Acknowledgements endorsements Background methodology executive Summary 11 Recommendations 22 Article — general obligations 38

Mental Health Service System

248. 
     Mental health legislation regulates the practice of compulsory treatment, but despite legislative provisions for the ‘least restrictive alternatives’ or for measures of ‘last resort’, seclusion and restraint are frequently used in the mental health system in Australia, “despite a lack of evidence that they offer positive health outcomes” and “are commonly associated with further trauma, risk of violence and potential human rights abuse”²⁰⁸ (See also Articles 12 and 17)
     
249. 
     Research indicates that there are a broad number of factors leading to the incidence of restraint and seclusion:²⁰⁹
     
     1. 
        a lack of community based intensive support , which results in transfers to public and private acute inpatient facilities that are not adequately resourced to provide an adequate level of care;
        
     2. 
        the regular turnover of mental health services staff, which contributes to a lack of appropriately trained staff administering care on an ongoing basis;
        
     3. 
        high levels of pressure experienced by mental health services staff;
        
     4. 
        an ingrained culture of acceptance of the use of restraint and seclusion as a preferred ‘behaviour management’ technique; and
        
     5. 
        the failure of some psychiatrists to undertake independent assessments examining the most appropriate and effective care to prevent ‘behavioural issues’ from developing.
        

Case Study

Bill resides in a large psychiatric facility in Queensland. He has dual-diagnosis including a psychosocial disability. He instructed his solicitor that he did not have a mental illness and he wanted to have his Involuntary Treatment Order (ITO) revoked so he could leave the hospital and return to the community. At the next ITO review hearing Bill had legal representation. The Mental Health Review Team ordered that an independent psychiatrist examine Bill to determine whether he had a mental illness and whether the ITO was the least restrictive approach to take in treating Bill. The independent psychiatrist found that Bill did not have a mental illness and the least restrictive approach would involve revoking the ITO. The MHRT revoked Bill’s ITO. Bill is now working towards transition back to the community where he wants to live with the appropriate supports in place for him.