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Mental Health

Alternatives to Medication

Different things work for different people. Below is a range of comprehensive alternative treatments that Justice Action strongly believes can be more effective than forced medication for people with mental health issues. 

ACUPUNCTURE

To balance the body’s energy system. Depression in Chinese medicine implies suicidal tendency and liver issue. Acupuncture would help these problems. There is one acupuncture point Pericardium 6 which when needled can change a person’s mental state from negative to positive.

AFFIRMATIONS

To say over and over lovely positive self-talk compliments, e.g. “I am special too”, “The universe loves me”, and “I am wonderful”.

AROMATHERAPY

There are a number of essential oils that help with balancing the body’s energies; mind; emotions and spirit.

ARTS AND CRAFTS

Creating builds confidence. Having a hobby of making things can instil a sense of pride, self-worth and accomplishment.

AUSTRALIAN BUSH FLOWER and BACH FLOWER ESSENCES

A subtle, simple and powerful way to shift old energy patterns and transforms mental/emotional/physical states in need of transformation, with no negative side effects. This method is also very inexpensive.

BOOKS

Reading books is great way to pass the time and keep your brain trained. Self-help books can offer ways to improve your thinking and attitude. Fiction books can offer a temporary escape from your problems. Reading other texts like poetry, philosophy and plays can also be very mentally and intellectually stimulating.

CENTRES

Hearing Voices groups, and Living Skills groups. Having regular social interaction in the form of centre or a group can be great mental support.

CLUBS

Laughter Club; “Laughter is the best medicine.” Toastmasters Club: express self. Such clubs can help build confidence and give you a place to meet and connect with others in a comfortable setting.

DEVELOPING FINANCIAL RESPONSIBILITY (DFR)

For those whose mental illness or mental disorder arises from stresses associated with money; money mismanagement disorder, financial incontinence disorder, lack of money disorder, budgeting difficulty disorder, overspending disorder, gambling disorder, lack of financial discipline disorder, no financial system disorder and associated money disorders eventually manifesting as full blown mental illness, dysfunctionality, depression, schizhophrenia, bipolar disorder, etc. Treatment should assist you so that within two years, you should be saving 20% - 70% of everything you earn.

EXERCISE

There are many types of exercise which may be helpful, in particular walking groups, yoga, pilates, swimming, dancing. Exercise induces the release of endorphins, serotonin and helps maintain general good health.

GARDENING

Taking care of a plant or a garden and watching it slowly grow and bloom can build a sense of individual responsibility and achievement. Some options are Community Gardens, pot plants, vases of flowers, and Parks Gardening groups.

GIFT GIVING

Channelling good can often help you feel good about yourself! Bringing joy to others can give you a sense of friendship or worth.

HANDIWORK

Knitting or crotcheting, such as making “Wrap with Love blankets” for charity, keeps your hands and mind occupied and focuses you on a productivity activity.

HOBBIES AND INTERESTS

Achievements bing contentment. Committing to something you enjoy, such as music, writing, reading, watching movies or playing sports, makes you happy and gives you something to look forward to.

HOME REMEDIES

Home remedies and therapies such as herbs, chamomile tea, aloe vera can have a calming or soothing effect. They are good for relaxation and have great health benefits as well.

HYPNOSIS MEDITATION CD

Reprograms the subconscious mind with positive affirmations to help create positive changes in a person’s life.

LAUGHTER THERAPY

Laughter Therapy (also called Humour Therapy) is founded on the benefits of laughter, which include reducing depression and anxiety, boosting immunity, and promoting a positive mood. The therapy uses humour to promote health and wellness and relieve physical and emotional stress or pain, and it’s been used by doctors since the thirteenth century to help patients cope with pain.

LIGHT THERAPY

Most commonly known for treating Seasonal Affective Disorder (SAD), light therapy started gaining popularity in the 1980s. The therapy consists of controlled exposure to intense levels of light (typically emitted by fluorescent bulbs situated behind a diffusing screen). Provided they remain in areas illuminated by the light, patients can go about their normal business during a treatment session. So far, studies have found that bright light therapy might be useful in treating depression, eating disorders, bipolar depression, and sleep disorders.

LISTING AND DECLUTTERING

Having over-cluttered living space or a lack of focus or goals can worsen one’s mood and contribute to one’s mental illness. Making and completing lists create a sense of responsibility and achievement. Cleaning the house, doing the dishes, decluttering one’s living space and making small daily accomplishments can improve one’s mood and give a sense of organisation and discipline.

MASSAGE THERAPY

Massage therapy can help ease feelings of stress, tension or anxiety. It also benefits your skin, muscles and blood circulation, and alleviates arthritis.

MEDITATION

Meditation reduces stress and improves concentration. Practising meditation on a regular basis increases self-awareness, happiness and encourages a healthy lifestyle. Taking time for Prayer and Bible reading may also be of great benefit to certain people.

MINDFULNESS

Stay in the present moment. Focus yourself on the now. Pay attention to your thoughts and feelings in a given moment without judging them as right or wrong, or as reasonable or unreasonable.

MUSIC AND SINGING

Music and singing gives happiness and enjoyment. Singing can lower stress levels and decrease the levels of a stress hormone called cortisol in your bloodstream. It also promotes mental alertness by improving blood circulation and allowing more oxygen to reach the brain. Making music in any form is relaxing. Listening to music also lowers stress and elevates your mood, relieving anxiety and even reducing depressive symptoms.

MUSIC THERAPY

There are loads of health benefits to music, including lowered stress and increased pain thresholds, so it’s hardly surprising that there’s a therapy that involves making (and listening to) sweet, sweet tunes. In a music therapy session, credentialed therapists use music interventions (listening to music, making music, writing lyrics) to help clients access their creativity and emotions and to target client’s individualized goals, which often revolve around managing stress, alleviating pain, expressing emotions, improving memory and communication, and promoting overall mental and physical wellness. Studies generally support the therapy’s efficacy in reducing pain and anxiety.

NEURO-LINGUISTIC PROGRAMMING

Has a wonderful technique where you take someone back to an initial trauma and then take them to a time and place they were very happy and then replaces the initial trauma with the positive other experience.

ORGASMIC MEDITATION / ORGASM THERAPY / SEX THERAPY

For women, whose mental illness or mental disorder arises due to pent up stress, inhibition, repression, false religion etc., orgasmic meditation and orgasm therapy provides, by way of the 15 minute orgasm, a natural no side effect release and source of empowerment when properly done on her own or with skilled partners or practitioners or by way of an orgasmic meditation machine or device within the context of proper orgasmic doctrine, philosophy and support with repetition and follow through.

PETS

There are health benefits to having a pet. Pets help to lower blood pressure and decrease anxiety, whilst boosting our immunity. There are many physical, mental and emotional improvements to caring for an animal companion.

POLARITY BALANCING

Similar to remedial massage, but a different technique that achieves the same result in balancing the flow of life energy within the human body.

PRIMAL THERAPY

It gained traction after the book The Primal Scream was published back in 1970, but Primal Therapy consists of more than yelling into the wind. Its main founder, Arthur Janov, believed that mental illness can be eradicated by “re-experiencing” and expressing childhood pains (a serious illness as an infant, feeling unloved by one’s parents). Methods involved include screaming, weeping, or whatever else is needed to fully vent the hurt. According to Janov, repressing painful memories stresses out our psyches, potentially causing neurosis and/or physical illnesses including ulcers, sexual dysfunction, hypertension, and asthma. Primal Therapy seeks to help patients reconnect with the repressed feelings at the root of their issues, express them, and let them go, so these conditions can resolve. Though it has its followers, the therapy has been criticized for teaching patients to express feelings without providing the tools necessary to fully process those emotions and instil lasting change.

RELATIONSHIP AGREEMENT OR TREATMENT

For those whose mental illness or mental disorder arises out of their primary relationship with their partner (or others) where durations and terms have not been defined or committed to in writing. Treatment includes the supervised setting of durations and renewal dates for the relationship, bond posting and defining of all terms for each partner so that the relationship will no longer be a cause of mental illness, distress or disorder. Guaranteed to terminate mentally unhealthy relationships and give more structure to those lacking written structure and definition. A perfect way to start a new relationship with purpose, direction, security and clarity where all is agreed and love is free to flow.

RELAXATION

Calming, soothing, relaxing. Everybody needs time to recharge and process the day. Not having enough time to relax can worsen feelings of stress and tension.

RELIGION

It is often observed that having a religious belief can give you a positive state of mind, and something to focus on while you face problems in life.

REMEDIAL MASSAGE

Past stress and/trauma gets locked in the cellular tissues. Massage helps to release from the body and people feel relaxed and lighter in the body and mind.

SLEEP AND RESTING

Sleep and resting is a vital pause and interval in the midst of our busy lives. Many of our problems, such as negativity, worry, bad moods and emotional instability, can be traced back to a bad night’s sleep. Making sure you get the right amount of sleep every night can give you much more energy and let you face the day’s challenges with a better, clearer attitude.

SOCIALISING

It is undeniable that human company is reaffirming. Friends are great for balance and fun, and everyone always needs to have a person to chat with. A support network is vital for your physical, mental and emotional wellbeing.

THETA HEALING

Also takes a person back to the original trauma that keeps getting replayed and reprograms the person with positive commands to the subconscious so that a new life experience may be experienced.

VITAMIN AND MINERAL THERAPY

Research shows that long-term use of medication depletes valuable nutrients in our bodies, which often has an impact on our physical and mental wellbeing. Supplements may be used to replenish these nutrients. Some vitamins and minerals may need to be added for a time to make up for any big imbalances.

VOLUNTEERING

Helping others can gladden the heart. It gives you a sense of purpose and fulfilment and increases your self-confidence, whilst decreasing your risk of depression. It can also help you find work and social opportunities. 

WHOLESOME FOODS

Sometimes not eating a balanced diet – too much processed food/junk food/sugar, or food intolerances or allergies (particularly to wheat and dairy) can affect people’s mental state. It can easily be fixed by vitamin/mineral supplements or removing the offending foods from the diet.  Eating more fresh fruit and vegetables can improve your health dramatically.

WILDERNESS THERAPY

Wilderness therapists take clients into the great outdoors to participate in outdoor adventure pursuits and other activities like survival skills and self-reflection. The aim is to promote personal growth and enable clients to improve their interpersonal relationships. The health benefits of getting outside are pretty well substantiated: Studies have found that time in nature can lower anxiety, boost mood, and improve self-esteem.

YOGA

For gentle stretching and maintaining subtlety in the body and also has the power to fight stress and improve moods. Mindfulness-based yoga lowers stress and anxiety and helps with bi-polar disorder and depression.

References

Croft, Harry, ‘Alternative Approaches to Mental Health Treatment’ (2016) Healthy Place.

Cooke, B., & Ernst, E (2000) Aromatherapy: a systematic review. The British Journal of General Practise, 50 (455): 493-496.  

Mind For Better Mental Health, Complementary and Alternative Therapy (November 2016) <https://www.mind.org.uk/information-support/drugs-and-treatments/complementary-and-alternative-therapy/different-therapies/#.WYqnoWR96M4>

Murphy, Gregory, ‘Various preferred section 68 part (e) treatment alternatives.’

Newcomer, Lauren, 8 Alternative Mental Health Therapies Explained (December 4, 2012) <http://greatist.com/happiness/alternative-mental-health-therapies-heal-mind >

SANE Australia, Complementary Therapies (3 August 2017) < https://www.sane.org/mental-health-and-illness/facts-and-guides/complementary-therapies>

Wheeler, Regina Boyle, ‘Alternative Treatments for Mental Health’ (2009) Everyday Health.

Report of Meeting 20.1.14 MHRT and JUSTICE ACTION

We look to the issues raised by Dan Howard at the CJC forum “Bedlam...The Way Out” in Parliament House on 19/11/13 to give some direction to the agenda. We really wish to establish a working relationship that isn’t confrontational, but becomes trusting and constructive. As suggested orally at the CJC Forum, most of the issues we need to present publicly and in the courts could be the subject of discussion and negotiation. 

Our role as a change agent has been widely acknowledged and appreciated. We just need results for the benefit of our and the general community.

 

The Mental Health Review Tribunal, constituted under Ch. 6 of the Mental Health Act 2007 (NSW), has functions imposed on it by both its constituting Act and the Mental Health (Forensic Provisions) Act 1990 (NSW). Its jurisdiction covers the following:

  • Considering the disposition and release of persons acquitted of crimes by reason of mental illness;
  • Determining matters concerning persons found unfit to be tried and prisoners transferred to a mental health facility for treatment;
  • Reviewing the cases of detained patients (both civil and forensic), and long-term voluntary psychiatric patients;
  • Hearing appeals against an authorised medical officer’s refusal to discharge a patient;
  • Making, varying and revoking community treatment orders;
  • Determining applications for certain treatments and surgery;
  • and making orders for financial management where people are unable to manage their own financial affairs.

 

Instrumental in the carrying out of its duties are the objectives of the Mental Health Act 2007 and UN principles for the protection of persons with mental illness and the improvement of mental health care, which outline the civil and human rights to be afforded to all mental health consumers, including but not limited to:

 

  • treating a person in the least restrictive environment (s 68(a))
  • assisting people to live in the community (s 68(c))
  • prescription of medicine for diagnostic/therapeutic needs, not as punishment or for the convenience of others (s68(d))
  • information sharing with patient and treatment alternatives provided (s 68(e))
  • minimum necessary interference with liberty, rights, dignity and self-respect (s 68(f))
  • involvement of person in development of treatment plans (s68 (h))
  • procedural safeguards so that hearings are fair (principle 18)

 

1. Choice

Choice is one of the key features of the legislation, s 3 objectives state the Mental Health Act 2007 (NSW) is intended to facilitate the involvement of affected persons in decisions involving appropriate care, treatment and control (s 3(e)) and is again reiterated in s 68 (h).

  • Representation for the consumer in Review hearings. Dan said that the mental health advocacy service does a “terrific job” in representing people. However, he also said that it found it “hard to cover all the ground”. Consumers express bitter unhappiness with the representation they currently receive.

 

Response:

Justice Action proposed to discuss and negotiate with the Mental Health Advocacy Service (MHAS) for ways in which the service could be improved. A discussion followed about the possible use of certified peer specialists (CPS). The MHRT agreed that peer support is very valuable and can assist recovery of the patient, however they were unable to mandate or require it. The MHRT emphasised they were happy for a certified peer specialist to support and advocate for the consumer, but it was their practice to provide reports to solicitors who would discuss it with the consumer. If the MHAS needed to improve on that the MHRT agreed to provide feedback to MHAS. The MHRT agreed that CPS could assist in interpreting for the consumer the reports as well as the determinations.

 

2. Independent psychiatric support

Dan expressed his desire for “it to happen a bit more than it does now.” Consumers in the forensic and involuntary health areas generally feel imposed on rather than therapeutically assisted. 


Response:

The MHRT stated that the law provides for a patient to be detained until they are well enough and this is something for the State to decide with care ‘ordinarily provided by the treating team, by Justice Health’. All participants agreed at this point that there needed to be a discussion around more consumer involvement and patient input. The MHRT agreed it had the authority to require the hospital to negotiate with and listen to the patient regarding treatment, but whether it was exercised in a particular case is a discretionary matter.

Justice Action emphasised that in line with recovery principles there should be a reduction in seclusion/restraint. The MHRT responded that it was a matter for the treating teams to change their approach to adopt recovery principles; that the MHRT had to work within its jurisdictional limits, but that it could certainly advocate in meetings with treating teams for a shift in approach. The MHRT stated an ‘independent’ opinion can be difficult to obtain, but sometimes the MHRT have requested a second opinion and the MHAS is also able to do this for clients. The MHRT made it clear that they do not have the funds to mandate second opinions, however. Justice Action proposed that certified peer specialists may assist to fill in the gaps and provide social support.

 

3. Access to Reports - Reviews

  • Access to reports: policy requires reports submitted to MHRT 2 weeks prior to hearing. In practice, reports submitted at the hearing. Consumers should have sufficient time to read reports, submit proposals/contradictory evidence; procedural fairness rules should be followed.

Response:

The MHRT outlined the practice of the MHRT to provide reports to legal representatives and not to consumers or lay representatives. This was because could be detrimental to the well-being of a consumer to receive sensitive information about their own case and it was not ‘appropriate’ or ‘safe’ to provide reports directly to the patient sometimes. The MHRT agreed that consumers should know ‘in broad terms’ what is in the reports, however it was not for the MHRT to make a call on providing a report directly to the patient because of clinical considerations. Justice Action agreed to contact Justice Health to enquire about the criteria for not providing a report to a consumer.

The tribunal agreed that the consumer should have time to digest the report before the hearing and submit evidence in response, but stated it was not for them to facilitate that beyond giving it to the solicitor as soon as they get it. They conceded that reports came too late from the hospital and sometimes go to legal representatives a couple of days before the hearing or even the day of the hearing; the MHRT tried to pass those reports on as quickly as possible but often did not get the reports early enough. However, it could be adjourned if necessary.

  • Detailed determination report post review:


Why did the MHRT make its determination?

  1. What evidence/reports did it rely on?
  2. What does the patient need to improve on for next review?

 

This would encourage the MHRT to act independently of Justice Health and treatment teams, rather than rubber-stamping their decisions.

  • Tribunal to read nurses daily reports: nurses have more interaction with patients. For the Tribunal to make an accurate determination all evidence should be considered and the consumer should be able to point at matters.

 Response:

The MHRT assured Justice Action that its practices regarding determination reports had changed in the last 6 months. One of the changes was that ‘reasons for decisions’ were typed, quite detailed. Some reasons included sub-headings including current mental state, physical issues, current risk of harm to themselves or others, likelihood of deterioration in the current circumstances of detention, situation since last review, plans for future and anything else notable from the decision. All reasons for decision are now provided to the consumer’s lawyer and the treating team, and where relevant also go to the disability services branch of the prison and the classifications division of the prison. This is the case even when there has been no change to the MHRT order. The idea was that it captured the consumer’s plans, the treating team’s plans and anything else that should be considered as well.

 

4. Recovery principles



Dan said: “In essence, we have lost our way with the medicalisation of people’s lives…. We try to be better and the recovery principles help. Clinicians on the Tribunal are hoping to encourage treating teams and clinicians to embrace these ideas where possible." We would like to talk about what that might be, especially around choices with treatment. Annual report 2012/13 makes reference to the importance of recovery principles in promoting hope, self management, self determination and the MHRT’s commitment to understanding mental health consumers’ needs and changing policies and procedures in response to those needs (p10).

  • Adoption of limiting term principle: see the NSWLRC Report 138 Exec Summary 1.27 page X1X
  1. A limiting term for NGMI consumers is “fair”, (see rpt) would promote hope, encourage self management, and give a sense of progress to patients.could be adopted retrospectively by the Tribunal, on the guidance of the MHAS without a need for legislation.
  2. Bring mental health in line with criminal justice system rather than having harsher penalties
  3. Places onus on the treating team and Justice Health to justify the ongoing detention of a patient after a certain period

 

Response:

The issue of adopting a limiting term principle raised by the NSWLRC was dealt with quite quickly, as MHRT stated that without a change in the legislation it would be impossible for the Tribunal to adopt this as a practice. It was suggested Justice Action could campaign to the people who might be able to amend the legislation.

 

  • Fair decisions re patient mistakes


I.oAccepting possibility of consumer mistakes without devastating consequences

  1. II.oCurrently consumers are forced to start over if a problem arises, sent back to acute ward, for example. Complete contradiction of recovery principles of promoting hope.
  2. III.oViolates s 68 principles regarding treatment in ‘least restrictive environment’ (s 68(a)), minimum restrictions on patients’ liberty (s 68(f), the provision of care should be designed to assist people to live in the community (s 68(c)).

 

Response:

The discussion around recovery principles began with an outline of the procedures following a breach. The MHRT did not see a return to the Forensic Hospital as ‘punishment’ however Justice Action responded that it was a return to a higher security area. The MHRT accepted that recovery is not a linear process, that people get unwell, and that there was a preference for a patient to go to a civil hospital. However, she conceded that s 68 Breach of Orders for Release of the Mental Health (Forensic Provisions) Act 1990 (NSW) was perceived as a reprimand. The MHRT invited Justice Action to draw their attention to particular cases of concern.

The MHRT agreed there was a way to go before recovery principles were fully adopted. They stated it was a matter for the treating teams to change their approach to adopt recovery principles; that the MHRT had to work within its jurisdictional limits, but that it could certainly advocate in meetings with treating teams for a shift in approach.

 

5. Connections with peer groups

Dan talked about the need for better community resourcing and "connections with peer groups”. We would like to suggest ways in which that might occur. The development of consumer workers and certified peer specialists both from inside the hospitals and out to give others support is very important and cost effective.

Response:

See item (1) certified peer specialists.

6. Transparency with MHRT

 

This includes MHRT personnel, witnesses and procedures. We have encountered a tendency for the mental health area to regard itself as a whole as entitled to a veil of secrecy, whereas that culture is inimical to public service and the maintenance of expected standards of behaviour. 

 

  • Section 162 Mental Health Act 2007 (NSW)

I.oBlanket prohibition on the publication of names: is this for the protection and privacy of the patient?

  1. II.oFunctions to allow Tribunal members to avoid public scrutiny/criticism/be held accountable for their decisions, places less personal responsibility on the individual members of the Tribunal to justify their decisions.
  • Transparency of determination

I.oMore detailed reports after review, outlining why/how the decision was made and what evidence was relied on.

  • Listing of cases on website:

I.oPrivacy of patients can be respected, while still allowing issues raised in cases to be easily accessible/publicly available.

  1. II.oThis will increase public confidence and trust in the MHRT as a quasi-judicial body
  2. III.oAccountability levels should be similar to that of a court as the MHRT is likewise responsible for making determinations about the restriction of liberty of a human being.

 

Response:

The MHRT suggested the determination made last week in regards to a s 162 application in a particular case did not set a precedent for other cases. The MHRT said there was now a Practice Direction on the MHRT website about s 162 applications and MHRT gave a short explanation about the expansion of the website in line with trying to make its practices/procedures more transparent. Further, it was explained that the MHRT is providing anonymised versions of key cases or decisions available on their website. However, the MHRT stated it would be too resource intensive to provide a listing of all cases on their website.

For comments on transparency regarding determination reports, see item (3).

FALSE STIGMA OF VIOLENCE

* The majority of violent crimes and homicides are committed by people who do not have mental health problems. In fact, 95 per cent of homicides are committed by people who have not been diagnosed with a mental health problem.[10]

* Contrary to popular belief, the incidence of homicide committed by people diagnosed with mental health problems has stayed at a fairly constant level since the 1990s. [11]

* The fear of random unprovoked attacks on strangers by people with mental health problems is unjustified. This has been highlighted by a US finding that patients with psychosis who are living in the community are 14 times more likely to be the victims of a violent crime than to be arrested for such a crime. [12]

* According to the British Crime Survey, almost half (47 per cent) of the victims of violent crimes believed that their offender was under the influence of alcohol and about 17 per cent believed that the offender was under the influence of drugs. [13] Another survey suggested that about 30 per cent of victims believed that the offender attacked them because they were under the influence of drugs or alcohol. In contrast, only one per cent of victims believed that the violent incident happened because the offender had a mental illness. [14]

* People with mental health problems are more dangerous to themselves than they are to others: 90 per cent of people who die through suicide in the UK are experiencing mental distress. [15]

* People with serious mental illness are more likely to be the victim of a violent crime than the perpetrator. One study found that more than one in four people with a severe mental illness had been a victim of crime in one year. [16]

[10] Kings College London, Institute of Psychiatry, 2006, Risk of violence to other people,

[11] National Confidential Inquiry into Suicide and Homicide by People with Mental Illness – Annual report: England and Wales 2009

[12] Walsh E et al. 2003, 'Prevalence of violent victimisation in severe mental illness', British Journal of Psychiatry, vol. 183, pp. 233–238.

[13] Home Office, 2009, Crime in England and Wales 2008/09, Vol. 1, Findings from the British Crime Survey and police recorded crime, Statistical Bulletin, 11/09, vol. 1.

[14] Coleman K, Hird C, Povey D. 2006, 'Violent Crime Overview, Homicide and Gun Crime 2004/2005', Home Office Statistical Bulletin,

[15] Hall D et al. 1998, 'Thirteen-year follow-up of deliberate self-harm, using linked data', British Journal of Psychiatry, vol. 172: pp. 239–242.

[16] Teplin L, McClelland M, Abram K, Weiner D, 2005, 'Crime victimization in adults with severe mental illness', Archives of General Psychiatry, vol. 62, pp. 911–921.

Our Position On Mental Health

Mental health broadly describes the level of our psychological well-being and inherently provides a basis to an understanding of our own identity, whether it be as a citizen of society or as an individual within a circle of family and friends.

The status of our psychological well-being however is conditional to an infinite range of factors. From basic daily anxiety to the more serious problems of alcohol and drug addiction to suicide, mental health continues to be an issue of concern today more than ever.

The increasing problems and lack of proper awareness of mental health has generated a class of individuals that have had their voices and rights dismissed. This has evoked an active need for the proper and necessary treatment of individuals concerned with mental health problems.

Identity Rights

Overview:

The right to a name is basic to being human, being of worth and having a place in society. Without a name you have no unique reference point for others to relate to. However in the mental health area this right is conditional on the permission of the Health authorities, as an expression of their concern for the reputation of the consumer. In practice it only protects the Health authorities from criticism with secrecy and no media examination of Tribunal hearings.  This is a touchpoint showing the lack of respect in mental health. Justice Action took this issue to the Supreme Court for Saeed Dezfouli, and finally won in a Tribunal hearing involving ABC lawyers.

Here is the original submission in his case, with an examination of the laws.

We have had to remove some of the details here under the threats of the NSW Mental Health Review Tribunal, but will supply more on request.


Justice Action Publications:

 

Mad in Australia: This publication exposes the history of abuse of mental health patients in historical and cultural context. It identifies how the culture of doctors forcing medication on mental health patients began, in breach of their ethical obligations, and against the evidence of its effectiveness. It also offers solutions.

The Our Pick Report
: This report written by Justice Action concerning the state of mental health in Australia. Justice Action decided to focus on the mental health area after it had become apparent that a new strategy was required to defend community interest and prisoners' rights against the law and the added effects of tension, boredom, powerlessness and isolation occuring in imprisonment. Many prisoners become forensic patients or remain in prison under medication: the rates of major mental illness in prisons have been found to be three times higher tha that of the general population. This report confront the abuse of 'care' in mental health and prisons.

Mental illness policy issues: There are serious failings in the way that public policy addresses mental illness in our society. The most serious failings as well as other inherent issues within mental health have been identified that is broadly reflected in Mental Illness Policy Issues. The single greatest cause of distress and difficulty; to the greatest proportion of those living with mental illness, is the way our society responds to them.

Letter by Saeed to Justice Action (08/09/2010)

Campaign Documents

Challenge to Tribunal's Ban on Saeed's Name


Media Releases:


Court hearing for patient's right to his name

 

 


Social Support Rights

visiting rights

Overview:

Maintaining adequate connections with the outside world is an essential right for any patient isolated with limited human contact. Mental health patients are legally entitled to rehabilitative care and support, not punishment based treatment. Therefore to withhold visitation rights of a patient, which is an essential aspect of their social devolvement during the rehabilitative process, is an unethical infringement upon patient’s rights. It is not only important for the patient, but also their family and the individuals of the community impacted by their disorder.


Justice Action Publications:

 

Mad in Australia: This publication exposes the history of abuse of mental health patients in historical and cultural context. It identifies how the culture of doctors forcing medication on mental health patients began, in breach of their ethical obligations, and against the evidence of its effectiveness. It also offers solutions.

The Our Pick Report
: This report written by Justice Action concerning the state of mental health in Australia. Justice Action decided to focus on the mental health area after it had become apparent that a new strategy was required to defend community interest and prisoners' rights against the law and the added effects of tension, boredom, powerlessness and isolation occuring in imprisonment. Many prisoners become forensic patients or remain in prison under medication: the rates of major mental illness in prisons have been found to be three times higher tha that of the general population. This report confront the abuse of 'care' in mental health and prisons.

Mental illness policy issues: There are serious failings in the way that public policy addresses mental illness in our society. The most serious failings as well as other inherent issues within mental health have been identified that is broadly reflected in Mental Illness Policy Issues. The single greatest cause of distress and difficulty; to the greatest proportion of those living with mental illness, is the way our society responds to them.

Denial of visiting: A report by Justice Action into the struggle for visitation rights for Saeed, the value of community access to mental health patients.

Breakthrough - First visit for Saeed's Friends: A report by a Justice Action worker into a visit to Saeed.

History of attempts to visit Saeed

Media Releases:

Media Release 27/04/2010 - Mental patient challenges abuse

Media Release 01/07/2010 - Launch Report on mental health abuse and Proposal

Media Release 15/09/2011 - Mental health outrage – hospital blocks visits


Media Release 29/09/2011 - Mental Health breakthrough – hospital visit approved

Media Release 18/10/2011 - Mental Hospital blocked ‘Celebration Day’ visits


Media Release 04/04/2013 - National Social Inclusion Conference hears Saeed and Malcolm

What is Mental Illness?

wr mental-200x0The term 'mental illness' is very broad. It covers a diverse range of health conditions relating to somebody's psychological state. It is useful to note that the definition of mental illness is fluid. It has changed frequently over time and is influenced by various social and cultural trends. Some behaviours that would have been diagnosed as mental illness a decade ago would not necessarily be diagnosed in the same way today. Depression and schizophrenia are some of the better known examples of mental illness. 

Mental Health and the Prison Population

The level of mental health problems and disorders is 3 to 4 times higher among inmates than that of the general Australian population. According to the 2002 National Survey of Mental Health and Wellbeing, 1 in 5 Australians are found to be at lifetime risk of being affected by a mental disorder.

In New South Wales, 54% of women in prison, and 39% of men in prison have at some point in their lives been diagnosed by a medical doctor as having a 'psychiatric problem' (Butler & Milner, 2003:96)

In women's prisons:

• 30% of female prisoners have attempted suicide, (Butler & Milner, 2003:101)
• 25% are on psychiatric medication (Butler & Milner, 2003:97) and
• 25% have been admitted to psychiatric unit or hospital (Butler & Milner, 2003:)94).

In men's prisons:

• 20% of male prisoners have attempted suicide (Butler & Milne, 2003:101)
• 13% are on psychiatric medication (Butler & Milner, 2003:97)
• 34% have been admitted to a psychiatric unit or hospital (Butler & Milner, 2003:94

Why are there so many people in prison with a mental illness?

There are a number of possible reasons why this trend has developed. The progressive closure of large psychiatric institutions, in NSW, over the years, while a welcomed initiative, was not followed by a corresponding rise in resources, funding and support services to assist people with a mental illness to maintain their lives within the community. This has resulted in an increasing risk of homelessness amongst people with mental health issues and this puts people both at risk of offending behaviour, and at risk of coming under more intense police surveillance. High levels of unemployment and poverty exacerbate these issues.

One of the most enduring myths about mental illness is that it causes people to be dangerous and violent. However, people with a mental illness are more commonly the victims of violent crime, rather than the perpetrators. Many people with a mental illness who are defendants or offenders in custody are often charged with summary offences or relatively minor crimes.

Of the total prison population, 60% of female and 44% of male non-violent offenders in NSW prisons have been identified with a mental disorder, including psychosis, anxiety and affective disorders (Corrections Health Service, 2002). The crimes they are in prison for include fraud, property, driving, and public order charges.

In many cases when such people appear before the courts, the magistrate or judge has very limited options. Sometimes prison is the safest option, and sometimes it is the only option. There is no alternative system to address the needs of people suffering from mental illness who have committed crime.

The public mental health system is so stretched in terms of its own resources that it can be reluctant to take on the complicated issues of a mentally ill person arrested for criminal behaviour. This can lead to situations whereby a judge recommends that the person with a mental illness be treated by a health service, only to find the same person appearing the following week, having being denied the relevant treatment.

Inadequate government funding of community-based health services and the absence of designated facilities within the justice system for people with mental illness are some of the main factors contributing to the high levels of imprisonment of people with a mental illness.

Legal Perspective vs. Medical Perspective

The Mental Health Act 2007 No7 2007 (NSW) aptly defined mental illness as a condition that seriously impairs, either temporarily or permanently, the mental functioning of a person. Characteristics include delusions, hallucinations, serious disorder of thought or form, severe disturbance of mood, and sustained or repeated irrational behaviour.

On the other hand, medical institutions primarily rely on the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorder (DSM-V). A person will be considered mentally ill if their behaviour is not considered to be an 'expectable' response to a particular event or situation and their behaviour causes them significant distress. This must be attributed to the manifestation of a behavioural, psychological or biological dysfunction.

Clearly, the medical interpretation of mental illness is much broader than the statutory definition. However, it is ultimately up to the courts to determine whether the defendant is suffering from a mental illness. The test of mental illness is extremely strict and the burden of proof lies on the defendant.

What is the problem with putting people with a mental illness in prison?

Prison is frequently a harsh and dehumanising system. This kind of environment can be a threatening and terrifying place for inmates suffering from a mental illness. It is not uncommon for people with mental illnesses to be the victims of violence within the prison system and the levels of suicide and self harm attempts are extremely high.

Many prisoners are reluctant to report their mental illness to the prison authorities for fear that this disclosure might leave them vulnerable to abuse and exploitation by other prisoners, or because they do not want to end up in a 'dry' cell.

'Dry' cells are designed to prevent people from committing suicide. They are under 24-hour surveillance by prison officers, are extremely sparse and are likened to being on 'segro' (segregation). Many prisoners see dry cells like punishment cells and do not view these as conducive to improving the state of their mental health. Also, where the person is experiencing an episode of mental illness, the dry cell is likely to exacerbate the illness and result in further trauma for the prisoner.

The trauma of prison life may result in the worsening of a mental illness. In many ways the prison environment is the opposite of the therapeutic environment, which would be ideal for working with people to try and alleviate mental health problems. Those who are incarcerated with a mental illness have to try and manage without any of their usual support systems and in an extremely difficult physical environment (even for people who have never had any psychological problems).

There are many people in prison with a mental illness who also have a problematic relationship with drugs and alcohol. Trying to manage both of these problems in the context of a dehumanising, and sometimes brutal, prison environment can be extremely stressful.

While there are forensic hospitals for people with a mental illness who have committed a crime, these are situated within the prison system. NSW is the only state in Australia, and one of only a few in the Western world, that hospitalises forensic patients within the precincts of a correctional facility and under the authority of Corrective Services staff.

How could prison be made safer for people with a mental illness?

While prison is not the answer, the prison system could introduce a more effective reception-screening program to detect if a person has a mental health issue. Having such a program could help with early detection rates, allowing inmates to receive adequate treatment when they first enter an institution. Each prison should have a psychiatric unit to treat the general prison population. This unit should provide 24-hour care and be staffed with a team of professionals who can provide medical and psychological interventions. For those inmates who have chronic psychotic disorders, medium term stays in such units could be a possibility until the prisoner is ready to join the main prison population.

What are the alternatives to prison for people with a mental illness?

Clearly prison is not an appropriate place for people with a mental illness. One alternative option is the use of a court diversion system, where people with a mental illness are diverted from the criminal justice system to secure community based hospital and community mental health facilities. This would allow the individual immediate access to appropriate treatment and support. It would also help to reduce the current overload on the court system. Furthermore it may also have the benefit of reducing the re-arrest or re-conviction rates as people would be accessing treatment. This diversion process could allow the court to closely monitor the person's progress. If the individual failed to meet the requirements of the program they could be required to appear before the court and only then, could a custodial sentence be imposed.

In NSW, Corrections Health runs a Mental Health Court Liaison scheme in some local courts where mental health professionals assess people who may have a mental illness. Recommendations are made to magistrates about the mental health status for people who have come from custody, or are at risk of going to custody. This is an extremely important scheme, but is constrained by the absence of viable alternatives to custody available for sentencing magistrates.

The prison system in NSW has been described by many as becoming like a surrogate mental hospital. Since the closure of most of the large psychiatric institutions, and the lack of a corresponding increase in resources, funding and support services within the community, there has been a steady drift of people with mental illness into NSW prisons.

To stop this trend, there is a need for a greater budgetary commitment on the part of the NSW state government to the needs of people with a mental illness who are living in the community, particularly those who are at risk of homelessness.

References
Freeman, K. (1998) 'Mental Health and the Criminal Justice System', Crime and Justice Bulletin, NSW Bureau of Crime Statistics and Research, October 1998, No. 38.
Fowler,G, (2001),"Victims of Law" The Manly Daily 16th Mar,P1
Greenberg,D (2002) 'Mental Health and the Criminal Justice System' ,paper presented at a Public Seminar, Institute of Criminology, University of Sydney, September.
Walker,F (2002) 'Mental Health and the Criminal Justice System',paper presented at a public seminar.Institute of Criminology,University of Sydney,September.
Select Committee Inquiry into the Increase in the NSW Prisoner Population (2001) Final Report, NSW Government, Sydney
Select Committee Inquiry into Mental Health Service in NSW, (2002) Final Report, NSW Government, Sydney
Radioeye www.abc.net.au/rn/arts/radioeye/crime

Mental Illness Policy Issues

  • There are serious failings in the way that public policy addresses mental illness in our society.
  • The most serious failings as well as other inherent issues within mental health have been identified that is broadly reflected in Mental Illness Policy Issues.
  • The single greatest cause of distress and difficulty; to the greatest proportion of those living with mental illness, is the way our society responds to them.

The most serious failings include:

• The endemic institutionalisation of those designated as mentally ill, whether that institutionalisation is carried out within the framework of a criminal justice or public health response.

• The lack of a public voice in Australia for those who have been designated as mentally ill and the de-legitimisation (and pathologisation) of their viewpoints by professional and political authorities.

• The abuse of psychiatric medication for the behavioural management of those designated as mentally ill, both in institutions and the community, and the lack of access by sufferers to well informed, non-coercive choice of therapeutic and support options. See Alternative Law Journal on UN Convention on Rights for People with Disabilities. UNCRPD attached.


Other significant failings:

• Neglect and lack of support for those living in the community with mental illness and making the transition from institutional to community living.

• False media portrayals of the mentally ill as being particularly prone to commit violent acts, which justify intrusive andcoercive measures to avert. Misleading media portrayals that promote the view that people can be appropriately categorised by their mental illness. Beliefs that mental illness can be easily diagnosed and successfully treated by mental health professionals. See Alternative Law Journal article on Stigma attached.

• The acceptance of the dubious diagnoses and untested opinions of mental health experts as 'scientific evidence' by elements of our criminal justice system.

• The increasing influence of large multinational pharmaceutical companies over mental health professionals, policymakers and the statutory bodies and NGOs involved in the resourcing, planning and delivery of mental health services.

• The ongoing stereotyping, vilification, discrimination and abuse suffered by those designated as mentally ill in our society.

The existence of mental illness and the real suffering it causes the many thousands of Australians afflicted with it and the millions of Australians affected by it continues to be poorly addressed. The single greatest cause of distress and difficulty to the greatest proportion of those living with mental illness is unfortunately the way our society responds to them. Fortunately however, it is also within our hands that we can help address these critical issues surrounding mental health.


Our society needs to:

• Recognise that those designated as mentally ill are particularly vulnerable to vilification, neglect, abuse and denial of rights during their interaction with public and private institutions

• Seek to address such discrimination wherever it exists, but with particular emphasis on its presence in the criminal justice system.

• Prioritise the voices of those who have been diagnosed as mentally ill and promotes their participation in mental health education, policy development, planning and service delivery.

• Recognise that those who have been subjected to coercive mental health treatment have perspectives and concerns that are rarely shared with mental health consumers, carers, professionals or industry bodies and rejects policy development processes that do not take into account the views of such people.

• Support the establishment in Australia of independent grass roots mental health advocacy and activism groups along the lines of 'Insane Australia' (Victoria); 'The Consumer Activity Network' (NSW), email: canmentalhealth.org.au ph: 8206 1841, or outside Sydney 1300 135 846; 'Support Coalition International' (US) mindfreedom.org ; 'The Icarus Project' (US) theicarusproject.net; 'Mad Nation' (Canada) tinyurl.com/6o7su; and 'Mad Pride' (UK) madpride.

• Demand an end to the use of psychiatric drugs for patient/prisoner management purposes.

• Promote programs, policies and campaigns that seek to end the institutionalisation and forced treatment of those designated as mentally ill. Oppose programs which are likely to lead to greater use of institutionalisation and forced treatment. Forced treatment is not therapy, it is abuse.

• Reject the methods used by drug companies to exert disproportionate influence on mental health policy, including financial backing for practitioners, political parties and mental health NGOs.

• Supports the right of the mentally ill to access a wide range of support and treatment services or to reject treatment and services. Respect the right of the mentally ill to choose their own therapies and treatments.

• Call for the rejection of psychiatric or psychological expert opinion in criminal proceedings unless supported with considerable experimental or actuarial data. Actuarial data should be treated with extreme caution and skepticism, especially in attempting to apply generalised findings to specific cases.

• Call for streamlining of the procedures governing the release of forensic prisoners and significant investment in services to facilitate the reintegration of forensic prisoners into the community. Responsibility for the release of forensic prisoners should be taken from the hands of the executive.

• Reject all systems which seek to socially classify people by their alleged mental illness (e.g. 'registers' of the mentally ill, transfer or sharing of their medical records without their consent, New York style 'Kendra's Laws').

• Reject the popular stereotyping of those designated as mentally ill as a threat from which the community must be protected. They are part of the community who have unmet medical or social needs and are particularly vulnerable to individual and institutional abuse.

Introduction

introductionMental health broadly describes the level of our psychological well-being and inherently provides a basis to an understanding of our own identity, whether it be as a citizen of society or as an individual within a circle of family and friends.

The status of our psychological well-being however is conditional to an infinite range of factors. From basic daily anxiety to the more serious problems of alcohol and drug addiction to suicide, mental health continues to be an issue of concern today more than ever.

The increasing problems and lack of proper awareness of mental health has generated a class of individuals that have had their voices and rights dismissed. This has evoked an active need for the proper and necessary treatment of individuals concerned with mental health problems.

Justice Action decided to focus on the mental health area after it had become apparent that a new strategy was required to defend community interests and prisoners' rights against the law and the added effects of tension, boredom, powerlessness and isolation occurring in imprisonment.

Many prisoners become forensic patients or remain in prison under medication: the rates of major illness in prisons have been found to be three times higher than that of the general population.

In mental health, the focus is on making patients well, without the elements of guilt and punishment, while retaining state control of citizens. Patients (consumers) had been asking for our assistance, and we saw the chance of a forward defence for mental health patients' rights. If we could not defend patients' human rights, what chance did we have with prisoners?

Upon examination we discovered that forensic (incarcerated) mental health consumers receive even less respect for their dignity and humanity. In practice it is definitely better to be bad than mad. Lawyers who have enticed clients with a psychiatric defence are cursed from the dungeons. In both prisons and mental health wards, almost everyone smokes, but it is the forensic consumers who have lost their tobacco.

Prisoners are regarded as normal people who have made mistakes, have to pay a penalty and then return to their former status. Forensic consumers however, are treated like children, unable to take responsibility for decision-making sometimes for the rest of their lives, depending on the psychiatric diagnosis. Total arbitrary control contrary to consumers' wishes is cloaked as euphemisms of expressions of care. The industry's culture creates professionals lacking empathy for patient; stumbling glassy-eyed humans are seen as effective work practice. In the new Long Bay Forensic Hospital, all patients are medicated. Patient resistance is construed as sickness.

The consumer focus in mental health has been hijacked. Stated rights have become valueless in the face of this culture. External service providers dependent on government money are part of the problem. Patients are dehumanized and exploited to yield budgets of over $205,000 per forensic patient per year. Privacy and security mean hiding from examination. Visitors are discouraged and refused. Social support for patients is seen as causing disturbance rather than a community right, a necessary measure and an alternative to medication. A "clinical decision that the patient's mental health might be affected" is enough for a refusal. There are no stated rules.

A long line of reports, including the 1992 'Burdekin' Report, the 2005 Mental Health Council of Australia (MHCA) (in association with the Human Rights and Equal Opportunity Commission) 'Not for Service' Report, as well as the Australian Medical Association (Treatment, Not Prison) (AMA) all express the failure in the treatment of mental health and the need for change. However, nothing has changed on the ground despite billions of taxpayers' dollars being spent.

The problem lies in the powerlessness of those for whom the services are provided: identified by the World Health Organisation (WHO) as one of the key barriers to consumer participation. Authorities have used the stigma of mental illness FALSE STIGMA OF VIOLENCE  and abused the trust of the public purse. They have taken control, redefined the services provided Prisons and mental Illness Link for the sick and bought the silence of those who should protest.

Patients' opinions and contributions to their own wellbeing have been de-legitimised by those whom society has trusted to help them, despite involvement being essential to good health. Further, enforced medication is often used contrary to international standards to fill the gap.

The Right Of Access To Education For Mental Health Patients

THE RIGHT OF ACCESS TO EDUCATION FOR MENTAL HEALTH PATIENTS

window light by imweasel2005

Latest News:

22nd January 2012: The major news outlets, namely the Heraldthe Australian and the Telegraph, have reported on Justice Action's recent victory in winning the right for Saeed Dezfouli to study law.

20th January 2012: Victory! Saeed Sayaf Dezfouli appeared on Monday in the Administrative Decisions Tribunal where he won the right to study law and learn a musical instrument. A vocation, education and training officer will meet with him to discuss his education aspirations. 

See Justice Action's Media Release on this wonderful news.

 

Education as a Right – not just a privilege

Education is an important factor in achieving the full development of the whole person and should include access to formal and informal education, literacy programs, basic education, vocational training, physical education and sport, social education, higher education and library facilities (UN Report of the Special Rapporteur on the right to education of persons in detention 2009 pp. 7 http://www2.ohchr.org/english/bodies/hrcouncil/docs/11session/A.HRC.11.8_en.pdf ). Education plays a significant role in the employment, rehabilitation and reintegration of prisoners, and if given the right opportunity, of mental health patients as well.

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