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House of Assembly - Fifty-Second Parliament, Second Session (52-2)
2012-03-14 Daily Xml
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MENTAL HEALTH (INPATIENT) AMENDMENT BILL

Introduction and First Reading

The Hon. J.D. HILL (Kaurna—Minister for Health and Ageing, Minister for Mental Health and Substance Abuse, Minister for the Arts) (15:48): Obtained leave and introduced a bill for an act to amend the Mental Health Act 2009. Read a first time.

Second Reading

The Hon. J.D. HILL (Kaurna—Minister for Health and Ageing, Minister for Mental Health and Substance Abuse, Minister for the Arts) (15:48): I move:

That this bill be now read a second time.

I seek leave to have the second reading explanation inserted in Hansard without my reading it.

Leave granted.

The Mental Health (Inpatient) Amendment Bill 2012 makes a subtle but important amendment to the Mental Health Act 2009 through a change in terminology from detention and treatment order to inpatient treatment order to more accurately reflect the way in which contemporary involuntary mental health treatment is delivered and to remove the negative connotation of the term 'detention' which is often associated with criminality and used in a punitive sense.

Some people with mental illness are our most vulnerable community members and are in need of proper care and treatment—not stigma, labels and judgement by others who may never have experienced what these people can experience on a day-to-day basis.

The introduction of the amendment Bill coincides with a mental health destigmatisation campaign, launched by SA Health in February and running in March and again in May 2012.

The title for detention and treatment orders in the current Mental Health Act 2009 sends too strong a message about the nature of the orders and leads readers to have a picture of all mental health patients subject to detention and treatment orders being locked up and physically prevented from leaving a treatment centre. This is not an accurate portrayal of our progressive mental health system.

The current Mental Health Act 2009 provides for two categories of orders, a community treatment order and a detention and treatment order.

A community treatment order requires mandatory treatment of a person living in the community. A detention and treatment order requires mandatory treatment of a person admitted to a treatment centre as an involuntary inpatient.

A common public perception is that those subject to detention and treatment orders are all managed in secure environments, when in reality, contemporary mental health care provides for an involuntary inpatient to be under supervision in non-secure environments, in accordance with the objects and guiding principles of the Act. These principles provide that people with mental illness retain their human rights and dignity as is consistent with their protection, the protection of the public and the proper delivery of the services, and requires patients to be treated in the least restrictive manner possible.

This common perception of persons subject to detention and treatment orders being 'locked up' contributes to negative stigmatisation at a time in their lives when compassion and support is required.

The Bill alters the title of a detention and treatment order in order to better describe that the order is for a person to receive treatment as an involuntary inpatient.

The change in terminology does not in any way change the functions of the orders or the limitations on their duration. It is merely a cosmetic amendment to remove potentially misleading terminology and substitute more accurate terminology. Neither does it change the ability to revoke the orders at any stage to ensure people are not treated involuntarily any longer than is clinically necessary.

Patients who cannot be adequately treated in the community, either voluntarily or under a community treatment order, are best treated subject to an order to receive treatment in an acute mental health inpatient unit. The reality is that not all persons subject to such orders are kept in secured areas. There are only a small number of patients who are clinically assessed as bearing a significant risk of harm necessitating being treated within a secure environment.

There is an ability to forcibly return patients to the inpatient setting if the patient leaves without leave of absence. The parameters under which the powers for returning absconding patients can be used are clarified in this Bill to ensure that people experiencing mental illness who are vulnerable to poor judgment are kept safe and protected from harm. After all, the way in which we look after our vulnerable people, is a measure of a civilised society.

The requirement to obtain a leave of absence and to comply with any conditions of a leave of absence is made express, as is the fact that confinement may be required along with other powers to ensure that necessary treatment may be provided and to maintain order and security at treatment centres. The focus of these provisions is on the ability to provide necessary treatment.

Although it has only been about two years since the Mental Health Act 2009 came into operation, it has become increasingly evident that not making this change to the terminology at that stage was an oversight, and consequently continued a way of thinking which does not accurately reflect practice. It is time to now move on from outdated and inaccurate views about the treatment of persons suffering mental illness.

A targeted consultation process with consumers, carers, clinicians and other key stakeholders, which sought feedback, including the suggestion to replace the word 'detention' in the Act was undertaken during the drafting stage of the amendment Bill.

There is no intention to open the Act up for any further amendment at this stage, given the requirement that it be reviewed within four years from the date of its commencement.

It is important with any legislation that it is expressed in clear terms and not in a way that is misleading. This Bill seeks to more accurately describe the nature of treatment orders and reflects contemporary attitudes and approaches to acceptance and treatment of mental illness. Importantly also, it ensures that terminology used in the Mental Health legislation does not contribute to negative stigmatisation and consequent marginalisation of people suffering mental illness, counter to principles of that very legislation.

I commend the Bill to honourable Members.

Explanation of Clauses

Part 1—Preliminary

1—Short title

2—Commencement

3—Amendment provisions

These clauses are formal. The Act is to commence on proclamation so that forms can be adjusted in readiness for implementation.

Part 2—Amendment of Mental Health Act 2009

4—Amendment of section 3—Interpretation

A detention and treatment order is to become an inpatient treatment order, that is, an order for the treatment of a person who has a mental illness as an inpatient in a treatment centre.

The expressions involuntary inpatient and voluntary inpatient are introduced to distinguish between inpatients who are subject to inpatient treatment orders and those who are not.

This clause amends the interpretation section accordingly.

5—Substitution of section 34

Current section 34, which provides treatment centre staff with necessary powers, is expanded into 2 new sections. Instead of the Act providing expressly for an order for detention, new section 34 provides that an involuntary inpatient in a treatment centre is not permitted to leave the centre or the care and control of treatment centre staff without a leave of absence and new section 34A makes explicit that measures may be taken for the confinement of an involuntary inpatient in a treatment centre, as well as other measures necessary for carrying out the order and maintaining order and security at the centre. Under existing provisions of the Act a patient at large, that is, a patient who has left the centre or such care and control without such leave or who has contravened conditions of leave, may be apprehended and brought back to the treatment centre. The clause recognises that exercise of the powers of confinement etc must be guided, in particular, by the principles set out in section 7 of the Act.

6—Amendment of section 42—ECT

These amendments are not intended to make any substantive change to the law, they simply explain the requirements for consent to ECT using a different approach.

7—Amendment of section 101—Errors in orders etc

This amendment is designed to ensure that a person confirming or varying an order etc may correct minor errors.

Schedule 1—Further amendments of Mental Health Act 2009

The change in terminology causes extensive minor amendments of the Act and these are set out in this Schedule.

Schedule 2—Transitional provisions

This Schedule converts current orders to the new names and provides that if, after implementation, an order of the old name is inadvertently made it will be regarded as an order of the new name.

Debate adjourned on motion of Ms Chapman.

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