Legislative Council Wednesday 10 April 2019

Ms FORREST - Mr President, I support the bill.  I want to make some comments on it and talk about some of my concerns about getting access to mental health care when people are requiring this level of treatment.

The Mental Health Bill, when it was introduced in Tasmania many years ago - I think it was 1996 - was deemed to be revolutionary in some respects.  It had a 12-month review clause in it because of that.  That 12-month review took 13 years.  This was when the Labor Party was in power.  I moved to establish a select committee to look at it.  That was vehemently opposed by the then minister for health, Lara Giddings.  But we pushed on, as we do in this House, and inquired into the provisions of the Mental Health Act, and undertook that long overdue review. 

The government of the day was doing some work at the time.  Our inquiry certainly informed the Mental Health Act 2013 and enshrined, as the member referred to, the United Nations Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care.

People with mental illness, particularly very serious mental illness, are very vulnerable members of our community.  We need to do whatever we can to ensure they get appropriate and adequate treatment in appropriate and adequate facilities by appropriately and adequately trained people.  Sometimes a decision is made to deprive them of their rights and liberties, detain them to do so and put them on involuntary orders, which means they have no choice.  It is a really serious measure.

So when these measures are being applied to any individual, any Tasmanian, we need to take it very seriously, to make sure they maintain their human rights.

It is a complex and complicated area in many respects, but it is excruciatingly important to ensure we look after people who are very vulnerable but in need of care and treatment in quite a restrictive environment at times.

The new Mental Health Act was implemented in 2013; when it was debated, it was acknowledged there would probably be further requirements for amendments at a later time, as we find with all our legislation. 

Are we not seeing that this week?  Another bill coming up later is all about fixing problems picked up with the operation of an act.

The protections put in place under the section 47A provisions were to require the Mental Health Tribunal to conduct a review with three members of the tribunal, regardless of whether a recent review had been undertaken of an order or another one was to be conducted very shortly in terms of the statutory time frame for those reviews to occur.

We were informed in the briefing that it is somewhat problematic at times because these reviews often have to be carried out where the patient is.  It is costly, but the cost is not so much the issue; more importantly, it can be very stressful and intimidating for the patient.  We heard that during the briefing, and we know from advocates, patients with mental illness and Mental Health Tribunal members that it is a fact.

In my view, this is an appropriate amendment to enable one member of the tribunal to conduct this particular review.  As the Leader said, it does not remove the requirements for these other statutory reviews to be undertaken in this process.

Children as well as adults are subject to these provisions.  With children, special provisions are made to ensure their rights are maintained, and that they are provided with the appropriate level of support at such a difficult time as this.

On that point, we have been told for many years that we are going to get a secure mental health facility for young people and adolescents.  As have other members, I have had constituents come to me because they are the parents of young people with very significant and serious mental illness who require admission to a child and adolescent mental health facility.  We all know that we have been told for years, under previous and current governments, that such a facility was going to be built.

We have not built one yet.  We are in the process of building one, but it is not staffed yet, and I understand it is not necessarily funded yet.  Until we have that, we need to be sure we provide adequate support facilities and care for these people.

I am aware of a young person under the age of 18 who is an inpatient of the acute, secure adult mental health ward at the Royal Hobart Hospital.  She has been there for at least 12 months.  It is a highly inappropriate facility for her care.  I understand too from queries I have made that there appears to be a memorandum of understanding for children younger than she is, maybe 13 and younger, where they can be transferred to a Victorian facility and be provided with the care they need there.  That does not appear to exist for young people around the age of 13 to 18.

What happens to these people?  I had a constituent of mine, a 17-year-old young woman, who needed admission to one of these facilities.  There is nothing in Tasmania.

She made a suicide attempt, which thankfully was unsuccessful, but it was pure maternal instinct that prevented that.  Her mother went in to check on her and found her just in time, literally.  She ended up in the ICU at the Burnie hospital, just in time. 

We need to be sure, if we do not have these facilities in the state, that we provide access to these facilities in Melbourne.

The good news is I understand this young woman will be transferred this week or next week to a facility in Melbourne.  This is after at least 12 months of being in the most inappropriate care setting.

However, I am informed the Child and Adolescent Mental Health Service has refused to look after her when she comes back.  I am saying that here.  I have been told this and raised it with the minister because it is a very serious concern.

She will probably be a few weeks in the appropriate facility in Melbourne.  She will no doubt receive good age-appropriate care.  Her mental illness problems will not disappear because of that admission and she will need care when she comes back.  What then?  If what I have been told is proven to be the case, it is disgraceful and I hope something happens to prevent it.

There is one live case right here, right now in Tasmania.  Another one - and these are just two I am talking about - is a case on the north-west coast that I know quite well.  I will leave the Government to respond to that point either now or at a later time.

Another point raised during the briefing was that an argument for this change was the cost associated with the hearings, where three members of the tribunal are required to conduct them under section 47A of the act, Admission to prevent possible harm.

This was introduced on 1 July 2017, and we were informed that in the first year of its operation, the cost of conducting those 82 hearings was $30 000.  There may have been a hearing that heard two or three cases on one day, so it was not 82 individuals, and it could have been an individual admitted and then discharged from another treatment order, a compulsory treatment order, and then readmitted later on.  It is not necessarily 82 people.

In the roughly nine months from 30 June 2018 to now, it has cost $40 000 with 104 hearings.  That is a huge increase in the number of hearings.  I would like the Leader to address this now, if she can; if not, it will be a question for a later time.  The minister can expect some of these questions to resurface during Estimates

Why are we seeing such an increase in people needing to be treated in such a restrictive manner?  Is it because we are not providing the appropriate services for their care in the community?  Is it because they cannot access appropriate facilities in other places and are not being managed well in the community?  We do not have enough appropriate mental health service providers or access to mental health care, which is why so many Tasmanians are having their rights and liberties removed for a legitimate purpose - yes, but why are we seeing so many?

It concerns me that we are not serving the people of Tasmania well - those who have acute mental health illnesses that require compulsory treatment - to ensure they have the best chance of recovering from their illness.

The protections provided in this review framework are vitally important and of course must continue.  We are not changing that; we are just changing the number of members of the tribunal who conduct this particular review.

I support the amendment.  To me it is not about cost.  The cost is obviously a matter and when we reduce it down to tribunal member, the money is not hypothecated and it does not go back into mental health, because we save it here.  We need to ensure adequate money is spent on mental health services, particularly for people who have acute mental illness who require high levels of care, often in a restricted environment.

If the Leader cannot answer those questions now, I do not intend to hold up the deal at all, but I just wanted to put them out there.  If there are opportunities to follow my questions up, I would appreciate that.