Australian Civil Liberties Union
Your Rights 2005
Chapter 18
RIGHTS OF MENTAL HEALTH CONSUMERS
Mental
Illness. Confidentiality. Types of Support. Criteria for Involuntary Detention.
Police
Powers. Discharge. Community Treatment Orders. Treatment and Consent. How to
Maintain
Your Mental Health. Relevant Phone Numbers.
Mental illness is becoming one of the most common health problems in Australia. About 20% of Australians receive treatment for some type of mental illness during their lives. The law varies from state to state and this chapter is only a general guide to your rights. As in other areas of the law you should ask questions about your rights. The Mental Health system encourages people to obtain information. For instance, prominent notices in institutions set out the phone numbers of independent watchdogs to which queries and complaints can be directed (see the phone numbers listed in Chapter 1).
Official visitors (or community visitors) make regular visits and can visit institutions without notice. They are required to make enquiries about the treatment of patients and may obtain full disclosure of relevant information.
For
the purposes of involuntary detention and tratment, you cannot be considered
mentally
ill only (to give some examples) because of sexual promiscuity; immoral
conduct;
illegal conduct; being intellectually disabled; taking drugs or alcohol or
having an
antisocial personality. Some examples of mental illnesses are depression,
schizophrenia,
schizo-affective disorder and bipolar affective disorder.
People
with a mental illness should be provided with timely and high quality
treatment
and care in accordance with professionally accepted standards; and wherever
possible,
should be treated in the community (e.g. at home). People with a mental illness
should
be provided with appropriate and comprehensive information about their mental
illness
or disorder, proposed and alternative treatments, including medication and
services
available to meet their needs.
Confidentiality
As
a general rule, the staff of a mental health service are obliged to keep your
personal
information confidential. If they want to release some of this information they
must
ask for your permission. However, there are some exceptions to this. For
example, information
may be released when the information is related to your psychiatric treatment
and is required by other staff who are on the treatment team, and when the
information
is required for some court in the course of proceedings.
Sources
of Support
When
a person has a mental illness or disorder, some of the ways they can seek
treatment
are by: admission to a hospital; assessment by a visiting Crisis Assessment and
Treatment
Team (CATT); assessment by a visiting Mobile Support and Treatment Team
(MST);
attending a Community Mental Health Clinic or Disability Support Service;
seeing
a general practitioner or private psychiatrist or
therapist.
Voluntary
Patient
If
you have admitted yourself to a hospital you will be referred to as an informal
or voluntary
patient. If you are a voluntary patient, you have the right to leave the
hospital at
any time. You have the right to choose whether you have treatment for your
mental illness.
If you want to leave or you refuse the treatment offered, the doctors may
consider whether
you meet the criteria for involuntary admission.
Admission
as an Involuntary Patient
Admission procedures vary from state to state. You may be recommended by attending the hospital on your own volition requesting treatment, being referred by a GP, being apprehended by the police following a complaint, or apprehended by a CATT team because you have not observed the conditions of a Community Treatment Order (CTO).
If
you are required to accept treatment against your will, then you are an
involuntary patient
(called a temporary patient in NSW).An involuntary patient can be an inpatient
in
a hospital or on a Community Treatment Order (CTO).The criteria for admission
vary but
the core requirements are that you appear to be mentally ill, evidenced by such
matters
as delusions, serious thought disorder, sustained irrational behaviour (NSW Act)
and
significant disturbance of thought perception mood or memory (Vic Act), you need
immediate
treatment, that treatment can only be given if you are detained, that you need
to
be detained for your own health or safety or the safety of others, and (NSW
only) that you
have one of certain specified symptoms.
Generally,
medical assessments by two doctors conducting separate examinations are
required
indicating that you meet the criteria. If you do not meet the criteria you
should not
be detained. If, later, you cease to meet the criteria you should be released.
The decision
to detain you for treatment must be subject to a speedy internal review by a
psychiatrist,
or (in NSW only) review by a visiting magistrate.The decision can be further
reviewed
in all states by the Mental Health Review Board in Vic and WA, the MHR
Tribunal
in NSW, the Patient Review Tribunal in Qld, the Guardianship Board in SA and
the
Mental Health Tribunal in Tas (all hereinafter referred to as “The Tribunal” –
see phone
numbers at end of chapter) at any time at the request of yourself, a friend or
an official
visitor. The decision must also be reviewed by the tribunal within an early
prescribed
period and be subject to further regular review (eg
annually).
The
police also
have a separate power to apprehend you if you have recently attempted
suicide or tried to cause serious physical harm to yourself or others or you are
likely
to attempt suicide or cause serious physical harm to yourself or others. In
these circumstances
the police must arrange for you to be examined by a doctor as soon as
practicable
after they apprehend you.
Statement
of rights
If
you are an involuntary patient you must be given a written and a spoken
statement of
your rights upon admission. You have the right to complain about your treatment
or anything
you are unhappy about, to staff, official visitors and Ombudsman, or the
Tribunal.
All involuntary patients will have an automatic review of their
involuntary status
within a prescribed period after their admission.You may obtain a second opinion
from
a psychiatrist, obtain legal advice and have a lawyer represent you and
have your detention
reviewed. (Contact Legal Aid - Chapter 1 or a Legal Health Centre). All
reviews
of involuntary patients are conducted by the Tribunal. If you do not want to
wait for
the automatic review, you can appeal against your involuntary status at any
time. You should
ask staff at the hospital about this.
Discharge
If
at any time you don’t meet criteria leading to your detention, you must be
discharged
from hospital. The treating psychiatrist, the chief or “orthorized” psychiatrist
at
the hospital, a Chief Medical Officer or the Tribunal may discharge the patient
or allow the
patient to be absent on trial leave.The patient may be discharged at the request
of the person
who first requested hospitalisation. Official visitors (community visitors in
Victoria)
can recommend a discharge.
Community
Treatment Order (CTO)
If
you are living in the community and you are required to accept treatment against
your
will (see criteria for involuntary detention) you must be placed on a Community
Treatment
Order (CTO).Wherever possible people should be able to receive treatment
in
the community. The maximum time a CTO can be made for is usually 12 months. A
CTO
can be extended by your psychiatrist. An extension must be reviewed within a
prescribed
period to make sure you continue to meet the criteria for involuntary
treatment.
A CTO can be revoked if you don’t take your medication or fail to turn up for
appointments
or have failed to comply with the order. This means you are deemed to be
an
involuntary patient who is absent from hospital without leave and you may be
apprehended
and returned to the hospital. If you are unhappy about being on a CTO or
wish
to have it varied, you can appeal to the Tribunal at any
time.
Treatment
and Consent
Psychiatric
treatment is
defined as things done with professional skill to remedy the illness
or to lessen its ill effects or the pain and suffering which it causes.
Treatment includes
medication, counselling, psychotherapy and monitoring to see how you are
going.
As a voluntary or informal patient you can refuse treatment or change your mind
about
treatment and withdraw your consent if you decide you don’t like any of the
treatment.You
have the right to get a second opinion from another doctor at this
time.
Involuntary
patients and consent to psychiatric treatment. If
you are an involuntary patient
in a hospital or on a Community Treatment Order you must still be given
sufficient
information about your psychiatric treatment and your preference will be
considered,
but you will not be required to give informed consent. You are legally
required
to accept the psychiatric treatment which is given to you.
Electroconvulsive
therapy (ECT) (shock treatment), ECT
can be performed without seeking
your informed consent if you are an involuntary patient and the authorised
psychiatrist
decides you are incapable of giving informed consent. However, the authorised
psychiatrist must also be satisfied that certain strict criteria have been met.
In NSW
the Tribunal must agree to the ECT.
Non-psychiatric
treatment:
Voluntary
(informal) patients Non-psychiatric
treatment is treatment which is not related
to a mental illness. If you are a voluntary patient, you have the same rights to
consent
to or refuse non-psychiatric treatment as can any member of the
community.
Involuntary
patients. If
you are involuntary doctors have to get your written consent for
non-psychiatric treatment if you are able to consent, unless it is emergency
treatment which
is necessary to save your life. There are different rules for involuntary
patients about
how you consent and what happens if you cannot consent, depending on the type
of
non-psychiatric treatment. If you are involuntary but can consent to major
non-psychiatric
treatment your
written consent must be obtained, unless it is emergency treatment
which is necessary to save your life. If you are deemed unable to consent a
psychiatrist
or a guardian may consent to the treatment on your behalf.
How
to maintain your mental health
Do:-
Keep
appointments with clinical therapist. Keep appointments with psychiatrists.
Maintain contact with your local GP. Ensure you get enough sleep. Eat a
balanced
diet. Take medication as prescribed and report any side effects. Monitor for
emergence
of early warning signs. Try to keep reasonably active. Discuss problems with
others.
Learn as much about your illness as possible.Try to set specific realistic short
term goals.
Ask for help when necessary.Take regular exercise.
Don’t:-
Stop
medication without discussion with your doctor. Overuse alcohol or drugs.
Withdraw from family and friends. Try to take on too much all at once. Keep all
your
problems to yourself.
Where
to get help
VIC
Legal Aid 9269 0234, Community Visitor 9603 9500, MHRB 8601
5270
NSW
Legal Aid 9745 4277, Official Visitor 9620 8218, MHRT 9816
5955
WA
Legal Aid 9261 6222, Official Visitor 1800 999 057, MHRB 9226
3255
QLD
Legal Aid 3234 0680, Official Visitor 3234 0160, PRT 3234
0702
SA
Legal Aid 8463 3555, Official Visitor 8269 7575, GB 8269
7515
TAS
Legal Aid 6233 8383, Official Visitor 6233 3085, MHRB 6233
3033
ALL
STATES. Police emergency 000. Lifeline 131 114.
Australian Civil Liberties Union