S50: Perspectives on Compulsory Mental Health Interventions

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By September 28, 2023 No Comments

Authors: Alison Schneller, Kelly Pope, Mohan Isaac, Kimbali Wild, Bernadette Sebar & Neeraj Gill

Year: 2023

Event: 2023 The MHS conference - Adelaide

Subject: Perspectives on Compulsory Mental Health Interventions

Type of resource: Video

Presentation 1: Focus report on compulsory community mental health treatment orders.
Authors: Alison Schneller & Kelly Pope
We present our mental health and addiction services’ monitoring report on compulsory treatment in community settings under the Mental Health Act 1992. Compulsory Community Treatment Orders (CCTOs) extend treatment without consent, typically medication, to people living in the community (‘outpatients’) and provide for recall to hospital. In 2020/21, 90 people per 100,000 were under a CCTO. Rates of CCTOs are not reducing over time, persistent inequity exists for Māori and Pacific, and there is considerable regional variation. The percentage of applications by clinicians granted by courts remains remarkably high. We analyse CCTO data, views from focus group participants and relevant evidence. This analysis leads into discussion on the need for a shift away from substituted decision making, by clinicians and courts, to supported decision-making that is aligned with human rights laws and Te Tiriti o Waitangi. We identify opportunities for CCTO decisions to be reduced under current law, such as practices being more inclusive of tāngata whaiora (people seeking wellness) in clinical reviews and court hearings. Pending new mental health law, we make ‘calls to action’ that advocate for cultural and practice changes to improve services and promote perspectives of tāngata whaiora and whānau in health and justice systems.

Learning Objective
A focus on interaction between participants can generate insights for improving rights in mental health law and practice

Presentation 2: Dilemmas of a public sector psychiatrist while placing a person on Community Treatment Order.
Author: Mohan Isaac
The presentation aims to highlight the constructive and creative use of the involuntary community treatment order (CTO) in Western Australia.
Based on the presenter's experience of placing persons on CTO which violates the the individual's personal autonomy and rights and based on qualitative analysis (demographic background, clinical profile and issues/problems faced) of the most recent, chronological 15 CTOs issued by the presenter at the Fremantle Hospital, the dilemma's faced by psychiatrists working in the public mental health sector will be described and discussed. Issues such as supervision of persons on CTOs, managing the obligatory requirement of presentation before the Mental Health Tribunal and timing of taking the individual off the CTO will be highlighted. Australia is considered to be a country with comparatively higher rate of use of CTOs for management of persons with serious mental disorders. This fact will be critically examined and debated. Presentation will highlight the constructive use and benefits of the legal instrument of CTO although it takes away certain rights and freedom of individuals for a certain period.

Learning Objective
1, For certain selected persons with serious mental disorders, the provision of involuntary community treatment order (CTO) is an effective tool for appropriate clinical management.
2.Use of CTOs is considered controversial in the light of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD)

Newton-Howes et al, Do Community Treatment Orders in Psychiatry Stand Up to Principalism: Considerations Reflected through the Prism of the Convention on the Rights of Persons with Disabilities. The Journal of Law, Medicine and Ethics, 47(1), 126–133. https://doi.org/10.1177/1073110519840492

Presentation 3: Clinician Perspectives of Increasing Involuntary Treatment in Queensland Mental Health Services.
Authors: Kimbali Wild, Bernadette Sebar & Neeraj Gill
This presentation will highlight the main findings from a research project investigating mental health clinicians’ perspectives of increasing involuntary psychiatric treatment in Queensland mental health services.
The project involved qualitative research, with two focus groups held with psychiatrists, psychiatric registrars, nurses, social workers and psychologists currently working across inpatient, acute and community mental health teams. Clinicians’ who were Authorised Mental Health Practitioners or Authorised Doctors under the Mental Health Act 2016 (Qld) were eligible to volunteer to participate in the research. Focus group data was recorded and transcribed, with a Reflexive Thematic Analysis of the data undertaken. The findings indicated that clinicians broadly agreed that involuntary psychiatric treatment is over utilised in practice. Data was organised into six main themes proposed by clinicians as the reasons for high and increasing rates of involuntary treatment. This presentation will summarise the main themes, which included risk aversion, systemic service deficiencies, a lack of voluntary alternatives, increased substance use in the community, legislative and policy shortcomings, and barriers to enacting criteria outlined in the legislation. The presentation will conclude by briefly outlining conclusions drawn from the research. This research will contribute to a larger mixed methods project being undertaken by Professor Gill and associates, which will include perspectives of service users, carers, legal representatives of service users, and legal members of the Queensland Mental Health Review Tribunal. The overall goal of the research is to identify the determinants contributing to high rates of involuntary psychiatric treatment in Queensland mental health services and to recommend strategies to implement evidence-informed alternatives to involuntary psychiatric treatment.

Learning Objective
1. According to a Human Rights Framework and the UNCRPD, alternatives to coercive practices in mental health should be implemented. Research has found that involuntary treatment has been increasing in Queensland Mental Health Services.
2. Examining what the barriers are to less restrictive practices from the perspectives of mental health clinicians working with the current Queensland Mental Health Act, 2016

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