National Inquiry Concerning The Human Rights of People with Mental Illness contents page

NATIONAL INQUIRY CONCERNING THE HUMAN RIGHTS OF PEOPLE WITH MENTAL ILLNESS

CONTENTS

VOLUME 1 PART I: BACKGROUND, DEFINITIONS, AND EXISTING SERVICES

Chapter 1 THE INQUIRY PROCESS 3 Background to this Inquiry 3 Procedure of the Inquiry 7 Scope of the Inquiry 11 Outline of the Report 12 Incidence of Mental Illness 13 Conclusion 15

Chapter 2 RELEVANT HUMAN RIGHTS PROVISIONS AND INTERNATIONAL LAW 20 Introduction 20 Human Rights of People with Mental Illness 21 Instruments Incorporated in Federal Legislation 21 Other International Conventions 27 Mental Illness Principles 31 Developing Further International Standards 34

Chapter 3 DEFINITIONS AND CONCEPTIONS OF MENTAL ILLNESS 38 Introduction 38 Changing Views of Mental Illness 38 Legal Definitions of Mental Illness 40 Medical Conceptions of Mental Illness 44 Cross Cultural Conceptions 46

Chapter 4 THE LEGAL FRAMEWORK 50 Commonwealth Legislation 50 New South Wales 61 Victoria 73 Queensland . 84 South Australia 94 Western Australia 101 Tasmania 109 Northern Territory 116 Australian Capital Territory 123

Chapter 5MENTAL HEALTH SERVICES 136 The Government Sector 136 The Private Sector 146 The Non-Government Sector 149

Chapter 6 THE ROLE AND TRAINING OF HEALTH PROFESSIONALS AND OTHERS 171 The Views of Health Professionals 171 Professional Training and Education 184

Chapter 7 DEVELOPMENTS SINCE THE INQUIRY BEGAN 210 Federal 210 New South Wales 213 Victoria 216 Queensland 218 South Australia 21 9 Western Australia 220 Tasmania 221 Northern Territory 222 Australian Capital Territory 223

Part II: LIVING WITH MENTAL ILLNESS

Chapter 8 INPATIENT CARE AND TREATMENT 227 Pre-Admission and Admission 227 Clinical Treatment and General Care 236 Medication 238 Electro Convulsive Therapy (ECT) 249 Alternative Therapies 250 Relationship Between Psychiatrists and Inpatients 255 Relationship Between Nurses and Inpatients 258 Access To Information 263 Privacy 267 Safety and Security . 268 Seclusion 269 Assaults and Abuse 271 Activities and Occupational Therapy 274 Environment and Facilities 276 Education in Hospital 280 Discharge Planning 281 Conclusion 287

Chapter 9 COMMUNITY CARE AND TREATMENT 298 Crisis Care 299 Continuity of Care 300 Treatment Follow-Up 308 Alternative Treatments 314 Psychosocial Rehabilitation 315 Health Promotion Activities 323 Financial Issues 325 Conclusion 328

Chapter 10 ACCOMMODATION 337 Introduction 337 Barriers to Appropriate Accommodation 338 Housing Options 344 Supported Accommodation 352 Special Needs Groups 363 Model Services: Supported Accommodation 370 Model Services: Accommodation Support 376

Chapter 11 BOARDING HOUSES 386 Background 386 Prevalence of Mental Illness in Boarding Houses 387 Living Conditions 388 Placement in Boarding Houses 390 Treatment for Mental Illness 391 Boarding House Management 393 Regulation of Boarding Houses 396 Improving Support for Boarding House Residents 398 Conclusion 399

Chapter 1 2 EMPLOYMENT 404 Background 404 Barriers to Employment 406 Vocational Options 41 3 Non-Employment Options 422 Research 423

Chapter 13 EDUCATION AND TRAINING 430 Barriers to Education and Training 430 Program Design 435

Chapter 14 DISCRIMINATION: THE PERSONAL EXPERIENCE OF MENTAL ILLNESS 439 What it Feels Like to be Mentally Ill 441 Inequality 445 Marginalisation 446 Discrimination 448 Conclusion 452

Chapter 15 CARERS: THE EXPERIENCE OF FAMILY MEMBERS 455 Introduction 455 Lack of Information 457 Difficulty in Obtaining Treatment for a Relative 458 Legal Procedures 459 Consultation between Family and Professionals 460 Attitudes of Professionals 464 Emotional Impact of Mental Illness upon the Family 468 Family Finances 474 Impact on Women 476 Carers' Need for Practical Support 477 Family Living vs Independent Living 483 Conclusion 484

Chapter 16 CHILDREN OF PARENTS WITH MENTAL ILLNESS 493 Post-Natal Depression and its Effects on Infants 493 Welfare, Care and Custody Issues 494 Effects on Young Children 498 Effects on School-Age and Teenage Children 501 Adults Whose Parents Were Affected by Mental Illness 504

VOLUME 2 PART III: PEOPLE WITH PARTICULAR VULNERABILITIES

Chapter 17 ELDERLY PEOPLE 509 Introduction 509 Dementia 509 Depression 511 Treatment of the Elderly Mentally Ill 511 Residential Treatment 514 Solutions: Special Dementia Care Facilities 521 Community Care 524 Policy Issues Emerging from the Evidence 531

Chapter 18 HOMELESS PEOPLE 548 Definitions 548 Who and How Many Are They2 548 Prevalence of Mental Illness 551 Treatment 553 Why Are They Homeless2 555 Particularly Vulnerable Groups 557 Conditions in Shelters and Refuges 558 Homeless Service Agencies 561 Access to Services 562 Agency Staff 568 Relations Between the Health System and Agencies 569 Poverty and Trustees 574 What the Services Should be Like 576

Chapter 19 WOMEN 585 Diagnosis and Treatment 585 Post-Natal Depression 589 Violence Against Women 592 Shelter 596 The Need For More Research 598 Chapter 20 CHILDREN AND ADOLESCENTS 603 Incidence and Prevalence . 603 Definitions and Terminology 605 Assessment and Diagnosis 607 Contributing Factors 609 Child and Adolescent Psychiatric Services 61 3 Difficulty in Obtaining Treatment 616 Deficits in Service Provision 618 Inappropriate Placement 626 Prevention and Intervention 629 The Juvenile Justice System 634 Youth Suicide 637 Appropriate Responses 643 Conclusion 647

Chapter 21 PEOPLE WITH DUAL AND MULTIPLE DISABILITIES 659 Mental Illness and Intellectual Disability 659 Mental Illness and Substance Abuse 664 Mental Illness and Deafness 668 Mental Illness and HIV / AIDS 671 Head Injury 672 Conclusion 673

Chapter 22 PEOPLE IN RURAL AND ISOLATED AREAS 678 Distribution of Services 678 Strains on Health Professionals 685 Strains on Consumers and Families 686 Pressures on Young People 687 Possible Solutions 687

Chapter 23ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE 692 Introduction 692 The Historical Experience 692 Cross Cultural Perspectives on Mental Illness 694 Prevalence of Mental Illness 695 Social Context of Aboriginal Mental Illness 695 Diagnosing Mental Illness 698 Aboriginal People with Special Needs 703 Servicing Rural and Remote Areas 709 The Need for Culturally Appropriate Services 711 The Importance of Self-Determination 716

Chapter 24 PEOPLE FROM NON-ENGLISH SPEAKING BACKGROUNDS 723 The Migration Experience . 723 Groups Particularly at Risk 724 Accessing Services 730 Lack of Culturally Appropriate Services 733 What is Required? 741

Chapter 25 FORENSIC PATIENTS AND PRISONERS 752 Definitions 752 Prevalence of Mental Illness Among Prisoners 753 Does Mental Illness Lead to Jail7 756 Does Jail Lead to Mental Illness? 760 Special Needs Groups in Prison 776 Shortage of Staff and Resources 782 Release from Jail 787 Prison vs Hospital 794 Governor's Pleasure Prisoners 797 Conclusion 804

PART IV: OTHER AREAS OF CONCERN

Chapter 26 MENTAL HEALTH RESEARCH 821 Introduction 821 Support for Medical Research in Australia 823 Cost of Mental Illness and Funding for Research 824 Commonwealth Funding Sources 827 The NHMRC and Mental Health Research 829 Affirmative Action in Medical Research 830 Some Specific Issues in Mental Health Research 833

Chapter 27 PREVENTION AND EARLY INTERVENTION 843 Community Issues and Prevention in the Mental Health Field 844 Opportunities for Prevention in Specific Contexts 850 Prevention and Serious Mental Illness 856 Schizophrenia 857 Depression and Bipolar Disorder 859 Groups Which Are Particularly Vulnerable 860 Conclusion 865

Chapter 28 ACCOUNTABILITY 870 Introduction 870 Quality Assurance 871 Standards 873 Peer Review 875 Monitoring 875 Accreditation 877 Professional Registration 878 Official Visitors 878 Patient Rights and Patient Advocacy 879 Complaints Mechanisms 880 Conclusion 881

Chapter 29 LEGISLATIVE PROPOSALS 883 Introduction 883 South Australia 883 Western Australia 887 Conclusion 891

PART V: FINDINGS AND RECOMMENDATIONS

Chapter 30 LEGISLATION: FINDINGS AND RECOMMENDATIONS 895 State Legislation 896 Statutory Objects and Definitions 896 Voluntary Admission 896 Involuntary Admission 897 Review 898 Procedural Safeguards 899 Treatment 900 Confidentiality 900 Forensic Patients 901 Legislative Controls 901 Guardianship and Administration 902 Anti-Discrimination 903 Inter-State Co-operation 903 Federal Legislation 904

Chapter 31 GENERAL FINDINGS AND RECOMMENDATIONS 908 General Conclusions 908 Mental Health Services (Chapter 5) 909 Health Professionals (Chapter 6) 910 Inpatient Care and Treatment (Chapter 8) 913 Community Care and Treatment (Chapter 9) 916 Accommodation, Boarding Houses and Homelessness (Chapters 10, 11 and 1 8) 919 Employment (Chapter 12) 921 Education and Training (Chapter 1 3) 923 Discrimination: The Personal Experience of Mental Illness (Chapter 14) . 925 Carers (Chapter 1 5) 925 Children of Parents with Mental Illness (Chapter 1 6) 927 Elderly People (Chapter 1 7) 928 Women (Chapter 19) 930 Children and Adolescents (Chapter 20) 932 People with Dual or Multiple Disabilities (Chapter 21) 935 People in Rural and Isolated Areas (Chapter 22) 936 Aboriginal and Torres Strait Islander People (Chapter 23) 937 People from Non-English Speaking Backgrounds (Chapter 24) 939 Forensic Patients and Prisoners (Chapter 25) 940 Mental Health Research (Chapter 26) 943 Prevention and Early Intervention (Chapter 27) 944 Accountability (Chapter 28) 946

Appendix 1 WITNESSES APPEARING BEFORE THE INQUIRY 948

Appendix 2 WRITTEN SUBMISSIONS 962

Appendix 3 FACILITIES VISITED BY THE INQUIRY 984

Appendix 4 DECLARATION ON THE RIGHTS OF DISABLED PERSONS 986

Appendix 5 PRINCIPLES FOR THE PROTECTION OF PERSONS WITH MENTAL ILLNESS AND FOR THE IMPROVEMENT OF MENTAL HEALTH CARE 989

Appendix 6 GLOSSARY OF ABBREVIATIONS 1006