Obligatory dangerousness criteria in the involuntary commitment and treatment provisions of Australian mental health legislation

Objective

Involuntary commitment and treatment (IC&T) of people affected by mental illness may have reference to considerations of dangerousness and/or need for care. While attempts have been made to classify mental health legislation according to whether IC&T has obligatory dangerousness criteria, there is no standardised procedure for making classification decisions. The aim of this study was to develop and trial a classification procedure and apply it to Australia's mental health legislation.

Method

We developed benchmarks for ‘need for care’ and ‘dangerousness’ and applied these benchmarks to classify the mental health legislation of Australia's 8 states and territories. Our focus was on civil commitment legislation rather than criminal commitment legislation.

Results

One state changed its legislation during the course of the study resulting in two classificatory exercises. In our initial classification, we were able to classify IC&T provisions in legislation from 6 of the 8 jurisdictions as being based on either ‘need for care’ or ‘dangerousness’. Two jurisdictions used a terminology that was outside the established benchmarks. In our second classification, we were also able to successfully classify IC&T provisions in 6 of the 8 jurisdictions. Of the 6 Acts that could be classified, all based IC&T on ‘need for care’ and none contained mandatory ‘dangerousness’ criteria.

Conclusions

The classification system developed for this study provided a transparent and probably reliable means of classifying 75% of Australia's mental health legislation. The inherent ambiguity of the terminology used in two jurisdictions means that further development of classification may not be possible until the meaning of the terms used has been addressed in case law. With respect to the 6 jurisdictions for which classification was possible, the findings suggest that Australia's mental health legislation relies on ‘need for care’ and not on ‘dangerousness’ as the guiding principle for IC&T.     

The right of caregivers to access health information of relatives with mental illness

This article reviews the legal, ethical and practical challenges of complying with the Ontario Personal Health Information Protection Act (PHIPA) within the context of a Canadian mental health system that is overburdened and under resourced. The advent of deinstitutionalization has placed significantly increased responsibilities on the families of mentally ill individuals. While research evidences that involving family members in the care of their mentally ill relatives improves treatment outcomes, mental health practitioners constantly face the challenge of engaging family caregivers while also complying with privacy laws. The authors propose an Ontario Caregiver Recognition Act (OCRA) to formally recognize family caregivers as informal health information custodians based on the practice of other jurisdictions which incorporate the rights of family members actively engaged in providing care to their mentally ill relatives.     

US concept wars,civil liberties and the technologies of fortification

The horrific events of September 11, 2001 led to calls for the deployment of state-of-the-art security systems and the creation of an “invisible shield” to protect America. Such proposals immediately triggered debate about the constitutional ethics of surveillance in the United States. While there has been widespread support for the surrender of some cherished civil liberties in the war against terror, surveillance, especially the visual variety, is still seen to be innately un-American. Technologies like biometric face recognition systems, critics argue, are not consistent with the values of an open society and should consequently be considered with great caution. The widespread introduction of such invasive technology, pundits claim, would signal a victory for the terrorists.Many American commentators fail to recognize, however, that the United States, far from being the open society they imagine, has long been characterized by exclusion. Moreover, such exclusion is increasingly enforced by the same high technology of which biometrics is a part. In fact, for at least a decade before the declaration of the war on terror, the United States has been undergoing a multifaceted process of fortification both within its cities and at the US-Mexican frontier. Investigation of this phenomena reveals the central role of the US’s longest running concept war, the war on drugs. This paper argues that within this narrative biometric surveillance and the creation of “an invisible wall” should not be regarded as a break with American traditions but as the next organic phase of an ongoing process of fortifying the United States.