The case of Michael Riley illustrates how the mental health system consistently fails to protect the rights of individuals whose behaviour is perceived as indicative of mental illness. In particular, it sheds light on how interpretations of section 14 of the Mental Health Act 2007 (NSW),1 which stipulates the definition of ‘mentally ill’, are often unsubstantiated by tangible evidence. This results in vague and imprecise outcomes. Mr Riley’s case also demonstrates how the mental health system favours immediate medication-based solutions, as opposed to social support mechanisms. Mental health institutions employ forced medication as a simple ‘fix’ rather than holistic long-term rehabilitation via support systems. In fact, as Mr Riley’s Designated Caregiver, Justice Action was not notified of his forced hospitalisation. The Mental Health Act is designed to protect individuals perceived to have a mental illness.2 Overall, Mr Riley’s situation highlights that mental health institutions show little respect for these safeguards for civil liberties.
Michael Riley was diagnosed with Schizoaffective disorder in early 2000. Since then, he has been admitted to mental health units on more than 17 occasions. Notably, there is clear agreement amongst health care professionals and family alike, that Mr Riley has never harmed anyone, nor does he pose a threat. Mr Riley lives with his mother, sister and brother-in-law. He also has a seven-year-old daughter called Anna. He has a mixed relationship with his family, who have frequently called the police and ambulance services when he has displayed behaviour indicative of mental illness. Mr Riley has a degree in Economics and Political Science from the University of Sydney. Mr Riley was completing his honours thesis when he was reported as having a mental breakdown.
Admission to Blue Mountains Mental Health Unit 2 November 2016
Mr Riley was admitted to the Blue Mountains District Anzac Memorial Hospital as an involuntary patient on 2nd November 2016, following a visit by Community Mental Health and police to his home. Mr Riley’s family had raised concerns regarding his mental health, having observed him speaking to the television and himself, fixating on news regarding the conflict in Syria, and displaying severe agitation. However, Justice Action, who is a Designated Carer for Mr Riley (as per section 71(c)),3 was not initially contacted about his hospitalisation. This is indicative of the mental health system’s immediate employment of force, as opposed to utilising social support mechanisms.
Arrangement of the MHRT hearing
An MHRT hearing overseen by Mr John Hislop was held on 16th November 2016, at the head office in Gladesville. The purpose of the hearing was to determine whether Mr Riley is mentally ill and whether he would be required to remain as an involuntary patient. Mr Riley attended the hearing via video from the Blue Mountains Mental Health facility.
The MHRT initially sought to exclude Justice Action from the hearing on the basis that the proceedings in Gladesville were not open to the public and subsequently Justice Action would need to attend in the Blue Mountains with Mr Riley. Nevertheless, Justice Action’s attendance at Gladesville was eventually accepted. Additionally, Justice Action was originally denied access to the documents that were to be brought against Mr Riley on the basis that Justice Action was not considered formal legal representation. However, following email communications with Rodney Brabin (Registrar for the MHRT) and consideration by the tribunal, Justice Action was given access to the documents and permission to represent Mr Riley.
Mr Riley wished to be discharged from the mental health facility without a Community Treatment Order (CTO). A Community Treatment Order is a legal order prepared by the Mental Health Review Tribunal or by a Magistrate.4 This order sets out the terms under which a person must accept medication as well as rehabilitation, counselling, supervision, and other services.5
Mr Riley believed that, given he had no criminal record and that there was no actual evidence to indicate he was a threat to himself or others, there were no grounds for him to be involuntarily admitted to the mental health facility.
Although the decision made by the MHRT in relation to Mr Riley was most likely able to be appealed, if he were ultimately discharged from the hospital, negotiations regarding the situation with his family and living arrangements would still be required.
Evidence given at the MHRT Hearing 16 November 2016
Dr Yvonne Djurovic presented a medical report during the tribunal. Dr Djurovic acknowledged Mr Riley’s diagnosis of Schizoaffective disorder in 2000. As mentioned above however, Mr Riley does not accept this diagnosis. The report further detailed that Mr Riley had not been taking his prescribed medication for three to four months and had subsequently suffered a relapse of psychosis. Dr Djurovic reported that Mr Riley was irritable and paranoid on admission, and that he wishes to live in China or Russia to escape persecution. It was reported that Mr Riley suffers from delusions and has been has been very vocal in regards to political issues, particularly the recent election in the United States.
Significantly, Dr Djurovic noted that Mr Riley was in fact at risk from suffering injury from other patients and as a result, was moved to a closed ward for his own protection. Dr Djurovic also established that according to Mr Riley’s family, he ‘had never harmed anyone’ and did not pose a danger to himself.
Dr Djurovic suggested that an appropriate course of action for Mr Riley would be to continue hospital treatment for up to four weeks. Following this, a discharge plan involving a CTO and a community-based mental state-monitoring program could be implemented.
A form completed by Dr Pauline Byrne as to the mental state of Mr Riley was also given in evidence. The comments on the form completed by Dr Byrne found Mr Riley to be a mentally ill person, evidenced by his pressured speech and paranoid delusions. Additionally, a Progress Note completed by Dr Bridget Regaily reported that Mr Riley had been agitated to the point of screaming, was talking to the television, referenced the Syrian War and wished to move to China. Dr Regaily also concluded that Mr Riley was mentally ill.
Other Mental Health progress reports demonstrated that Mr Riley’s cooperation was improving, and that he had become more settled and less agitated, despite his delusions persisting.
Arguments made for Mr Riley at the Hearing
It was argued on Mr Riley’s behalf that his delusions regarding political events did not indicate a mental illness or disorder, in accordance with section 16(1)(a).6 Mr Riley understands that an individual is entitled to their own religious and political beliefs and that expressions of, or failures to express a certain political or religious belief are entirely insufficient to indicate that a person has a mental illness (according to 16(1)(a)). Moreover, despite the fact that anti-social behaviour was used to justify Mr Riley’s mental illness, it was argued that section 16(1)(l) deems anti-social behaviour as inconclusive in indicating mental illness.7
Furthermore, it was argued that Mr Riley has never exhibited violence towards himself or other people and would thus not satisfy the criteria in sections 14(1)(a) or 14(1)(b) for requiring ‘care, treatment or control’ owing to mental illness.8
Notably, Dr Djurovic’s report indicated that Mr Riley was in fact at risk of harm from other patients whilst being held at the hospital. This raised questions as to the hospital’s duty of care towards Mr Riley and whether adequate steps had been taken at a management level to ensure appropriate treatment of patients.
It was similarly argued that Mr Riley’s social support network as well as the requirements in section 14(2) regarding ‘the continuing condition of the person’, failed to be considered in the decision to retain him as an involuntary patient.9 Given the constant lack of success with previous interventions, it is unlikely that admission to hospital would produce positive results in Mr Riley’s situation. As such, it may be more beneficial to Mr Riley’s ‘continuing condition’ that he be able to utilise social support. Moreover, in its findings, the tribunal failed to consider Dr Djurovic’s acknowledgement of Mr Riley’s potential for improvement.
Finally, in Mr Riley’s case, section 68 of the Mental Health Act was not observed.10 This section requires people with a mental illness receive care in ‘the least restrictive environment’ possible.11 This was breached when Mr Riley was placed in a closed ward. This action seemed unnecessary and grossly restrictive given that the reason for doing so was for Mr Riley’s protection rather than the prevention of harm to other patients. Similarly, section 68(f) states ‘any restriction on the liberty of patients…is to be kept to the minimum necessary in the circumstances.’ In holding Mr Riley within a closed ward, no consideration was given to holding him with an environment that may have been more appropriate to his treatment, such as one that utilises his support system.
The Tribunal’s Finding
The tribunal held that Mr Riley would remain as an involuntary patient, undergoing review in four weeks on 14 December 2016.
Mr Hislop provided no findings of facts and did not outline the evidence he examined to support his decision. Mr Hislop merely stated that the requirements of the Mental Health Act were proven. Mr Riley was supplied with an incomprehensible written document, which Justice Action believes outlined more detailed reasons for the decision of the tribunal.
Mr Riley’s Perspective on the Hearing
Mr Riley believes that the mental health system does not strive to achieve justice for people perceived to have a mental illness. He asserts that he did not have a chance of being discharged at the tribunal, as he believes that the tribunal sought to avoid setting a precedent that would allow other individuals, in similar situations to Mr Riley, to be released. Mr Riley does not want a CTO and believes he does not require one owing to no prior history of violence, or any experience with violence-related activities or sports. Mr Riley believes the only way he will ever be discharged is if he agrees to take medication and accepts that he is mentally ill, despite the fact that he does not believe this to be true. Mr Riley expresses that he does not believe that medication is an appropriate solution and has conveyed frustration towards the focus placed on medication, as opposed to ensuring access to his support system or stable accommodation.
Mr Riley’s family attended the tribunal with him at the Blue Mountains hospital and attended via video. Mr Riley states that his family did not speak with him afterwards and left immediately following the tribunal.
Justice Action’s Perspective on the Hearing
Mr Riley was treated with respect and decorum at the hearing. Nonetheless Justice Action was appalled that the tribunal made no finding of fact to support the ultimate declaration of Mr Riley as mentally ill under the Mental Health Act. The evidence was clear that there was no justification for such a verdict. The tribunal had a legal obligation to apply the act correctly and to support this application with fact. This duty went unsatisfied. Justice Action is yet to see a fair outcome for Michael Riley but continues to seek a fair result.
1 Mental Health Act 2007 (NSW) s 14.
2 Ibid s 3.
3 Ibid s 71(c).
4 Mental Health Review Tribunal, Community Treatment Orders (2013) NSW Governemnt <http://www.mhrt.nsw.gov.au/civil-patients/community-treatment-orders.html>
6 Mental Health Act 2007 (NSW).
9 Mental Health Act 2007 (NSW).