Submission to the Review of the Mental Health Act 2000

Transcription

1 Submission to the Review of the Mental Health Act July / 31 July 2014 Mental Health Act Review

2 Introduction The Queensland Council of Social Service (QCOSS) is Queensland s leading force for social change, working to eliminate poverty and disadvantage. With more than 600 members, QCOSS undertakes informed advocacy and supports a strong community sector. QCOSS s key activities focus on providing effective policy advice, work to strengthen responsive community services and having productive partnerships with government, private sector, the media and the sector. This work is done with a Queensland free of poverty and disadvantage front of mind. QCOSS is also funded by the Queensland Government to undertake advocacy to improve culturally and linguistically diverse (CALD) communities access to services and their social and economic participation in Queensland. As part of this role, QCOSS convenes the Queensland Accessing Interpreters Working Group (QAIWG) of non-government representatives providing advice to Government on access to language services in a linguistically diverse state. A number of Australian and Queensland research studies have highlighted the risk of mental illness among migrants and refugees who have experienced significant stress in the pre and post migration periods. Their health and well-being is a matter of human rights and is also critical to their effective social and economic participation. QCOSS welcomes the opportunity to make a submission to Queensland Health in relation to the review of the Mental Health Act QCOSS supports reform of the legislation that will: 1. facilitate greater support to patients, and 2. strengthen appropriate protections for the rights of people from refugee and disadvantaged migrant backgrounds. Key recommendations QCOSS makes the following recommendations: 1. That amendments to the Mental Health Act 2000, the Hospital and Health Boards Act 2011 and Queensland Mental Health Commission Bill 2012 provide for the inclusion of principles and objectives that mandate the responsiveness of services under the Act to patients of culturally and linguistically diverse backgrounds. 2. That an amendment be made to the Hospital and Health Boards Act 2011 to include as a principle the requirement to use qualified interpreters for patients from culturally or linguistically diverse backgrounds as part of the provision of all health care services. Additionally that this principle be included as part of the amendments to the Mental Health Act That should the proposed amendment to introduce the Independent Patient Companions be agreed, the program be placed within the Office of the Public Advocate. 4. That an amendment to the Mental Health Act 2000 be introduced to require mental health services to involve guardians appointed by the Queensland Civil and Administrative Tribunal (QCAT) 2 / 31 July 2014 Mental Health Act Review

3 5. That should the proposed amendment to introduce a community category of forensic order be agreed, government acknowledge and resource the role of the non-government service providers, particularly ethno-specific services providers working with patients from culturally and linguistically diverse backgrounds. 6. That should amendments be made to create options for more timely facilitation of transition of persons with Involuntary Treatment Orders to community, government acknowledge and resource the role of the non-government service providers, particularly multicultural and ethno-specific services. 7. That monitoring devices for patients on Involuntary Treatment orders not be introduced having regard for the potential effects on survivors of torture and trauma. 8. That should the amendment to require legal representation for patients at Mental Health Tribunal meetings be agreed, government be required to provide specific training to legal practitioners in cross cultural competence and in how to work with an interpreter in cases involving persons from culturally and linguistically diverse backgrounds who experience communication difficulties. 9. That should the proposed amendment to give powers to the Magistrates Court on findings of unsoundness of mind or unfitness for trial be agreed, there would need to be greater access to interpreters for assessments of persons from culturally and linguistically diverse backgrounds who experience communication difficulties. Deprivation and disadvantage One in five Queenslanders are born overseas, more than a third are either overseas born or have at least one parent born overseas, speak more than 220 languages and approximately one in 10 Queenslanders speaks a language other than English at home. Overseas migration continues to be the largest contributor to the State s growing population. Since 2011 to June 2014, almost 7000 new humanitarian entrants have settled in Queensland (Department of Immigration and Border Protection, 2014). In May 2014, humanitarian settlement services were provided to approximately 2000 new arrival humanitarian entrants in Queensland. In the March quarter, 2014 more than overseas born persons in Queensland were in receipt of the Commonwealth Disability Support Pension (Department of Social Services, 2014). Queensland also receives and supports Unaccompanied Humanitarian Minors, a population group who have experienced significant trauma. As at 30 April 2014, there were 87 Minors in Queensland (Department of Immigration and Border Protection). The Queensland Program of Assistance to Survivors of Torture and Trauma (QPASTT) provides counselling and support services to approximately 2000 individual clients per year who have been tortured or who have suffered refugee related trauma prior to migrating to Australia. In QPASTT also ran more than 48 sets of groups totalling 545 group sessions with clients coming from 68 different countries of origin and services provided in 53 different languages. Awareness of the prevalence of mental illness amongst refugee communities is increasing. Studies of the social and emotional well-being of CALD young people in Queensland identify a number of risk factors in their struggle to maintain mental health. This can be achieved only when mental health clinical services become more attuned to the issues of identity, self-worth and loss for these young people (Gorman et al, 2003, Brough et al, 2003). 3 / 31 July 2014 Mental Health Act Review

4 Studies of Sudanese refugees living in Southeast Queensland highlight the compounding difficulties of coping as they moved from pre-migration trauma, during the transit phase and during the post-settlement period. Loss and separation from loved ones has caused significant impact on their mental health. Studies have examined the level and range of traumas experienced by refugees and their current psycho-social functioning. The studies predict levels of depression, anxiety and other psychological and mental health problems (Khawaja et al, 2008, Schweitzer et al, 2006). A study of the mental health of West Papuan refugees in Far North Queensland, Australia, has been undertaken to inform the appropriateness and effectiveness of current clinical responses in dealing with adaptation and development after persecution and trauma. Limited English language skills and education meant that West Papuan refugees were obliged to migrate to small rural areas in Far North Queensland to obtain employment. Isolation has increased social marginalisation and access to support services which would otherwise play a role in assisting adaptation to the new country (Rees et al, 2009). Principles and objectives in the Act In line with the Government s Queensland Cultural Diversity Policy (2013), amendments to the Mental Health Act 2000 should include commitment to meeting the needs of patients of culturally and linguistically diverse backgrounds. This should be emphasised in the preliminary sections of the Act in the form of overarching statements of commitment to equitable access to services for all eligible persons who do not have sufficient levels of proficiency in English to fully understand examination, assessment and treatment processes under the Act. The existing objective referring to social inclusion and the reduction of disadvantage which specifically targets Indigenous Australians should be expanded to also include persons of culturally and linguistically diverse backgrounds. Similar representations have been made previously in submissions to the Queensland Government in relation to the Queensland Mental Health Commission Bill Specifically, it was recommended the Act should include: Culturally and linguistically diverse communities should be provided with treatment, care and support in a way that is consistent with cultural traditions, practices and values and which is culturally appropriate and respectful. (ECCQ, 2013). However, the principles of the Queensland Mental Health Commission Act 2013 include a strong principle in relation to the Aboriginal and Torres Strait Islander background, it does not include a similar statement of principle in relation persons from culturally and linguistically diverse backgrounds. In line with the Queensland Government s Queensland Diversity Policy (2013), it is suggested that amendments be made to the Hospital and Health Boards Act 2011, the Mental Health Act 2000 and to the Queensland Mental Health Commission Act 2013 to include a specific principle in relation to persons from culturally and linguistically diverse backgrounds. 4 / 31 July 2014 Mental Health Act Review

5 Right to interpreters A significant plank in the Government s Queensland Cultural Diversity Policy (2013), Queensland Cultural Diversity Action Plan (2014) is the Queensland Language Services Policy (2013, updated 2014). These policy instruments state emphatically the Queensland Government s commitment to ensure access to qualified interpreters as part of the provision of government and government-funded services. The need for qualified interpreters in the health and social service sector has been documented through community and industry consultations and through the research. A recent survey by Centacare Cairns, highlighted the growing need for access to mental health promotion materials in languages other than English and reported an underutilisation of interpreters and lack of cultural responsiveness by mental health care providers to refugee and migrant patients (Centacare Cairns, 2013). Studies reinforce the critical role of interpreters in ensuring understanding of crosscultural issues and accuracy of communication between practitioners and client (Splevins, 2010). While some clinicians are concerned that the introduction of the interpreter as a third party into what is traditionally the dyadic therapeutic relationship between clinician and patient (Miller, 2005), this should not be used as an excuse to deny a patient the right to an interpreter. Queensland Reports, A matter of Interpretation (QAIWG, 2008) and Still a matter of Interpretation (QAIWG, 2012) highlight the serious implications of not using qualified interpreters across the complex settings of health and social services. In the area of ageing and dementia, reports and submissions have in recent years highlighted the requirement for interpreters in the administration of cognitive assessments of culturally and linguistically diverse aged persons and younger persons with early onset dementia. (FECCA, 2013) In line with the Queensland Cultural Diversity Policy and the Queensland Language Services Policy, it is suggested that the right to interpreters for patients from CALD backgrounds who experience communication difficulties should be included in the Mental Health Act It may also be considered appropriate to include a mandate for the use of interpreters in all health services as an amendment to the Hospital and Health Boards Act In this way the right to interpreters for patients would be enshrined in a comprehensive and consistent legislative manner, applying not only to mental health care services but also to all other health services. Support persons and substitute decision-makers For the CALD population, the identification of representation and support is often a very sensitive and difficult matter. This is due to the isolation experienced by migrants and refugees who come without family and close relatives and due to the heterogeneity of ethnic and religious sub-groups amongst migrant and refugee populations. It is noted that the Allied persons model in the Act is recommended to be discontinued and that a new model of support to the patient is proposed in the form of an Independent Patient Companion. In replacing the Allied persons model it will be important to maintain an emphasis on the patient s own choice of friend. 5 / 31 July 2014 Mental Health Act Review

6 Should the amendment to introduce Independent Patient Companions be agreed, it will be optimum to place that program with an organisation that: is not managed under the authorised mental health service to avoid perception of conflict of interest is not managed by a non-government organisation that provides services and support to patients to avoid conflict of interest is part of or is able to access a state-wide infrastructure to support the Independent Patient Companions across the state can garner resources for and deliver a consistent approach to induction, training and guidance, including best practice in working with patients from culturally and linguistically diverse backgrounds can advocate effectively at a systemic level the use of interpreters for persons with communication difficulties in the mental health system or at risk can facilitate the necessary liaison between the Independent Patient Companions and guardians (including the Public Guardian) that may already have been appointed for that patient through QCAT. For these reasons it may be considered appropriate to place the Independent Patient Companion Program with the Office of the Public Advocate, within the Office of the Public Guardian. The proposed amendments to the Mental Health Act 2000 seek to provide greater advocacy and protections for the patient through a number of strategies including greater involvement of support persons for the patient. For patients from culturally and linguistically diverse backgrounds who do not have family supports it has often been assumed at the service level that ethnic community leaders and community liaison people can represent the person. It is important for the protection of the rights of the patient considered not to have capacity, and who does not have family members available to support him/her, that, if a guardian has been appointed by QCAT for any matter, that the guardian be contacted by the mental health service. It would be advisable to require engagement with any appointed guardian to protect the rights of vulnerable refugee settlers. Treatment in the community Should the proposed amendments to create a community category of forensic order for forensic patients living continuously in the community be agreed, it will be necessary to acknowledge and resource the role of non-government service providers who support the patient. This is particularly the case in regional and rural areas where the outreach of community mental health teams may be limited. In the case of patients from refugee and migrant backgrounds, the involvement of multicultural and ethno-specific services would be beneficial to the patients recovery in community. However, such a role does not appear to be adequately funded under current arrangements. It is important not to expect that community organisations providing social support services would also provide supervision of the patients compliance with conditions of the order (unless specifically resourced for that purpose). Any proposal to introduce tracking devices for patients on Involuntary Treatment Orders would not be supported given the potential of such devices to re-traumatise those who may have experienced persecution in their country of origin and that this is contrary to recovery-oriented practice. 6 / 31 July 2014 Mental Health Act Review

7 Reducing length of Involuntary Treatment Orders It is noted that consistent with the least restrictive principle and the desire to transition patients on Involuntary Treatment Orders (ITOs) to community for recovery, there may be some merit in any new strategy to reduce the length of time of patients on ITOs. In doing this however, it would be important to note the additional support that may be needed by families, communities and the non-government sector to provide support to those patients in a broad range of area, especially in relation to meeting cultural and linguistic needs. Legal representation at Tribunal meetings Should the proposed amendment to require legal representation at meetings of the Mental Health Review Tribunal be agreed, it will be necessary to provide specific training to legal practitioners in cross-cultural competence and in how to work with an interpreter in cases involving persons from CALD backgrounds. Psychiatric assessments for Magistrates Courts Should the proposed amendment to give powers to the Magistrates Court on findings of unsoundness of mind or unfitness for trial be approved, there would be a need for a significantly enhanced model of service for providing psychiatric assessments to the Magistrate within a short timeframe. This concern for an increased investment in this area is based on a consideration of: the need to have interpreters available for assessments of persons from CALD backgrounds who experience communication difficulties research which shows the increasing number of offenders with increasingly multiple and complex needs and the additional time this may require of the clinicians undertaking the assessments potentially limited capacity of the clinical workforce in Queensland to meet increased demands for forensic assessment services in a fast turnaround time. Prevalence data in Australia indicates that people with mental illness and mild to borderline intellectual impairment are over-represented in the criminal justice system and that numbers are increasing significantly (Hayes, 2004, Hayes, 2006, French, 2007). In light of this data, it would imply that persons with complex needs are also increasing in presentations to Magistrates Courts. This may impact resources required to implement the proposal to provide psychiatric assessments to Magistrates within a short time-frame, particularly if interpreters are required for persons with communication difficulties. 7 / 31 July 2014 Mental Health Act Review

8 Appendix 1 - Engagement process Engagement undertaken to develop this submission includes: Harmony Place (Multicultural Mental Health and Well-Being) Multicultural Development Association Transcultural Mental Health Service (Queensland Health) Queensland Program of Assistance to Survivors of Torture or Trauma (QPASTT) Queensland Alliance 8 / 31 July 2014 Mental Health Act Review

9 REFERENCES Brough, M, Gorman, D, Ramirez, E, Westoby, P, 2003, Young refugees talk about well-being: A Qualitative analysis of refugee youth mental health from three States (Australian Journal of Social Issues, 38(2), ) Centacare, Cairns, 2013, Migrant Settlement and Mental Health In Far North Queensland (Background Paper). Department of Social Services, Benefit Recipient data Department of Immigration and Border Protection, Settlement Database (SDB), 2014 Ethnic Communities Council of Queensland, 2013, Submission to the Queensland Mental Health Commission Bill 2012 Federation of Ethnic Communities Council of Australia, 2013, Submission on The Dementia and Veterans Supplements in Aged Care French, P, QUEENSLAND ADVOCACY INCORPORATED, Disabled justice: barriers to justice for persons with disability in Queensland, Brisbane, Queensland, Queensland Advocacy Incorporated. Gorman, D, Brough, M, Ramirez, E, 2003, How do young people from culturally and linguistically diverse backgrounds experience mental health: Some insights for mental health nurses (International Journal of Mental Health Nursing, 12, ) Hayes, S Interaction with the criminal justice system. In: Emerson, E, Hatton, C, Thompson, T, Parmenter, T (ed.) The International Handbook of Applied Research in Intellectual Disability. England: John Wiley and Sons. Hayes, S Homicide and Intellectually Disabled Offenders. Australian Institute of Criminology. Khawaja, N, G, White, K, M, Schweitzer, R, Greenslade, J, 2008, Difficulties and Coping Strategies of Sudanese Refugees: A Qualitative Approach (Transcultural Psychiatry, 45, ) Khawaja, N, G, Milner, K, 2012, Acculturation stress in South Sudanese refugees: Impact on marital relationships (International Journal of Intercultural Relations, 36, ) Miller, K, E, Martell, Z, L, Pazdirek, L, Caruth, M, Lopez, D, 2005, The role of Interpreters in psychotherapy with refugees: an exploratory study, (American Journal of Orthopsychiatry, 75 (1), 27-39) Rees, S, Silove, D, Kareth, M, 2009, Dua Sakit (double sick): trauma and the settlement experiences of West Papuan refugees living in North Queensland (The Royal Australian and New Zealand College of Psychiatrists, Australasian Psychiatry, 17, ) Splevins, K, A, Cohen, K, Joseph, S, Murray, C, Bowley, J, 2010, Vicarious Posttraumatic Growth Among Interpreters, (Qualitative Health Research, 20(12) ) 9 / 31 July 2014 Mental Health Act Review

10 Schweitzer, R, Melville, F, Steel, Z, Lacherez, P, 2006, Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees, (Journal of the Royal Australian and New Zealand College of Psychiatrists, 40, ) (Australian Study) Queensland Accessing Interpreters Working Group (QAIWG) A matter of interpretation(2008) Queensland Accessing Interpreters Working Group (QAIWG) Still a matter of interpretation(2012) 10 / 31 July 2014 Mental Health Act Review