Australian mental health tribunals--'Space' for rights, protection, treatment and governance?

This paper draws on a multi-year Australian collaborative study of mental health review tribunals ('MHTs') in three jurisdictions (Victoria, New South Wales and the Australian Capital Territory) undertaken in conjunction with the NSW Law and Justice Foundation, using qualitative and quantitative methods to examine the role of MHTs in advancing goals such as fairness, legality and access to treatment. Study findings regarding stakeholder and client concerns - about access to quality treatment and associated support services, review of treatment adequacy and drug regimes, and their 'participation' or dignity of engagement in review processes - are presented as variants of the need for adequate hearing 'space': temporal, jurisdictional, cognate/relational, physical and symbolic, and 'connective'. Building on earlier arguments for MHTs to engage not only legal, but also clinical and social domains, and for adopting some processes more characteristic of case-conferencing, this paper examines the implications of tribunal 'flexibility' and a wider overall 'governance' jurisdiction in mental health.     

Responsiveness to the chlorhexidine epidural tragedy: a mental block?

Paralysis following an epidural anaesthetic is a rare event. The mechanism usually involves accidental injection of skin antiseptic instead of local anaesthetic. Two recent cases, one involving paralysis, the other a "near-miss", are described. The first case resulted in an extensive root cause analysis and an admission of liability by the hospital. The response of the anaesthetic community and the New South Wales Department of Health was swift but failed to produce uniform protocols across the region. Furthermore, the requirement of medical staff to double check medications with a second person before their administration was not addressed. Abandoning a more effective but neurotoxic antiseptic solution in favour of a solution with weaker antiseptic properties, as had previously occurred in one Sydney hospital, could incur higher risks of epidural infection. Defensive medical practice can lead to unwanted negative consequences.     

Terrorism and mental illness: is there a relationship?

This article examines the connections between mental illness and terrorism. Most social scientists have discounted a causal relationship between mental illness and terrorism. This is not necessarily always the case within terrorism studies, the media, or political circles where the psychology of terrorism is often expressed in the language of mentalisms, and theories of pathologisation continue to exist. This article reaffirms the view that apart from certain pathological cases, there is no causal connection between an individual's mental disorder and engagement in terrorist activity. The individual terrorist's motivations can be explained by other factors, including behavioural psychology. However, there may be a connection between an individual engaging in terrorist activity and developing a mental disorder[s]. Certain stressors that occur because of terrorist activity may result in psychological disturbance in terrorist individuals. These factors may partially explain terrorist group instability and should be taken into account when detaining and interrogating terrorist suspects.     

Fat and the law: who should take the blame?

The incidence of obesity in both adults and children is rising at a rapid rate in most developed countries, including in Australia. Some obese people are seeking to place the blame for their condition on the fast-food industry, as demonstrated by the recent litigation in the United States brought by two obese plaintiffs against McDonald's. This litigation was unsuccessful, and on existing Australian negligence principles any similar litigation commenced here is likely to suffer the same fate. Principles of personal responsibility, autonomy and free will should prevail to deny a negligence claim. The risk of obesity and concomitant health problems from eating fast food to excess is an obvious risk which the plaintiff should not have ignored and which he or she has voluntarily assumed. It is for the Australian Government, not the courts, to regulate the behaviour of the fast-food industry. The government should take action by requiring all major fast-food chains to label their products with nutritional information, and by imposing restrictions on the advertising of food to children.     

Who do I turn to? Resolving complaints by mental health consumers and carers

The current Australian system for handling complaints by mental health consumers and carers against service providers is complex and difficult to navigate. Complaints may be made to a range of people and organisations, including the relevant mental health service, community or official visitors, Health Services Commissioners, Chief Psychiatrists, Public Advocates, Ombudsmen and Members of Parliament. This Legal Issues column provides an overview of the law relating to complaints handling by community or official visitors, health service commissions and offices of the Chief Psychiatrist. It argues that while health service commissions may provide the best current avenue for complaints, there is a need for independent, centralised complaints bodies in Australian jurisdictions with similar powers to that of the Mental Welfare Commission for Scotland.     

Dosage of treatment to sexual offenders: are we overprescribing?

A sample of 337 offenders who received treatment in a variety of sex offender treatment programs in the Ontario region of Correctional Service Canada between 1993 and 1998 were divided based on the highest intensity sex offender programming that they received (low, moderate, and high). The three groups were compared with reference to a variety of actuarial risk assessment measures, criminogenic factors, and the number and type of treatment programs completed. It was hypothesized that the high-intensity group would have more criminogenic risk factors, higher actuarial scores, and participate in more treatment programs than both the moderate- and low-intensity groups. The results indicate that in general, the hypotheses were supported. Nonetheless, the results suggest that the low-intensity group may be receiving too much sex offender-specific treatment.