Recently, SANE Australia released their ‘National Stigma Report Card’– the findings from their ‘Our Turn To Speak’ survey. While we take a different view to how the report categorises people with “complex mental health issues”, we thank SANE Australia for highlighting several critical human rights issues and barriers that consumers face.
Of particular concern, but comes as no surprise to us, is that this report highlights the issue of coercion and control in mental health services; stating that 44% of respondents felt they had been pressured to receive mental healthcare treatment that they did not think was necessary, and 54.1% felt they had been unfairly excluded from having a say in decisions made about their mental healthcare and treatment planning.
This is an opportunity pause and reflect on what we know about Victoria’s mental health system.
Unfortunately, in Victoria, the law currently permits compulsory treatment in hospitals or in the community under the Mental Health Act 2014.
VMIAC rejects all forms of compulsory mental health treatment unless the person requests it in their advance directive.
This usually means that the law allows force to be used to ensure that a person accepts medications (as tablets or injections), electro-convulsive treatment and psychosurgery. Victoria’s limited data on the mental health system paints a similar picture to Sane’s report, with around half of consumers in the system formally under the Mental Health Act. And then there are those who are voluntary but experiencing coercion or threats of compulsory treatment.
But why are we doing this? The Royal Commission has highlighted that ‘fear of compulsory treatment can affect the way in which people with lived experience of mental health challenges and emotional distress choose to engage with services. In some circumstances, this fear can deter people from seeking treatment altogether.’ Similar observations about coercion and exclusion from decision-making were made in the Mental Health Complaints Commissioner’s submission to the Royal Commission.
When consumers speak to us and tell their own stories, they communicate abuse and human rights violations. Victoria Legal Aid recently released their ‘Your story, your say’ report, highlighting that over 80% of interviewed people reported experiences of power and control from the mental health system. People spoke about power imbalances between them and clinicians, as well as a lack of accountability on mental health clinicians and the system.
‘What is clear looking at how the 1986 and 2014 Mental Health Acts have actually worked, is that there is a two-tiered legal system. Clinicians are exercising powers under these Acts but are not bound to any of the obligations. Meanwhile consumers are bound to compulsory treatment but are enjoying none of the “rights” designed to protect them. These are human rights, regulatory and rule of law issues.’Chris Maylea (Chair)
VMIAC hears from its members about the profound trauma that compulsory treatment and coercion has caused them.
‘We come to you for help, and many of us are damaged instead. Please work more with consumers – we’ve got expertise about this and we’re uniquely motivated.’Anonymous consumer of compulsory mental health treatment.
‘VMIAC knows that the mental health system is built around a mental health act and force, rather than what consumers want and need. The Royal Commission needs to fundamentally reshape the system. Compulsion must go. Services by and with consumers must start.’Maggie Toko (CEO)
We call upon the Victorian Government to develop a comprehensive, funded and coordinated strategy to eliminate all coercion and control, including compulsory treatment, from mental health services. We also implore the Royal Commission into Victoria’s Mental Health System to repeal the current Mental Health Act and bring mental health legislation in line with international human rights law in order to protect consumers from this violence, abuse and neglect.
For more information about this, please read our position paper on compulsory treatment, and our position paper on preventing and responding to violence, abuse and neglect.
 State of Victoria, Royal Commission into Victoria’s Mental Health System, Interim Report, Parl Paper No. 87 (2018-2019), 229.