Mental Health (Review) Amendment Bill

Second Reading

Adjourned debate on second reading.

(Continued from 22 March 2015.)

Ms COOK (Fisher) (15:34): I am pleased to offer my contribution in this place to the Mental Health (Review) Amendment Bill 2015. As many people here know, I started nursing way back in 1986 at The Queen Elizabeth Hospital after completing my year 12 the year before.

People with mental health conditions are some of the most vulnerable members of our community and certainly some of the most vulnerable people that I have had the pleasure to look after. Providing comprehensive, inclusive health care of a high standard poses a huge challenge as each patient is unique and responds differently in circumstances that they find themselves in. Providing mental health services is a skill and also an art delivered by caring and committed practitioners across the healthcare system.

Section 111 of the Mental Health Act 2009 required a review of its operation by 30 June 2014. This was carried out with the Office of the Chief Psychiatrist placing a focus on the enhancement of service delivery to people with mental illnesses, their carers and families. While a full redraft was not required, there have been many amendments made, with 37 of them enhancing rights and reinforcing clinical best practice, a number of which we will see the Office of the Chief Psychiatrist work closely with the sector and consumers to ensure understanding of the intent and impact of the changes. I will mention just a few.

Firstly, Level 1—Community Treatment Order provisions have been amended in order to ensure clinicians can enhance service delivery while optimising patient rights (very important). Secondly, changes to provisions regarding electro-convulsive therapy (ECT) (a treatment sometimes used in order to provide relief from some psychiatric illnesses) and other prescribed psychiatric treatment will improve patient rights and enhance service delivery. These changes will:

clarify consent (such as the addition of consent capacity for a substitute decision maker);

clarify that the ECT consent does not include the use of reasonable force and that consent can be withdrawn at any time;

change notification requirements (all ECT consent must be notified to the Chief Psychiatrist);

improve review and decision-making capacity (such as the introduction of the new Prescribed Psychiatric Treatment Panel); and

change process requirements (such as applications for neurosurgery for mental illness to go before the Prescribed Psychiatric Treatment Panel).

Thirdly, the addition of Patient Assistance Requests will change the way community mental health services, the SA Ambulance Service (SAAS) and South Australia Police (SAPOL) are able to collaborate to keep a person with mental illness safe and well.

Currently, if a person on a Community Treatment Order refuses their medication when a community mental health team visits them in their home, the team must use a Patient Transport Request to ask SAAS or SAPOL to transport the person to a hospital where they will be assessed and their medication involuntarily provided before the person is transported by SAAS or SAPOL back to their home again.

This is very disruptive. It is traumatic for the person and for their family, it is traumatic for SAPOL and for SA Ambulance, and it is traumatic for hospital emergency department workers also. It would be preferable to avoid unnecessary use of mental health services.

The amendments will allow a community mental health team to ask for the assistance of SAAS or SAPOL to deliver a person's medication to them involuntarily in their own home, a much less restrictive, less traumatic option for the person and their family and a more efficient form of use of public resource and service perspective. A Patient Assistance Request will only be made when it is safe and appropriate to do so.

Fourthly, our Community Visitor Scheme, which provides an incredible point of contact and advocacy for users of our mental health services, will see an increase in the facilities and services within the scope of the scheme to now include community mental health centres, community rehabilitation centres and intermediate care centres. This provides increased advocacy and voice to our vulnerable community members.

I am very pleased to support this important work which provides an opportunity for our government the means to improve the rights of people with mental illnesses, enhance the capacity of mental health services to provide treatment and care, enhance the capacity of government agencies to collaborate, provide clarity for matters that are currently ambiguous and to remove provisions that are stigmatising and potentially discriminatory.

I also want to thank all the health and community sector workers, many of whom I consider friends, for all the invaluable work they do in advocating for this group of patients within our community. I commend the amendments to the house.

Ms DIGANCE (Elder) (15:40): I would like to speak in support of the Mental Health (Review) Amendment Bill 2015. In particular, I will speak on cross-border arrangements and, of course, rights associated with this particular issue.

Part 10 of the Mental Health Act 2009 provides for the transfer of care of patients under community treatment orders and inpatient treatment orders between South Australia and other Australian states and territories. Cross-border provisions are essential to protecting the health, safety and rights of around 20 to 30 individuals per year who are moving between states and territories. It is important to keep cross-border provisions as succinct and usable as possible to enhance the rights and service options available for this group in the context of a part of the act that is used less often and is less familiar to consumers, carers, clinicians and advocates alike, but nevertheless can bring distress to those who are caught in this particular issue.

The bill proposes amendments to the act which will provide more cross-border treatment options for people in South Australia and who are subject to an interstate community treatment order or inpatient treatment order so that an individual can be provided treatment in South Australia under the interstate order, subject to the principles and protections in our act, while the person, their family and the South Australian and interstate treatment teams decide in which state the person wants to reside.

It also provides more cross-border treatment options for people in other states who are subject to a South Australian community treatment order or inpatient treatment order so that an individual can be provided treatment interstate under the South Australian order while the person, their family and the South Australian and interstate treatment teams decide in which state the person wants to reside.

It will also enhance consent options so that a person and their family can consent to an interstate transfer and waive the existing mandatory minimum 14-day waiting period. It will improve rights for people and their families so that they will be given copies of the appropriate orders and statements of rights when receiving involuntary treatment and care in South Australia.

It will reduce administrative impediments by streamlining the recognition of corresponding law, requiring Chief Psychiatrist approval for cross-border arrangements and improving how ministerial agreements may guide interstate collaboration. It will clarify the powers for authorised officers and police officers by specifying that South Australian and interstate authorised officers and police officers will draw their powers from the act, from corresponding law and from any ministerial agreement.

In regard to rights, we all agree rights are essential, and they certainly are a central part of any act that suspends the liberty of individuals. The review found that the rights contained in the act required enhancement only to match developments in legislative and clinical practice in more recent times. The bill proposes amendments to the act which will:

Introduce the guiding principle that mental health services should meet the highest standards of quality and safety.

Introduce individual rights so that people subject to section 56 powers (usually called care and control) and forensic mental health patients subject to a supervision order of section 269 of the Criminal Law Consolidation Act 1935 are included in the act's definition of a patient. This means they will receive the general rights of a patient under the act, including receiving copies of orders and statements of rights, access to the Community Visitor Scheme, access to interpreters, reasonable freedom of communication, and falling within the oversight of the Chief Psychiatrist and the minister.

Clarify existing rights, especially for children, since the introduction of the Advance Care Directives Act 2013 and the amendment of the Consent to Medical Treatment and Palliative Care Act 1995.

Formalise contemporary treatment order practice by introducing a decision-making capacity criterion, based on the Advance Care Directive Act 2013 definitions, for community treatment orders and inpatient treatment orders.

Formalise contemporary clinical practice by requiring services to take into account the specific needs of individuals, which may include developmental stage and age, gender and sexuality, cultural and linguistic background, Aboriginal and Torres Strait Islander beliefs and culture, disability and the experience of torture or trauma.

In practical terms, this set of clauses will overcome a situation where a person may be under mental health legislation in another state and they visit South Australia. If a person becomes unwell and needs to be an inpatient needing care and then progresses to being well (often times this can take a few days), they would currently need to apply to return home, and this may be just across the border, say, in Victoria. Even then they would have to wait 14 days before they can return home even though clinically they are well enough and all involved in their care agree that it is best for them.

These clauses will take away that problem and assist their return home in a timely fashion. This type of situation happens about once or twice a month, when someone from another state is affected by this situation. It is in no-one's interest for someone to have to remain unnecessarily in Glenside, as occurred recently, for an extra two weeks after the person is well enough and waiting to return home but, because of our current legislation, unable to leave.

As you can imagine, this type of situation as it stands needs to have these amendments put in place as it can cause a lot of aggravation and uncertainty and extra distress to people. In closing, I support the progress that this mental health review and amendment suggest.

The Hon. L.A. VLAHOS (Taylor—Minister for Disabilities, Minister for Mental Health and Substance Abuse) (15:46): I thank honourable members for their contributions.

Bill read a second time.

Committee Stage

In committee.

Clauses 1 to 4 passed.

Clause 5.

The Hon. L.A. VLAHOS: I move:

Amendment No 1 [MenHSubAb–1]—

Page 5, after line 5—Insert:

(1a) Section 3, definition of approved treatment centre—delete 'Minister' and substitute:

Chief Psychiatrist

Amendment carried; clause as amended passed.

Clauses 6 to 15 passed.

Clause 16.

The Hon. L.A. VLAHOS: I move:

Amendment No 2 [MenHSubAb–1]—

Page 11, line 16 [clause 16(2), inserted paragraph (c)]—Before 'illness' insert:

Mental

Amendment carried; clause as amended passed.

Clause 17.

The Hon. L.A. VLAHOS: I move:

Amendment No 3 [MenHSubAb–1]—

Page 11, line 26 [clause 17(3), inserted paragraph (ba)]—Before 'illness' insert:

Mental

Amendment carried; clause as amended passed.

Clauses 18 to 20 passed.

Clause 21.

The Hon. L.A. VLAHOS: I move:

Amendment No 4 [MenHSubAb–1]—

Page 12, line 22 [clause 21(2), inserted paragraph (ba)]—Before 'illness' insert:

Mental

Amendment carried; clause as amended passed.

Clause 22 to 24 passed.

Clause 25.

The Hon. L.A. VLAHOS: I move:

Amendment No 5 [MenHSubAb–1]—

Page 13, line 24 [clause 25(2), inserted paragraph (ba)]—Before 'illness' insert:

Mental

Amendment carried; clause as amended passed.

Clauses 26 to 69 passed.

New clause 69A.

The Hon. L.A. VLAHOS: I move:

Amendment No 6 [MenHSubAb–1]—

Page 35, after line 9—After clause 69 Insert:

69A—Amendment of section 92—Annual report of Chief Psychiatrist

(1) Section 92(1)—before paragraph (a) insert:

(aa) in respect of the administrative functions conferred on the Chief Psychiatrist under this Act—information about how the Chief Psychiatrist has performed those functions; and

New clause inserted.

Remaining clauses (70 to 81), schedule and title passed.

Bill reported with amendment.

Third Reading

The Hon. L.A. VLAHOS (Taylor—Minister for Disabilities, Minister for Mental Health and Substance Abuse) (15:50): I move:

That this bill be now read a third time.

Dr McFETRIDGE (Morphett) (15:51): I would just like to put on the record my congratulations to the new minister on her first bill.

Bill read a third time and passed.