Mandatory Mental Health Services - Case Study Example

Review of Mandatory Mental Health Services The Mental Health Act 1996 contains of provision for the mandatory hospitalisation of patients for certain circumstances. As quoted from the act, “A person should be an involuntary patient only if- (a) the person has a mental illness requiring treatment; (b) the treatment can be provided through detention in an authorised hospital or through a community treatment order and is required to be so provided in order” (1996: 20). Specifically, Reasons for involuntary patient status include “(i) to protect the health or safety of that person or any other person; (ii) to protect the person from self-inflicted harm of a kind described in subsection (2); or (iii) to prevent the person from doing serious damage to any property” (1996: 20). The Act also includes provisions for early release of patients with mandatory community treatment orders. While there are more specifics to the conditions of being an involuntary patient, these basic guidelines are enough to understand the specific aspect of the Mental Health Act 1996 in order to be able to discuss the effects of the this act. Where this is specifically concerned is in regards to the Medical Treatment Act of 1988. The Act “clarifies the right existing under common law to refuse medical treatment” and “creates an offence of medical trespass where a medical practitioner carries out or continues any procedure or treatment that a competent person refuses” (MTA 2008). Most countries and governments have some version of this law enacted. The difficulty of having both this type of law enacted and the Mental Health Act 1996 is in the phrasing of “a competent person.” What constitutes a competent person might be open to interpretation. Furthermore, this wording might have been chosen to refer specifically to patients who were in an accident of some sort and were not conscious to a degree of being able to make informed decisions about the healthcare to be received. However, the problem is that there are not typically single events which set off mental health problems. To confound the problem even further, a patient might not be considered competent to refuse medication before receiving the kind of medication that the patient would ultimately receive; upon receiving the medication and gaining the mental faculty to do so, the patient should then have the right to be able to refuse medical treatment in accordance with the law. If a competent person is forced to receive medication, even if that medication is what is making the person competent, then to what extent should we consider this a human rights violation. Considering the severity of the implications of the possible human rights violation that might occur given patients’ inability to refuse treatment under the Act, it must be taken into consideration whether or not the measures are effective: “Detention and involuntary treatment represents a severe infringement of basic human and common law rights including freedom of movement and the right to refuse medical treatment” (Review 2007:6). If there are no gains to be made through these measures, or if the gains are too small, obviously there would be no reason for these kinds of human rights violations. “The principle of reciprocity suggests that where governments curtail freedoms they incur a reciprocal responsibility to provide for the best interests of the person whose rights are curtailed” (Review 2007:6). If the best interests of the involuntary patients are not being met, then the human rights violations should be put an end to quickly. The other option would be to determine the best way to ensure that the patients’ best interests would be met to justify the human rights violations. Beyond the detention of patients who are likely to incur harm upon themselves or upon others, the Act is meant to lower the costs of the mental health costs to the state by reducing the amount of time that patients are hospitalised. If the total costs of services incurred are not significantly lower than regular hospital stays, then the mandatory community treatment orders and the compulsory taking of medication is not an effective way to either treat patients or to lower costs in any way that’s beneficial to the state. There are many aspects of these measures which need to be studied. Varying factors make getting precise statistics problematic, and without precise statistics there is no way to determine how effective these measures actually are. Let us first consider the following statistic: “The majority of involuntary patients (approximately 65%) are taken off that status by their psychiatrist within the first 28 days of the order” (Barber 2001:36). This statistic by itself seem encouraging and positive, though we need to examine the rates of readmission, especially involuntary readmission, in regards to how we should determine what to think of this particular statistic. Also, we need to examine the rate of violent patients in regards to which patients are taken off of the involuntary status. It is likely that violence prone patients more than likely are not being released as readily as patients who are not prone to violence, and it is these patients who are going to be in need to extended hospital stays anyways. Considering this, it does not seem as though these patients should not be considered to be the same in regards to these studies and these statistics. As we can see, there are many facets to consider, and the more the problem is examined, the problem difficult the problem becomes. The studies that have been made to probe the question as to the effectiveness of these measures have had mixed results. Various studies have found different degrees of results, yet they do generally tend to agree that the current measures need to be improved upon for their overall effectiveness if the Act is to continue in anything close to its current version. Without any changes, the current version of the Act will not be able to affect the changes that it was meant to do. In one study, “Various forms of compulsory treatment in the community have been suggested as being effective in reducing use of services by patients with mental health disorders” (Preston et al 2002). This would suggest that, at least in this capacity, the measures are at least partially successful in reducing patients’ dependence upon the use of services. This alone is not on its own enough to suggest that the Act is effective as it should be. This is because the researchers found overall that “The study therefore raises questions about the effectiveness of such an invasive procedure as enforcing treatment in the community” (Preston et al 2002). Another study that at least partially found the Act to be effective said that “Community treatment orders can be a useful tool for some but not necessarily all objectives. In the form of conditional release, orders reduce the likelihood of extended hospital stays. As a means to prevent hospitalization, the utility of community treatment orders is more complex, being dependent on services provided and on the judicious selection of person for those orders” (Segel et al 2009). As we can see, this is a rather complex issue with many sides to consider. While the Act was effective to an extent in reducing the likelihood of extended hospital stays, the measures were not effective in preventing any or all future hospitalisations. It would seem as though one way to interpret this data would be to say that patients’ problems are merely being dealt with in the short term, but over an extended period we can see that patients are not being effectively treated to the extent of not needing further hospitalisations. Since this is the case, for this provision of the Act to be improved upon, psychiatrists must be able to decrease the need for future hospitalisations, because the entire point of compulsory community treatment is to reduce the time patients spend in the hospital. If, for instance, patients might be better served by being hospitalised for an extended period until their issues and mental health problems are properly dealt with, then compulsory community treatment has no real purpose. It might simply be a matter of the Act and its measures being more or less a revolving door, and while each visit might be shorter on its own, if the overall long term hospitalisation times add up to more time than one single extended hospital stay, then obviously the patients’ best interests are not being served and the human rights violation are meaningless. One of the main reasons behind these measures is because many of the patients who are affected by the involuntary patient status do not have the mental capacity to realise that they are in need of any sort of treatment by mental health professionals. Since the severity of these patients’ conditions would mandate that these patients would probably be unaware of human rights violations that were being incurred against them, it is important that the utmost care is taken in dealing with these patients. The United Nations has been monitoring the legislation in the countries which feature the sort of involuntary patient measures as what is featured in Australia. The United States and the UK both have similar sorts of measures in place, though each country is different in the exact wording and implications of legislation. What is interesting is that all countries tend to have similar results in regards to studies that attempt to determine the effectiveness of these measures, such as the studies that have been mentioned previously. In regards to Australia and the Mental Health Act 1996, “The United Nations Association of Australia believes that it is imperative for United Nations Conventions and Principles be incorporated into the wording of the Mental Health Act” (Clark 2003). Furthermore, the report stated that: It is disappointing to see that no where in the Act were the Principles specifically mentioned…We also believe that the Review should be aware of Australia’s human rights obligations as set out in the six main United Nations Conventions on human rights that have been signed and ratified by Australia (Clark 2003). Though mere wording of legislation alone cannot solve a problem if the laws and rules are not followed or misinterpreted, it is important to follow these guidelines as Australia has in fact already agreed to do so. This might be a small part of the problem, but ever part of the problem must be addressed in order for it to be solved. In conclusion, we need to keep in mind that the Mental Health Act 1996 did not solve all of the problems that it set out to do: “Community treatment orders alone do not reduce admissions” (Kisely et al 2004). It did, however, create more problems to deal with in regards to worrying about the extent to which human rights are being violated. As such, “Evaluation of the outcome should be included if this type of legislation is introduced” (Kisely et al 2004). As all of the studies mentioned have found, there needs to be further refining of the measures in order to achieve maximum effectiveness, and if the results yielded cannot be improved upon, the entire involuntary patient and compulsory community treatment aspect of the Act need to be done away with. Works Cited Australian Government, 2009 Mental Health Act 1996. Government printing service. Accessed February 2009, www.health.wa.gov.au/mhareview/resources/legislation/wa_mental_health_act_1996.pdf Australian Government, 2008 Medical Treatment Act. Government printing service. Accessed February 2009, http://www.health.vic.gov.au/mta/ Anglicare, 2007 Review of the Mental Health Act 1996. Anglicare printing services. Accessed February 2009, http://www.anglicare-tas.org.au/index.php?option=com_docman&task=doc_view&gid=72&Itemid=86. Barber, N. 2001 Mental Health Report 2001. Government printing services. Accessed February 2009, http://www.health.wa.gov.au/mhareview/resources/documents/Neville_Barber_Paper.pdf. Clark, C, 2003 Review of the Mental Health Act (MHA) 1996. Government printing services. Accessed February 2009, http://www.health.wa.gov.au/mhareview/submissions/docs/UN.A%20of%20AUS.pdf. Jones, C., Strengthening safeguards and support: Review of the MHA 1996. 2007. Government printing services. Accessed February 2009, http://www.health.wa.gov.au/mhareview/submissions/docs/UN.A%20of%20AUS.pdf. Kisely, S, Xiaou, J, Preston, N, 2004 “Impact of compulsory community treatment on admission rates.” British Journal of Psychiatry; 184: 432-438. Preston, N, Kisely, S, Xiaou, J, 2002 “Assessing the outcome of compulsory treatment in the community: Epidemiological study in Western Australia,” BMJ; 324: 244. Segal, S, Preston, N, Kisely, P, Xiaou, J, 2009 “Conditional release in Western Australia: Effect on hospital length of stay.” Psychiatric Services ; 60: 94-99. Read More