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.     

Rights-based mental health legislation and the right to be treated

Following the United Nations Declaration on the Rights of Persons with Mental Illness (1991), the Australian Government released the National Mental Health Policy in 1992. Pointedly, the Report of the National Inquiry into the Rights of People with a Mental Illness in 1993 was critical of the failure of a number of Australian jurisdictions to adequately protect the rights of people with mental illness. A subsequent critique of the capacity of mental health law and policy to respond to current and future challenges of community-based care suggested that while Australian legislation and policies may pass human rights scrutiny in principle, there was insufficient focus on the monitoring processes to ensure implementation and adherence to those measures. The new Commonwealth Attorney-General has foreshadowed the development of a Charter of Rights to create a framework for legislators and regulators when drafting legislation to cover "aspirations" such as the recognition of fundamental human rights. However, it is argued that the dilemma of how best to care for and protect those afflicted with mental illness as well as the public who may be affected by violence or offending by those persons with untreated mental illness, will not be resolved by resort to a didactic Charter of Rights, however idealistic or well intentioned.     

A comparison of mental health legislation from diverse Commonwealth jurisdictions

IntroductionIn the regulation of involuntary treatment, a balance must be found between duties of care and protection and the right to self-determination. Despite its shared common roots, the mental health legislation of Commonwealth countries approaches this balance in different ways. When reform is planned, lessons can be learned from the experiences of other countries.MethodCriteria for involuntary treatment used in a sample of 32 Commonwealth Mental Health Acts were compared using a framework developed from standards derived from the Universal Declaration of Human Rights. Reasons for non-compliance were considered and examples of good practice were noted. Changes in the criteria used over time and across areas with differing levels of economic development were analysed.Results1. Widespread deviation from standards was demonstrated, suggesting that some current legislation may be inadequate for the protection of the human rights of people with mental disorders. 2. Current trends in Commonwealth mental health law reform include a move towards broad diagnostic criteria, use of capacity and treatability tests, treatment in the interests of health rather than safety, and regular reviews of treatment orders. Nevertheless, there are some striking exceptions.DiscussionExplanations for deviation from the standards include differing value perspectives underpinning approaches to balancing conflicting principles, failure to keep pace with changing attitudes to mental disorder, and variations in the resources available for providing treatment and undertaking law reform. Current good practice provides examples of ways of dealing with some of these difficulties.     

Refining the definition of death for Australian legislation

In the article Mr. Smith considers the need for reform in the area of defining when death occurs and the various approaches that exist to define death. He then analyses the stages of the developments in the various Australian jurisdictions and discusses the substantive content of the basic definition adopted and the practical implications of any enactment. The author suggests that the concept of death should be legislatively enacted in relevant pieces of legislation which call for a resolution of the question at the present time and a more general separate statement defining death should be avoided at the moment. Conceptually death should be defined as the permanent and irreversible loss of consciousness of the individual as determined by irreversible cessation of the brain stem function. The actual operational criteria of death should form the subject of a circular published by the relevant statutory health authority for the guidance of medical practitioners in relation to the specific problems they face.     

What police want from liquor licensing legislation: the Australian perspective

Qualitative interviews were undertaken with 53 Australian police officers with specialist expertise in liquor law enforcement to ascertain their perspectives concerning the liquor licensing legislation in Australia’s eight states and territories. Respondents generally indicated that current arrangements favoured the interests of the alcohol industry and did not sufficiently empower them to reduce alcohol-related harms. Other key themes included: ambiguity surrounding the police role in liquor licensing; difficulties in enforcing drunkenness-related offences; partnerships; strategies to enhance enforcement; data/intelligence gathering; and the separation of Ministerial responsibilities for liquor licensing and policing. Overall, police in Australia are not currently being given the tools they require to effectively reduce alcohol-related harms.