ISLANDin front of each psychiatric ward before I started working, I would take a Valium, beta blockers (to rest my heart rate) and keep some cigarettes at hand. It was a scary experience to advocate for people on compulsory treatment across most psychiatric units in the big cities, but not for the reasons you have been taught to believe.
Violence pervades mental health units. But contrary to what you have been told in the media, most things are done to people with lived experience of mental challenges.
All Australian states and territories allow the use of mandatory mental health care and restrictive practices, including the use of compulsory medicine, compulsory electroconvulsive treatment and the use of seclusion (solitary confinement) and restraint (by human power or through mechanical instruments). This is despite consumers telling us so this is violenceand despite international authorities finding it to be in breach of international human rights law.
Even within the parameters of compulsory mental health care, there are safety measures designed to protect people’s rights and involve them in their treatment decisions.
“But we have no rights.” This is something I regularly heard as a lawyer working in Victoria’s mental health system. I wanted to tell people their rights under the Mental Health Act, and they would tell me I was wrong. We told their psychiatrist and a room full of clinicians (something I found incredibly scary, so you can only imagine a person’s experience when he was detained) about their legal obligations, and they would ignore them.
Later colleagues and I published fund that revealed violations of mental health laws were so common that they put people’s rights in order illusory. The law was applied to people with mental health problems, but their rights and protection were out of reach or ineffective.
Victoria’s Royal Commission on Mental Health, which reported back in 2021, signaled an opportunity to set a new course. Based on a real recognition of the socio-economic drivers of distress, a new mental health system would be a system that retained the use of medical or psychiatric treatment but shifted the balance to take reasonable account of the other forms of support people ask for. : conversational therapies, art, connection with mental health professionals working from their shared experience of distress (called peer workers). It is important that the system is inviting and culturally secure enough to attract people to its voluntary embrace, rather than being so rigid and unattractive that it requires power.
The introduction of Victoria’s Mental Health and Wellness Act to the state parliament on Wednesday represents a step in this direction. Replaces the former Mental Health The bill creates new principles for informing care, such as the protection of rights, and introduces changes in how people can communicate their needs in advance.
But despite an obligation to remove seclusion and restraint within 10 years, they remain in force and largely unchanged in this legislation. After resistance from peak psychiatric collegethe Victorian government has left the criteria for coercive treatment unchanged and subject it to a further revision process.
In addition to the headlines, this means that the changes in people’s perceived experience of the system remain uncertain. In fact, the CEO of the Victorian Mental Illness Awareness Council, Craig Wallace, reflected that: “This is a welcome but small step forward. Most of the relevant work is ahead of us.”
Although the current bill is likely to be adopted, major advances in human rights must be found through other avenues. Embedding our existing human rights laws, the Victorian Charter, into the mental health system has long been required and promises a lot. 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 alternatives. The origins of the Royal Commission are new services that will hopefully complement and provide a cultural competitor to services caught in the usual use of force and coercion. It is important that these services tackle stigma and discrimination by putting them off with us lived experience with responsibility of the service.
Finally, these laws will only be as good as their enforcement. The bill expansion of the state’s non-legal advocacy is welcome, but the creation of the new Mental Health and Wellbeing Commission needs to be improved where the current enforcement bodies have 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 listen to those who call for help behind locked wards.