National Inquiry Concerning The Human Rights of People with Mental Illness contents page

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