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10th National Seclusion and Restraint Reduction Forum

Report on the 10th National Seclusion and Restraint Reduction Forum 2015

The 10th National Seclusion and Restraint Reduction Forum was held in Melbourne on 28th and 29th of May 2015. The Forum continues the work to give respect to mental consumers and help with their issues without force being used against them.

The National Mental Health Commission (NMHC) launched its position paper “A case for change” which featured consumer workers, however it avoided the forced medication issue. It acknowledged the use of force as “a failure of care.”

However the direct voices of those suffering seclusion and restraint were absent from the Forum. There was no attempt to bring those affected to speak or produce a joint statement about their experiences.

The Forum also failed to examine the hidden reality of forced medication. However Justice Action raised this issue at the Forum and distributed flyers to all participants.

The Forum was also missing representation of the consumer worker movement, which provides crucial alternatives to forced seclusion and restraint.

 National Mental Health Commission Position Paper

 The NMHC launched its Position Paper on the second day of the Forum, titled ‘A case for change: Position Paper on seclusion, restraint and restrictive practices in mental health services.  The paper supports working towards “reducing the use of involuntary practices…and jurisdictions must contribute to a national data collection with public reporting on all involuntary treatment…from 2013”.

Nevertheless, the NMHC avoided forced medication as a method of restraint. By defining “chemical restraint” as medication administered primarily to control a person’s behaviour, not to treat a mental illness or physical condition, the NMHC sidestepped the issue of forced medication, despite referring to ‘involuntary treatment orders’ later in the paper as a “form” of restrictive practice.

The NMHC position paper endorsed the role of consumer workers to reduce seclusion and restraint, citing the need for an approach that involves consumers and carers as one of the six core strategies to combat the issue.

Direct voices of those affected

 Although the Forum’s specified objective was to “stimulate a robust dialogue that will shape the path beyond achievements to date,” no mental health consumers currently suffering seclusion and restraint were present on the day, nor were their perspectives heard via prepared statements. The voices of those consumers should have been the centrepiece of the Forum. Their perspectives are essential to establish an effective overview.

Bradley Foxlewin, Deputy Commissioner of the NSW Mental Health Commission, was presented as the significant mental health consumer and gave a keynote speech. He said: “we don’t want to bully the profession.” That statement does not assert the centrality of the consumer and is very far from the reality.

Forced Medication

Justice Action distributed the flyers to focus discussion on the issue of forced medication prior to the afternoon of the first day.

In the ‘Chemical Restraint: Is it possible to define and measure?’ seminar, there was in-depth discussion about defining chemical restraint. The Panel afterwards included A/Prof John Allan Queensland Chief Psychiatrist, and Dr Grant Sara from NSW Health. The use of the terms ‘emergency’ and ‘risk aversion’ for ensuring a ‘safe workplace’ were presented as key considerations for protecting the rights of workers and consumers alike.

However such definitional questions cloud the fact that both physical and chemical restraints are examples of forced control imposed upon the consumer. Forced medication whatever is intended by its imposition, whether described as treatment or due to crisis, is coercion and should be honestly admitted as such. The power and authority imbalance is overwhelming, so honesty is a fair concession in the discussion. Consumer preference is the only test of whether it is coercion. The 45,000 Community Treatment Order is the evidence.

Panel members acknowledged the point. However later in conversation a NMHC member said that consumers hadn’t raised it as a problem and only JA was doing so. “It is your job to get those voices out” we were told.

Consumer Workers

 The Forum overlooked the consumer worker movement. The program contained no paper on the use of consumer workers as an alternative to seclusion and restraint. No research had been done.

This omission led us to question whether there is a gap between the rhetoric and the reality of the situation. In NSW, agreements with the Health Department after Tribunal recommendations on focus people have been totally unsupported in practice.

Organisational culture change, through an emphasis on recovery, trauma-informed care, human rights, consumer workers and interdisciplinary activity, were advocated in the NMHC’s position paper, as alternatives to coercion.

Consumer workers are employed for their expertise developed from their lived experience of mental illness, their personal commitment to their own recovery and shared experience of mental illness. These skills as social support are the links consumers crave, and are invaluable in a clinical setting. 

Sally: Code black

 A/Prof Ruth Black from Melbourne Health, emphasised the need to reinstate control in the seminar ‘An examination of Code Black (armed threat) incidents in the acute adult mental health inpatient setting’. Anti-psychotic medications were presented as a necessary solution to armed threat scenarios, as it was argued that other methods of management of violent patients are simply too costly and risky

 In response to these issues, the ‘Walking the tightrope: Balance and decision – Should seclusion ever be an option’, Panellists Chris Marsland, Lisa McCormack, Esther Dzvindu, Caren Fairweather and Shannon Simons from Justice Health & Forensic Mental Health Network NSW raised a confronting case study of 13-year-old ‘Sally’.

Sally’s story was incredibly tragic, detailing a long history of abuse and life in foster care, and an instance where she attempted to attack mental health staff provoked a “Code Black” scenario where Police were summoned. As a result, Sally was placed in seclusion. Eventually, Sally was eligible for release. However, she had nowhere to go and the day before her release she attacked a nurse once again.

As the seminar posed, seclusion can be a highly traumatising experience for individuals, particularly for young children and adolescents. Questions regarding the amount of interaction that staff actually had with Sally in the short time she was institutionalised and when the police were called should be raised. Where were the consumer workers or the NGO that she trusted. Alternate ways of handling the situation could also have been considered to avoid the repetition of such scenarios of violence.  

It was a stark reminder of how far away reality is for adults when thirteen year olds get treated that way.

Download pdf version of report.

Malcolm Baker's Letter to the Mental Health Review Tribunal

Malcolm Baker

H.R.M.C.C.

Goulburn, NSW

30 July 2012

To Whom It May Concern,

I would like to express to you that I feel sad and frustrated regarding the decision to have me take anti-psychotic medication based on incorrect diagnosis made by a Justice Health psychiatrist.

In support of my claim that I do not have mental illness are the following points:

  • There is no family history of mental illness
  • Prior to my arrest, I had not been diagnosed with a mental illness
  • I was deemed sane by three forensic psychiatrists prior to my sentencing
  • I accept responsibility for my crimes and the imposed sentence by the courts
  • I have normal social interactions with others in the jail and experience a variety of emotions due to the constraints imposed at the H.R.M.C.C.
  • I feel better and experience no side effects when I cease taking the anti-psychotic medication
  • I do not experience any kind of delusions

Previously I was held down and forcibly medicated with injections when I have refrained from taking medication, which has been both unfair and traumatizing on every occasion that I see the psychiatrist since being forcibly medicated. I feel extremely nervous and intimidated as his [the psychiatrist] view of me and diagnosis (even though incorrect) determines what happens to me.

The Justice Health psychiatrist whom has misdiagnosed me with a mental illness is also degrading towards me and describes me as being; PARANOID, ANGRY, DELUSIONAL and have MOOD swings. He also has failed on every occasion that I’ve seen him to offer me any advice on options aside from medication (which as I understand is prescribed only due to his incorrect diagnosis).

The descriptors he uses to label me are untrue, however I am, as stated previously, frustrated by this situation that I am in.

I am dealing with this challenge by applying for Legal Aid to represent me and present evaluations by credible forensic psychiatrists to the court so that a court order to cease the medication is ruled.

I have refrained from taking anti-psychotic medication for approximately 3 months with the knowledge of nursing staff and correctional officers. At this stage, no effort has been made to forcibly medicate me and everyday that goes by I feel more positive and less frustrated.

As I have not demonstrated any adverse behaviours since medication cessation and they have not forcibly medicated me this indicates that there is a general agreement that I do not need the medication – otherwise it would be seen as a breach of their Duty of Care.

To be fair to the psychiatrist after the last interview, I became aware that I was rambling a bit and must have sounded like a real fool! Due to my nervousness!

Now I am aware of my nervousness. I believe that I can keep it in check as you will see in the near future on the 7 August 2012 interview.

Any assistance that you could provide to me to assist me to prove my healthy mental state and cease taking harmful and unnecessary medication is greatly appreciated.

Yours Sincerely,

Malcolm G. Baker

An Open Letter to the Long Bay Treating Team

An open letter to Dr. Antonio Simonelli, head of the Justice Health Treating Team for Malcolm Baker

 

Re: Malcolm Baker Mental Health Review Tribunal Hearing, 30 April 2015

From: Brett Collins

To: Antonio Simonelli

Date: Tuesday, 28 April 2015 19:40 pm

   

Dear Dr. Simonelli,

Malcolm’s independent psychiatrist, Dr. Yola Lucire, has asked to see treatment and medication sheets in the file. Would you forward them to her to assist her evidence please? She is copied into this email.

Also, we want to clarify some matters before the hearing on April 30 and give you notice of some issues, so you can prepare yourself properly. We have examined the 53 page report you have submitted for the Mental Health Review Tribunal (MHRT) Review.

There is no social worker report or anything about how he functioned at Nowra in the main prison after being in SuperMax at Goulburn for 18 years. Nor has the fact that he has been in contact with his family and friends been included in the report. We talked with him almost every day, as did his family members. He is our friend and I am his primary carer. Why am I not mentioned in your report?

Your report on 26 February 2015 tendered to the Review says at p.2 that Malcolm was discharged on 9 February 2012 from the Long Bay Prison Hospital on a Forensic Community Treatment Order (CTO). You have not mentioned that he returned to your hospital on 18th August 2012 after the CTO expired on 7th August 2012 and that the Tribunal did not renew the CTO at its hearing on 13 September 2012. This was after Malcolm sent a letter imploring the Tribunal to not forcibly medicate him again.

You also failed to mention that he was off medication entirely during the many months before the hearing held on 7 August 2012 and wasn’t again forcibly medicated until this year. You say at p.4 that in January 2014 he was given and accepted reluctantly the medication Olanzapine. What treatment sheets exist supporting that? Malcolm denies taking any such medication. In April and October 2014, you imply that he was taking no medication but do not suggest that he was causing any problems. There is no statement that there was any risk of serious harm to himself or others. The prison did not say so.

After he went to Nowra on October 8 2014, after 18 years in SuperMax, you did not say that he settled into his job working with another 30 prisoners and living with 60 prisoners after being in effective solitary confinement for 18 years. His resettlement was amazingly successful. He did really well. Other prisoners liked him. He made no complaint or request for assistance to health staff. 

You did not include in your report, the Malik report 2 February 2015 that transferred him to your hospital under s 55(3). It says that the initiative for Malcolm's forcible medication began when health staff at Nowra prison said that he “regularly sends drawings and ideas for inventions to…Clive Palmer.” His letters should have been private and his political interests not medicalised. 

Since that time he has lost his cell and his job at Nowra prison and has been locked in a cell in G Ward at your hospital for 23 hours a day. He has no toothbrush, pen or paper in his cell. He has his face forced into a pillow by prison officers and nurses every two weeks, with his trousers taken down and injected with a substance that makes him feel sick all the time. He lies down, as he cannot walk easily. He is harmed immeasurably by your brutal intervention. He wants just to be left alone. 

Where is the respect? Where is the person-centred approach? Is this upholding the Justice Health motto?

“Our values: Care, Clear Communication, Honesty, Professionalism, Respect.”

Are we misunderstanding something? Is there some information we do not have?

Please pass the Treatment Sheets to Dr. Lucire.

See you on Thursday.

Regards,

Brett Collins

New Mental Health Bill Useless

The Sydney Morning Herald article dated 7 November 2014 criticises the Mental Health Bill. The Bill comes before the NSW Legislative Council the week of 10 November. It needs to be stopped and amended.

Our analysis of the Bill is underneath the Sydney Morning Herald article. 

Act now! Contact the Minister Jai Rowell    This email address is being protected from spambots. You need JavaScript enabled to view it. (02) 8574 7100 

And shadow minister Barbara Perry  This email address is being protected from spambots. You need JavaScript enabled to view it. (02) 9644 6972

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