Oct 18, 2010

The ‘severe erosion’ of rights of mentally ill patients

The mentally ill are among the most vulnerable and disadvantaged people in society, and past scandals have led to provisions for routine external review of detention decisions, writes Sydney psychiatrist Dr Tad Tietze.

A young man, until recently a law student, is wrestled into the emergency department by two police officers. He is distressed, agitated and acutely paranoid. Convinced he is being tracked by local underworld figures, he believes they have hospital staff in their pay. As the psychiatrist taking on his care, I have to make a decision that has profound implications for him: should I detain and forcibly treat him even though he has done nothing to harm himself or others?

Public hospital psychiatrists have long had the power of preventative detention, a power that bodies such as the Federal Police have only recently and controversially been allowed in respect of anti-terrorism laws. The necessary debate over that legislation stands in contrast to the limited public discussion of recent limitations to the rights of patients detained in NSW mental health units.

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3 thoughts on “The ‘severe erosion’ of rights of mentally ill patients

  1. kate

    I know this isn’t directly on point but I’m hoping one of the Crikey brains trust can help me.

    I have a neighbour who presumably has some form of mental illness. She doesn’t answer her door and rarely ventures out, but she keeps her curtains open and we can see her front room when we walk down the street. Recently we became concerned because we hadn’t seen her around for several days. We called the police; they eventually broke in and discovered no-one was there, and the flat was in a state of squalor, unfit for human habitation, strewn with food and rubbish. Later we found out that her sister had visited and found her passed out on the floor, and had her taken to hospital. She discharged herself, and within hours had fallen and needed hospitalisation again (fortunately, this time she fell in the street outside her house, and neighbours called an ambulance).

    She got home yesterday and within hours she had called the police to say that her house had been ransacked by her sister, who had thrown all her things in the garbage. She was ratting through the garbage bins outside the house – I managed to persuade her that she could take the magazines back inside, but it really was better to leave all the rotten food in the garbage. She is incredibly thin (dangerously so, to my untrained eye), and claims to have stopped eating entirely. I tried unsuccessfully to persuade her to give me her sister’s phone number. I tried offering food but she refused.

    I don’t know what to do.

    I have been lucky enough not to have to think about mental illness most of my life. Strictly speaking none of this is any of my business but how can I ignore it? What should I do? I am genuinely concerned that if she is not involuntarily hospitalised she may die.

  2. Dr_Tad

    I can only give very general advice but in such cases it is often best for the local community mental health team to get involved. Anyone can refer a person who they are worried about. There may be medical, psychiatric or combined causes of the kind of pattern of behaviour you describe, but a proper mental health assessment would seem to be in order. The team will want to know the kinds of details you provide here.

  3. John

    Kate, bless you. Thank you for caring.

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