Criminal and civil community-based "detention": some parallels

Over the last 20 years, governments in Australia and elsewhere have increasingly embraced the notion of community-based treatment of the mentally ill in preference to detention in a mental health facility. At the same time, governments have also embraced the notion of community-based treatment and punishment of criminal offenders in preference to detention in a custodial facility. This article examines the use of Community Treatment Orders (CTOs) within the Victorian mental health regime, and the use of Intensive Correction Orders (ICOs) within the Victorian criminal justice regime. It is argued that a number of striking similarities can be found in the respective legislative schemes and policy considerations.     

Dilemmas for clinicians in use of Community Treatment Orders

Clinicians who treat patients using Community Treatment Orders (CTOs) face many potential dilemmas in their relations with involuntary outpatients and the exercise of their powers. We compare the dilemmas identified in the literature with those reported by responsible clinicians in New Zealand (NZ). These clinicians experienced a number of well-known dilemmas, such as determining the right moment for a person's discharge from a CTO, but they seemed less troubled by some other difficulties than might be expected, usually because they considered involuntary outpatient treatment the best option for the patient or the best way to manage the risks involved. Further dilemmas were identified by the NZ clinicians that have not been widely discussed, concerning the proper scope of clinical authority over patients under CTOs and the decision to revoke involuntary outpatient status. In conclusion, some suggestions are made as to how clinicians might best manage the dilemmas involved.     

New assisted reproductive technology laws in Victoria: a genuine overhaul or just cut and paste?

A new Assisted Reproductive Treatment Act was passed in Victoria on December 2008 and came into effect on 1 January 2010. The new legislation changed who was eligible for assisted reproductive technology (ART) and the types of services that clinics could provide. This article reports on interviews with service providers in Victoria who experience first hand the impact of legislation on clinical practice and patients, as well as regulators who are able to provide insight into the values underpinning the regulatory framework. The new legislation was viewed by all participants as an improvement on the old Act because of the removal of discriminatory and ambiguous aspects. The authors argue that while some of the details of the legislation have changed, the underlying principles and the framework have not.     

Donor conception legislation in Victoria, Australia: the "Time to Tell" campaign, donor-linking and implications for clinical practice

The State of Victoria in Australia was one of the first jurisdictions in the world to introduce legislation regulating donor conception. Under the Infertility (Medical Procedures) Act 1984 (Vic), donor-conceived people, aged 18 years and over, parents of children under 18 years, and donors gained the right to apply for the release of identifying information about each other recorded in a Central Register. As a result, of this and subsequent legislation, services providing donor treatment were obliged to change clinical practice relating to recruitment of donors, counselling of donors and recipients and recordkeeping. Since this legislation was introduced in 1988, over 5,000 donor-conceived children have been born and in 2006 the first 100 of these children reached the age of 18. The Victorian Infertility Treatment Authority (ITA) conducted a public education campaign to provide information and support to people affected by the legislation. This article describes clinical practice changes prompted by legislation, the 'Time to Tell" campaign and the service model developed for linking parties on the donor registers. The Victorian experience demonstrates that laws allowing the parties involved in donor conception access to information about each other must be accompanied by changes to clinical practice, public education about the implications of the laws, and services to meet the needs of those seeking information relating to donor conception and those contacted as a result.     

Penal abolitionism: a different kind of reform

Rates of reoffending are high, both for people leaving prison and people on community sentences: the reconviction rate for all custodial sentences is 46.8 per cent, rising to 56.8 per cent for custodial sentences less than one year in duration. The reconviction rate for Community Orders is 36.8 per cent (Ministry of Justice, 2011).

Reoffending is expensive. Prison costs £45,000 per prisoner per year, plus £170,000 to build and maintain each new place (Prison Reform Trust, 2010). Cheaper community sentences can still cost £4,200 per offender per year. Many people in the criminal justice system have multiple and complex needs. For example, 72 per cent of male and 70 per cent of female sentenced prisoners suffer from two or more mental health disorders (ibid).     

Problems with the regulation of assisted reproductive technology: a clinician's perspective

The use of the Infertility Treatment Act 1995 (Vic) as a model for regulating reproductive technologies throughout Australia poses many problems. This article argues that the legislation in Victoria is overly restrictive. In particular, banning embryo research is hypocritical. Embryo research was required to develop the clinical procedures and should be used to test innovations. Other problems are restricted access; privacy infringement; an intrusive regulatory body; conflicts with other laws; and confusion because of poor drafting or lack of foresight. Uniform statutes are unnecessary. The interests of individuals and the community are better served by regulation through the Reproductive Technology Accreditation Committee.     

An australian adolescent sex offender treatment program: Program and client description

Abstract

The following paper outlines the key components of the Adolescent Sex Offender Treatment Program (ASOTP), an Australian program that provides assessment and therapeutic services to children and adolescents with sexually abusive behaviours. The ASOTP is auspiced by the Children's Protection Society (CPS), Melbourne, Victoria, Australia. If is committed to an integrated program model, which focuses on the parallel process of work with child and adolescent victims and perpetrators of sexual abuse. Specific attention is paid to describing the main modules of the formal group therapy program, which most clients enter following risk assessment. Criteria for assessing positive outcomes are also outlined. The characteristics of children and young people who have attended the ASOTP are described, including prior history of victimisation and self-reported problem behaviours as assessed by the Achenbach Youth Self-Report Form. A summary of sexually abusive behaviour and victim characteristics is also provided. Findings are discussed in light of relevant practice and systems issues.     

Social media for social change lawyers: an Australian housing rights lawyer's experience

This paper reflects on the use of Twitter and Facebook at the PILCH Homeless Persons' Legal Clinic (HPLC), and the lessons for social change lawyers. While these two forms of social media have been useful tools in the HPLC's mission to address the systemic and structural issues that impact on people experiencing homelessness in Victoria, Australia, there have been salutary lessons in their deployment, engagement and impact. This paper, written in autoethnographic form by a former HPLC manager, reflects on the costs and benefits of these new media forms for ‘social change lawyering’.     

The POLST (Physician Orders for Life-Sustaining Treatment) paradigm to improve end-of-life care: potential state legal barriers to implementation.

The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm is designed to improve end-of-life care by converting patients' treatment preferences into medical orders that are transferable throughout the health care system. It was initially developed in Oregon, but is now implemented in multiple states with many others considering its use. An observational study was conducted in order to identify potential legal barriers to the implementation of a POLST Paradigm. Information was obtained from experts at state emergency medical services and long-term care organizations/agencies in combination with a review of relevant state law.     

A qualitative analysis of the use of community treatment orders in Saskatchewan

This study examined the opinions of patients who have been placed on a community treatment order (CTO), their relatives, mental health clinicians and representatives of community agencies about the use of CTOs in Saskatchewan. Patients were assessed using indepth interviews, while their relatives, mental health professionals and representatives of community agencies took part in facilitated focus groups. Patients had contradictory feelings about CTOs. Most experienced some degree of coercion while on the orders but many believed that CTOs provided necessary structure in their lives. Clinicians were more consistently positive but recognized the difficult choices in balancing the subject's right to self-determination with the benefits of a treatment order. Family members viewed CTOs as necessary to control a chaotic situation caused by the subject's limited insight.     

Social disadvantage, mental illness and predictors of legal involvement

The following study evaluates the complex association between legal involvement and mental illness. It describes a population of consumers of community mental health programs, comparing those with legal involvement to those without legal involvement, on a number of demographic, clinical and social indicators. It is a secondary analysis of data collected in studies making up the Community Mental Health Evaluation Initiative (CMHEI) in the province of Ontario, Canada. Legal involvement was a significant issue among community mental health program consumers; about one in five consumers had at least some contact with the legal system in the preceding nine months. Legally involved consumers were more likely to be in receipt of social assistance and be unstably housed than those legally uninvolved. However, there were no significant differences between legally involved and uninvolved consumers with respect to severity of symptomatology, current medication use or number of hospitalization days in the past 9 months. A predictive model compared the differential impact of clinical and social determinants upon legal involvement. Analyses failed to uncover a significant relationship between severity of psychiatric symptomatology and legal involvement. Significant predictors of legal involvement included gender, race, drug use as well as housing instability, and receipt of social assistance. Legal involvement was attributable to factors other than the severity of mental illness; these results challenge assumptions that the most symptomatically severe consumers are most at risk of legal involvement. Accordingly, the rate of legal involvement in a sample of community mental health program users must be considered in a broad context, with particular emphasis on social disadvantage.     

Regulation of donor conception and the "time to tell" campaign

The first jurisdictions in the world to introduce legislation regulating donor conception were Victoria (Australia) and Sweden in the 1980s. Under the Infertility (Medical Procedures) Act 1984 (Vic), donor-conceived people (aged 18 years and over), their parents (if children were under 18 years) and donors gained the right to apply for identifying information about each other. Information can only be given with the consent of each party. To date, over 3,500 donor-conceived children have been born in Victoria since the 1984 Victorian legislation was introduced (and enacted in 1988). The first 106 donor-conceived children under this legislation turned 18 in 2006 and many of them may not know that they are donor-conceived. The Infertility Treatment Authority, Victoria, conducted a public education campaign to provide information and support to people affected by the legislation. The campaign and services associated with donor registers have had a significant initial impact.     

Social justice and women leaving prison: beyond punishment and exclusion

Questions related to social justice are often considered frivolous or irrelevant in the context of people who come into conflict with the law. Young (1990, Justice and the politics of difference, Princeton University Press) has pointed to the importance of social justice, especially in societies where the dominant perspective of the privileged is regarded as neutral (and presumably fair), while others remain oppressed and excluded. We investigate the relevance of social justice in the treatment of women who are in prison. Based on more than a decade of practice and four years of research with women in one of Canada's federal prisons for women, we explore the question of social justice in the context of a recreation and leisure initiative whose aim is to assist women not only while they are incarcerated but most especially on release. The social recreation program is brought into the prison by a restorative justice community‐based organization. Men and women from the community come into the prison to recreate together and, in that context of natural conversation, relaxation and dialogue, Circles of support may develop. If a Circle is formed, volunteer members then follow the woman into the community and support her efforts to live as a participating citizen on release. The relevance of the work of Circles in furthering social justice within a system that, despite recent potentially innovative approaches to incarcerating women, has struggled to move beyond traditional practices of punishment and exclusion, which tend not to encourage strong and healthy community life, will be explored.     

Back for the future: a client centred analysis of social welfare and family law provision

The landscape of legal advice provision is entering a period of significant change in England and Wales. Whilst there is a great deal of uncertainty about how the future landscape of advice service provision will evolve, there are lessons to be drawn from past delivery models.

This article first looks back at the period following the Access to Justice Act 1999, setting out a range of delivery models initiated following the Act, as well as research and evaluation conducted in the millennium decade. Findings are then presented from a comprehensive qualitative study on how people experience and deal with social welfare and family problems, and on facilitators and barriers to integrated advice provision, including inter-organisational working. This is explored through the lens of a delivery model which emphasised partnership and the pooling of resources and specialisms to meet client needs: the Community Legal Advice Centre model.     

Drawing the Necessary Line: A Review of Dating Domestic Violence Statutes around the United States

Orders of protection help combat dating violence by ensuring a period of separation between the victim and the abuser. The prevalence of dating violence is similar to that of spousal abuse and the effects on the nonmarried victims are just as severe. Some jurisdictions in the United States do not offer victims in dating relationships protective orders and two states restrict orders for same‐sex couples only. Other state statutes are inadequate. A uniform statute that permits participants in dating relationships access to protective orders should be implemented across the country.

Key Points for the Family Court Community:
• See and understand the changes in dating domestic violence statutes
• Up to date as of 2011 with 2012 amendments to state statutes

     

The Importance of Ecological Context for Correctional Rehabilitation Programs: Understanding the Micro- and Macro-Level Dimensions of Successful Offender Treatment

The resurgence of support for offender rehabilitation has led to an increased emphasis on correctional program integrity. Treatment programs are now being evaluated and tailored in accordance with the principles of effective intervention, which are rooted primarily in methods of individual behavior modification through a social learning approach. The problem with this exclusive focus on the individual is that it fails to recognize the importance of certain ecological factors that have been shown to be significant predictors of recidivism. The purpose of the current research, therefore, is to examine the impact of structural characteristics on both treatment program quality and effectiveness of halfway house programs in Ohio. Our results reveal that ecological context influences the magnitude of program treatment effects largely indirectly though its influence on program quality. The implications of these findings for correctional theory and practice are discussed.     

How research ethics' protections can contribute to public policy: the case of community treatment orders

Though community treatment orders (CTOs) were first used in 1986 in Australia, debate about their clinical and ethical merits continues even today. For some, the benefits of reduced frequency and duration of involuntary hospitalizations are believed to adequately outweigh the harms of restricted liberties in community living. For others, however, such benefits are believed to be achievable by simply arranging integrated, devoted community resources sans any threat of forced re-hospitalization. In response to this enduring controversy, this article examines the ethical merits of community orders using a novel approach. “Novel” because the examination is based on research ethics and its foundational principles.When hospital and community clinicians, family members, consumer/survivors, and advocacy groups discussed the idea of amending Ontario's mental health legislation to permit CTOs in the late 1990s, evidence of their effects and efficacy was very limited. Moreover, an order was characterized much like standard pharmacological or medical therapies because the person or an appropriate substitute decision maker's consent was necessary to authorize the order or make it valid. These two factors prompted this retrospective analysis: if CTOs - as a public policy initiative - had been treated like most other promising therapies, would any different ethics-related concerns have been raised that, in turn, would have benefited the public debate and the legislature's decisions? In other words, if respected safeguards that apply to new drugs and medical devices had applied to CTOs, would anything have changed?     

Engagement processes in model programs for community reentry from prison for people with serious mental illness

Linking prisoners with mental illness with treatment following release is critical to preventing recidivism, but little research exists to inform efforts to engage them effectively. This presentation compares the engagement process in two model programs, each representing an evidence-based practice for mental health which has been adapted to the context of prison reentry. One model, Forensic Assertive Community Treatment (FACT), emphasizes a long-term wrap-around approach that seeks to maximize continuity of care by concentrating all services within one interdisciplinary team; the other, Critical Time Intervention (CTI), is a time-limited intervention that promotes linkages to outside services and bolsters natural support systems. To compare engagement practices, we analyze data from two qualitative studies, each conducted in a newly developed treatment program serving prisoners with mental illness being discharged from prisons to urban communities. Findings show that the working relationship in reentry services exhibits unique features and is furthered in both programs by the use of practitioner strategies of engagement, including tangible assistance, methods of interacting with consumers, and encouragement of service use via third parties such as families and parole officers. Nevertheless, each program exhibited distinct cultures and rituals of reentry that were associated with fundamental differences in philosophy and differences in resources available to each program.     

Judges as legislators

Among the regulatory measures intended to control the transboundary movement of hazardous waste is the European Community Regulation concerning the Supervision and Control of Shipments of Waste within, into and out of the European Community, 1993, and it is this Regulation, in particular, that this work intends to treat. In this context, the European Parliament's attempts to counteract the weight of economic argument in favour of the conflicting interests of human health and the environment will be examined. Despite international and European Community regulation, it is submitted that double standards in law and practice are continually applied to the transboundary movement of hazardous waste. Emphasis will be placed on both the international and European dilemma of defining hazardous waste.