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Legislative Council - Fifty-First Parliament, Third Session (51-3)
2009-04-29 Daily Xml
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MENTAL HEALTH BILL

Second Reading

Adjourned debate on second reading.

(Continued from 8 April 2009. Page 1968.)

The Hon. A. BRESSINGTON (20:00): I will resume my comments on the Mental Health Bill, having sought leave to conclude my remarks on the last Wednesday of sitting. Just to recap briefly, the main point so far is that there are many viral causes that can mimic or show the signs and symptoms of schizophrenia and bipolar disorder. Many of the people in our mental health system at the moment who have been diagnosed with schizophrenia may well have fallen victim to these viral infections. They have been on medication quite some time, and it is a concern that perhaps they are not receiving the medical attention and medical examinations that they need prior to a diagnosis for those mental illnesses dictating their medications and treatment.

Proving a causative role for infectious agents in schizophrenia and bipolar disorder would open the door to new treatments and disease prevention strategies. With the support of the Stanley Medical Research Institute, several double-blind treatment trials are being conducted that involve the use of adjunctive antibiotics and anti-viral medications in persons with schizophrenia and bipolar illness.

To date, these medications show some promise in patients with recent onset disease. The results are less remarkable in persons with long-standing illness. In the future, it might even be possible to develop a vaccine to protect children against possible infections that contribute to these two mental illnesses. Early intervention and early detection seem to be the key.

Even with what is known today in clinical settings, some patients who present initially with symptoms suggestive of schizophrenia or bipolar disorder could instead be in the initial stages of viral encephalitis. Some physicians would argue that patients with first admission psychosis should have a lumbar puncture and a CSF analysis adding other studies, as appropriate, if indicated by an increase in CSF protein or lymphocytes. A small sample of the CSF could be frozen and stored for future analysis.

With further advances in research at the interface between psychiatry and infectious disease, these samples may eventually provide the key to proving the connection between infection and mental disturbance and pave the way for pharmacological treatment specifically targeted to the causative infectious organism.

I have a paper that was written by Dr James Gottstein, who is a graduate of the Harvard Law School 1978 and Bachelor of Science at the University of Oregon. He is currently the president of the Law Project for Psychiatric Rights where he works on a pro bono basis. His paper is titled 'Involuntary Commitment and Forced Psychiatric Drugging in the Trial Courts: Rights Violations As a Matter Of Course'. I am not going to read out the entire study (for which, I am sure, members are all very grateful), but I would like to quote a small piece of this study. This is his opening statement:

A commonly-held belief is that locking up and forcibly drugging people diagnosed with mental illness is in their best interests as well as society’s as a whole. The truth is far different. Rather than protecting the public from harm, public safety is decreased. Rather than helping psychiatric respondents, many are greatly harmed. The evidence on this is clear. Constitutional, statutory, and judge-made law, if followed, would protect psychiatric respondents from being erroneously deprived of their freedom and right to decline psychiatric drugs.

However, lawyers representing psychiatric respondents, and judges hearing these cases uncritically reflect society’s beliefs and do not engage in legitimate legal processes when conducting involuntary commitment and forced drugging proceedings. By abandoning their core principle of zealous advocacy, lawyers representing psychiatric respondents interpose little, if any, defence and are not discovering and presenting to judges the evidence of the harm to their clients. By abandoning their core principle of being faithful to the law, judges have become instruments of oppression, rather than protectors of the rights of the downtrodden.

I am not suggesting for one moment that a person who is exhibiting behaviour that may be diagnosed as a mental illness should be allowed to commit crimes against society or themselves or involving property and that there would be no consequences or intervention, because I am not a bleeding heart do-gooder. I hold the firm view that every person who co-exists as a member of society must take personal responsibility for their actions and for the effect that their actions have on members of the wider community. However, just as the client I spoke of earlier was able to recover and has repaid his debt to society many times over, so too does any person who has a mental health issue have the right to try.

There are numerous causes for aberrant behaviours. Those causes are well listed and well researched, and I mentioned them earlier in my speech on this bill. Not all mental health issues are caused by substance abuse, as we all know, but could we not at least start with the process of elimination? By that, I mean getting the proper history of a person and, if substance abuse is an issue, dealing with that. If there are viral infections, we should test for them and deal with them and see how the person progresses. When a person is presenting and re-presenting and no progress is being made, would it not make sense to first of all take these precautionary measures and identify what could be the core issue with respect to the person exhibiting mental health problems, such as schizophrenia, bipolar or psychosis?

There is already sufficient legislation in place in the Controlled Substances Act 1984 to allow for a person to be put into mandatory treatment if substance abuse is an issue and, if anyone in this place believes that this is a violation of human rights, please spare me the platitudes, because what we are talking about here is being able to involuntarily commit people into the mental health system. I know that there are opinions that enforced treatment for substance abuse perhaps does not work, but the research from overseas shows a very different result, and I think it all depends on the kind of treatment a person is receiving as to whether the argument should be based around whether it is to be enforced treatment. I think the whole issue of enforced treatment for people with substance abuse issues comes down to the mental picture that we get in our head about the sorts of places people would attend to receive the treatment and perhaps even the counselling they need.

Human beings have committed the worst atrocities against their own kind while professing to be trying to deal with mental health issues. We have used the vulnerable as lab rats, in my opinion, and the human toll is at the extreme end. In 1888, Swiss asylum superintendent Gottlieb Burkhardt became the first known psycho-surgeon when he removed brain tissue from six patients. Although one died and others contracted epilepsy, paralysis and aphasia (a loss of ability to use or understand words), Burkhardt was pleased with his newly subdued charges and reported the results in glowing terms at the Berlin Medical Conference of 1890.

The year 1935 truly marked the true birth of psycho-surgery. Egas Moniz, a professor of neurology in Lisbon, Portugal, observed an experiment in which the frontal lobes of two chimpanzees were removed, leaving the animals docile and vacant. Moniz wasted no time in conducting the same operation on his own mental patients and pronounced the procedure a stunning success. However, a 12 year follow-up study revealed that Moniz's patients suffered relapses, seizures and death.

In 1935, after hearing of operations that rendered monkeys docile and malleable, Egas Moniz conducted his own psycho-surgery on troublesome patients. His fellow psychiatrists lauded his work, and he was even awarded the Nobel Prize in 1949, but his victims viewed matters in an entirely different light. In 1939, Moniz was shot five times and paralysed by one of his leucotomised patients. In 1955, another patient attacked him, this time fatally. Some may say that indicates that they have a mental illness. I would say that it probably indicates they were pretty displeased with the way in which they had been treated, and it also shows that removing brain tissue from a person does not necessarily mean that they will remain docile and malleable for the rest of their life.

On 14 September 1936, an American psychiatrist, Walter Freeman, hammered an icepick through the eye socket of a patient and into the frontal lobes of the brain. Slashing the instrument from side to side, Freeman destroyed wide sections of tissue. Following Moniz's lead, Freeman described his lobotomy as 'mercy killing of the psyche' and widely promoted it. At the height of his fame, Freeman toured cities in a campervan called the lobotomobile, publicly lobotomising patients for the press corps and curious onlookers. The psychiatric community successfully convinced state governments that psychosurgery would reduce mental health budgets.

The superintendent at Delaware State Hospital, for example, was so taken in by the propaganda that he hoped to reduce the number of mental patients by 60 per cent. The combined total of anticipated deaths and discharges would provide savings of $351,000. By the time operation icepick ended in the 1960s, an estimated 113,000 people—40,000 of them Americans—had been lobotomised, with the death rate ranging from 10 to 20 per cent. At least 22,000 of those were fatalities.

In spite of the multitude of victims whose lives have been completely destroyed by psychosurgery, psychiatrists have never been forced to stop the butchery. Today, instead of icepicks, psychiatrists use a scalpel or electro implants to destroy healthy portions of the brain, crippling patients.

I give that historical account of psychosurgery, not to say that there may not have been some improvement in the way in which we do it—I know we do not use icepicks—but, rather, to show that psychiatry on the whole has a dubious history. They have done these types of experiments on human beings with little success and little long-term outcome—not very good outcomes for the patients—yet this particular modality is held up to be the be all and end all authority on mental illness.

Previously, I mentioned the increase in mental illnesses listed in DSM-IV over a period of decades. It now refers to disorders such as written expression disorder and, as I will address later, ADD and ADHD for children. For none of these is there a medical or genetic test that could be conducted to show that these mental illnesses exist on their own, that there is not some other sort of antagonist which is contributing to the signs and symptoms we are seeing. Although we talk often about no funding, not enough resources, and needing bigger and better facilities to house people, it seems we are somehow reluctant to look into what might be the primary cause of people suffering from hallucinations, and whatever else.

This has been a historical practice of psychiatry, and they have got it wrong many times in the past. In 2009, one would hope that we would be prepared to look at that history, rather than believe that it does not need to be acknowledged. We have done all this before. We have tried all this before and it has failed. We have not made people well. Very few people who are caught up in the mental health system recover well and get on with their life—yet we persist. We persist to do it in the same way in which they were doing it even in 1888. One has to ask the question: why do we do this?

It was always the belief that those with a mental illness were subject to certain psychopathology; that is, those who murder and maim without fear of conscience and those who were not able, for whatever reason, to live within the reasonable expectations of a civilised society. However, the higher the expectations of governments and bureaucracies to moderate people's behaviour and freedom of speech through the requirement to be politically correct, the more confusion there is about who is mentally ill and who is simply being their true authentic self. We are all known for eccentric behaviours and oddities, but more and more this is now being listed in DSM-IV and branded as a sign or a signal that someone has a mental illness.

I have also seen average citizens in search of nothing more than justice become labelled as belligerent, vexatious, unreliable, or even unhinged, because they dare to stand up to what they have been able to prove in the courts time and again and seek recourse. In fact, I would go so far as to say that the actions of this place and the other place at times can take and have taken some people to the brink of insanity through nothing more than refusing to admit that due process was set aside because certain powers simply wanted to win in order to deliver a profit or sometimes simply to save face.

There seems to be little acceptance that our actions and decisions in this place here affect many who would otherwise have been content to live their lives and to raise their children with as little interference as possible, but it seems that, once you invite the government into your life, you will struggle to regain any kind of normalcy from that point on—and I have literally seen hundreds of examples of this. We have now been convinced that depression is a mental illness. I am very much aware that people with depression can be absolutely immobilised by this condition, and I am also acutely aware that short-term use of re-uptake inhibitors can have a positive effect on their feeling of wellbeing, but I challenge depression being classified as a mental illness. Again, this will be seen as highly politically incorrect.

I believe that, at some time, most people in their lives have been depressed and that their lives have fallen in a hole for a period. It is also my experience that those who get to the reason why have a far greater chance of recovering and living well than those who rely solely on medication to take away the feeling of uncomfortableness and despair. Of course, in a medication focused society this may be hard to comprehend, but that is where we are today; that is, where anyone who does not feel 100 per cent all the time suffers episodes of mental illness and they need to be medicated for that.

I have read stories of teenagers presenting at a doctor's surgery who are stressed because of the expectations placed on them today, and rather than being told to take care of themselves and to cut back on their responsibilities, they are prescribed antidepressants such as Prozac. Now, governments are partly responsible for this because we gradually expected our teenage children to work, study for year 12 exams, and then told them they were old enough to make their own decisions about whether or not they wanted to live by the rules of their parents—all this, expecting them to be adults before they have even completed their adolescence.

We create the environment and then wonder why these days so many kids suffer from depression. My theory is that they are expected to grow up way before their time and they miss the fun, the real fun of growing up and being able to establish a healthy level of autonomy, a sense of worthiness and an opportunity to connect emotionally with family and to live their lives with reasonable expectations and limits. Today it is all or nothing. I believe this has been a social experiment that has failed our children dismally and created a market for mental illness to be invented and medications to be promoted. The quick fix has been created. It was not an accident: it was merely poor social policy and now we live with the consequences.

Our families have been under attack and we are creating a society where the need for families is minimised to the point where it is no longer important to so many. Our kids can leave home, if they do not like the rules, and set up house before they have any preparation time for adulthood or responsibility. If we are to have a revamped mental health act that is about true mental health, then we need to look at a social policy that has fragmented our families, our values and our responsibility to our children. Most families are trying desperately to create meaningful relationships with their children but, sadly, the external environment does not support those parents.

We really did not figure out where our kids fit in the scheme of things, I do not believe, and we still struggle with that. We are not sure any more of what the role of parents is. Just as corporations are losing that generational knowledge, I believe that, as a society, we are losing that generational knowledge of family, the hierarchy of family and how that all fits into the scheme of helping our kids to grow into well balanced adults who have a reasonable understanding of personal responsibility.

Family breakdown is a main concern for many communities. Rather than look back on what we have done differently that has not worked, we just seem to push forward with policies that put everybody under a great deal of distress, trauma sometimes and strain, and it seems to be nobody's responsibility to look, wind back the clock and admit that somewhere along the line we have thrown the baby out with the bath water. I also have a paper called 'An Epidemic of Depression' from the Psychiatric Times, volume 25, No.13. I will not read the entire study, which I am sure members will be pleased about, but will table it so that members have access to it if they desire. I will quote a couple of paragraphs as follows:

Major depressive disorder (MDD) has become psychiatry's signature diagnosis. Depression is diagnosed in about 40 per cent of patients who see a psychiatrist. This percentage is double that of just 20 years ago and it is far higher than that of any other diagnosis. The World Health Organisation estimates that worldwide depression is the leading cause of disability for people in mid-life and for women all ages. Consumption of antidepressants has soared since 1990. Roughly 10 per cent of women and 4 per cent of men in the United States take antidepressant medication at any time. By 2000, antidepressants were the best selling prescription drugs of any type, yet epidemiological studies suggest that there are still vast numbers of untreated depressed individuals.

So, literally, we are all depressed! It continues:

To catch the problem early a presidential commission has recommended that every adolescent in the country should be screened for depression by the time he or she reaches the age of 18. Screening is proceeding in some schools. What accounts for this seeming epidemic of depression? Although depression has been part of the psychiatric canon since the earliest writing of the ancient Greeks, depression was a relatively insignificant diagnosis just 50 years ago.

In our recent book, The Loss of Sadness: How Psychiatry Transformed Normal Misery into Depressive Disorder (Oxford University Press), we argue that the recent pandemic of seeming depressive disorder is the result of changes in the psychiatric diagnostic system presented in the DSM-III in 1980, and that persists to the present. In many respects DSM-III and subsequent versions has been one of psychiatry's greatest accomplishments. It was the first to use observable symptoms rather than unobservable and undemonstrated etiological processes to define the various types of mental disorders.

Its clear definitions of discrete categories of disorder enhance diagnostic reliability, thus putting to rest anti-psychiatric arguments about the spuriousness of psychiatric diagnosis. These definitions allowed psychiatrists to communicate in a common theory-neutral language, irrespective of theoretical perspectives, that improve the cumulativeness of research, yet these undoubted achievements also entailed some important disadvantages. These drawbacks have become especially apparent in the definition of MDD and have had substantial social consequences.

A diagnosis of MDD is warranted, according to DSM, when a patient has at least five of nine specified symptoms for at least two weeks, and the five symptoms include either depressed mood or an inability to derive pleasure from life. The sole exception is that bereaved patients are not considered to have a disorder if they otherwise meet the criteria, as long as their symptoms are not unusually severe and last no longer than two months. The reason for the bereavement exclusion seems obvious: people who respond to the loss of an intimate with intense sadness, sleep and appetite difficulties, a loss of concentration on usual roles, and the like, do not have a mental disorder.

Rather, they are responding normally to a situation of intense loss. The distinction between sadness that is a normal result of painful losses and depressive disorder is a fundamental one that has been explicitly recognised throughout the 2,500 year history of psychiatric medicine.

Yet, the bereavement exclusion rate raises the question of whether people with enough symptoms to meet the MDD criteria—after, for example, the unexpected loss of a valued job, the collapse of a marriage, the failure to achieve a highly-valued goal or the diagnosis of a life-threatening illness in oneself or a loved one—are similarly reacting normally to situations of intense loss. For thousands of years, until DSM-III, physicians understood that these kinds of situational contexts were an important consideration in determining whether someone was experiencing normal—although intensely distressing—sadness or a depressive disorder in which something has gone wrong with mood processes, and the sadness symptoms are no longer linked to the situation or likely to remit over time. Unlike many other diagnoses in DSM, which contain qualifiers that require symptoms to be 'excessive' or 'unreasonable', no such qualifiers exist for MDD. Aside from the bereavement exclusion, the diagnostic criteria do not take into account the context in which symptoms arise.

Ample scientific evidence, ranging from infant and primate studies to cross-cultural studies of emotion, suggested that intense sadness and response to a variety of situations is a normal biologically-designed human response. Recent epidemiological analysis suggests that the consequences of stresses can be either normal or abnormal and similar to those for bereavement. In its quest for reliability via symptom-based definitions that minimise concern with the context in which the symptoms appeared, DSM unintentionally abandoned the well-recognised, scientifically supported, indeed, commonsensical distinction between normal sadness and depressive disorder.

The blurring of the distinction between normal intense sadness and depressive disorder has arguably had some salutary effects. For example, it has reduced the stigma of depression and created a cultural climate that is more accepting of seeking treatment for mental illness. Many people with normal sadness might benefit from medication that ameliorates their symptoms. However, the usefulness of medication for normal sadness and especially the trade-off between symptom reduction and adverse effects has not been carefully studied, partly because the necessary distinctions do not exist within the current diagnostic system.

We have seen that psychiatry is actually capable of blurring lines that used to be quite clear. I am not suggesting that anyone who has been diagnosed with depression should not seek some sort of medical intervention, but I was also told that these serotonin reuptake inhibitors were never designed for long-term use. They were actually designed for a period of about six weeks to help rebalance the central nervous system and the endorphins such as serotonin and dopamine which help to balance our mood. At Drug Beat, for example, I have seen people who have been on anti-depressants now for 15 years. When one anti-depressant stops working they are simply prescribed another and another, and they reach the point where they have a serious addiction and their lives are falling apart. They cannot even remember why they were prescribed a medication in the first place.

The detox, I might tell members, and the recovery period from these kinds of medication is very severe, and it must be done very slowly. We have one particular client in Drug Beat now who has been reducing her doses of anti-depressants for more than three years. The effects of that on her have been quite remarkable, both physically and emotionally, and she has gone through some pretty dodgy times wondering whether she could complete her program. She is there voluntarily, but her family makes the point that since she has been on these medications for so long it seems that nothing is able to give her pleasure of life any more.

She derives no pleasure from her children or her grandchildren. As she comes off these medications now (and she is at the tail end of this), she said that it is like she has just moved out of this huge black fog she has been living in for so long.

So, we need to be careful about this sort of stuff, and we need to be aware that the legislation that we put in place here has a remarkable effect on people's lives and also on the latitude that is allowed to be taken by professionals who prescribe these medications. I had a conversation with the Minister for Mental Health and Substance Abuse, and I was quite surprised, when trying to get a handle on how we regulate this, that if we were to try to do that we would be laughed at by the medical profession.

After three years, I am still not clear what our role is in regard to regulating that kind of thing, but you would think that, if we were to do research on this and find that these kinds of practices were doing people great harm, it would be the role of this parliament to step in and regulate to some degree. Frankly, I, for one, would not care a toss whether the medical or psychiatric professions wanted to laugh at me for taking a proactive role in reversing some of the damage we are doing.

We do a lot of good things, also. Members should not get me wrong: I am not saying that the whole of the mental health system is a failure. However, when it is not working for everyone, when it is not working on a case-by-case basis and when the one-size-fits-all approach does not work, I believe we have an obligation to look for other means and other ways to help those people who have approached the system or been caught up in the system for whatever reason, and I do see that as a responsibility of this place and the other place. To quote further from that document, it states:

Psychiatrists need not be moralists, judging whether patients should or should not take medication for life's normal disappointments and suffering. It is, however, each psychiatrist's responsibility to diagnose as fully and as accurately as possible and not to bias a patient's decision regarding treatment by a diagnosis that mistakenly labels as a disorder what is likely a normal response that will abate on its own as the patient copes with a difficult life change. Watchful waiting, as well as a range of empirically tested psycho-therapeutic interventions that are demonstrated to be as effective as medication for treating non-severe conditions, might be substituted for prescriptions in such cases.

That is a medical paper that basically backs up my concerns with the way that this system is going. Another concern I have is that we will see ADD/ADHD in children included in DSM-IV, and we still do not even know that ADD/ADHD exists. We do not know that it is not food allergies, we do not know that it is not partial deafness or, again, viral infections. There is a number of allergies and conditions that can cause children to be overactive, hyperactive and have poor attention.

To make the point, I went to a meeting some months ago now at which about 600 people were in attendance, and it was about this very issue of ADD/ADHD in children. All people attending had had their children diagnosed or were in the process of being diagnosed with ADD/ADHD. Some of them, I might add, had to do nothing more than walk into a doctor's surgery and ask for a prescription of Ritalin or Strattera for that diagnosis.

In the process, the people who were conducting this meeting had the DSM-IV criteria for ADD/ADHD and, for a child to be diagnosed with those particular disorders, they have to exhibit only six of a list of about 39 symptoms. The people conducting this meeting read out the symptoms, and we were all asked to stand and, when we counted six symptoms that we knew that we exhibited, to sit down.

It should be remembered that this is a room with 600 adults, and there were pockets of people sitting down all over the place. They read the list of symptoms for ADD/ADHD and, by the time they had finished reading through the whole 30 symptoms, there was not one adult in the room standing.

I do not believe that every adult in that room was ADD/ADHD. However, these are the sort of signs and symptoms and the tools that are being used to diagnose our children with ADD/ADHD. A lot of these children are being put on some pretty heavy duty medications that do result in kids being addicted to amphetamines. I have seen kids who have been diagnosed with ADD/ADHD who exhibit more signs of addiction than they do of ADD/ADHD.

I have also seen children who have been diagnosed with ADD/ADHD who have had a change in diet and who have had a regular sleep pattern and routine implemented in their home, and their behaviour changes dramatically and their concentration improves, and teachers comment on the change. My seven year old son is one of those kids. He was diagnosed with ADD/ADHD at the age of three, and the recommendation was that he go on medication. I did not do that. I went through the process of learning about ADD/ADHD.

We are very careful about his diet: he does not drink coke or eat chocolate. His understanding is that he is allergic to these foods, and he can make the choice, when he goes to a friends place, to refuse to eat these foods. He says himself that, when he eats them, they make him feel unwell. This is a seven year old child who has been educated to understand that he has a reaction to certain foods and drinks and that he needs eight hours sleep a night. I am proud to say that, at the age of seven, he can take a level of personal responsibility to make sure that he is not disruptive at school.

So, there are a number of things we need to consider. One of the amendments I will move in relation to this issue is that children under the age of six should not be prescribed these medications. That is not based on my personal experience with my son. It is based on a handful of freedom of information documents from the TGA that show adverse affects on children who have been prescribed Ritalin and Strattera under the age of six.

It should be remembered that these drugs that we are giving these kids have never been approved for use for anyone under the age of 16, yet we are prescribing these drugs to children, some as young as 12 months old, and these children are being described as disturbed toddlers. I would like anyone in this place who has dealt with toddlers to explain to me how, at some stage, every toddler is not a little disturbed, because that is what being a toddler is about.

It was my original intention to read out a number of these documents, but I will read only a couple of them. As I said, these are freedom of information documents (public case details) from the Therapeutic Goods Administration. The first one relates to a five year old boy who was prescribed Zoloft. He was admitted to hospital with severe muscle twitching and severe, continuous facial twitching. After a night of observation, the Zoloft was ceased.

Another one relates to a 12 year old who was prescribed Zoloft. He was diagnosed with a platelet disorder, resulting in an increasing bleeding time. The patient was hospitalised, and Zoloft was ceased. Another one relates to a five year old who was prescribed Strattera who, after two days on the medication, was having ideations of throwing himself in front of a car. He was hospitalised for a week. His medication was stopped, and his suicidal ideations—at the age of five—ceased within a week.

A four year old who had been prescribed Zoloft was admitted with agitation, nausea, palpitations and severe parasthesia. This four year old was suffering severe panic and feelings of impending death. He was on 50 milligrams of Zoloft, a dose that most adults probably could not tolerate. One of the other reasons he was admitted was depression—at the age of four. He was hospitalised, put under observation, medication was ceased, and within a week he was a normal four year old child again.

I need to stress this because I feel that medication as a first resort is a disturbing practice, but we have so many parents out there who do not know that there are alternatives. There are so many parents who do not understand diet, exercise and all that sort of thing. I am not saying that it is the government's responsibility to make sure that people know, but surely it is the government's responsibility to educate people, to put that information out there and distribute it as widely as possible, and to discourage the use of these medications on our children.

I saw a case of a 12 month old baby on Prozac, because the baby was not sleeping at night. Now, we could get a bit cranky with the parents for accepting that their 12 month old should be on Prozac, but I believe we could also get quite peeved at a medical practitioner who prescribed Prozac to a 12 month old baby when the baby was, in fact, simply teething. Parents need to understand, and be educated at parenting classes, that when they have children they will have sleepless nights.

Life changes when you have a child, and it changes when you have two children. We have lost that generational memory, or knowledge, of parenting and all the rest of it, and if families cannot provide that kind of knowledge we have to do something—other than have 12 month old children on medications that change their central nervous system biology for a very long time, if not forever. We do not know what effect these drugs will have on the developing brain of a 12 month old baby. In 10 or 20 years' time, when these kids grow up and perhaps exhibit signs and symptoms of schizophrenia or bipolar, or whatever it might be, because of what was done to them at 12 months old, what will the face of our mental health system look like? We need to have a vision for this, we need a long-term view; we need to take responsibility, because no-one else will and it will continue and be perpetuated.

I think I have covered the main points I wanted to make, and I think I also made most of these points in my previous contribution, so I will close on this. I beg all members in here to do their own research into the history of psychiatry. I am not by any means anti-psychiatry but I think that when we start holding up one modality in particular as the be-all-and-end-all for finding solutions to our mental health system we leave ourselves wide open to catastrophe in the future.

The historical practices of psychiatry, psychosurgery, and all those sorts of things are, to say the least, dubious. There are many other people out there and many other—I will say it—non-government organisations that treat people with mental illness without medication, and actually do what psychiatry was meant to do in the first place, which was to study the soul. I believe that 'psyche' is the Greek word for soul. This was never about manipulating brain chemicals, and whatever else: it was about getting to the depth of people's distress—what sends them into a spin in the first place, what changes their body chemistry and creates depression and trauma (and whatever else), and dealing with those traumas, rather than medicating (because it is a cheap option) and trying to get people to forget that they have a history and that they are a part and product of their emotions.

Let us start to get back on track and start treating people as people rather than receptors for any kind of medication that we would like to prescribe for them. For me, this is a bill that needs serious consideration and, if we can do things differently and do them better in the future, that is what we should be aiming at, rather than just revisiting a bill for the sake of it. So, I leave that contribution with members.

The Hon. DAVID WINDERLICH (20:46): I have also wrestled with this bill, because it is essentially a coercive bill that gives the power to detain people against their will and force them to accept treatments they do not want. These treatments can have very unpleasant side effects, ranging from fatigue, feeling dead and rapid weight gain even to the loss of a sense of humour. These are all the sorts of side effects of standard psychiatric medication that have been identified by participants in research. However, these infringements on people's liberties are ostensibly designed to be for their benefit.

In considering this bill, I have met with Carers SA, the Public Advocate and a representative of the Human Rights Committee of the Law Society, and I have run a seminar here in Parliament House which brought together carers, mentally ill people and the advocates of the mentally ill. That seminar and the discussions since that time have highlighted the fact that this bill includes some improvements; for example, the recognition of the role of carers in caring for the mentally ill. These are very strongly supported by individuals, families and organisations that are struggling to give support to the mentally ill. I have an email from one person who is very supportive of this bill and said simply, 'We are full of hope.'

At the seminar, the point was made that the biggest abuse of human rights of the mentally ill was the denial of treatment. At the same seminar, mentally ill people and their advocates gave examples of the abuse of their rights. So, I am supportive of this bill, but I will also be putting forward a number of amendments to increase protections for the rights of the mentally ill.

I will be supporting the opposition's amendments for a community visitors scheme. This is widely supported by both carers and the mentally ill. Such schemes operate in most other jurisdictions, and I think they are a valuable way of both engaging the community to support mentally ill people and ensuring the accountability of the professionals and the systems that care for the mentally ill.

My amendments will be along the following lines: inserting the word 'serious' as a threshold for intervention for community treatment orders and detention orders. Why would we want to give the power to detain or forcibly treat people unless the condition in question was serious or potentially serious? I am told 'serious' is too subjective, but we use this word in legislation all the time. In fact, the government has an amendment that involves adding the word 'serious' to the Public Sector Bill in relation to the code of conduct for public sector employees. We have the Serious and Organised Crime (Control) Act. So, it is clearly a word that we can deal with in legislation.

I will also be moving an amendment to give representation on appeals to the Guardianship Board. It has been pointed out to me very forcibly that someone charged with murder or sexual assault, or serial traffic offences, can get legal representation, even legal aid. A mentally ill person who could be detained for years, or forcibly be given powerful drugs with unpleasant side effects, cannot get legal representation. That seems intrinsically wrong.

One example of the need for legal representation that was given to me is the case of a 93 year old man whose family wanted him out of his family home. They made an application to the Guardianship Board, and the Guardianship Board made orders that he be removed from his home.

He had no idea what the Guardianship Board was and no idea that he could be taken from his home. He did not attend the hearing and, the next thing he knew, there were two police cars and an ambulance at his door. Two years later, after many hearings, his grand-niece got the orders overturned, but he never returned to his home and he never even saw his dog again. If he had had a lawyer, the lawyer would have explained to him the importance of the hearing and his need to attend and would have got a medical report that said he did not have dementia, as was claimed by his family. I am told this is one of numerous such cases.

I would be looking to amend the Chief Psychiatrist's functions to require a report to parliament. This would see the Chief Psychiatrist provide an annual report to parliament that details the number and duration of any community treatment orders or detention orders. The annual report would also provide demographic information about the persons subject to such orders, including information about where the persons subject to such orders resided, were treated and were detained. This would build in a level of accountability around the exercise of the great powers envisaged under this bill and also provide important information that could be used to improve the function of the system.

I will be moving a further amendment around confidentiality and disclosure of information. Essentially, I believe that there is a powerful case for carers and guardians to have access to the full range of information, including information about the specific treatment needs of a mentally ill person. However, more general family members and friends need not necessarily have access to this information, although they are entitled to general information about the wellbeing of the person detained or under a community treatment order. This is simply to preserve some level of privacy and confidentiality for people who are mentally ill.

Finally, I will be looking at an amendment to interstate transfers to ensure that it specifies more clearly a transfer to the nearest treatment centre. This is designed to minimise the risk that a person can be dumped into another jurisdiction. There is a documented case of this occurring in South Australia. Almost all of these amendments have already been prepared by parliamentary counsel so they will be able to be filed tomorrow, I believe, without holding up consideration of this bill.

I see a number of key arguments for building in these sorts of protections for the mentally ill. First, there is an enormous power imbalance; the mentally ill are often confused, alone, and have a very low status in our society. When they come up against the medical profession and the state they need protection. This is an attitude I take to power imbalances generally in society. Secondly, psychiatry has a chequered history. It has a place. I spent the weekend with a friend who says that, without her drugs, she would not be able to cope with her depression. However, psychiatry also has a long history of dubious decisions and abuses. It was a tool of oppression in the Soviet Union and Eastern Europe, where dissidents were routinely seen as psychiatrically ill.

Homosexuality was not finally taken off the list of mental illnesses by the American Psychiatry Association until 1986. However, this parliament has just passed an equal opportunity bill that has made most forms of discrimination against homosexuals illegal. This shows that the classification of mental illness is subjective and is influenced by cultural and historical ideas.

Mental illness is complex. Some people are only periodically mentally ill. This has led to suggestions of an advance directive as to how a person should be treated when they are mentally ill. For example, they could specify that they do not want a particular drug because of its side effects. Mental illness is complex, but the classification of mental illness is somewhat arbitrary; something becomes a mental illness when the American Psychiatry Association agrees in a vote that it is, and it goes onto the DSM list.

Fourthly, there is a legitimate debate about whether we are turning social problems and temporary natural states into mental illnesses. I believe the Hon. Ann Bressington canvassed this very well, with the overemphasis on drugs; treating a form of ADHD is a well-known example. She also spoke of depression. There is a long history of depression in literature, poetry and art. It was often referred to as melancholia. It often inspired great art without being classified necessarily as a mental illness. These things are not black and white. Certainly, depression can be a serious problem or it can be confused with understandable states of sadness because of various hardships in life, for example, loss of a loved one and so forth.

There are also regular accounts of human rights abuses in the mental health system, including in this state, and I gave a couple of examples before. Commercial interests play a role in the definition of mental illness and in the approach of psychiatric medicine to mental illness.

A lively debate is ongoing in the United States about the effect of the pharmaceutical industry on the categorisation of mental illness. Essentially, if something like ADHD is added to the DSM, it can be treated with drugs and whole new markets open up.

Finally, many examples in our daily lives cause us to wonder about the medicalisation of behavioural and emotional states; the Hon. Ann Bressington mentioned a number of these. In my own experience, at one stage I was involved in the learning assistance program at a primary school helping a boy who was seen as difficult by the school. There was talk about his having ADHD. My own amateur assessment was that he was the sort of person who was not suited to sitting in a classroom all day and who needed a much more active component to his education.

More recently, I was involved in a community project in a disadvantaged community and found out by accident that almost every child involved seemed to be on medication for ADHD. This was very strange. I do not think this would have happened in an affluent eastern suburb, so it leads you to look beyond the medical and biomedical causes to wonder whether there is not, in fact, a social one.

I am proposing a number of amendments, not all of which are supported by carers, parents and relatives of the mentally ill. The very clear message from most of them is that they want this bill passed quickly and they want to be able to ensure that mentally ill people (the people they are often helping care for) get the treatment they need. This is entirely understandable, but I believe that, for the most part, the issue here is not legislation but resources.

Child protection is a good example of where good legislation is meaningless without adequate resources. On balance, despite the fact that some of the amendments I am proposing will not necessarily be supported by carers, I will put them forward in committee. I think we need to protect the rights of the mentally ill. This is an area of medicine and care that is open to abuse, and we need to build in some protections to prevent that.

The Hon. D.G.E. HOOD (20:57): I rise to indicate that Family First supports the second reading of this bill and, in doing so, we ask the question: what can be done to help our health system, not only here in South Australia but throughout the world? The Advertiser recently published an article entitled 'The horror of Psych Ward 8B', which is the mental health ward at the Royal Adelaide Hospital. It is not the first time that I have heard of horror stories, if you like, about that ward.

We also hear about James Nash House from time to time through the media. I recently had the opportunity to hear from a solicitor who attended James Nash House. She told me how she was traumatised after visiting a client there. Her story was quite horrendous. She told me that the venue itself was depressing enough for her not to want to go back, let alone the events she saw take place.

Dr Van Den Bos, who ran Ward 8B for some time, has gone so far as to tell a coronial inquiry that up to 1,000 patients a year were sent through the ward and that the staff are overwhelmed by the volume of patients. He went on to say that he was aware of patients who had tried to kill themselves on the ward, as tragic as that is, and it reads as though staff regularly have to barricade themselves in the office when patients become violent. I am not sure how frequent that is, but the use of the word 'regular' concerns me greatly. Apparently, it is a fairly negative, depressing place on the whole, yet this is one of the primary front lines, if you like, in our mental health system.

The 2008 ABS estimates are that approximately half of the 16 million Australians aged 16 to 85 (some 7.3 million) had experienced a so-called mental health issue in their lifetime. One in five (or 3.2 million) of those had experienced symptoms in the previous year, and this bill deals with those whose symptoms become so serious that the medical system becomes involved.

I think it is pertinent to add at this point that the comments of the Hon. Ann Bressington were insightful and, whilst they would be seen as controversial, I believe there is some truth to the points she made. It staggers me that we see such statistics as these: that something like 7.3 million Australians experience a mental health issue in their lifetime.

My concern is that those things are potentially over-diagnosed, and that the reality is that people sometimes get sad. It is not unnatural for someone to be sad in their life, and that could be called clinical depression in some circumstances.

An honourable member interjecting:

The Hon. D.G.E. HOOD: Exactly. You will be happy to know that I will not be going on for too long. The bill replaces the Mental Health Act 1993 and implements a number of recommendations suggested by the review that commenced in August 2004 by Mr Ian Bidmeade in a very comprehensive report involving some 500 stakeholders entitled 'Paving the Way: A Review of Mental Health Legislation In South Australia, April 2005.'

I note in the report that there is something like nine pages of recommendations at the conclusion of the first part, and this bill does not address all of them. However, in essence, this bill addresses the need to do a couple of things, and I will list them. First, modernise the wording of the current legislation. I do not see that anyone will object to that necessarily.

Secondly, more clearly articulate the rights of people using the mental health service and the rights of carers and all of those involved. It will place greater emphasis on community care, not just hospital or institutional care, which, I understand, has the widespread support of stakeholders. It will recognise the particular circumstances of children, and it will better acknowledge Aboriginal and Torres Strait Islander issues, which can be somewhat unique.

Support for rural mental health patients will also certainly need to be improved. I note comments from the select committee that looked into the Glenside redevelopment for 46 beds to be provided for rural and remote patients. Certainly, we agree with those comments, and where ever possible there should be beds available in our rural hospitals for mental health patients, and I will follow that with some interest as the debate ensues.

One key element of the Paving the Way report that has not found its way into the legislation is the community visitor scheme. Perhaps that omission was due to the cost of setting up such a scheme; I am not certain. However, I am conscious that South Australia is currently the only jurisdiction in the nation that does not have such a scheme in place. I am aware that the Hon. Michelle Lensink has proposed amendments to that effect.

I indicate at this point that we are favourable to those amendments. Obviously, the debate will need to ensue, but we have certainly had strong indications from a number of stakeholders in this area that they are very keen to see such a program established. Unless we are given good reasons otherwise, Family First will be inclined to support that.

Carers SA supports a community visitor scheme, as do many other groups, including Geoff Harris from the Mental Health Coalition, and there are many others I could name. What the system needs is quite clear: adequate funding for mental health. As the Mental Health Coalition regularly complains, mental health contains some 13 per cent of our total health burden, yet it receives some 7.2 per cent of the overall health budget.

Quite simply, we need to invest appropriately in this area of medicine and, again, as the Hon. Ann Bressington brought to the surface of the discussion, which I commend her for doing, determine what really is happening in some of these cases. I do not want to be derogatory of the psychiatric community. I am sure that they are learned people who have great knowledge of these areas, and as a lay person it would be wrong for me to question their judgment. However, what I would say is that sometimes it can be that patterns of treatment can be established and can go on for some period without being adequately questioned. It may be that we are seeing over diagnosis of conditions because of a greater acceptance of these conditions in the community when, in fact, they may be simply over-diagnosed.

Quite simply, we need to invest more in prevention and recovery. We need to focus our efforts on recovery-oriented practice. We need a whole-of-government approach to recovery, and we also need a comprehensive housing plan with mental health issues. All of these things cost money—none of us will dispute that fact—and it can be very expensive indeed.

Some 80 per cent of people with mental illness are on Newstart or disability support, and 30 per cent have experienced homelessness or were vulnerable to homelessness, according to recent statistics. We need to build the non-government community mental health sector and we need to better safeguard the rights of patients in mental health facilities. The need for real action regarding mental health is clear, and I think everyone in this chamber will accept that fact.

One phrase that I hear a lot is that we are going through a 'mental health epidemic'. It is a strange statement because it makes it sound like mental health problems are contagious. They are traditionally thought to be physiological, rather than thought of in terms of epidemics. So, we have to ask: why is there a spike in mental health complaints in recent times? I think the Hon. Ann Bressington brought some of those issues to the fore in her speech.

Perhaps one reason is that we are a more introspective and permissive society than we were some decades ago. People seem to be more willing to define, excuse and medicate their behaviour than in times past. It has become somewhat acceptable to excuse a child's bad behaviour as a medical condition, rather than admitting to failed parenting, perhaps, or simply a lack of discipline in some cases.

Another reason is undoubtedly the tremendous breakdown in the family unit that we have seen in our society in recent years. The truth is that South Australian families have never been more fragmented or the consequences so evident. In 2006, we had some 51,375 divorces in Australia, 3,913 of those in South Australia alone.

Each divorce represents a broken family and many divorces result in lost children and hurting parents. Clinical depression often results. Again, as has been highlighted by other speakers in this place, what exactly that clinical depression means and whether or not pharmaceuticals are the right treatment for it I think is a very significant topic that needs further debate.

The marriage rate in Australia has only once been lower than it is currently, and that was during World War I when, of course, so many of our young men were overseas fighting. In the 1950s, statistically, the average Australian felt emotionally close to seven family members and friends. Today that number is just four. And one in four homes in South Australia is now occupied by only one person.

Indeed, people are lonely and the strong family bonds that kept us together as a society are missing and breaking down, and many people find it difficult to cope. That is another reason for the so-called mental health epidemic, but again, as has been stated by previous speakers, the question has to be asked: is that true clinical depression? I am not certain, but one can understand how somebody would just be sad or depressed, to use the term in a more colloquial sense, having such experiences impact on their life.

Then, of course, the drug epidemic—and I think in this case it is appropriate to use that word—is another obvious reason for the surge in mental health related conditions in recent times. I would say that a mental health strategy that does not tackle the problem of illicit drugs is really doomed from the start. To quote from The Australian:

A five year review of the histories of mentally ill patients in New South Wales who had been committed to an institution or needed compulsory treatment found four out of five had smoked marijuana regularly in adolescence.

So, 80 per cent of mentally ill patients have been regular users of marijuana in their adolescence. No wonder there is a so-called epidemic. I think now the psychiatric community clearly draws the parallel between drug use, particularly marijuana in the adolescent years, and later mental health problems. Dr Andrew Campbell of the New South Wales Mental Health Review Tribunal is on record as saying 'the psych wards are full of these people' who used drugs when they were young.

There used to be a class of drugs we called harmless or so-called party drugs, but that assumption now, I think, can be declared categorically wrong and is now having a dangerous impact on our community in terms of the mental health problems that we are now reaping, if you like. Another article from the Daily Mail in the UK reads, 'Even a small amount of cannabis "triggers psychotic episodes" warn doctors.' The Advertiser of 22 May last year states:

A study by psychiatrists has reviewed the latest evidence of links between cannabis use and mental illness. That concludes association is 'stronger and clearer than ever'. A pot smoker is 40 per cent more likely to suffer a psychotic episode than a non-[pot]smoker, the review of major published international research shows. For people who smoke [cannabis] daily over long periods their risk is 200 per cent higher.

I could go on. There have been many articles appear in the media quoting eminent learned people who have established this link—I think probably beyond any serious doubt now. Of course, marijuana is not the only problem. It tends to be the gateway to more serious drugs.

There was another media report showing that scans from longer term users of drugs showed a smaller hippocampus and other parts of the brain. So it seems that not only is there an impact on the mental state of the individual, but there may actually be physical impacts of these substances. Meth is an even more powerful drug, and a recent article in the Business Spectator noted that an incredible 48 per cent of meth users were suffering from major depression and, frankly, that is a phenomenal statistic.

I realise that I am quoting a lot of names and dates and media sources, but I will conclude with the 2007 National Drug Strategy Household Survey which found that, of Australians aged 18 years and over, more than one in five (it was 20.2 per cent) who had used an illicit drug in the previous month reported a high or very high level of psychological distress, more than twice the percentage (8.7 per cent) of those who did not take an illicit drug—so, 20.2 per cent of those who did; 8.7 per cent of those who did not.

Illicit drugs cause not only psychotic illnesses such as schizophrenia but also depression and anxiety disorders particularly when smoked by young people. Any mental health initiatives that do not tackle illicit drugs are only skirting around one of the central issues of today's so-called mental health epidemic. I am heartened by the government's recent willingness to increase various penalties for drug use and the comprehensive overhaul of the Controlled Substances Act. More measures will be needed to bring our so-called mental health epidemic under control, and this legislation is one part of that puzzle.

I understand that it has the general support of the Mental Health Coalition, other key stakeholders including Carers SA and some other people whom I mentioned earlier in my speech. Family First are generally supportive. However, we are very open to the amendments, some of which have not been tabled yet, but I am aware that they are coming, and we will certainly have a very close look at those. I look forward to the committee stage.

The Hon. G.E. GAGO (Minister for State/Local Government Relations, Minister for the Status of Women, Minister for Consumer Affairs, Minister for Government Enterprises, Minister Assisting the Minister for Transport, Infrastructure and Energy) (21:11): By way of concluding remarks, I would like to thank all members for their very constructive contributions to this important piece of legislation. There have been many important changes in our understanding of mental illness and mental health in the 16 years since the current Mental Health Act was passed by this parliament, including developments in understanding how the brain works.

Members have asked a number of questions about the bill during this debate, and I will attempt to answer some of them now. It is refreshing that most members have informed themselves of the issues under consideration in this debate. This bill is about bringing the South Australian mental health system into the 21st century, and most members are aware of this. Most members are also aware that providing room for the exercise of professional discretion is also part of this bill. People are individuals, and all professionals administering the provisions of the new act will exercise their professional judgment when faced with particular circumstances. That is as it should be.

Some of the debate has been highly ill-informed, however. I find it surprising that there have been suggestions that there are two types of mental illness: genuine and, presumably, those that are fake or fraudulent. The implication of some of what has been said in this debate is that those individuals who have both a substance abuse issue and a mental health issue do not have a genuine mental health issue.

There seems to be an argument that we should consider people who require the assistance of the health system for mental illness as either deserving or undeserving of assistance because they may have contributed to their illness through the use of various illegal and illicit substances. If we extend this argument to other areas of health care, it would lead to a situation in which smokers, for example, would be considered undeserving if they sought treatment from their general practitioner for bronchitis, or if obese or sedentary people sought treatment for cardiovascular disease. This is clearly both unethical and quite ridiculous.

In relation to children, the current act does refer to a patient under 16 in the consent procedures for category B prescribed psychiatric treatment, which is ECT. In order to clear up any uncertainty, the bill makes it perfectly clear that it applies to children and includes special provisions such as shorter orders and more frequent reviews to ensure that their interests are fully protected.

In response to the question regarding whether a provision is made for placing a voluntary patient on an order, the bill states in clause 8(2) that a voluntary patient can leave the treatment centre at any time unless a detention and treatment order then applies to them. Obviously, they could also be placed on a community treatment order should that be deemed appropriate.

Mental health staff make every effort to identify the next of kin of patients. Often it is not a problem, because many people are accompanied to a treatment centre by their family members or carers. The Guardianship Board is required to notify interested parties, which includes relatives and carers, of any hearing. They maintain and update lists of interested parties. This information may come from a variety of sources but is usually supplied by mental health teams in the first instance.

It is anticipated that fewer orders for detention and treatment will be made under the provisions of this bill. The reforms of the mental health system are designed to have a stepped model of care for the treatment of people before they reach the stage of needing to be involuntarily admitted. The bill is clear that voluntary treatment or treatment in the least restrictive manner must be considered with the provisions for orders providing a safety net should particular individuals require involuntary admission at a particular point in time.

The Hon. Michelle Lensink has asked that the government provide on the record some information about the background to the criteria for orders and why harm has replaced health and safety. I refer the member to the second reading report, which discusses this matter in some detail. One cannot read only one element of the criteria, such as the component which discusses harm, and gain an understanding of what is intended. The elements of the criteria must be considered together and in the context of the objects and guiding principles of the act.

The criteria have been crafted giving consideration to Bidmeade's recommendations, the recommendations arising from the Palmer inquiry into the immigration detention of Cornelia Rau, the criteria in other states and territories, recent policy research on the impact of various forms of criteria on outcomes for patients and stakeholder feedback when the bill was released for public consultation.

The criteria in this bill aim to ensure that an order can be made when a person is so unwell that they will not accept treatment and they need treatment to protect themselves or others. The extent of harm necessary is not qualified in this bill. Obviously, I make no apology for that.

The evidence that supports this approach is that medical practitioners cannot reliably predict whether a person is likely to suffer harm or pose a risk of harm to others when the mental illness is not treated. The best predictor of future behaviour is past behaviour, making prediction following diagnosis and treatment more reliable. In the case of young people experiencing a first psychotic episode, there is obviously no previous behaviour on which to base an assessment.

If a young person's psychosis is untreated it can lead to permanent damage to their brain. For that reason, we do not want to limit access to care and treatment by qualifying the extent of the harm that must occur to the person before an order can be made. Please bear in mind that all the elements of the criteria must be satisfied and, if there is a less restrictive means of treating the mental illness, an order cannot be made.

Members should note that the criteria for involuntary intervention are also designed to protect people other than the person with the mental illness from harm. Recent cases reported in the media provide examples of the types of situations that may arise where consideration needs to be given to the harm to which a child may be subjected by their parent's mental illness. One of these cases involved a four year old girl who was thrown to her death off a bridge in Melbourne by her father. Mental illness is implicated in that case. How much harm was it acceptable to subject this child to before an order was made with respect to her father?

I will now turn to the questions raised by the Hon. Mark Parnell. In regard to the matter of the likelihood of a person complying with voluntary treatment being a consideration when making an order, I believe this matter is dealt with by the fact that the guiding principles state that the services should be provided on a voluntary basis as far as possible and otherwise in the least restrictive way and in the least restrictive environment. Determining whether or not a person is likely to comply with voluntary treatment is part of the range of factors that need to be addressed when an order is being considered.

The bill contains comprehensive provisions for mutual recognition of orders between states and territories, transferring inpatients on orders between states and taking a person to the most appropriate facility for an assessment, even if it is an interstate facility. South Australia has signed a ministerial agreement with the Northern Territory, which came into force in September 2008. A similar agreement with New South Wales is now in force and one with Victoria has been finalised.

The bill deals with this matter in a much more comprehensive manner than the current act and provides significant guidance to staff in relation to how these matters are to be handled. Ministerial agreements must be in place with any state or territory for any of the provisions to be utilised.

The provisions in clause 58 will allow someone to be taken interstate for an assessment against their will. Again, I make no apology for this and ask members to bear in mind that if medical staff in the new MedStar retrieval service consider that a patient's medical need is such that he should be transferred across state or territory borders, even if the patient is unconscious and, therefore, unable to consent, then this proceeds. Mental illness should be treated no differently, and a person should be able to be taken to the most appropriate health facility without accusations of breaching of human rights being made.

The Hon. Mr Mark Parnell cited the annual report of the Guardianship Board regarding the difficulties which occur when people with a mental illness require legal representation. The Department of Health is aware of the different approaches inherent in the legal and psychiatric perspectives.

The Chief Adviser in Psychiatry, Dr Margaret Honeyman, is leading the implementation of the new act, which will include education and training. Professional development opportunities for lawyers will be part of this comprehensive approach to implement the new act. In line with the review of the Health and Community Services Complaints Act, which was tabled in the other place recently, the government supports, in principle, the establishment of a community visitor scheme. The government has committed to undertaking consultation in order to determine the best model for a scheme and an appropriate auspicing body, which ensures the independence of the scheme that this sort of model requires.

I thank all members for their contributions and support for this important bill, which will provide South Australia with a contemporary legislative framework to support the government's broader mental health reform agenda. I thank Ian Bidmeade for his excellent report, which has provided the basis for the bill, and the Attorney-General's Department, including the Guardianship Board, the Public Advocate, SAPOL and the Department for Families and Communities for their cooperative approach in developing the bill. Finally, a large number of specific questions were raised in the debate. I seek leave to insert the answers to those questions into Hansard without my reading them.

Leave granted.

Training for the expanded group of authorised health professionals and professional development on mental health law, and duties of care and confidentiality

In regard to the identification of people who will become authorised health professionals for the purposes of the new Act and the training they will receive, I can advise the Council that the Chief Advisor in Psychiatry within in the Department of Health is already planning for the implementation of the new Act.

Training and educating staff will be critical to successfully implementing the Bill and planning is underway for this. Members should be aware that once the Bill is passed it will be about 12 months before it is brought into force. This is because the regulations will need to be developed, staff trained, community education undertaken and new administrative systems developed to support the administration of the Act. At this stage individuals who are likely to become authorised health professionals have not been identified.

Will other professions (other than occupational therapists mental health psych nurses. social workers or psychologists) be captured by the changes to the legislation relating to authorised health professionals

Authorised health professionals will primarily be front line mental r health workers, therefore it is not likely that physiotherapists and dentists will be included, although it is legally possible.

Why has the section relating to the authorised medical, Practitioners been created?

An authorised medical practitioner will be a person who has undertaken several years of psychiatric training at a reputable training institution and has considerable psychiatric experience. These people will be selected by the Minister, on the advice of the Chief Psychiatrist.

Chief Psychiatrist

The Chief Psychiatrist will be delegating powers and functions where it makes sense for service delivery and accountability.

Review of the Guardianship Act

The Guardianship and Administration Act is under active management and review as part of the Attorney-General's legislative agenda. If the Act can be improved and a bill eventuates, the public can provide comments on the proposal to the Attorney-General.

Information for Guardians/Carers

Mental health staff make every effort to identify the next of kin of patients. Often it is not a problem as many people are accompanied to a treatment centre by their family members or carers. The Guardianship Board is required to notify interested parties, which includes relatives and carers, of any hearing. They maintain and update lists of 'interested parties'. This information may come from a variety of sources but is usually supplied by mental health teams in the first instance.

Memorandum of Understanding

The Mental Health Emergency Services Memorandum of Understanding (between the Department of Health, South Australian Ambulance Services, the South Australian Police and the Royal Flying Doctor Service) was signed in June 2006. The MOU provides a framework and specific guidance to staff transporting people with a mental illness and will be updated prior to the new Act coming into force. Practices, driven by the Memorandum of Understanding, are already consistent with the intentions of the Bill and have resulted in the safe transportation of people with mental illness.

Interstate transfers

Clause 58 sets out the circumstances of transfer of a patient who is subject to an order and which will only be able to occur if:

(a) there is a ministerial agreement in place and

(b) there is a formal request in accordance with the ministerial agreement and

(c) the action is in the best interest of the person.

Further, clause 65 (1) of the Bill requires any proposed transfer of a patient receiving involuntary treatment in hospital is to be approved by the Chief Psychiatrist and ensures the patient can appeal the decision. Transfer will not be able to occur until the appeal period has expired, the appeal is determined or lapses. The Bill enables a person to be taken to an interstate facility for assessment. This is common practice in other areas of health where a person is taken to the most appropriate health facility.

The Bill contains comprehensive provisions for mutual recognition of orders between the states and territories, transferring in-patients on orders between states, and taking a person to the most appropriate facility for an assessment even if it is an interstate facility.

The Bill deals with this matter in a much more comprehensive manner than the current Act and provides significant guidance to staff regarding how matters are to be handled. Ministerial agreements must be in place with any State or Territory for any of the provisions to be utilised. Clause 58(1) specifies all the provisions which must be in place with each State and Territory and I refer members to that clause.

Mental Health (non-legislative)

The reforms inherent in the Mental Health Bill 2008 complement the Government's previously announced $107.9 million mental health reform package to implement the Social Inclusion Board's recommendations. This reform package comprised funding for:

90 intermediate care beds;

73 supported accommodation places;

6 new community mental health centres;

the employment of 8 new mental health nurse practitioners in the country;

the establishment of a priority access service for about 800 people with chronic and complex needs, including those with drug and alcohol problems, a history of homelessness or who may be involved in the criminal justice system;

the provision of non clinical community based support services by non-government organisations; and

the establishment of an early intervention service for young people experiencing their first episode of psychosis.

Intermediate Care facilities are being planned and the currently anticipated timeframe for opening of these units is—

1. Noarlunga Intermediate Care (15 Beds) mid 2010, this will cover the South

2. Glenside Intermediate Care (15 beds) mid 2010, this will cover the East

3. West Intermediate Care (15 Beds), site to be advised, planned for 1010-11

4. North Intermediate Care (15 Beds), site to be advised, planned for around 2013-14

5. Country Health SA are planning to open a total of 30 beds, the first 10 places in Country regions are expected to be opened in the South East of the State during 2009-10. The location of the other 20 is under consideration.

Relationship between mental health services and drug and alcohol services?

Drug and Alcohol Services South Australia currently operates state-wide clinical services through 8 metropolitan sites. It is envisaged that services at 3 of the metropolitan sites will be merged onto the Glenside campus. In addition, Drug and Alcohol Service South Australia's policies, programs, research and administrative functions will also be transferred to this site.

The consolidation of these sites will see the establishment of the most up-to-date and modern facilities in Australia for the treatment of people with alcohol and other drug problems. It will enable enhanced service delivery and achieve significant gains through service integration and closer collaboration, where appropriate, with the mental health sector.

Training for mental health workers get in drug and alcohol awareness and how it may effect an individual?

Drug and Alcohol Services South Australia works in close collaboration with Mental Health Services to ensure continuing development of skills in providing services to people with mental health and substance misuse co-morbidities in both sectors.

Some examples of collaborative initiatives designed to develop both sectors include the following:

Mental Health Services has 7 drug and alcohol workers building the capacity of mental health and drug and alcohol staff to respond to people presenting with co-morbidity issues.

Drug and Alcohol Services South Australia Co-morbidity Nurses provide a service response in both the Northern and Southern metropolitan regions, working with a range of government and non-government agencies, Divisions of General Practice and community based Mental Health Teams.

Co-morbidity Nurses provide assessment, liaison and treatment at the Lyell McEwin and Modbury Hospitals and the Flinders Medical Centre.

Drug and Alcohol Services South Australia provides services at the Child and Adolescent Mental Health Service and the Eastern Adult Mental Health Service.

Since 2008, Drug and Alcohol Services South Australia and Country Mental Health have been working within a Formal Co-morbidity Partnership.

Drug and Alcohol Services South Australia has also been a key partner in the provision of a three-day emergency mental health and drug clinical training program. This course has been provided to approximately 1800 nurses, hospital doctors, Aboriginal health workers, paramedics; medical students and General Practitioners.

Differences between true mental illness and drug induced psychosis

Treatment orders have been changed from 3 days to 7 days to allow for the effects of drugs and alcohol to subside in order to enable a proper assessment to be made of a person's mental condition.

Recording of suicide

The trends show that the rates of suicide are decreasing, however there may be other incidences where cause of death is recorded as something other than suicide, eg a car accident.

Based on data supplied by the National Coroner's Information System, between 2001 and 2006 there has been an average of 157 suicides per year for metropolitan Adelaide and an average of 38 suicides a year from regional and rural South Australia, making an average of 195 suicides in South Australia each year. Certainly, this is 195 too many, but that absolute number has decreased somewhat in recent years and there has been an overall decline in suicide of 19.1 per cent, with a drop of 17.1 per cent in metro South Australia and a drop of 26.7 per cent in rural South Australia.

Terminology of prescribed psychiatric treatments

Neurosurgery is a branch of medicine that deals with the surgical treatment of problems affecting the brain, spine, peripheral nerves and the arteries of the neck and includes procedures such as removing blot clots caused by accidents or hypertension, removing brain tumours and dealing with aneurysms. Psychosurgery, as it is called in the current Act is a subset of neurosurgery designed to change the performance of the brain and hence cognition and behaviour. Neurosurgery for mental illness is a more I contemporary term than psychosurgery.

Treatment centres

As a result of the Social Inclusion Board reforms, the Government has allocated capital funding for the development of 30 new intermediate care beds or places across Country South Australia.

Intermediate care will provide short term mental health care designed to reduce reliance on acute and emergency care, and may assist in preventing admission to acute mental health facilities or to provide early discharge options from an acute facility to enable the person to return to their residence earlier. It is expected that these services will be completed by 2010-11. The first 10 places in Country regions are expected to be opened in the South East of the State during 2009-10. The location of the other 20 is being assessed.

The Mental Health Bill enables the creation of Limited Treatment Centres in a number of regional hospitals, each with the capacity to provide acute care for involuntary patients who have been detained for assessment and treatment under the provisions of the new Act. The Limited Treatment Centres will be able to admit patients for up to 7 days, thereby reducing the need to transfer some patients to metropolitan based hospitals. It is estimated at this time that up to 10 acute beds may be initially created in Country regions for this purpose. The location of the limited Treatment Centres and the beds is yet to be determined.

Rural and Remote Mental Health Services, located on the Glenside site, currently provide a 23 bed adult, acute in-patient service for country residents. A key aspect of the Rural and Remote service includes the Distance Consultation Service which comprises:

24/7 Emergency Triage and liaison Service,

Telepsychiatry,

Transfer of care Coordinators,

Aboriginal Mental Health Team,

Outreach Psychotherapy Service, and

Outreach clinical services through visiting psychiatrists.

These beds and services will be retained in the new Glenside Hospital. Country residents will still be able to access other acute mental health beds in the metropolitan area, as they currently do, should the need arise, although the frequency should decline over time as other country services increase in capacity.

Treatment orders

Patients can appeal at any time against any order and legal representation for appeals will continue to be provided. 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.

The Bill states at clause 8(2) that a voluntary patient can leave the treatment centre at any time, unless a detention and treatment order then applies to them. Obviously they could also be placed on a community treatment order should that be deemed appropriate.

It is anticipated that fewer orders for detention and treatment will be made under the provisions of this Bill in the longer term. The reforms of the mental health system are designed to have a stepped model of care for the treatment of people before they get to the stage of needing to be involuntarily admitted. The Bill is clear that voluntary treatment or treatment in the least restrictive manner must be considered with the provisions for orders providing a safety net should particular individuals require involuntary admission at a particular point in time.

Errors in in orders

On 26 March 2001, a man appealed against a Guardianship Board order (which followed a s12 detention order). Both orders referred to Glenside Hospital rather than Glenside Campus. He appealed on the grounds that Glenside Hospital was not an Approved Treatment Centre. The District Court held that the definition of Approved Treatment Centre referred to the physical premises and that the physical premises previously known as Glenside Hospital were the same as Glenside Campus and that there was no ambiguity in the order. The appeal was dismissed. The provisions regarding mistakes in order which are in the Bill are to further ensure that errors in orders do not result in the order being invalid.

Under the new Mental Health Bill, the Board or person making the order may correct orders without invalidating the form/order if the intent/meaning is apparent. Therefore, if a clerical error is made for an order under the new legislation but the intent is there, then an appeal will be upheld.

There are currently 12 A TCs in SA as follows:

Adelaide Clinic

Flinders Medical Centre .Glenside Campus

Lyell McEwin Health Service .Modbury Public Hospital

Noarlunga Health Services

Repatriation General Hospital .Royal Adelaide Hospital

The Queen Elizabeth Hospital

Women's and Children's Hospital .James Nash House

Oakden Services for Older People

Variations or revocations of Ion term Community Treatment Orders or Detention and Treatment Orders

The Bill states that variations or revocations of a level 3 detention and treatment order may be made by—

the patient; or

the Public Advocate; or

a medical practitioner; or

a mental health clinician; or

a guardian, medical agent, relative, carer or friend of the patient; or

any other person who satisfies the Board that he or she has a proper interest in the welfare of the patient.

Data on the percentage of persons who are reviewed within the guidelines versus what percentage fail to meet the aspirational target

There may be many factors that may delay review, for example, if a person is detained in a remote location, there may be a delay in the person being able to be transported, for example, by the Royal Flying Doctor to an approved treatment centre in metropolitan Adelaide. A detained person cannot be admitted to a country hospital at present and there is also currently no explicit provision for the use of audiovisual conferencing. Also, if a person who is intoxicated or severely affected by illicit or prescription drugs or a medical condition is admitted in the interest of their health and safety, it may impact on how soon a psychiatric review can be undertaken.

Bill read a second time.

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