Parental Consent Not Needed.

In June 2021, The World Health Organization (WHO) released guidelines that lashed out against coercive psychiatric practices such as restraint, seclusion, forced electroshock and forced detainment and treatment, that it says “are pervasive and are increasingly used in services in countries around the world, despite the lack of evidence that they offer any benefits, and the significant evidence that they lead to physical and psychological harm and even death.”

The WHO highlighted the fact that coercive practices occur because “they are mandated in the national [or state] laws of countries.” Despite the challenges to changing laws and treatment paradigms, WHO says “it is important for countries…to eliminate practices that restrict the right to legal capacity, such as involuntary admission and treatment.” Coercive psychiatric practices continue to be rife in NSW.¹

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ELECTROSHOCK OF NSW CHILDREN: It is appalling that the current NSW Mental Health Act allows for children to be electroshocked (ECT) – the brutal application of hundreds of volts of electricity to the head potentially causing brain damage, memory loss and sometimes death. There are no bans to prevent its use on children in NSW.

In NSW an involuntarily detained child can be given electroshock without parental consent required at any stage of the approval process including at a Tribunal who give final approval. There were 8,180 Medicare funded electroshocks given in NSW in 2020/21. In 2018, there were 156 electroshocks given to teens aged 15-19 years old and in 2020/21 there were 3 children under 16 given electroshock. There were 785 Tribunal Hearings for forced electroshock given to involuntary patients.² ECT must be banned for all ages including children, the elderly and pregnant women. [s94, s96 of NSW Mental Health Act 2007 (NSW MHA)]

RESTRAINT AND SECLUSION OF NSW CHILDREN: The current Mental Health Act does not cover and provide protections against the use of mechanical restraint (the use of belts, harnesses, manacles, straps, etc.) and chemical restraint (the use of psychiatric drugs to subdue and control) or seclusion, leaving these traumatic and abusive procedures in place without legal safeguards. The Act allows for the use of reasonable force and the administration of sedatives while transporting someone to a mental health facility, which could constitute chemical and physical restraint. Instead of legal protections covered by law, restraint usage is covered under a NSW Health Policy Directive, compliance of which is a condition of subsidy for public health organisations; private facilities do not have to follow the Directive and are expected to have policies in place.³ In 2018 a plan to reduce restraint was also implemented and public health organisations are expected also to implement this plan.⁴ In 2019/20, the average duration of a seclusion in NSW was over 6 hours, the longest in Australia and NSW had the second highest rate of mechanical restraint.⁵ Psychiatric chemical, mechanical and physical restraint must be prohibited including for use on children, pregnant women and the elderly, with criminal fines and prison terms imposed for their use. [s81 of NSW MHA].

STERILISATION (Special Medical Treatment): Can be performed on involuntarily detained patients over the age of 16. Consent is not required from the patient or their carer. A psychiatrist applies to the Mental Health Review Tribunal to have the sterilisation performed. It is a gross human rights violation to enforce an irreversible medical procedure such as sterilisation. Sterilisation should be completely removed from the Mental Health Act. [s98, s103 of NSW MHA & Mental Health Review Tribunal Civil Hearing Kit: Surgery or Medical Treatment, p.5]

CHILDREN IN WARDS WITH ADULTS AND SEXUAL ABUSE: The law does not rule out children being held in wards with adults. Not having legal protections that prevent children from being exposed to such an environment leaves them open to physical and sexual abuse in an environment where there is insufficient supervision. Also there is no mandatory reporting of sexual abuse or criminal fines in place to ensure reporting of alleged sexual assault of patients. The law must be amended to ensure children are not placed in wards with adults and to ensure mandatory reporting of alleged sexual abuse to the police.

INFORMED CONSENT DENIED: The Act provides “Principles for Care and Treatment” [s68] which outline 10 points of care, including that patients should be provided with information about treatments, alternatives, the effects of treatment and informed of their legal rights. However, another clause [s195] states that these principles, including informed consent, are not a “right or entitlement enforceable at law.” All fundamental patient rights should be enforceable by law.

CHILDREN CAN BE INVOLUNTARY DETAINED AND TREATED WITHOUT PARENTAL CONSENT: A staggering 17,648 NSW people were taken to a psychiatric institution involuntarily in 2020/21. The law allows for children to be involuntarily detained and treated without parental consent. Parents are not able to discharge their involuntarily detained child and parental consent is not needed for further detainment or treatment including psychiatric drugs, restraint, seclusion and electroshock. While this situation is abhorrent enough, parents who wish to appeal to a Tribunal to have their child discharged have no guarantee that an appeal will result in the child allowed to return home. Of the 5,514 initial involuntary treatment detainments the Tribunal reviewed in 2020/21, only 35 were discharged (0.63%). 868 of these resulted in a legal order to receive drugs/treatment at home.⁶ No child should be treated without parental consent. The World Health Organisation’s instructions to eliminate Involuntary admission and treatment must be implemented for all ages. [s12, s13, s14, s15, s34, s35, s84, s94 of NSW MHA]

CRUELTY TO AN ANIMAL CARRIES AN 8 TIMES GREATER MONETARY FINE AND LONGER JAIL TERM THAN ILL-TREATING A PSYCHIATRIC PATIENT: Under the NSW Prevention of Cruelty to Animals Act, if someone is cruel to an animal it carries a maximum penalty of $44,000 or imprisonment for 1 year or both. Yet in stark contrast, if a psychiatrist or mental health worker ill-treats a psychiatric patient it carries a penalty of only $5,500 or imprisonment for 6 months or both under the current NSW Mental Health Act–significantly less than the penalty for being cruel to an animal.⁷

DEATHS, COMPLAINTS and ACCOUNTABILITY: spending on mental health in NSW reached a staggering $2.4 billion in 2020/21 up 26% since 2017/18.⁸

Despite this huge increase in spending, the Productivity Commission’s latest Report on Government Services 2020, reveals that results in NSW were appalling in 2018/19:

• 34.3% of children aged 0-17, discharged from a psychiatric ward/facility had not significantly improved.
• 47.6% of children aged 0-17 discharged from community based care did not significantly improve.
• 64.1% of children aged 0-17 in ongoing outpatient community based care had not significantly improved.
• Along with South Australia, NSW had the highest readmissions rate within 28 days of discharge for 25-34 year olds in Australia.
• NSW had the highest re-admission rate for 65-74 year olds and 75+ year olds in Australia.⁹

Between 2009/10 and 2019/20, the NSW Health Care Complaints Commission reported complaints for psychiatry increased 128% and complaints for mental health medical practitioners increased 147%.¹⁰

• Australia’s drug regulatory agency has issued over 80 psychiatric drug warnings to warn of the risk of agitation, aggression, increased blood pressure, diabetes, hallucinations, life-threatening heart problems, suicidal behaviour and possible death.¹¹
• In Australia, by December 2019, there were 49,248 adverse drug reaction reports linked to antipsychotics and antidepressants, 1,907 of these deaths.¹²
• Unlike Victoria and Western Australia, the number of deaths in psychiatric wards and deaths within 28 days of discharge is not publicly reported in NSW.¹³

If psychiatric treatments were working there would be evidence of this in the reduction of children and adults requiring assistance. Money cannot be continued to be poured into the current failing NSW mental health system when there is a dire need for accountable and effective care.

No other industry would be allowed such a poor performance for money invested. In contrast, money given to other areas of medicine shows noticeable progress, such as improving survival rates from cardiovascular disease over the past 20 years.¹⁴ Existing money spent must be re-directed into proven workable solutions that provide real help.

ALTERNATIVES: There is no doubt that some children who are troubled require special care. But they should be given holistic, humane care that improves their condition. Institutions should be safe havens where children and adults voluntarily seek help for themselves or their child without fear of indefinite incarceration or harmful and terrifying treatment. They need a quiet and safe environment, good nutrition, rest, exercise and help with life’s problems. Extensive medical evidence proves that underlying and undiagnosed physical illnesses can manifest as psychiatric symptoms and therefore should be addressed with the correct medical treatment, not psychiatric techniques. Studies show that once the physical condition is addressed, the mental symptoms can disappear. With proper medical treatment and real help people can lead healthier, happier lives.

The NSW Mental Health Act can be found on this link: http://www.austlii.edu.au/au/legis/nsw/consol_act/mha2007128/

References

1. “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,” World Health Organization, 10 June 2021, pages 4,6,7,8. https://www.who.int/publications/i/item/9789240025707.
2. Statistics generated on Medicare Australia website using MBS item code: 14224 for electroconvulsive therapy. http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp ; For the MBS Item Code: http://www9.health.gov.au/mbs/search.cfm and enter “electroconvulsive therapy” in the search box ; “Number of Electroconvulsive Therapy Treatments (Item 14224 by state and territory for calendar years 2016, 2017 and 2018 for age groups under 10, 10-14 years and 15-19 years old,” Freedom of Information Request, Australian Government Department of Health, Department Reference Number: FOI 1150, Document 1, contact Department of Health or CCHR for statistics.; Mental Health Review Tribunal Annual Report 2021, p. 25.
3. Aggression, Seclusion & Restraint in Mental Health Facilities in NSW, NSW Health Policy Directive: PD2012_035, 25 June 2012, cover page.
4. Mental Health Safety and Quality in NSW: A plan to implement recommendations of the Review of seclusion, restraint and observation of consumers with a mental health illness in NSW Health Facilities, May 2018.
5. Table RP.8: Restraint rate, public sector acute mental health hospital services, states and territories, 2015–16 to 2019–2020, Mental Health Services Australia, Australian Institute of Health and Welfare. Web report last updated 1 February 2022. https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/restrictive-practices ; Table RP.5: Seclusion data for public sector acute mental health hospital services, states and territories, 2008-09 to 2019-20. Mental Health Services Australia, Australian Institute of Health and Welfare. Web report last updated 1 February 2022. https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/restrictive-practices
6. NSW Mental Health Review Tribunal Annual Report 2021, pages 22, 41. https://www.mhrt.nsw.gov.au/annual-reports.html
7. NSW Prevention of Cruelty to Animals Act 1979, No 200, s5. https://legislation.nsw.gov.au/view/whole/html/inforce/current/act-1979-200#sec.5 ; NSW Mental Health Act 2007, No 8, s69. https://legislation.nsw.gov.au/view/whole/html/inforce/current/act-2007-008
8. “Record $1.9 billion budget for mental health,” 20 June 2017, NSW Health, https://www.health.nsw.gov.au/news/Pages/20170620_04.aspx ; “Mental health budget, NSW Budget 2020-21,” NSW Health, 2 March 2021. https://www.health.nsw.gov.au/mentalhealth/Pages/budget.aspx
9. “People who received mental health care provided by State and Territory public mental health services and who significantly improved, by service type and age group,” Productivity Commission Report on Government Services 2021, Part E, Section 13, 28 January 2021, Table 13A.62. https://www.pc.gov.au/research/ongoing/report-on-government-services/2021/health/services-for-mental-health ; “Readmissions to hospital within 28 days of discharge, by selected characteristics,” Productivity Commission Report on Government Services 2021, Part E, Section 13, 28 January 2021, Table 13A.33. https://www.pc.gov.au/research/ongoing/report-on-government-services/2021/health/services-for-mental-health
10. “Health Care Complaints Commission Annual Report 2011-12,” Appendices p101, Table 16.4, https://www.hccc.nsw.gov.au/ArticleDocuments/75/HCCC%20Annual%20Report%202012_Part%203_Appendices.pdf.aspx ; “Health Care Complaints Commission Annual Report 2019-20,” Appendices p155, Table A.4. https://www.hccc.nsw.gov.au/ArticleDocuments/75/AnnualReport2019-20Final.pdf.aspx ; “Health Care Complaints Commission Annual Report 2011-12,” Appendices p101, Table 16.4, https://www.hccc.nsw.gov.au/ArticleDocuments/75/HCCC%20Annual%20Report%202012_Part%203_Appendices.pdf.aspx ; “Health Care Complaints Commission Annual Report 2019-20,” Appendices p155, Table A.4, https://www.hccc.nsw.gov.au/ArticleDocuments/75/AnnualReport2019-20Final.pdf.aspx
11. Fully referenced layman’s summary of all psychiatric drug warnings issued by Therapeutic Goods Administration. Fully referenced layman’s summary of all psychiatric drug warnings issued by the Therapeutic Goods Administration, https://cchr.org.au/ptanegul/2022/03/Australian-government-warnings-other-actions-on-psychotropic-drugs-2022-12-30.pdf
12. Therapeutic Goods Administration Database of Adverse Event Notifications-Medicines, List of reports generated for each antidepressant, as of 05/03/2020 and added manually. https://www.tga.gov.au/database-adverse-event-notifications-daen; Therapeutic Goods Administration Database of Adverse Event Notifications-Medicines, List of Reports generated for each antipsychotic, as of 05/03/2020 and added manually. https://www.tga.gov.au/database-adverse-event-notifications-daen
13. “Chief Psychiatrist of Victoria, Annual Report, 2010-11,” Figure 4: Reportable deaths by cause and gender, 2010–11, p.29. https://www2.health.vic.gov.au/about/key-staff/chief-psychiatrist/annual-reports; “Chief Psychiatrist of Victoria, Annual Report, 2018-19,” Reportable deaths in 2018-19, p. 19, https://www2.health.vic.gov.au/about/key-staff/chief-psychiatrist/annual-reports; Annual Report of Chief Psychiatrist of Western Australia, 1 July 2019 – 30 June 2020, p.49. https://www.chiefpsychiatrist.wa.gov.au/about/publications/; Annual Report of Chief Psychiatrist of Western Australia, 1 July 2020 – 30 June 2021, p.68. https://www.chiefpsychiatrist.wa.gov.au/chief-psychiatrists-annual-report-2020-21/ OR https://www.chiefpsychiatrist.wa.gov.au/about/publications/
14. “Cardiovascular disease most deaths and highest costs, but situation improving,” Australian Institute of Health and Welfare, Media Release, 17 March 2011.
    https://www.aihw.gov.au/news-media/media-releases/2011/2011-mar/cardiovascular-disease-most-deaths-and-highest-co