OVERVIEW
Nathan Chetty is a gentle person of Indian-Fijian descent, who is almost blind. Nathan had been traumatised following threats from a family member. In 2015 he was accused of pulling overhead electrical wires while standing on the car in the garage, responding to a perceived threat of electrical damage. Since 2015 he has been forcibly treated through involuntary hospitalisations and monthly injections of antipsychotic medication under a Community Treatment Order (CTO).
The order was implemented and repeatedly approved in response to the exaggerated ‘electrical wires’ incident and a false allegation of subtle shoulder collision causing injury to his elderly father. The diagnosis varied between neurotic and psychotic. Consequent forced medication caused severe side effects and a deep sense of resentment, despite his posing no serious risk to himself or others.
In February 2021 Nathan and his mother asked for support from Justice Action. JA represented Nathan in a series of Mental Health Tribunal hearings and negotiated a NDIS package. As a result, in addition to the general practitioner of his choice, he started to receive an annual $93,000 NDIS package that includes a NDIS coach, clinical psychologist and support workers. JA then argued that there was now enough support working with Nathan, rather than against him, on the elimination of the need for the CTO and acceptance of his personal management plan as a workable alternative.
Nathan’s case highlights impediments across the entire mental health system: the dearth of counselling and recovery-oriented pathway for people deemed mentally ill; poor record keeping that risks catastrophizing and distorting past facts; the lack of fair process in communications with patients regarding MHRT hearings; the lack of independence of the MHRT in investigating the basis for psychiatrists’ opinions; the dearth of due diligence by police and health staff to use their discretion; the unnecessary enforcement of minor technical breaches that instil fear and cause unnecessary hospital detention under police escort and following security guards’ supervision while under detention; the ignoring of detained consumer’s rights and requests for carers, Official Visitors, and community visitors for consumer representation in decision-making meetings; and the detaining of consumers for several days in hospital with neither providing any formal reason for that, nor any discharge summary.
Late in 2022 Nathan’s arrest and detention exposed the lack of health staff compliance with the MHRT’s own Breach Notification Guidelines. It also demonstrated that his requests for a Community Advocate and a Public Visitor were not proactively facilitated but continuously ignored; and that a person who was considered by the staff neither presenting as thought nor behaviourally disordered could be held indefinitely and without explanation.
Following the late 2022 detention, JA notified all NSW mental health authorities of the coercive mental health practices that Nathan had been subjected to. This included the Liberal Party Mental Health Minister, Mental Health Commissioner, Chief Psychiatrist, CEO of the Sydney LHD, MHRT President, Official Visitors, mental health carers, and ‘Being’. JA asked for their intervention and stated:
We wish to draw to your attention a case that reveals once again the poor behaviour of NSW Health Department. What has happened in the last few weeks to Nathan Chetty and his family highlights the lack of respect and care. This is a Civil, Mental Health matter that reveals how easy it is to get a Community Treatment Order (CTO), lack of adopting the least restrictive practices during a CTO, and how hard it is to ever get off an order.
However, no one followed up on the issue of consumer mistreatment that Nathan’s case highlighted.
The hopelessness instilled by our health system, and the dearth of any services or pathway for repair or recovery is antagonistic to contemporary mental health. It leaves people defenceless, and struggling in a continual state of resisting coercive approaches. What happened to Nathan Chetty shows how the public health system perpetuates a vicious cycle, similar to the exposures of Kerry O’Malley and Miriam Merton.’
On the 17th of April 2023 they agreed to discontinue their CTO and end his forced medication. Finally, after an 8-year battle Nathan is now able to pursue his own personal management plan of recovery.
Justification for Forced Medication
Nathan was first admitted at Concord Centre for Mental Health (CCMH) in mid-2015 following a referral to the police following the ‘electrical wires’ incident. NSW Health through the Canterbury Community Mental Health Centre (CCMHC) made a preliminary diagnosis of schizophrenia.
This resulted in the centre conducting a Risk Assessment 2015 in which Chetty was determined to have no foreseeable risk of suicide, low risk of harm to himself and others, and low risk of absconding. It was also determined that he was a person vulnerable to ‘damage to reputation’.
In 2021, he was voluntarily admitted into hospital with an unclear diagnosis that included depression and social anxiety disorder. The staff, however, also believed that he had suicidal ideation. In reviewing and analysing the CCMHC and CCM files about the incident and the collision with his father, repeated notes successively and increasingly exaggerated the risk and this became the driving force to justify the CTO continuation.
Side Effects of Medication/Treatment
Nathan was prescribed a 400mg injection of Abilify/Aripiprazole every four weeks, which he was receiving for nearly seven years. This followed two years on Paliperidone monthly injections.
He repeatedly expressed clearly his wishes not to undergo this forced treatment due to its adverse side effects, which included weight gain, feelings of losing consciousness, insomnia, declining overall health (such as kidney function), and pain in the right side of his body. Nathan experienced distress in the loss of dignity and felt degraded. He described the experience as “psychologically scarring”.
The monthly requirement to comply with the CTO was accompanied by a surveillance-type approach. They are substantially time-consuming: arranging appointments, monitoring reviews with the centre psychiatrist and case manager; the requirement for centre attendance or home visits for depot injections; threats of breach notices; often receiving reports late or even not receiving any before Tribunal hearings. Decision-making and the ability to offer respected input always seemed outside Nathan’s control. The process was not only disempowering but was repeatedly traumatic, in some ways reinforcing Nathan’s pathology.
Carer and consumer’s questioning or engaging within a review or inquiry was misattributed by centre staff and the Tribunal as either oppositional or reported later as if they were psychiatric symptoms of agitation, anger or resistance.
Initial Tribunal Hearings
In February 2021 Nathan and his mother asked for support from Justice Action. JA represented Nathan in a series of Mental Health Tribunal hearings and three-month Orders and finally negotiated for an NDIS package. As a result, in addition to the general practitioner of his choice, he got an annual $93,000 NDIS package that included a NDIS coach, clinical psychologist and support workers. JA then argued that there was now enough support working with Nathan, rather than against him. Nathan also developed a Personal Management Plan as a workable alternative to their Community Treatment Plan.
Final Tribunal Hearing October 2022
In October 2022 there was a final Tribunal hearing. The CCMHC argued in favour of continuing Nathan’s CTO on the basis that he may deteriorate to his former state without their medication. The Tribunal determined that if there was to be a further application for a CTO, the CCMHC personnel needed to provide evidence of having formed a ‘therapeutic relationship’ with Nathan. Although the CTO was enforced, there was certainly no attempt to form a relationship with Nathan, particularly in light of Nathan’s later detention and arrest.
Arrest and Hospital Detainment
In December 2022, in a blatant act of abuse, Nathan was arrested and detained in Concord Hospital for six days. The CCMHC insisted on obscure ‘safety’ reasons in the justification for their requirement of Nathan to attend the Centre to receive his injections. The prior arrangement of home visits suited Nathan better as he is nearly blind and is unable to walk unaided. In addition, he suffers from anxiety outside home and has been acting as carer for his elderly father. All of those factors impact his travel accessibility.
JA argued that it was unfair to change his in-home treatment to a centre arrangement and tried to negotiate the unsubstantiated and false allegation of ‘safety’. Despite continuing negotiations documented in emails, the CCMHC formally breached Nathan’s CTO without warning. As a consequence, Nathan was arrested at his home by two police officers, strapped into the back of an ambulance in front of neighbours, and detained in the Concord Hospital Locked Ward for six days, under guards’ supervision. Despite specialist reports stating that he was not disordered, he was detained for a longer period than necessary and forcibly injected.
Nathan’s Successful Independence from CTO
In preparation for the next Tribunal hearing, JA presented to the CCMHC’s treating psychiatrist Dr Dutta a report about the support and success of Nathan’s Personal Management Plan, asking her not to apply for a further CTO.
On April 17th 2023, the CCMHC again threatened Nathan with police if he failed to attend their office by midday. Naturally this instilled further stress in Nathan and his support network, as they scrambled to bring him to this impromptu and unnecessary appointment. Soon after issuing their threat however, the CCMHC unexpectedly decided not to pursue their CTO against Nathan. These confusing events make it clear that the CCMHC had no genuine intention of assisting Nathan overcome his condition. Rather than establishing a genuine therapeutic relationship with Nathan, as had been required by the Tribunal, the CCMHC had clearly been more committed to harassing, panicking and abusing Nathan.
To read more about forced medication, click here.