MENTAL HEALTH BILL

Second Reading

Adjourned debate on second reading.

(Continued from 3 March 2009. Page 1462.)

The Hon. J.M.A. LENSINK (15:43): I thank the council for its indulgence in allowing me to conclude my remarks as, inevitably, with a bill that has this much depth to it and has had so much input from various stakeholders, I would forget details. I regret to say that I did forget certain details about which I have questions. For the benefit of the drafters of the answers, I will place those on the record this afternoon and add a few other comments.

I would also like to note the pivotal role that the Guardianship Board plays in administering the various provisions of the Mental Health Act which, I think in this bill before us, will be of even more importance to people who are detained or who are subject to orders in the future.

I would like to place on the record the concern I have that the board be adequately resourced to fulfil that role. I did ask in my previous contribution about the status of the revision to that act and whether the government has any plans to provide more resources or alter the administration of the Guardianship Board in any way.

I would also like to know the status of the review of the memorandum of understanding between various agencies, which, in the House of Assembly version, was on page 9 of the report. At the bottom of page 9, it states that it is planned that the memorandum of understanding between the Department of Health, Ambulance Services, the police and the Royal Flying Doctor Service will be updated prior to the new act coming into force. I would like to know the status of that MOU.

On page 13 of the same edition of that report, which was tabled in the House of Assembly on 7 November last year, there is reference to legal representation. In the second paragraph on that page, it states that patients can appeal at any time against any order and legal representation for appeals will continue to be provided. I have made the notation 'More info please'. The second sentence begins with the words:

A range of people may make an application to the Board for a variation or revocation of a long term Community Treatment Order or a Detention and Treatment Order, both of which are made by the Board.

I have made the notation 'Who?' in relation to 'A range of people'. On my reading of the matter, similar requirements exist that a psychiatrist must review a level 1 or, in the current act, an equivalent, within 24 hours. Does the minister have any data about the percentage of persons who are reviewed within the guidelines versus what percentage fail to meet the aspirational target?

I note the preference is within 24 hours in relation to the language 'as soon as practicable', but that is not always possible. As I mentioned in my previous contribution, the lack of staffing may contribute to these things, and I think we need to be very mindful that a lack of planning for additional needs does not lead to an inferior service. My alternative question is: what is the average number of hours before an order is reviewed? The only reason I ask that question is that the fallback position of 'as soon as practicable' may not alert anyone to when the system is under pressure; for instance, an average of two days would, in my view, be unacceptable.

The final issue I refer to is the matter of privacy. I do have reservations about the way in which the bill has been drafted in relation to information that may be provided to other people and so forth. My concern is with people I will call 'busybodies', for want of a better word, going to a hospital or asking a medical practitioner for information, without having a valid reason for so doing, in relation to a person who is subject to an order.

This is indeed a very vexed question because, on the other side of the ledger, I have spoken to many parents, particularly in relation to adult children, for whom they could not strictly be categorised as 'carers' in the strictest sense, as framed by the Carers Recognition Act. They say that they can call the hospital when their son or daughter is detained, but they are never told anything. They are certainly not telephoned in a proactive way, so as to include them as part of the treatment process. This is very frustrating, and I think it causes a parent a lot of distress. As they quite rightly say, they are the ones who are required to pick up the pieces when their son or daughter is discharged from hospital, and I think trying to find where the balance lies is quite tricky.

The Bidmeade report is the instructive means of determining this. Mr Bidmeade, in chapter 7 of his report entitled 'The confidentiality barrier to sharing of information', made the following recommendations:

7.1 Barriers to proper disclosure of information should be removed as a matter of urgency by legislative change.

7.2 There should also be professional development of mental health staff on mental health law, and duties of care and confidentiality.

In relation to the second recommendation, my questions for the government are: does it have any plans, and has it prepared a package of information to be distributed when this bill is passed to ensure that staff are aware of where the line is drawn in relation to that sharing of information? I think it is fair to say that stakeholders have varying views as to where the line should be drawn and, if the patient says no, whether or not that should be overridden. This relates to clause 96 in the new bill, which is quite different from the old act. I think it is better than the old act, which I think was a barrier to the sharing of information.

It is particularly vexed because, in the case of psychosis (and I have spoken to families where this is the case), the son or daughter's version of reality is quite different from that of their parents and it may, indeed, have been the parents who triggered the detention that was obviously required. However, the circumstances under which people have been detained, certainly in the past, might have been very traumatic for everyone involved—the police are called out, an ambulance may be called and the person is handcuffed or chemically restrained and taken to hospital.

In many cases, that has damaged the level of trust between parents and their children. The children can become quite suspicious of their parents and explicitly state to the hospital staff that they do not wish their parents to be informed of any aspect of their treatment, which may include when they are discharged from hospital, in which case, as I said, the parents may be required to pick up the pieces.

Subclause (4), which some people, in the legal profession in particular, have urged us to delete, basically means that, for any person who is subject to a community treatment order or a detention and treatment order, any conditions attached to whether or not the person consents to provide that information do not apply. So, it is quite a different situation with respect to voluntary patients and involuntary patients. The people who may have information disclosed to them are covered under subclause (2)(c), which refers to 'disclosing information to a relative, carer of the friend or person'. So, that is fairly broad.

I accept that this clause is identical to the one contained in the Health Care Act. For that reason, it has been drafted to ensure that it is consistent. However, I have some reservations that this may have been drafted a little too broadly, notwithstanding the fact that my sympathies are with the families, and particularly with the parents of people who have a mental illness, those parents having been frustrated by their dealings with the system over many years. I look forward to the committee stage of the debate.

The Hon. J.S.L. DAWKINS (15:53): I rise to indicate my support for the bill. I also want to indicate my support for the very considered and detailed contribution made by the Hon. Michelle Lensink, as the lead speaker for the opposition. I think that most members in this chamber would recognise that the Hon. Ms Lensink's long commitment to mental health services in this state has been exemplary. I remember that last year, amid all the concerns about the government's development programs for the Glenside Hospital, it was the Hon. Michelle Lensink who initiated the select committee on that development, which I chaired. I will not go into detail about the bill because that has been covered very well by my colleague. I will quote from the honourable member where she said:

There is also a section here about treatment centres, which includes limited treatment centres that will be available in the country, which I think is to be welcomed. In relation to those country treatment centres, I think (from memory) in the order of 30 beds were to be provided under that provision, and I would like the government to advise the status of those beds and where they will be located, whether they will be solely in the fully upgraded, country regional centres or whether they will be in other centres as well.

I would like to pick up on that point. Certainly, the opposition really does need to know whether the intention to provide further beds in regional areas goes beyond the four major hospitals, which I think the honourable member was referring to, because there are considerable distances between those four major hospitals of Port Lincoln, Whyalla, Berri and Mount Gambier.

Certainly, the select committee that looked at the Glenside issues responded to the evidence given to it about the need for additional rural and remote beds for mental health patients in that under the development Glenside is scheduled to incorporate 23 beds for rural and remote patients. The select committee recommended that that be doubled to 46. I am still of the view, however, that there should be more capacity in hospitals in regional areas—the Hon. Caroline Schaefer would well know that in the Upper Eyre Peninsula there are hospitals that are not close to either Port Lincoln or Whyalla and that there are many other examples around South Australia.

The reference to the inquiry into the Glenside Hospital redevelopment brings me to an interview I became aware of that was broadcast on FIVEaa on 26 February during the Matthew Pantelis program after 7 o'clock when the news events of the day are summarised. The Hon. Jane Lomax-Smith (the now Minister for Mental Health) was featuring in an interview that was part of that program. I will pick up on a couple of excerpts from her comments. First, she said:

You know, I'm very keen to speak to everyone with ideas and every time we take suggestions we try to incorporate the views. And I know the nurses union have been working very closely with the consultation involved in developing models of care, involved in the process of the reform agenda.

Further in that recorded interview, the minister said:

Having said that, of course, people have legitimate points of view and I speak very regularly not just to the local residents trying to take on board their issues and what they have concerns about but also the local government. I spoke to them only yesterday. I spoke to the union last week. We will continue to consult with them because it is important to have their points of view. I mean, I'm disappointed that people don't want to engage in consultation. I'm really disappointed that people would complain and not be part of the consultation process and I'm really very committed to making sure that everyone has their say and we can take on board a lot of those comments. In terms of the plans...the plans haven't been finalised yet and there's still a consultation process going on whereby the shape of a building, the form of the building, the way the buildings are designed is being worked upon now.

The members of the select committee, I have to say, are still waiting for the minister to respond to the interim report that we tabled in this parliament on 11 September last year. Surely that reflects some of the views and consultation the minister talks about. The select committee did a great deal of consultation and listening to evidence from a wide range of people who have a strong interest in the future of Glenside.

I would have to say that I am disappointed that we have not yet received a response to the interim report about the development of a training and research institute for mental health on the Glenside site. I am also disappointed that we have not yet got an indication of when we might receive a response to the final report, which was tabled earlier in the year. Some might say that we have not given the department enough time, but the issues have been there right throughout this proposed redevelopment for Glenside.

Certainly, if the minister is sincere in what she says, I would think she would look at not only the report handed down and the recommendations but also a lot of the sincerely held—in many cases, heartfelt—views of the people who gave evidence to that select committee. So, those of us who have been involved in that committee and many others who have an interest in the Glenside site are very keen to know when both those reports will be responded to.

The interview that I just quoted from was in response to the protest or action that was taken by mental health nurses on the Glenside Hospital land, and I think there is growing anxiety amongst those who work in the mental health fraternity about the changes that are being made and the central part in all of that which the Glenside redevelopment plays. Before concluding, I say once again that I do support a bill such as this which takes up the recommendations of a report that wants us to move on in the delivery of mental health services in this state, so I do support its passage.

I also want to make some comments in relation to the area of suicide prevention, and members in this place would know that it is a matter that I have been concerned about and have been following with keen interest for some time. It does disturb me that there is an increasing number of suicides reported and, unfortunately, a lot of others that are not recorded or registered as suicides are occurring not only in country areas but also in metropolitan areas.

I have for some time been advocating that the Community Response to Eliminate Suicide (CORES) program be implemented in this state, and I have been asking the government not to shell out huge amounts of money but to sponsor community groups who are very keen in many areas; and there are some in metropolitan Adelaide who would happily take up the role of coordinating a CORES program in the community if the government assisted them in the funding of such a program. To date, that has not happened. The previous minister refused to consider the CORES program whatsoever, for what reason I have no idea.

I give great credit to the current minister for listening to me in relation to the CORES program. Her staff have listened to the director of the CORES program in Tasmania whilst in Adelaide, and I have been promised that the program will be part of the minister's current review into mental health, particularly suicide prevention processes.

However, I must say that it is a little bit like the interim report from the select committee: it has been many months since those promises were made, and the silence is deafening. While there is silence, unfortunately that silence does not exist in the community anymore because people are increasingly concerned by the level of suicide.

I have seen evidence of the CORES program in Tasmania, and I have read and spoken to people about what is happening in Victoria and Queensland. Further advances are now being made into other parts of Tasmania, and certainly the Western Australian government is considering implementing a CORES program in that state. The people who have been involved in those programs are so emphatic about the fact that the involvement of people off the street from all walks of life in helping people to deal with the times of crisis is such an important factor in the community. For that reason, I continue to implore the government to think about at least allowing a pilot program to be established.

A number of local government bodies and regional development boards are keen to conduct a CORES program in their area. However, like many organisations in those communities, they do not have a lot of money lying around and they need some assistance. They do not need a large sum of money; in fact, the opposition's research allowed us to formulate a policy which, on coming to government, would establish 10 CORES programs across South Australia at a total cost of $35,000 each, and that amount includes training for a number of community people who would then go on to train up to 100 people in each community over a period of one year. We think that that is a very good bang for our buck.

I say to the minister: in reviewing the way in which mental health services are implemented in this state, give further consideration to those who sincerely seek help to deal with people who are suicidal or who are dealing with their own suicidal thoughts and, in some cases, actions. Once again, I support the bill, and I thank the council for its time in listening to my sincere views about the enormous problems with mental health I think we have in this state, particularly in relation to those prone to suicidal thoughts.

Debate adjourned on motion of Hon. Carmel Zollo.