The help that John does not want

Roberts, Peter A

doi:10.5694/mja13.00164

Cited by 4 publications

(5 citation statements)

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“…As the law is currently interpreted, carers, case workers, and doctors must stand by, watching and waiting for the person to become a serious risk of harm to self or others before they can legally intervene. By then, the person might have lost insight into their illness and might resist police if confronted (Roberts ). However, people with a mental illness are more likely to have force used against them by police (Kesic et al .…”

Section: Discussionmentioning

confidence: 99%

Lived experience of involuntary transport under mental health legislation

Bradbury

Hutchinson

Hurley

et al. 2016

Int J Mental Health Nurs

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Police have historically been responsible for transporting people during a mental health crisis in Australia. A major change to the New South Wales (NSW) Mental Health Act (MHA) in 2007 expanded the range of coercive transportation agencies to include NSW Ambulance (paramedics) and NSW Health (mental health nurses). Anecdotal reports, however, describe a lack of clarity around how these changes should be implemented in practice. This research aims to explore this lack of clarity through qualitative analysis of interviews with people with the lived experience of involuntary transport under the MHA. Sixteen interviews were conducted; most (n = 14) interviews in northern NSW regions: six with people who had been transported (consumers), four with carers, and six with service providers (two police, one paramedic, and three mental health nurses). For consumers and carers, the police response was often perceived as too intense, particularly if the person was not violent. Carers were often conflicted by having to call for emergency intervention. Service providers were frustrated by a lack of a coordinated interagency response, resourcing issues, delays at emergency departments, and lack of adequate training. A central theme across all groups was the importance of communication styles. As one participant (consumer) said: 'Everybody needs a lesson in kindness'. All groups agreed that high-risk situations necessitate police involvement. However, invocation of the MHA during a high-risk situation is fraught with stress and difficulties, leaving little room for empathetic communications. Effective and diverse, evidence-based, early intervention strategies - both consensual and non-consensual - are necessary to reduce the requirement for police involvement in mental health transports.

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Section: Discussionmentioning

confidence: 99%

Lived experience of involuntary transport under mental health legislation

Bradbury

Hutchinson

Hurley

et al. 2016

Int J Mental Health Nurs

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“…In the accompanying scenario 4 there is a point where John's parents and his caseworker, Kate, are all concerned that John is showing signs of serious deterioration. At the point where Kate advises John's parents that she cannot force John to receive care there may be strong ethical grounds for non‐consensual intervention.…”

Section: Ethics In Practice: Case Scenariomentioning

confidence: 99%

“…However, people living with mental illness are increasingly recognised as a vulnerable population with high rates of exposure to traumatic life events; 2 and many are exposed to distressing experiences within mental health care systems. Being transported in handcuffs in a police vehicle has recurrently been reported as particularly distressing 3 (see also John's experience in the fictional scenario 4 ). A submission to the Australian Human Rights Commission's “Not for Service” inquiry summed up the experience within the context of perceived mental health service failures:…”

mentioning

confidence: 99%

Mental health emergency transport: the pot‐holed road to care

Bradbury

Ireland²,

Stasa

2014

Medical Journal of Australia

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Police have, historically, been the first point of contact for people experiencing a mental health crisis in the Australian community. Changes in the NSW Mental Health Act 2007 extended the powers and responsibilities for involuntary transport to paramedics and accredited mental health practitioners. The Mental Health Act also allows for police assistance to other agencies during transport of people living with mental illness if there are serious safety concerns. Involuntary intervention for people living with mental illness is based on risk-of-serious-harm criteria under the Mental Health Act, implying serious deterioration before the Act may be invoked. At the point of risk of serious harm, police involvement may be more frequently required according to the acuity of the situation. If the legal basis of non-consensual treatment under the Mental Health Act was lack of capacity, it would provide a more comprehensive legal and ethical basis for early intervention. Police contact is intensified in rural and remote regions, particularly after hours, where crisis assessments and intervention by health services are further stretched. Further reducing police involvement using strategies that increase access to consensual pathways of care for people living with mental illness, particularly for people in regional and remote areas, is desirable but not likely in the foreseeable future.

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“…Occasions of potential involuntary detention of patients who refuse treatment are not limited to dramatic situations involving the police, with such unfortunate outcomes as John's 1 . Consider the following scenarios: in a coronary care unit, a man wants to discharge himself without explanation one day after having a myocardial infarction; in a general practice waiting room, a patient with a serious head injury makes for the door saying he can't wait; in an emergency department, a young woman wakes up from a presumed overdose and demands to leave.…”

mentioning

confidence: 99%

Potentially incapable patients objecting to treatment: doctors' powers and duties

Eagle¹,

Ryan

2014

Medical Journal of Australia

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Generally, a patient may only be assessed and treated with his or her consent. It is difficult to interpret the law regarding doctors' powers and duties to assess and treat in cases where a patient refuses to accept medical advice but it is unclear whether the patient has decision-making capacity (DMC) or whether they are mentally ill. An examination of legal principles in this area suggests that there is a limited justification for doctors to detain a person for the purpose of assessment if they have good reason to suspect the person may either lack DMC or be mentally ill and if failure to detain the person is likely to lead to serious harm. This limited justification to detain would only apply for as long as the uncertainty about DMC or mental illness prevailed. Doctors have a duty to provide appropriate advice to patients who want to leave their care in circumstances where medical assessment or treatment may be required. Whether there is also a duty to detain someone in this situation is less clear, but we provide guidance to health care practitioners faced with this situation.

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The help that John does not want

Cited by 4 publications

References 0 publications

Lived experience of involuntary transport under mental health legislation

Lived experience of involuntary transport under mental health legislation

Mental health emergency transport: the pot‐holed road to care

Potentially incapable patients objecting to treatment: doctors' powers and duties

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