The SA Mental Health Act is under review. Now is the time to stop these psychiatric human rights abuses in South Australia.

The SA Mental Health Act is under review. Now is the time to change this.

The South Australian Mental Health Act still allows psychiatry to commit the above torturous practices on vulnerable children and adults.

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.” It points to the United Nations Convention on the Rights of Persons with Disabilities (CRPD) which in essence, calls for a ban on “forced hospitalization and forced treatment.”

The WHO report highlights the fact that coercive practices such as restraint, seclusion, involuntary commitment and treatment occur because “they are mandated in the national [or state] laws of countries.” Coercive psychiatric practices continue to be rife in SA.

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.” ¹

With the SA Mental Health Act under review, these human rights abuses which are legal in SA must be banned now.

Download a short fact sheet here

ELECTROSHOCK OF CHILDREN (ECT): Also called electroconvulsive therapy, ECT is the application of hundreds of volts of electricity to the head to create a seizure (convulsion). It can cause brain damage, permanent memory loss, heart problems, stroke and death.² In other words, ECT inflicts harm.

Not only is it legal for use on all ages in SA, including on children, pregnant women and the elderly, but it can be given up to four times in one session to establish how much electricity is needed for a convulsion. This could be done more than once in a course of electroshock. A course is a maximum of 12 shocks–multiple courses can be given.³

So torturous is ECT that one Australian woman forced to undergo electroshock against her will, close to 100 times, said she has had security guards wheel her to the “treatment” room holding her down so she didn’t escape. “I felt like I was being wheeled down to the gas chamber really,” she said. She would even eat from stashed food to avoid the general anaesthetic and when staff found her food, she resorted to eating grass to avoid the electroshock.⁴

• Any claim that ECT does not cause brain damage ignores basic electrical science as when electricity is sent through the brain, it is converted into heat, increasing the temperature. Cells can suffer dysfunction, temporary injury, permanent damage or even cell death according to Dr. Ken Castleman, Ph.D., a biomedical engineer who has provided legal testimony in ECT device litigation.⁵
• When the Therapeutic Goods Administration (TGA) approved the current electroshock machines for use in Australia in 2004 and 2015, no medical studies proving safety and efficacy were required, provided or relied upon to make this decision. Yet, on 19 October 2018, following a lawsuit it settled, Somatics LLC, the manufacturer of the Thymatron ECT device, which is used in South Australia, issued a warning of “permanent brain damage” in its new risk disclosures.⁶

Despite all of this the SA Mental Health Act, allows for both children and adults to be forcibly given electroshock, no consent is needed by the patient or the parents. If that were not bad enough, the current law allows for the use of “emergency electroshock,” where not even a Tribunal Hearing is held before the electroshock is given.⁷

In addition to the World Health Organisation calling for elimination of forced electroshock in 2021, in 2019, the concluding observations of United Nations Committee on the Rights of Persons with Disabilities in response to Australia’s periodic reports on the Convention on the Rights of Persons with Disabilities stated that Australia should,

“Prohibit the use of non-consensual electroconvulsive therapy on the basis of any form of impairment.” ⁸

Australia is a signatory to the Convention on the Rights of Persons with Disabilities. This ban has not been done in SA.

Instead, completely ignoring the United Nations and the World Health Organisation instructions for forced electroshock and psychiatric restraint to be prohibited, psychiatry wants to continue both of these human rights abuses and perform them together! This is evidenced by a question being asked of the SA public as part of this review: “Should the law allow reasonable force [restraint] to ensure the person receives ECT? If so, when?” The very idea of this should not even be considered.⁹

• In 2020/21 there were 6,182 electroshocks given to South Australians.¹⁰

Recommendation: Electroshock is not therapy, it is torture. It must be banned for all ages with severe criminal fines and prison terms for violation of the ban. [South Australian Mental Health Act 2009 (SA MHA) s42 (1), s42 (2) (3), s42 (c) ii, s42 (c) ii A & B, s42 iii, s42 (6).]

RESTRAINT & SECLUSION OF CHILDREN: All forms of psychiatric restraint can and do cause death. It is well-known within psychiatric circles to have zero therapeutic benefits and instead can greatly increase trauma.¹¹

Psychiatric restraint includes chemical restraint–the use of psychiatric drugs to subdue and control behaviour. The SA chief psychiatrist states the use of chemical restraint has the following risks: “over-sedation, respiratory depression, collapse, head injuries and death.” ¹²

In 2019, it was reported that SA children were being tied down with nets, taken to psychiatric wards and being locked in seclusion at a rate that was far above the national average.

SA child psychiatrist Professor Jon Jureidini said in response to this, a “significant proportion” of kids crises “currently managed with netting, involuntary sedation and seclusion” could be managed less restrictively given “appropriate training, support and staffing levels.” ¹³

• In 2021 there were 439 physical restraint events (bodily force) a 16% increase on the previous year. There were a further 42 mechanical restraint instances (e.g., being cuffed to a bed).¹⁴
• 1,291 seclusions occurred in the same year.¹⁵

There are valid ways to calm and work with traumatised people that preclude the need for harsh and inhumane treatment.

A 2017 NSW review of restraint and seclusion in mental health facilities report states,

It is not unusual for staff to raise concerns that staff and consumer safety will be compromised if seclusion and/or restraint are reduced, but this concern is not supported by the weight of evidence.”¹⁶

The SA chief psychiatrist wants to reduce/eliminate where possible the use of restraint. You do not “minimise or reduce” harming people you immediately stop it and ban it. Recommendation: The World Health Organisation’s Guidance must be followed and all forms of psychiatric restraint (chemical, mechanical and physical) are banned with heavy criminal fines and prison terms for violation of these bans. [SA MHA, pages 6, 8,9 (definition of a child, restraint and seclusion), s90 (2) (3).]

PSYCHIATRIC DRUGS: There have been over 80 psychiatric drug warnings issued by the Australian Government to warn of such risks as, aggression, increased blood pressure, hallucinations, suicide, heart problems, withdrawal symptoms and possible death.¹⁷

• Seven of these drug warnings are to warn of suicidal behaviour linked to antidepressants, including one for the “ADHD” drug Strattera which is an antidepressant.¹⁸
• Australia wide, by December 2019, there were 49,248 adverse drug reaction reports linked to antipsychotics and antidepressants, 1,907 of these were deaths.¹⁹
• Despite this, there were over 3.1 million psychiatric drug prescriptions written in South Australia in 2019/20. This equates to a staggering 334,396 children and adults on a psychiatric drug.²⁰

Recommendation: In 2020, one of the recommendations in the Final Report of the Productivity Commission’s Mental Health Inquiry, was to require that all mental health prescriptions include a clear and prominent statement saying that clinicians should have discussed possible side effects and proposed evidence based alternatives to psychiatric drugs prior to prescribing. This was recommended “start now” in 2020, but has not. The SA Government should request this is done now.

INVOLUNTARY DETAINMENT & TREATMENT: The current SA Mental Health Act allows for the involuntary detainment and treatment of both children and adults. This means that parents cannot take their child home and their consent is not needed for psychiatric drugs, restraint or seclusion. Electroshock can also be given to children under 16 if an application is made to and approved by the Tribunal. As if this violation of parental rights were not bad enough, psychiatry can also stop a parent from visiting or communicating to their child.

In 2013, the United Nations Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment called upon States [countries] to,

“Impose an absolute ban on all forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind-altering drugs, for both long and short-term application.” ²¹

Australia is a signatory to this UN Convention on Torture.²² SA has not implemented this ban.

• In 2021 there were 10,005 involuntary treatment orders (involuntary admissions for forced treatment at a psychiatric facility/ward) including 39 children aged 15 or under.
• There were an additional 2,471 community treatment orders where the person was forced to have treatment at home.
• There has been a 19% increase of these forced treatment orders since 2015/16.²³

Recommendation: Involuntary detainment and treatment are eliminated in the law per the World Health Organization’s and United nations instructions with heavy criminal penalties for each instance of these occurring.²⁴ [SA MHA, s4, s42 (1) (C) iii, s48(2) (a) (b)]

PSYCHOSURGERY: All forms of psychosurgery are correctly banned in NSW and the NT. Qld bans the forms of psychosurgery involving cutting or burning the brain for all ages. Cutting and burning the brain and deep brain stimulation (DBS), inserting electrodes deep into the brain through which an electrical current is sent are legal in SA for anyone aged 16 or over.

Psychosurgery can cause memory loss, irreversible brain damage, bleeding in the brain and post-operative death.²⁵

In 2014 the NSW Ministry of Health commissioned an investigation into the efficacy of DBS which concluded, “There is insufficient evidence at this point in time to support the use of DBS as a clinical treatment for any psychiatric disorder.” ²⁶

Incredibly, the SA law allows for psychosurgery to be given without the consent of the person if a Tribunal approves.²⁷

Last time the SA Mental Health Act was reviewed, psychosurgery was re-named “neurosurgery.” This is an attempt by psychiatry to hide the true nature of this completely barbaric practice. Recommendation: All forms of psychosurgery must be banned with very high criminal fines and prison terms for violation of the ban. [SA MHA, p. 8 definition of neurosurgery, s43]

CHILDREN IN ADULT WARDS & SEXUAL CONTACT: Despite the Guiding Principles of the Act stating that, “Children and young persons should be cared for and treated separately from other patients as necessary…,” psychiatry and mental health workers only have to be “guided” by these Principles. There are absolutely no legal provisions in the Act which rule out children being placed in adult wards or that protect women from being placed in wards with men, placing both women and children at risk. To even consider exposing children to such an environment shows pitiful respect for them and leaves them open to physical and sexual abuse in an environment where there is insufficient supervision. Paul Mason, former Tasmanian Commissioner for Children and barrister, said that putting children in adult wards should be illegal.²⁸

In 2020 The Medical Journal of Australia published an analysis that looked at sexual misconduct notifications/complaints to regulatory authorities for all 15 registered health professions in Australia between 2011-2016. It found that psychiatrists had the highest rate of notifications/complaints alleging a sexual relationship, sexual harassment or sexual assault.²⁹

The SA Mental Health Act does not mandate that alleged sexual assault of a child or adult by staff must be reported. Western Australia makes a start towards ensuring alleged sexual assault/sexual assault is reported with a $6,000 fine for not reporting in their Mental Health Act.³⁰ Recommendations: Children should never be placed in wards with adults and criminal fines and prison terms should be implemented for violations of this. ⬥ The SA Mental Health Act must mandate that men and women have separate wards with criminal penalties added for failing to do this. ⬥ Criminal fines and prison terms must be added to the Mental Health Act for failing to report alleged sexual assault to police. [SA MHA s7 (1) (e).]

DEATHS AND COMPLAINTS: In 2020/21 there were 73 deaths reported to the SA chief psychiatrist. 40 of these deaths were reported by adult community health teams. Between 2014/15 and 2020/21, there were 559 deaths reported.³¹ The SA Health and Community Services Complaints Commission received over 320 complaints made by mental health consumers in 2020/21, a 228% increase since 2010/11.³²

NOTE: Recorded deaths relate to where the person was in a psychiatric facility or who had been in contact with a public mental health service within 6 months of their death or who were in an emergency department for a mental health issue.

LACK OF ACCOUNTABILITY: Results are appalling in South Australia despite a 20% increase in spending in 5 years, reaching over $500 million in 2019/20.³³ A 2022 Productivity Commission report reveals the following:

• 56.2% of 0–17-year-olds discharged from community-based care did not significantly improve.
• 63.9% of children aged 0-17, over 76% of 18–64-year-olds and 69% of 65+ year olds in ongoing outpatient community-based care did not significantly improve.
• 33.1% of people discharged from public psychiatric facilities/wards either did not significantly improve or had significant deterioration.³⁴

The recent amount of money spent on mental health was not found on-line in Budget Papers or media articles. CCHR phoned the SA Mental Health Commission on 13/7/22 to obtain the information on the amount of money spent on mental health in 2020/21 and 2021/22. They said they did not have the information and suggested calling the SA Department of Health and Wellbeing who when called also did not have this information. They put CCHR through to the Minister for Mental Health and Wellbeing’s office. They said they did not give out this information and the Minster would need to be emailed. This was done on the same day and CCHR is awaiting their response. This lack of transparency and accountability needs to be rectified immediately. The public have a right to know this key information.

ADVANCED CARE DIRECTIVES (Living Wills): Advance care directives are a key part of fully informed consent, yet they are not fully legally binding. They can be overridden if a psychiatrist involuntarily detains the person and decides it is “mandatory medical treatment.” This includes electroshock. They must be made legally binding for all psychiatric treatment in the SA Mental Health Act.³⁵

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. Recommendation: Existing money spent needs to be re-directed into proven workable solutions that provide real help.

To read the current SA Mental Health Act: https://www.legislation.sa.gov.au

The SA Law Reform Institute expect to submit their review to the SA Government by end of February 2023. https://www.adelaide.edu.au/newsroom

Download a short fact sheet here

Read CCHR’s submission here

Warning: No one should stop taking any psychiatric drug without the advice and assistance of a competent medical doctor.

References

1. Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches, World Health Organization, 10 June 2021, pp.4,6,7,8, https://www.who.int/publications/i/item/9789240025707 (to download report).
2. Electroconvulsive Therapy (ECT) Devices for Class II Draft Guidance for Industry, Clinicians and Food and Drug Administration Staff, US Food and Drug Administration, 29 December 2015, pp.13,14, https://www.fdanews.com/ext/resources/files/2016/01/01-16-FDA-ECT.pdf?1451949526; Electroconvulsive Therapy (ECT) Services: Monitoring and Auditing – MHDA, Guideline, NSW Government Health, Northern Sydney Local Health District, GE2013_022, 22 June 2016, s4(2)(3)
3. Electroconvulsive Therapy (ECT) Devices for Class II Draft Guidance for Industry, Clinicians and Food and Drug Administration Staff, US Food and Drug Administration, 29 December 2015, pages 13,14. https://www.fdanews.com/ext/resources/files/2016/01/01-16-FDA-ECT.pdf?1451949526; ECT Policy Guideline – Guiding Document, Titration Charts, SA Office of Chief Psychiatrist, Heath Department for health and Wellbeing, Government of South Australia, see under heading, “Titration guidelines.” https://s3-ap-southeast-2.amazonaws.com/sahealth-ocp-assets/general-downloads/ECT-Policy-Guideline-Document-Titration-Charts.pdf; South Australian Mental Health Act 2009, s42, s42(2)(3). https://www.legislation.sa.gov.au/lz?path=%2FC%2FA%2FMental%20Health%20Act%202009
   
4. Sarah Farnsworth, “Hundreds of patients forced to have ECT in Victoria without legal representation,” ABC News, 21 November 2016. https://www.abc.net.au/news/2016-11-20/patientsforced-to-have-ect-without-legal-representation/8030996
   
5. Ken Casselman, Ph.D., “Testimony presented to the Maryland Senate Finance Committee Hearing on the SB 302: Mental Health – Electroconvulsive Therapy for Minors – Prohibition,” 20 February 2019.
   
6. User Manual Thymatron® System IV, UM-TS4, Rev 21, Somatics LLC, 2019, https://www.manualslib.com/manual/1629768/Somatics-Thymatron-System-Iv.html#manual
   
7. South Australia Chief Psychiatrist Annual Report 2020-21, p.3, https://s3-ap-southeast-2.amazonaws.com/sahealth-ocp-assets/general-downloads/Chief-Psychiatrist-of-South-Australia-Annual-Report-2020-21.pdf; South Australia Mental Health Act 2009, s42(c)ii, s42 (c)ii A & B, s42 iii, s42 (6), https://www.legislation.sa.gov.au/lz?path=%2FC%2FA%2FMental%20Health%20Act%202009
   
8. “Concluding observations on the combined second and third periodic reports of Australia,” Committee on Rights of Persons with Disabilities, 15 October 2019, https://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=6QkG1d%2FPPRiCAqhKb7yhsnzSGolKOaUX8SsM2PfxU7sdcbNJQCwlRF9xTca9TaCwjm5OInhspoVv2oxnsujKTREtaVWFXhEZM%2F0OdVJz1UEyF5IeK6Ycmqrn8yzTHQCn
   
9. “Review of the Mental Health Act 2009 (SA), Fact Sheet 6- Electroconvulsive Therapy, South Australian Law Reform Institute, University of Adelaide, 2022. https://ehq-production-australia.s3.ap-southeast-2.amazonaws.com/54c939d218d2dbcfbef637b5d427ea49681649a5/original/1649899397/6a783897740027b75ecda6f520b805ba_Fact_Sheet_6_-_Electroconvulsive_Therapy_14.4.22.pdf
   
10. South Australia Chief Psychiatrist Annual Report 2020-21, p.23, https://s3-ap-southeast-2.amazonaws.com/sahealth-ocp-assets/general-downloads/Chief-Psychiatrist-of-South-Australia-Annual-Report-2020-21.pdf
    
11. Minimising the use of seclusion and restraint in people with mental illness, RANZCP, Position Statement 61, February 2016, https://www.ranzcp.org/News-policy/Policy-submissions-reports/Document-library/Minimising-the-use-of-seclusion-and-restraint-in-p
    
12. South Australia Mental Health Act 2009, s90 (2)(3), https://www.legislation.sa.gov.au/lz?path=%2FC%2FA%2FMental%20Health%20Act%202009; Chief Psychiatrist Restraint and Seclusion Standard, A Standard to Reduce and Eliminate where Possible the Use of Restraint and Seclusion Applied under the Mental Health Act 2009, 28 May 2021, Government of South Australia, p.13. https://s3-ap-southeast-2.amazonaws.com/sahealth-ocp-assets/general-downloads/Restraint-and-Seclusion-Standard-28-May21_FINAL-005.pdf
    
13. “Netted, drugged, locked away: the damning face of child mental health in SA,” InDaily, 23 September 2019, https://indaily.com.au/news/2019/09/23/netted-drugged-locked-away-the-damning-face-of-child-mental-health-in-sa/
    
14. South Australia Chief Psychiatrist Annual Report 2020-21, pp.25, 26, https://s3-ap-southeast-2.amazonaws.com/sahealth-ocp-assets/general-downloads/Chief-Psychiatrist-of-South-Australia-Annual-Report-2020-21.pdf
    
15. South Australia Chief Psychiatrist Annual Report 2020-21, p.26, https://s3-ap-southeast-2.amazonaws.com/sahealth-ocp-assets/general-downloads/Chief-Psychiatrist-of-South-Australia-Annual-Report-2020-21.pdf
    
16. Review of seclusion, restraint and observation of consumers with a mental illness in NSW Health facilities, NSW Government, December 2017, p.II, https://www.health.nsw.gov.au/mentalhealth/reviews/seclusionprevention/Pages/about.aspx
    
17. Fully referenced layman’s summary of all psychiatric drug warnings issued by the Therapeutic Goods Administration, https://cchr.org.au/ptanegul/2023/10/Australian-Psychiatric-Drug-Warnings-Fact-Sheet.pdf
    
18. Department of Health and Ageing Therapeutic Goods Administration, Medicines Safety Update, “Medicines associated with a risk of neuropsychiatric adverse events,” Vol. 9, Number 2, June 2008; Department of Health and Ageing Therapeutic Goods Administration, Medicines Safety Update, “Antidepressants – Communicating risks and benefits to patients,” Vol. 7, Number 5, October-December 2016; Department of Health and Ageing Therapeutic Goods Administration, Medicines Safety Update, “Atomoxetine and suicidality in children and adolescents,” Vol. 4, Number 5, October 2013; “Australian ADHD drug warnings are already in place: TGA,” AAP Newswire 22 February, 2007; “Suicidality with SSRIs: adults and children,” The Australian Therapeutic Goods Administration, Adverse Drug Reactions Bulletin, Vol. 24, No. 4, August 2005; “Use of SSRI antidepressants in children and adolescents” The Australian Therapeutic Goods Administration, Adverse Drug Reactions Bulletin, Vol. 23, No. 6, August 2004; “Warnings for high dose tricyclic antidepressants,” The Australian Therapeutic Goods Administration, Adverse Drug Reactions Bulletin, Vol. 23, No. 5, October 2004.
    
19. 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
    
20. “Table PBS.11: Number of mental health-related prescriptions dispensed, by type of medication prescribed and prescribing medical practitioner, states and territories, 2019-20”; “Table PBS.2, Number of patients dispensed one or more mental health-related medications prescribed and prescribing medical practitioner, states and territories, 2019/20,” Mental Health Services in Australia, Australian Institute of Health and Welfare, Australian Government, Last updated 17 May 2022. https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/mental-health-related-prescriptions
    
21. A/HRC/22/53, Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Mendez, United Nations, General Assembly, Human Rights Council, Twenty-second Session, Agenda Item 3, 1 February 2013, s89(b) p.23, https://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf
    
22. “Chart of Australian Treaty Ratifications as of May 2012, – Human rights at your fingertips,” Australian Human Rights Commission, https://humanrights.gov.au/our-work/commission-general/chart-australian-treaty-ratifications-may-2012-human-rights-your
    
23. South Australia Chief Psychiatrist Annual Report 2020-21, pp. 37, 31, https://s3-ap-southeast-2.amazonaws.com/sahealth-ocp-assets/general-downloads/Chief-Psychiatrist-of-South-Australia-Annual-Report-2020-21.pdf
    
24. Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches, World Health Organization, 10 June 2021, pages 7,8,187, https://www.who.int/publications/i/item/9789240025707 (to download report).
    
25. Freedom of Information Request 1213/11807, North Western Mental Health’s “Deep brain stimulation (DBS) for psychiatric illness. Information for patients and referrers,” for OCD DBS trial, Melbourne Health, 8 July 2013; “Deep brain stimulation,” Department of Neurosurgery, VCU Medical Center, Harold F Young Neurosurgical Center, accessed 29 December 2010.
    
26. Prof. Paul Fitzgerald, Dr Rebecca Segrave, “Deep Brain Stimulation in mental health: review of evidence for clinical efficacy,” NSW Ministry of Health, NSW Government Information (Public Access) request number PA 15/70. Please contact the NSW Ministry of Health (quoting the request number) or CCHR Australian National Office for a copy.
    
27. South Australia Mental Health Act 2009, p.8, 43 (c)ii. https://www.legislation.sa.gov.au/lz?path=%2FC%2FA%2FMental%20Health%20Act%202009
    
28. “Review of the Mental Health Act 2009 (SA), Fact Sheet 9–Guiding Principles and Accountability Mechanisms,” South Australian Law Reform Institute, University of Adelaide, 2022, https://ehq-production-australia.s3.ap-southeast-2.amazonaws.com/38d26f51ef9a244c2d6c0617cbbb64d2cb9ee100/original/1654083397/b70525cc69667bb25df9c98505943305_Fact_Sheet_9_Guiding_Principles_and_Accountability_Mechanisms.pdf; Felicity Ogilvie, “Kids in adult psych wards a ‘human rights breach,’” ABC News, 2 September 2009. https://www.abc.net.au/news/2009-09-03/kids-in-adult-psych-wards-a-human-rights-breach/1415670
    
29. Marie M Bismark, David Studdert, Katinka Morton, Ron Paterson, Mathew Spittal, Yamna Taouk, “Sexual Misconduct by health professionals in Australia, 2011-16: a retrospective analysis of notifications to health regulators,” Medical Journal of Australia, 10 August 2020, pp.1,5. https://www.mja.com.au/journal/2020/213/5/sexual-misconduct-health-professionals-australia-2011-2016-retrospective
    
30. WA Mental Health Act 2014, s254, https://www.legislation.wa.gov.au/legislation/statutes.nsf/law_a147019.html
    
31. South Australia Chief Psychiatrist Annual Report 2020-21, pp.79,80. https://s3-ap-southeast-2.amazonaws.com/sahealth-ocp-assets/general-downloads/Chief-Psychiatrist-of-South-Australia-Annual-Report-2020-21.pdf
    
32. Health and Community Services Complaints Commissioner Annual Report 2010/11, p.25, https://www.hcscc.sa.gov.au/wp-content/uploads/2013/08/h_2010_11_annual_report.pdf; Health and Community Services Complaints Commissioner Annual Report Companion Document 2020/21, p. 17, https://www.hcscc.sa.gov.au/reports-2/
    
33. “Table EXP.1: Recurrent expenditure ($000) on state on territory specialised mental health services, states and territories, 2018-19,” Mental health services in Australia: Expenditure on mental health services, Mental Health Services in Australia, Australian Government, Australian Institute of Health and Welfare, last updated 8 December 2021, https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/expenditure-on-mental-health-related-services; “Table EXP.1: Recurrent expenditure ($000) on state on territory specialised mental health services, states and territories, 2013-14,” Mental Health Services in Australia: Expenditure on mental health services, Mental Health Services in Australia, Australian Government, Australian Institute of Health and Welfare, https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/archived-reports-and-data
    
34. “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, Table 13A.63, Part E, Section 13: released on 1 February 2022, https://www.pc.gov.au/research/ongoing/report-on-government-services/2022/health/services-for-mental-health#downloads; “Clinical outcomes of people receiving various types of mental health care provided by State and Territory public mental health services,” Productivity Commission Report on Government Services, Table 13A,64, Part E, Section 13: released on 1 February 2022, https://www.pc.gov.au/research/ongoing/report-on-government-services/2022/health/services-for-mental-health#downloads
    
35. Advance Care Directives Act 2013, s12 (1) (b), s12,(4) (a), https://www.legislation.sa.gov.au/lz?path=%2FC%2FA%2FADVANCE%20CARE%20DIRECTIVES%20ACT%202013; South Australia Mental Health Act 2009, s42 (1)(c)ii A, https://www.legislation.sa.gov.au/lz?path=%2FC%2FA%2FMental%20Health%20Act%202009