National Inquiry Concerning The Human Rights of People with Mental Illness contents page
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NATIONAL INQUIRY CONCERNING THE HUMAN RIGHTS OF PEOPLE WITH MENTAL ILLNESS
CONTENTS
VOLUME 1
PART I: BACKGROUND, DEFINITIONS, AND EXISTING SERVICES
Chapter 1 THE INQUIRY PROCESS 3
Background to this Inquiry 3
Procedure of the Inquiry 7
Scope of the Inquiry 11
Outline of the Report 12
Incidence of Mental Illness 13
Conclusion 15
Chapter 2 RELEVANT HUMAN RIGHTS PROVISIONS AND INTERNATIONAL LAW 20
Introduction 20
Human Rights of People with Mental Illness 21
Instruments Incorporated in Federal Legislation 21
Other International Conventions 27
Mental Illness Principles 31
Developing Further International Standards 34
Chapter 3 DEFINITIONS AND CONCEPTIONS OF MENTAL ILLNESS 38
Introduction 38
Changing Views of Mental Illness 38
Legal Definitions of Mental Illness 40
Medical Conceptions of Mental Illness 44
Cross Cultural Conceptions 46
Chapter 4 THE LEGAL FRAMEWORK 50
Commonwealth Legislation 50
New South Wales 61
Victoria 73
Queensland . 84
South Australia 94
Western Australia 101
Tasmania 109
Northern Territory 116
Australian Capital Territory 123
Chapter 5 MENTAL HEALTH SERVICES 136
The Government Sector 136
The Private Sector 146
The Non-Government Sector 149
Chapter 6 THE ROLE AND TRAINING OF HEALTH PROFESSIONALS AND OTHERS 171
The Views of Health Professionals 171
Professional Training and Education 184
Chapter 7 DEVELOPMENTS SINCE THE INQUIRY BEGAN 210
Federal 210
New South Wales 213
Victoria 216
Queensland 218
South Australia 21 9
Western Australia 220
Tasmania 221
Northern Territory 222
Australian Capital Territory 223
Part II: LIVING WITH MENTAL ILLNESS
Chapter 8 INPATIENT CARE AND TREATMENT 227
Pre-Admission and Admission 227
Clinical Treatment and General Care 236
Medication 238
Electro Convulsive Therapy (ECT) 249
Alternative Therapies 250
Relationship Between Psychiatrists and Inpatients 255
Relationship Between Nurses and Inpatients 258
Access To Information 263
Privacy 267
Safety and Security . 268
Seclusion 269
Assaults and Abuse 271
Activities and Occupational Therapy 274
Environment and Facilities 276
Education in Hospital 280
Discharge Planning 281
Conclusion 287
Chapter 9 COMMUNITY CARE AND TREATMENT 298
Crisis Care 299
Continuity of Care 300
Treatment Follow-Up 308
Alternative Treatments 314
Psychosocial Rehabilitation 315
Health Promotion Activities 323
Financial Issues 325
Conclusion 328
Chapter 10 ACCOMMODATION 337
Introduction 337
Barriers to Appropriate Accommodation 338
Housing Options 344
Supported Accommodation 352
Special Needs Groups 363
Model Services: Supported Accommodation 370
Model Services: Accommodation Support 376
Chapter 11 BOARDING HOUSES 386
Background 386
Prevalence of Mental Illness in Boarding Houses 387
Living Conditions 388
Placement in Boarding Houses 390
Treatment for Mental Illness 391
Boarding House Management 393
Regulation of Boarding Houses 396
Improving Support for Boarding House Residents 398
Conclusion 399
Chapter 1 2 EMPLOYMENT 404
Background 404
Barriers to Employment 406
Vocational Options 41 3
Non-Employment Options 422
Research 423
Chapter 13 EDUCATION AND TRAINING 430
Barriers to Education and Training 430
Program Design 435
Chapter 14 DISCRIMINATION: THE PERSONAL EXPERIENCE OF MENTAL ILLNESS 439
What it Feels Like to be Mentally Ill 441
Inequality 445
Marginalisation 446
Discrimination 448
Conclusion 452
Chapter 15 CARERS: THE EXPERIENCE OF FAMILY MEMBERS 455
Introduction 455
Lack of Information 457
Difficulty in Obtaining Treatment for a Relative 458
Legal Procedures 459
Consultation between Family and Professionals 460
Attitudes of Professionals 464
Emotional Impact of Mental Illness upon the Family 468
Family Finances 474
Impact on Women 476
Carers' Need for Practical Support 477
Family Living vs Independent Living 483
Conclusion 484
Chapter 16 CHILDREN OF PARENTS WITH MENTAL ILLNESS 493
Post-Natal Depression and its Effects on Infants 493
Welfare, Care and Custody Issues 494 Effects on Young Children 498
Effects on School-Age and Teenage Children 501
Adults Whose Parents Were Affected by Mental Illness 504
VOLUME 2
PART III: PEOPLE WITH PARTICULAR VULNERABILITIES
Chapter 17 ELDERLY PEOPLE 509
Introduction 509
Dementia 509
Depression 511
Treatment of the Elderly Mentally Ill 511
Residential Treatment 514
Solutions: Special Dementia Care Facilities 521
Community Care 524
Policy Issues Emerging from the Evidence 531
Chapter 18 HOMELESS PEOPLE 548
Definitions 548
Who and How Many Are They2 548
Prevalence of Mental Illness 551
Treatment 553
Why Are They Homeless2 555
Particularly Vulnerable Groups 557
Conditions in Shelters and Refuges 558
Homeless Service Agencies 561
Access to Services 562
Agency Staff 568
Relations Between the Health System and Agencies 569
Poverty and Trustees 574
What the Services Should be Like 576
Chapter 19 WOMEN 585
Diagnosis and Treatment 585
Post-Natal Depression 589
Violence Against Women 592
Shelter 596
The Need For More Research 598
Chapter 20 CHILDREN AND ADOLESCENTS 603
Incidence and Prevalence . 603
Definitions and Terminology 605
Assessment and Diagnosis 607
Contributing Factors 609
Child and Adolescent Psychiatric Services 61 3
Difficulty in Obtaining Treatment 616
Deficits in Service Provision 618
Inappropriate Placement 626
Prevention and Intervention 629
The Juvenile Justice System 634
Youth Suicide 637
Appropriate Responses 643
Conclusion 647
Chapter 21 PEOPLE WITH DUAL AND MULTIPLE DISABILITIES 659
Mental Illness and Intellectual Disability 659
Mental Illness and Substance Abuse 664
Mental Illness and Deafness 668
Mental Illness and HIV / AIDS 671
Head Injury 672
Conclusion 673
Chapter 22 PEOPLE IN RURAL AND ISOLATED AREAS 678
Distribution of Services 678
Strains on Health Professionals 685
Strains on Consumers and Families 686
Pressures on Young People 687
Possible Solutions 687
Chapter 23 ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE 692
Introduction 692
The Historical Experience 692
Cross Cultural Perspectives on Mental Illness 694
Prevalence of Mental Illness 695
Social Context of Aboriginal Mental Illness 695
Diagnosing Mental Illness 698
Aboriginal People with Special Needs 703
Servicing Rural and Remote Areas 709
The Need for Culturally Appropriate Services 711
The Importance of Self-Determination 716
Chapter 24 PEOPLE FROM NON-ENGLISH SPEAKING BACKGROUNDS 723
The Migration Experience . 723
Groups Particularly at Risk 724
Accessing Services 730
Lack of Culturally Appropriate Services 733
What is Required? 741
Chapter 25 FORENSIC PATIENTS AND PRISONERS 752
Definitions 752
Prevalence of Mental Illness Among Prisoners 753
Does Mental Illness Lead to Jail7 756
Does Jail Lead to Mental Illness? 760
Special Needs Groups in Prison 776
Shortage of Staff and Resources 782
Release from Jail 787
Prison vs Hospital 794
Governor's Pleasure Prisoners 797
Conclusion 804
PART IV: OTHER AREAS OF CONCERN
Chapter 26 MENTAL HEALTH RESEARCH 821
Introduction 821
Support for Medical Research in Australia 823
Cost of Mental Illness and Funding for Research 824
Commonwealth Funding Sources 827
The NHMRC and Mental Health Research 829
Affirmative Action in Medical Research 830
Some Specific Issues in Mental Health Research 833
Chapter 27 PREVENTION AND EARLY INTERVENTION 843
Community Issues and Prevention in the Mental Health Field 844
Opportunities for Prevention in Specific Contexts 850
Prevention and Serious Mental Illness 856
Schizophrenia 857
Depression and Bipolar Disorder 859
Groups Which Are Particularly Vulnerable 860
Conclusion 865
Chapter 28 ACCOUNTABILITY 870
Introduction 870
Quality Assurance 871
Standards 873
Peer Review 875
Monitoring 875
Accreditation 877
Professional Registration 878
Official Visitors 878
Patient Rights and Patient Advocacy 879
Complaints Mechanisms 880
Conclusion 881
Chapter 29 LEGISLATIVE PROPOSALS 883
Introduction 883
South Australia 883
Western Australia 887
Conclusion 891
PART V: FINDINGS AND RECOMMENDATIONS
Chapter 30 LEGISLATION: FINDINGS AND RECOMMENDATIONS 895
State Legislation 896
Statutory Objects and Definitions 896
Voluntary Admission 896
Involuntary Admission 897
Review 898
Procedural Safeguards 899
Treatment 900
Confidentiality 900
Forensic Patients 901
Legislative Controls 901
Guardianship and Administration 902
Anti-Discrimination 903
Inter-State Co-operation 903
Federal Legislation 904
Chapter 31 GENERAL FINDINGS AND RECOMMENDATIONS 908
General Conclusions 908
Mental Health Services (Chapter 5) 909
Health Professionals (Chapter 6) 910
Inpatient Care and Treatment (Chapter 8) 913
Community Care and Treatment (Chapter 9) 916
Accommodation, Boarding Houses and Homelessness
(Chapters 10, 11 and 1 8) 919
Employment (Chapter 12) 921
Education and Training (Chapter 1 3) 923
Discrimination: The Personal Experience of Mental Illness (Chapter 14) . 925
Carers (Chapter 1 5) 925
Children of Parents with Mental Illness (Chapter 1 6) 927
Elderly People (Chapter 1 7) 928
Women (Chapter 19) 930
Children and Adolescents (Chapter 20) 932
People with Dual or Multiple Disabilities (Chapter 21) 935
People in Rural and Isolated Areas (Chapter 22) 936
Aboriginal and Torres Strait Islander People (Chapter 23) 937
People from Non-English Speaking Backgrounds (Chapter 24) 939
Forensic Patients and Prisoners (Chapter 25) 940
Mental Health Research (Chapter 26) 943
Prevention and Early Intervention (Chapter 27) 944
Accountability (Chapter 28) 946
Appendix 1 WITNESSES APPEARING BEFORE THE INQUIRY 948
Appendix 2 WRITTEN SUBMISSIONS 962
Appendix 3 FACILITIES VISITED BY THE INQUIRY 984
Appendix 4 DECLARATION ON THE RIGHTS OF DISABLED PERSONS 986
Appendix 5 PRINCIPLES FOR THE PROTECTION OF PERSONS WITH MENTAL ILLNESS AND FOR THE IMPROVEMENT OF MENTAL HEALTH CARE 989
Appendix 6 GLOSSARY OF ABBREVIATIONS 1006