Craig Wallace, reflected that: “This is a welcome step forward, but a small one. Most of the relevant work is ahead.”
While the current bill is likely to be passed, important human rights advances will need to be made through other avenues. Integrating our existing human rights laws, the Victorian Charter, into the mental health system is long overdue and holds great promise. This legislation requires the government to initiate all policies and reforms from a commitment to equality, justice and respect for the needs of particular communities, including Aboriginal Victorians.
Hope is also found in the alternatives. New services emerge from the royal commission that will hopefully complement and provide a cultural competitor to services caught up in the habitual use of force and coercion. Importantly, these services will address stigma and discrimination by putting those of us with lived experience in charge from service
Ultimately, these laws are only as good as their implementation. Invoices expansion of state non-legal defense service is welcome, but the creation of the new Mental Health and Welfare Commission should improve where the current enforcement agencies have it has failed.
The changes in this bill are not insignificant, nor are they enough to say a job well done. Let us hope that our current and future leaders will listen to those calling for help from behind closed rooms.
