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Cases

"Make Orders!" says Saeed

“Make Orders!” says Saeed.

Saeed Dezfouli is locked in a mental health system with no oversight. The Mental Health Review Tribunal (MHRT) refuses to defend the people whom it is designed to protect. It is less than a rubber stamp. It says its "practice is not to make orders". That means the psychiatrists can do whatever they want, present Treatment Plans to the Tribunal at Reviews and then change them without any discussion or justification. Out of control but with the appearance of professional respect.

Recommendations made by the President of the Tribunal Dan Howard in March 2014 for Saeed to have a computer and consumer worker support "as soon as practicable" have been ignored. During the September 2014 Review Howard said: "sometimes the system needs a kicking" and still he was ignored. Contempt for him as he deserves! But Saeed gets the kicking.

Introduction

The Mental Health Review Tribunal is a dysfunctional and corrupt organisation and a waste of the taxpayer’s money. This disgraceful Tribunal hides behind the NSW Mental Health Department. Make orders as you are required!” 
– Saeed Dezfouli (9 March 2015)

As outlined in the Mental Health (Forensic Provisions) Act s 40 (a-c), the MHRT exists to “adopt the perspective of the protected person and his or her best interests” with primary regard to the protection of the individual and the community. In addition to this, Lindsay J noted that the MHRT possesses the “implied authority to uphold, protect and fulfil the functions conferred on it by statute”: Harry v Mental Health Review Tribunal (1994) 33 NSWLR 315.

Hence, the MHRT wields a clear degree of responsibility and influence as a body that guides the treatment, care and control of a forensic patient. Whether or not the MHRT is able to adequately fulfil its protective obligations is another question altogether.
Of pressing concern is the limited employment of binding orders, which are necessary to enforce the recommendations provided by the MHRT. Such a lack of legal enforcement has the alarming potential to result in abrupt changes of treatment running contrary to the recommendations given. This has been the case in the most recent update on Saaed Dezfouli, who on the 8th of December, 2014, was forcibly injected with medication for which he had a known sensitivity to, that had been changed without consultation or clinical justification. 

Tribunal fails to interfere

The Mental Health Review Tribunal sat on the 26th March 2015 in light of the change in Saeed Dezfouli’s medication, from paliperidone to forcibly injecting clopixol.

The Tribunal asserted it would not intervene in the actions and decisions of the psychiatrist and the treating team, rationalised on the grounds of the overwhelming number of cases that could be presented before the Tribunal if every medication change required their authorisation. The scope of the Tribunal’s intervention to review and authorise clinical practices could be limited, as suggested by solicitor Peter O’Brien, to where changes in medication involves forcefully medicating without consent. The Tribunal asserts it is not its practice to intervene.

Despite refusing to intervene, the Tribunal inquired into the reasonableness of the treatment. This issue was superficially dealt with as the psychiatrist merely informed the court that such a change in medication would have been administered by other psychiatrists in the reasonable course of clinical action.  The psychiatrist also stated that there was no “peer reviewed evidence” of the negative side effects of clopixol. The Tribunal President believed the drug had not been prescribed to Saeed for a long enough period to observe the effectiveness.

In 2014 the Tribunal made an order to provide Saeed with access to a consumer worker and a computer. At the 26th March 2015 hearing the Tribunal clarified that they were mere recommendations and still stand. When questioned on why a consumer worker was not yet allocated to Saeed, despite the recommendation being a made a year ago, slow processing was blamed. The psychiatrist also stated there were objections to providing Saeed with an advocate by the NSW Consumer Advocacy Group. Brett Collins clarified that a consumer worker was sought from NSW Health, not an advocate.

Saeed’s attack

Only four days prior to the assault on Saeed, Justice Action, on Saeed’s behalf, had sent an email to the hospital administrators stating that they had “run out of patience” due to Justice Health’s disregard of the MHRT’s recommendations for Saeed’s access to a computer and a consumer worker. The email read:

“Your treatment of him is clearly unfair and wrong. It is clear that you don’t respect the Mental Health Review Tribunal, Saeed or me. We demand the answers to which we are entitled, to the questions presented carefully underneath.”

“It is Saeed’s fifty sixth birthday today. We are pleased not to listen to your false excuses for further disrespect.”

Saeed was attacked on Monday the 8th of December 2014 at 2:15pm. Memory (a nurse) informed Saeed that the psychiatrist, Dr Barbara Sinclair, wished to talk with him for a minute. Saeed said that he did not wish to talk unless Brett Collins (his primary carer) was present. At 3:15pm, nine nurses approached Saeed and stated that they wanted him to go to the treatment room.

It was expected that Saeed would accompany the nurses to receive his first dosage of the changed prescription from paliperidone to 200mg of Clopixol, to be administered fortnightly. Saeed refused because of problems that Clopixol had caused him between May 2009 and May 2012; he had been on a 150mg dose but had been taken off the drug for the past two and a half years due to negative side effects.

Upon refusing to enter the treatment room, Saeed was dragged to his own room instead. His face was pushed down onto the floor and someone sat on him to hold him down, resulting in Saeed feeling as though he “couldn’t breathe”. His protests and screaming went ignored, and his pants were forcibly removed so he could be injected in the buttocks. At 3:45pm the same day, Saeed phoned Brett about the assault: “Brett, I am shocked; they just attacked me.”

Court costs.

The Crown Solicitor’s office sent a letter to Justice Action on the 2nd of March 2015 informing them that two cost orders previously issued against Brett Collins, coordinator of Justice Action and Saeed’s primary carer, had been waived. These government legal costs totalling $60,000 were the result of the first appeal in 2010.

This was a huge relief for Justice Action, which had dedicated years of work towards the case for Saeed and hopes to improve the position of those subject to forced medication by ensuring that there is a proper review authority. We intend to hold the MHRT responsible for its functions as set out in the Mental Health Act 2007 and the common law. An action brought about by Justice Action (A vs Mental Health Review Tribunal [2014] NSWSC 31) and two prior supreme court cases all established that the MHRT has the responsibility to look out for a patients’ best interests lies.

The nature of the MHRT’s obligations

The Tribunal delivers official reviews, determinations, provides reasons for decisions concerning mental health patients and is presented with agreed management plans. According to common law and the Mental Health Act 2007 (NSW), all of these functions must be performed in while keeping in mind the best interests of the patient.

The most current order for Saeed was made on the 27th of August 2009, which authorised his detention at the Forensic Hospital at Long Bay for care and treatment. This order has not changed since it was issued. It is the Tribunal’s practice to not issue fresh orders following a hearing unless a decision has been reached to change the order.

On the 31st of October 2014, Saeed’s bi-annual report was released. While not legally binding, this included summaries of responses to proposed treatment plans. Within the section titled ‘Reasons for Decision’, Tribunal President Howard SC made it clear in his conclusion that treatment with “the paliperidone (not clopixol) will continue.”

Unfortunately, when no authoritative direction is given by the MHRT, the hospital is not bound to follow the recommendations provided. To not issue orders runs counter to the MHRT’s agreement with Justice Action on the 20th of January 2014. This inaction from the Tribunal, and consequent lack of binding order resulted in leaving the treating team unrestricted from making an abrupt change in treatment plan if they “believe such a change is clinically appropriate” – even despite knowing Saaed’s sensitivity to the changed medication, clopixol.

In the aforementioned agreement, the Tribunal said it would abide by the recovery principles that seek to promote ‘self-management’ and ‘self-determination’. Additionally, the agreed statement said that ‘choice is one of the key features of the legislation [Mental Health Act] [to] ...facilitate the involvement of affected persons in decisions involving care, treatment and control.’ By disregarding the obligations in the provisions of the Mental Health Acts, the Tribunal may be contravening the United Nations’ Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, as well as the Commonwealth government’s National Mental Health Service Standards.

Government policy

Saeed’s case is an opportunity to expose the alarming disconnect between MHRT’s recommendations and primary purpose, and the actual enforcement and results of the treatment provided to its forensic patients. It is the belief of the NSW government that forced medication is only administered when authorised by the MHRT. This has clearly not been the case. It has only become more evident that the role of the Tribunal must be clarified and its recommendations must be enforced.

Justice Action held a Pre-Election Forum on the 17th of February 2015. In the Forum, the Attorney General and Minister for Justice, Brad Hazzard stated,  “where medication is prescribed by professional clinicians and authorised by the Mental Health Review Tribunal, Justice Health reserves the right to enforce medication.”

That statement was in response to the question: “Will you commit to supporting and reinforcing the principles of recovery and consultation with mental health consumers including the right to refuse medication, in order to foster more therapeutic treatment for prisoners suffering with a mental health disorder?” The full response can be found at http://www.communityjusticecoalition.org/events/2015-party-responses-to-questionnaire

Conclusion

Through the examination of relevant mental health legislation, Lindsay J’s judgement in A v Mental Health Review Tribunal and the Tribunal’s express reasoning for changing Saeed’s treatment to Paliperidone, it is evident that there has been a breach of duty by Dr Sinclair and her medical team.

Furthermore, the Tribunal has not complied with its role to work “within the framework of a protective concern for the benefit and best interests of each forensic patient as an individual”. On the 13th of January 2015, the Tribunal denied any responsibility in ensuring that Dr Sinclair complies with its directives. Saeed’s case was directly addressed with the statement: “[Saeed’s] Paliperidone depot will continue and side effects will be monitored and the dose will be titrated appropriately.” Their unwillingness to intervene on the 26th March is further disappointing evidence of  the Tribunal’s self-imposed impotency.

If Dr Sinclair wished to deviate from the Tribunal’s decision, she should have applied to change Saeed’s treatment plan at the next Tribunal Review. The Tribunal has both the authority and obligation to intervene in Saeed’s case following such a blatant disregard for both Saeed’s rights and the October 2014 Tribunal Determination.

The MHRT’s failure to intervene constitutes a blatant disregard for Saeed’s rights. Justice Action has asked the MHRT to exercise their power and hold Saeed’s doctors accountable for their actions. In response, they have claimed that they did not have authority to make orders relating to Saeed’s medication. Justice Action believes that these actions do not satisfy the MHRT’s supervisory obligations. We have been working tirelessly to make the MHRT properly define their role and effectively exercise their jurisdiction to hold Justice Health doctors accountable. The MHRT’s complete lack of action is in contradiction with their clearly stated objectives.

Visit To Saeed - full article

Cheerful banter with the on-duty nurse of the Dee Why Ward at the Forensic Hospital provided a stark contrast to what life behind the twenty-foot high concrete walls must be like. For many forensic patients, including Saeed Dezfouli, there is no indication of when they will be released, having had an indefinite sentence imposed. For Saeed and all the forensic patients, this isolation and disjunct from the outside world is a day-to-day living reality. 

 

On 12 September 2014, we (Damian, Danielle, and Melissa), as workers from Justice Action, visited Saeed at the Forensic Hospital. Visitations as friends of the patient was previously not permitted. As a forensic patient, being able to have visits from friends is a fundamental right and is also important for their overall wellbeing. Despite this, it was not seen as a right until 2011, when Justice Action was finally granted access for the first time to visit Saeed as friends, after extensive campaigning for almost two and a half years. This is an example of the heavy-handed institutionalisation of forensic patients. 

 

Our visit to see Saeed at the Hospital proved to be quite a challenging task, filled with a myriad of stringent security checks and having to enter through a series of locked metal-detector doors. From the moment of arrival, our impression of the Hospital was that it was clean, sparse, and extremely clinical. Our first point of contact was the security staff, who was seated in an enclosed office with a glass-panelled window. For the first half hour of our arrival, we were denied access to see Saeed, as apparently we were not ‘on the list’ according to the computer database. This was despite the fact that our visit had already been arranged with the Hospital the day before. Ultimately, due to a misunderstanding on their part, we were finally granted access to see Saeed. 

 

However, this marked only the beginning of a series of rigorous security checks, including biometric scanning, that we had to undergo. The first step was to inspect our identification. After being ID’d, we were given keys to a locker space, whereby all our paraphernalia had to be kept inside. Scarves were also not permitted. The second step involved scanning our fingerprints and taking retina scans. This was done several times. Even after being permitted access to the check-in room where we passed through the metal detectors, we were again asked to scan our fingerprints. Next, we passed through a second solid steel door, after it was electronically unlocked, and we sat for a few minutes in an almost empty room waiting for someone to escort us to the Dee Why Ward. Eventually, two nurses arrived and guided us to the complex where Saeed currently resides.

 

During our short walk to the complex, we saw that there were ovals and open spaces for exercising. However, we soon found out that patients are not allowed use these spaces for exercising, jogging, or playing any sporting activities. Along our walk, we also saw 20-feet high security walls, mauesoleums, and concrete buildings. All of these added to a feeling of being institutionalised. 

 

Once inside the complex, we were struck by how bureaucratic and clinical everything was. There were forensic patients who passed by us. They seemed somewhat subdued, which is the effect of being heavily medicated. The nurses were garbed in blue and were guiding the patients along. We later learned that there is actually minimal interaction between patients and nurses. Finally, we were led to a room where we were to meet Saeed and talk with him for an hour. 

 

Saeed proved to be different from what is expected of a patient living under maximum security who has been diagnosed with “paranoid schizophrenia”. He had an open and warm demeanour during the meeting. He was polite, poised, and articulate in sharing his views. He was very well informed of the current law and offered helpful critique of hospital life. Saeed discussed his belief that there is a lack of responsive programs in the hospital that would have long term benefits for patients. In the discussion, he detailed his daily life, saying that for each day, there is only one group activity offered. This group activity comprised of listening to other patients share a news article. He feels that such a program is highly ineffective as people don’t actively interact with each other, and that labelling it as a ‘program’ is purely a “game of deception”. 

 

As part of such a “game of deception”, Saeed has developed a distrust of the nurses and the system as a whole. According to Saeed, although the hospital is relatively safer than prisons, the difficulty he has in convincing those outside of the need for improvements leave patients at risk of having their dignity compromised. He feels that by openly speaking out about this, he may receive backlash. However, this does not detract from the need to reform the system to reflect the current societal standards of rights. 

 

A way to reform the system is to provide access to computers for forensic patients. On one level, it would allow patients, including Saeed, to use their time productively, instead of sitting idly. On another level, patients will feel less isolated from the real world. With these computers, they’re able to access their rights and stay informed of current affairs. Being able to maximise their time in such a way through computer access will mean forensic patients feel less detached from reality. When we raised this up with Saeed, we could see that it is something that he is looking forward to. 

 

It is evident from our visit to Saeed the kinds of institutionalisation methods which are being employed. These include heavy-handed security checks for visitors, lack of access to computers for patients, poorly-implemented social treatment programs, and inefficient use of resources (such as the ovals) that would improve their physical and mental wellbeing. From the visit, we, as part of Justice Action, have seen how crucial it is that there be reform to help and support forensic patients, and more effective use of resources that would cater for the needs of different patients. 

Visit To Saeed

On 12 September 2014, three workers from Justice Action visited Saeed Dezfouli at the Forensic Hospital in Long Bay. The following is a report on the experience of the visit. After meeting and talking with Saeed, it gave Justice Action some insight into what day-to-day life is like inside the Forensic Hospital for these patients. Read full article here.

Latest Saeed Hearing

On 4 September 2014 the Mental Health Review Tribunal (MHRT) convened for Saeed Dezfouli. The hearing followed a series of meetings with the hospital that were held to address why key recommendations from the last MHRT hearing had not been implemented. Justice Health’s conduct during those negotiations demonstrated an absolute unwillingness to be held accountable for their actions and a cavalier approach to the implementation of MHRT recommendations. The Lindsay judgment giving power to the Tribunal had been ignored by the hospital. Here is our Media Release.

Read more

Saeed blog

Voice Inside Madness

Blog: by Saeed Dezfouli

Monday 13th October 2014

Open Day at Forensic Hospital

Friday October 10 was the NSW Mental Health Open Day. Between 11am to 2pm, the psychiatrists and most of the psych nurses of Justice Health in the Forensic Hospital actively treat us with respect, dignity and courtesy. Overall, the day was enjoyable and appeared successful. It was positive to see patients, nurses, doctors, and representatives from Justice Health and the Mental Health Review Tribunal all enjoying a day together. It was as though everyone was on equal ground for a fleeting moment.

The forensic patients who have behaved themselves were allowed to invite two visitors to share the day with them. This year, I invited the Coordinator of Justice Action my primary carer, Brett Collins, and one of Justice Action’s caseworkers, Dion.

From 11am till 1pm, there was a speech by the Director of Service, Vince Ponzio, about how wonderful life is inside of this maximum-security mental hospital, according to him. Some patients shared their feelings in poems about the ‘Snake and Ladder’ game that is the NSW Mental Health System.

There was music and entertainment, which made me feel sorry for those patients who were not allowed to share the day with two of their friends. One female patient who had no visitors was allowed to sit at the opening ceremony for one hour, while four nurses escorted her. She has been in strict seclusion for a year now because she reacted to nurses pressing her buttons, by hitting them. It is a shame she was not allowed to enjoy the entire day.

At 1pm, lunch was served for about 200 patients and their visitors, as well as about 50 nurses. The food was good- it is the one day of the year the patients in here get the opportunity to eat like human beings. You can eat as much as you want with your visiting friends and loved ones. This kind of social gathering and activity is therapeutic- they should do it at least once a month.

I really enjoyed having lunch with my friends, Brett and Dion.  We talked about the nature of the NSW Mental Health system, which was designed and set-up decades ago and hasn’t changed since then. We also talked about how it hasn’t been changed because there are no votes in it for the politicians in NSW.

After a long chat with them, they left, and it was back to reality for me in this unproductive, depressing, inactive boring, and maddening environment for another year. I’m already looking forward to the open day next year.

 

 

Thursday 24th July 2014

New Hospital Standover

Hi, its Saeed again! I am finally able to update my blog after several delays. There has been resistance to my posts by my treating team, a group of people who seem unwilling to be open and accountable for their actions. Despite countless meetings over the last twelve years, I still feel trapped and isolated, but continue to fight for my concerns to be heard. I’m lucky I have support. Others around me just keep their head down and watch. See some earlier correspondence with authorities.

The last meeting was on the 30th of June with Barbara Sinclair the Psychiatrist in Charge, Dom Seric the Registrar Psychiatrist, Liz the Primary Nurse, Gemma Weeks the Occupational Therapist and Brett Collins, my primary carer. This meeting was held to discuss whether the promises from 6 weeks ago had been implemented. The discussions left me frustrated and in disbelief; you can read more about this below. I saw once again how difficult it is to get them to listen to me as a person.

The team was aggressive and treated Brett and me with contempt, hostility and rudeness. It was clear they felt we were insignificant and “passive” stakeholders in the process rather than intrinsically involved. Brett asked why he was not kept up-to-date, even though as my primary carer, he was entitled to be informed as under the Act.

Barbara Sinclair has said that she won’t “respond to emails because they could be used against her”. Dr. Tobias Mackinnon, the Statewide Clinical Director of Forensic Mental Health, emailed Brett, displaying empathy that had little substance. He resorted to the default response that they will try to ‘expedite … the meeting as soon as we can.” Still waiting… While he says that the Forensic Hospital would never work to “crush a consumer”, their actions suggest otherwise.

Dom said he wanted to talk about this blog. He questioned whether Brett had permission from the Mental Health Review Tribunal. They failed to acknowledge that such permission is unnecessary. Dom said that this blog is “all lies”. Brett asked “Where?” Dom said, “You do things other than sit around. We wouldn’t force people to get up”.

Come On! There is no question of force. If we were given a choice to do something else, we would take it. But it is always nice to know of new readers of my blog. Hi Barbara! Hi Dom!

What about the two things promised by the Mental Health Review Tribunal on May 2nd 2014? When this was raised at the meeting, we were told that I hadn’t been provided with access to a computer because I hadn’t asked directly! Gemma didn’t think it necessary to let me know. Come on! Secondly, no consumer workers have come to see me, another blatant disregard of the Tribunal’s recommendations.

The third failure was in relation to my Management Plan, their official statement about me and how I should be treated. At the May 15th meeting, they agreed to fix some false accusations, but no changes were made! The treating team also refused to correspond with Brett about the plan, arguing that it was “private.” Brett as my carer challenged this. Their actions are at odds with Dr Mackinnon’s email, which states that they are “committed to engaging with consumers and their families, carers and advocates”. This just shows the continual struggle to obtain information and hold those in charge accountable for their actions.

The treating team says I should trust them and stop being dependent on Brett, but I can’t when there are 12 years of bad history and they dismiss my concerns and make decisions that are not in my best interests. The biggest shock was when Barbara said she “wanted to double the dose of the medication” and “preferred to use Clopixol” injections. She mocked my horror and previous “zombie” experiences with Clopixol and remarked, “We don't want you to kill anyone.” Clearly 12 years of treating me, and my proven gentleness has meant nothing and in their view, there is no room for forgiveness and trust.

This meeting was the first time the team had mentioned increasing my medication, which flipped the idea trusting them on its head. For them, trust seems to be a fleeting concept that is trumped by bureaucracy and procedure. Brett said that my trust has to be earned, not compelled out of me. Barbara and Liz both laughed and ridiculed Brett in response to this, telling me that I “shouldn’t expect to be treated specially” and to accept the treatment I receive.

My references to s 68 of the Act protecting my rights led to sarcastic remarks as well. “Don’t get paranoid,” Barbara said, despite acknowledging my right to a copy of my Management Plan turning on my mention of s 68. My treating team continues to single me out only when it is to their advantage. They said that they wanted to do psychometric testing on me. This is inappropriate, not only because I am the highest functioning person in the unit, but also after 12 and a half years in the system, they have only now decided to do these tests.

Their resistance to label their new approach “Cognitive Behavioral Therapy” rather than their term ‘psycho-educational’ further highlights the continual pill popping attitude to mental health. This is a concession, but not real.

No additional friends have been permitted to visit me at the hospital. Their contact details had been provided, but the hospital hasn’t approved anyone. The only contact we have is with the nurses that occurs everyday at 8am and 8pm when we get our medication. Other than that, they just continue to fill out their days completing paperwork.

This ‘sit down, put up and shut up’ regime still reigns supreme. But despite this, I will continue to update this blog regularly.

I have so many more stories to tell, and they will be heard.

Back soon!

Saeed

 

Thursday 22nd May 2014

Hi I am Saeed, I'm very happy to be the first to start a blog on iExpress! I am currently living in the maximum security hospital. Today, I would like to ask you to please come into my world and see how I live.

The experiences I have gone through have made me feel that the way inmates are being treated in this particular maximum security hospital, is not an appropriate way of being treated. The obligations the hospital needs to comply with under section 68 of the NSW Mental Health Act 2007 are not being met. The process followed by the hospital is simply physical and mental torture, as well as constant medication and confinement. The hospital medicates the patients for the purpose to simply force us to comply with their sit down, put up and shut up policy.

The daily routine in this hospital is waking up at 7:30am, have breakfast at 8:00am, we are then sat down to watch TV till lunch, which is at 12pm, after lunch we are back watching TV till 6:00pm, which we have dinner and once again back to TV till we go to bed at 10:00pm. Also included in our routine is our twice a day nurse visits, which are at 8:00am and 8:00pm. The visit to the nurses is the time we are given our medication. We are treated like zombies for 7 days of the week.

July 2013, I wrote a petition to Health Case Complaints Commission (HCCC) – The complaint was about the lack of interaction between the nurses and the patients. This was a concern because at the end of the shift, the nurses are required to wright notes in our medical file about mood, thoughts and behaviour. However the notes are superficial and untrue. The notes are given to the doctor, as they are now the clinical notes. The petition was signed by 28 patients in the ward, but did not interest the HCCC, as they handed the complaint back to the Justice Health. The petition worked against me, as the psychiatrist wrote in my treatment and case management plan that I was manipulating other patients to sign the petition, and I was delusional. It is quite clear, if you complain about what is going on in here they accuse you of being delusional.

How is someone meant to feel better, if they are always putting you down?

Let me tell you a tragic story of how the system is causing people to commit suicide. On 3 December 2013 the patient next to my room committed suicide by cutting his throat, which is the only way out of this destructive system. The patient who committed suicide was subject to walk with a walking frame, he was losing his ability to walk due to the side effects of the mediation. I myself have a heart condition, high blood pressure, have diabetes and have gained 30kg. I cannot have a relationship or have children anymore - this is all side-effects of the large amount of medications that have been pumped into our body.

Once every 6 months we appear before the NSW Mental Health Review Tribunal, which basically rubber-stamps the recommendations that the psychiatrist recommends to them in 5 minutes.

I was representing myself from February 2002, until 2011 at the NSW Mental Health Review Tribunal, my review would only last 5 minutes. This occurred even though section 46 of the NSW mental Health (Forensic Provision) Act 1990, requires them by law to review my case, treatment and detention thoroughly – That is what is NSW Mental Health System is all about, while they fill their pockets with taxpayers money. The only thing we get is a large amount of psychotic medications and their policy of sit down, put up and shut up.

 

Check out my iExpress page here. You can use it to send me an email.

Mental Tribunal threatens indefinite imprisonment

After an unprecedented six weeks in consideration, the Mental Health Review Tribunal made a 58 page decision on March 20, 2014 on the future of Saeed Dezfouli, the man who was subject of the ABC Background Briefing program “The Man Without a Name”.

‘The Tribunal rubber-stamped the hospital’s authority to act as it wants, despite the Supreme Court saying it had power over the hospital. The forced injections will continue in the highest security cells. It said if Saeed doesn’t "make a genuine effort to engage with the treating team’s current treatment plan which includes injected medication…he may simply continue to remain in his current circumstances indefinitely”. We are considering another appeal’ said Justice Action Coordinator Brett Collins.

Saeed said today: “I’m not surprised by the result. For twelve years they have been trying to reduce me and those around me to dazed, medicated semi-humans. That is their culture. They must respect our human right to learn and recover”. He has begun a weekly blog called “VOICE INSIDE MADNESS" reporting on what is happening around him.

Saeed has been held for over twelve years in the highest security hospital, never having intended any harm. If he was convicted as a criminal he would have served four years. The Tribunal referred to arguments that he had paid the penalty as “a complete misconception and fallacious”, “irrelevant and unhelpful …. and likely to unfairly raise false hopes and expectations”. It ignored the NSW Law Reform Commission Report that this was unfair, and its recommendation [dead link] on “extending the requirement for the court to set a limiting term for all forensic patients”.  (Report 138 [dead link] Exec Summary 1.27 page X1X Recommendation 7.2) This issue featured in its media release” said Mr Collins.

The Tribunal permitted Saeed Dezfouli to publish his own name, and for comments to be published by his primary carer on the Justice Action website, media releases, emails and talks. But in a separate 12 page judgment the Tribunal said that the judgments themselves couldn’t be published, nor could the names of the psychiatrists or Tribunal members. No statements could be made on social media. It made threats against full public exposure like: “Mr Collins would need to be very cautious” and “he would be well advised to seek legal advice on in any case where there is the least doubt” make it clear that Saeed’s health interests aren’t the ones being protected from view’ said Mr Collins.

'On forced medication, the Tribunal dismissed in one sentence the international research showing that cognitive behaviour therapy and social support are more effective, refusing to engage on the issue. The treating team had said there is "no evidence that suggests that consumer support in the absence of antipsychotic medication is effective for managing a chronic psychotic illness” and “there is in theory a risk of harm if he is in the community if he acted upon his delusions. Medication will lessen preoccupation with delusions, even if they are ongoing and would make him more manageable in the community”. That is the medicalisation of social problems’ said Mr Collins.

Douglas Holmes, TheMHS Emeritus Standing and spokesperson for consumers said: “I am disappointed with the Tribunal's response as it seems to contradict their support for the newly released Mental Health Consumer Information Sheet and doesn’t understand the status of Justice Action”

Update on Saeed: 12 March, 2014

Saeed’s hearing before the Tribunal is fast approaching! On Thursday 20 March the Tribunal will conduct an urgent review of Saeed’s case, that has been brought forward from the usual six-monthly timetable in light of the extraordinary circumstances that Saeed is facing. After a period of high tension between Saeed and the hospital, appeal to the NSW Supreme Court, an injunction, disrupted negotiation, forced medication and a water and hunger strike, Saeed’s case is finally coming to a head.

Read more

Saeed's Strike Ends

"Forty eight hours after Saeed Dezfouli  was forcibly injected by eight staff from the Forensic Hospital, he called off his hunger and thirst protest strike” said Justice Action Coordinator Brett Collins. 

"On Saturday afternoon the hospital told him that it was reducing the dosage of paliperidone. After consultation with his support group, Saeed decided to keep his strength rather than endangering his life further,” Mr Collins explained.

"This was tactical decision by Saeed, pending a Mental Health Review Tribunal Review five weeks away, foreshadowed by the Supreme Court. An application was made yesterday to bring the hearing forward because of the Forensic Hospital’s decision to ignore alternative treatment using social support, and compel submission for its own convenience. An agreement Saeed had made with Mental Health Consumer Workers would have avoided the continued confrontation, but wasn’t even listened to” said Mr Collins.

"Saeed's David and Goliath struggle with the mental health system continues to highlight its brutality. Forcibly medicating intelligent and gentle Saeed when he is causing no problem, is contrary to the principles of “Recovery”, and against the national agreement that seclusion and restraint is anti therapeutic. It is easy bullying vulnerable people who are instead entitled to service, but have no power or support to compel it” said Mr Collins. 

"Saeed has served twelve years of brutal imprisonment without an end, for an act that would have merited four years in the criminal system. It is time to let this proud man go, giving him support to resettle in the community” said Mr Collins.

Saeed's Treatment Proposal

Great progress continues for Saeed’s battle!

In preparation of the pending review of Saeed’s case, he has constructed a proposed treatment plan for himself to be decided on by the Mental Health Review Tribunal (MHRT). In this plan, Saeed accepts responsibility for his behaviour in 2002 and realises that it caused the death of a person despite no intention to do so. Saeed will also continue to engage with the Justice Health and accepts the taking of Paliperidone orally daily.

On the other hand, he wishes to be transferred to a Forensic Mental Health Unit of lower security within the next 2 months and upon being transferred, have meetings with a Consumer Worker and psychiatric support for a 6-month period. Finally, his devised treatment plan states that in the September Review, if the MHRT receives reports that there is no significant risk of Saeed causing serious harm to himself or others, then he will be released with Neami National or a similar facility.

CRISIS: Saeed Forced Medication Begins

On Thursday 20th February 2014, mental patient Saeed Dezfouli was held face down by seven nurses and a doctor, had his trousers removed and was injected with 150mg of Paliperidone as a new trial medicine by the Forensic Hospital, after twelve years of other forced medication.

He has collapsed in a cell and is now refusing all food, water and medicine in response. He said he: ‘felt crushed, detached from life, hopeless without a future and his life was ended’. He is expected to be removed to Prince of Wales Hospital within days, to be strapped to a bed and have drips inserted to keep him alive. This is a shameless example of the coercive culture of mental health in an $17 billion annual Health budget. He was causing no one any problem.

Earlier in the day psychiatrist Dr Rafe Pulley consulted with the Director of the Hospital Adrian Keller, and declared that injections were needed. They rejected an alternative plan with Health Department Mental Health Consumer Workers, agreed to by Saeed, without hearing it. A Supreme Court injunction preventing the forced treatment was lifted on January 17thLindsay J. supported an early review by the Mental Health Review Tribunal to direct the hospital to act for Saeed’s benefit. The hospital has now usurped that forthcoming review.

Over the previous twelve years despite being a gentle intelligent person he has been forcibly medicated and has suffered diabetes, high blood pressure, a heart condition, weight gain, loss of concentration and loss of sexual arousal as side effects. He did an act for which he would have received a four years sentence but is being tortured without end, to force him into submission.

Justice Action is applying for an urgent intervention by the Tribunal and the Minister of Mental Health Kevin Humphries.

Attachment: Transcript of Mental Health Review Tribunal hearing held on 12 September 2013.

Report Meeting 20/2/14 Saeed at Forensic Hospital

 

Rafe Pulley psychiatrist, Liz (Saeed’s primary nurse) Saeed Dezfouli, Douglas Holmes (consumer worker) and Brett Collins primary carer

The initiative for this meeting was an email sent  29/1/14 by Brett to Adrian Keller, the Clinical Director of the Forensic Hospital and Long Bay Hospitals to consider the use of consumer workers to assist Saeed in his future directions. (see under)

Douglas and Brett entered the Forensic Hospital and were escorted into Deewhy ward at 9.30am by Liz. The meeting began at 9.43am.

Rafe Pulley came in and we agreed for the four to talk first before asking Saeed to talk separately with Douglas and Brett, and then a meeting between all five people, and then finally a discussion with Douglas Brett and Saeed.

Pulley explained that Saeed had previously been in Eloura Ward which is the lower security section of the Forensic Hospital, and that he had been injected with clopixol (Zuclopenthixol) under the control of psychiatrist Mastroianni until Saeed had complained about the side effects and it was decided to change it to injected (depot) paliperidone in 2012. The injection was ordered, took a while to be delivered and meantime – in a two week delay, Saeed said he didn’t want it. Because he refused it, and the ward didn’t have any seclusion cell to force him to accept the medication, they moved him back to Deewhy where he has been since.

Pulley said they are now wishing to use the same medication he is taking orally, - paliperidone at 75mg/month as a depot injection to ensure his compliance before he could be transferred to a less secure hospital.

Pulley said that Saeed had ongoing delusions and he was mentally ill. He hadn’t talked with him since 2012 although he did talk with nurses and other staff. Whenever they talked about the fire Saeed used irrational responses to justify it, and didn’t see it as irrational. He continued to hold delusions shown in his letters where he approaches US Senators Democrats as if he had information “too hot to handle” and discussion about global warming, misinterpreting information that he was given.

Douglas said he could assist in communication, encouraging Saeed to start discussions with Pulley and cooperation with the Treating Team. He said he could put aside 2 hours a week over a month to do so, and that might help lessen the tension.

Saeed came in after they had left, and talked with Douglas and Brett for 20 minutes about what the problems were, what cooperation was possible and what Saeed’s hopes for the future were. He took a recovery bus and agreed to a proposal that would allow him to receive support and start to work with the Treating Team.

Pulley and Liz returned at 10.36am

Immediately Pulley said: “I have talked with Adrian Keller and we feel that we need to act today with the injections. It is in the best interests of getting you out of here. I want to let you know that.”

Brett said that he was really sad to hear that. We felt that we had a useful proposal and agreement with Saeed, but you haven’t listened to that and are just delivering a fait accompli, and forcing a confrontation. I think it is really disrespectful and it gets my back up. Why is there an urgency? Even as a layperson you can see in Saeed’s eyes that he is medicated. Why can’t you do a blood test?  Pulley said that blood tests for this medication wasn’t available in Australia.

Douglas said he was flabbergasted. He said he was still available to help Saeed if he wants. Saeed said that it was all an attempt to get him out of the Forensic hospital. He wanted to go to Bunyah but knew that it would be 7-9 years after that before he was allowed to re-enter the community. Previously in 2010 they recommended he be in Morisset but Saeed had denied his mental illness and they didn’t like that so rejected him.

Pulley said that Saeed could pursue his legal rights, to challenge on fitness to plead and try to get a limiting term, but he could also progress through the system at the same time. That he had lost 18months in his recent reversal from Eloura Ward when he refused depot medication. Saeed said others aren’t forced to take depot and are let into medium security. Pulley said it depends on each case. Pulley said you may not agree with this, but we believe you have delusions and that medication is critical.

Douglas said that he would talk with Liz Roberts and others about bringing in some educational material to the Hospital. He gave to Pulley the box of Narrative Resources.

Saeed said that his decision is clear. “There is no clinical justification for injecting me. To move me to medium security isn’t a proper reason. I will cease all oral medication and not eat or drink. I would lose face or honour if I didn’t. I was hoping to come to an agreement but that’s the way it is. I realise that I’m risking my life but the medication has caused me to have heart problems.

Brett offered Pulley a copy of Mad in Australia on the issue of medication. Pulley refused it saying he already had a copy.

Pulley and Liz left. Douglas Saeed and Brett talked.

Saeed said: I feel really rocked by that. Crushed. We couldn’t penetrate at all. If I take the injection I am still in a hospital for 7-9 years and Pulley agreed that is the process. I feel that I have nothing left. The medication they have given me so far has caused diabetes, a heart condition, high blood pressure, weight gain, cramps and loss of concentration, restlessness and I haven’t had any sexual arousal for five years. I feel detached from life with no light at the end of the tunnel. I have lost hope.”

Douglas and Brett assured him of their continuing support. Brett agreed to bring it back to the MHRT as soon as possible, rather than wait until April 3rd.

They left the hospital at 11.30am

Saeed rang Brett at 4.15pm and said that he had been injected at 11.45am and had been lying on his bed since. He said that he felt totally dejected.

INITIATING EMAIL TO ADRIAN KELLER

Dear Dr Keller,

 
 Justice Action is most concerned about Saeed's well being. We are trying to resolve the tension involving Saeed, following the decision of Lindsay J. on 17/01/2014 to lift the injunction preventing the hospital from forcibly injecting Saeed.  After a wide consultation with stakeholders we have a proposal that could defuse the matter, and have been advised to approach you to help resolve it.

 

Saeed has told us, and we understand told your staff, that he will refuse all food, water, and even his heart medication if they hold him down and inject him with Zuclopenthixol. The advice we have is that, given his medical condition, this will rapidly be extremely dangerous. Though Saeed has not in the past rejected oral medication, he feels that the threatened injections will have much more serious side effects than he is presently suffering, and finds being forcibly injected extremely personally invasive. He trusts the psychiatrists who gave evidence before the Tribunal in September last year that the medication could do him harm, and has referred to Mad in Australia as supporting a better way, involving recovery principles. We see that Saeed is moving towards a very unpleasant confrontation, that will end, we understand, with him strapped to a hospital bed in the Prince of Wales Hospital with drips attached to keep him alive.  

 

We are most worried about this situation and the risk of serious harm that could result from the hospital’s imposition of its preferences for his care, especially when he feels that he has already more than paid the penalty for the act he did, if he was treated fairly with a limiting term, or treated as a criminal as fit to plead. (NSW Law Reform Commission Report 138, para 0.28)

 

We have talked with Saeed and have his support to approach you for another way to deal with this, with the cooperation of your team. The proposal would be that we ask for the assistance of Department of Health employed consumer workers to visit Saeed urgently to give him their professional assistance.

 

In preparation for this intervention, Justice Action has approached the NSW Mental Health Consumer Worker Committee (CWC) and has secured an undertaking from Mr Tim Heffernan, Chair of the CWC, to assist Saeed by providing two of their workers – similar to Certified Peer Specialists – for support. This undertaking also includes later provision of assistance by Consumer Workers in a Community Mental Health Team.

 

We urgently ask you to address this matter. Please acknowledge this email upon receipt.

 

Regards,

 

Brett Collins

 

RESPONSE EMAIL FROM ADRIAN KELLER

 

Dear Mr Collins

I acknowledge receipt of your email.

I will provide no undertakings in relation to the proposal you have put forward.

Mr Dezfouli’s treating team will be discussing his future management plan with Mr Dezfouli and yourself, as primary carer. They will consult with myself and other members of the Forensic Hospital team as is considered appropriate.

Yours sincerely

Adrian Keller

Clinical Director | The Forensic Hospital & Long Bay Hospitals

Justice Health & Forensic Mental Health Network

 

Commentary on Lindsay J’s Judgment Power of MHRT

The power of the Mental Health Review Tribunal (MHRT) to control the treatment of patients by the hospital was considered for the first time at the hearing about Saeed Dezfouli held on the 20th September 2013. Judicial member Helen Morgan asked Saeed’s lawyer:

You say the Tribunal has that power?”[1] After hearing all arguments the Tribunal stated it would only “intervene in exceptional circumstances”.[2]

That decision was challenged by the NSW Supreme Court. The recent judgment of Lindsay J in Saeed Dezfouli’s case [2014] NSWSC 31 establishes the Tribunal’s power over the mental health system.

The Mental Health Consumer Information Sheet was created after consultation with the Tribunal and Justice Health. Download here

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