- We recommend a range of consumer-centred reforms that will ultimately create an environment in Victoria where compulsory treatment is no longer needed and can be eliminated.
- Steps can be taken now to radically reduce the use and duration of compulsory treatment, which can have devastating long-term consequences on people that echo throughout their lives.
- We make 27 recommendations, including that reform must be co-designed with consumers, to realise a rights-based system that is centred on respect and recovery.
‘What I hope for the future of mental health treatment is to have people involved that really understand what it is like living with a mental health issue from their own experience … support and understanding are key.’ – Ali
People get the mental health support they want, when they want.
This is our vision for Victoria’s mental health system.
We have outlined this vision in a submission to the , calling for a new mental health landscape where compulsory treatment is no longer required and where a rights-based system, centred on respect and personal recovery, is fully realised.
‘We see directly how compulsory assessment and treatment operates in this state through our advocates and the work of our lawyers at the Mental Health Tribunal,’ said Rowan McRae, Executive Director, Legal Practice, Civil Justice, Access and Equity.
‘We regularly hear from consumers about the harmful impact compulsory treatment has on them by depriving them of their rights and removing their voice and views from decisions that can be life changing.’
‘Informed by the expertise of our lived experience advisory group, , and by the consumers we work with every day, we want to see a fundamental shift in our mental health system – and ultimately, the creation of a new foundation that will eliminate the need for compulsory treatment.’
‘It will take time and collaboration across the whole sector to establish the necessary changes, but we’ll end up in a better place for mental health consumers and the community more broadly.’
A future without compulsory treatment
Victoria has a disproportionately high rate of compulsory treatment compared with other jurisdictions, particularly for First Nations consumers and those from culturally and linguistically diverse backgrounds.
‘Last resort is relative … this can change depending on tolerance levels of the staff, including security, adequate training in de-escalation, staffing numbers, workload at the time as well as staff management and morale.’ – Speaking from Experience member
Compulsory treatment often robs consumers of their dignity.
Long periods of inpatient treatment can sever their connections to their families, kin and communities, which can lead to lost work and housing.
We also see enforcement of treatment orders re-traumatising consumers and increasing their distress.
We envisage a mental health system that is designed with the people who will use it – a system that is safe and responsive, and that transforms what was described as ‘catastrophically broken’ in the royal commission’s report.
We hope to get to the point where there is never a need to order mental health treatment if people don’t agree to it.
As an essential part of this journey, reforms must centre consumers’ rights and dignity. Supporting people to make their own decisions about their treatment and recovery should be how the system works with people.
Working towards the elimination of compulsory treatment will provide a framework to achieve a right-based mental health system.
This must be supported through systems reform, physical environment improvements, partnerships between lived experience experts and clinicians, cultural change and sustained resourcing.
We are committed to working with the sector to achieve this change.
Moving towards elimination
Strategies to improve our mental health system so we can ultimately eliminate compulsory treatment must be co-designed and co-produced with people with lived experience of that system.
There are multiple reforms that can be implemented now, to set the groundwork for the elimination of compulsory treatment and realising a rights-based system that centres respect, supported decision making and personal recovery.
Among our recommendations, we support:
- embedding supported decision-making into the system through additional staff training, policies and procedures, and binding and enforceable advance statements
- limiting the ability to order compulsory treatment, including by:
- narrowing the current criteria for compulsory treatment
- presuming that treatment must be provided voluntarily and that the criteria do not apply
- requiring practitioners to provide early detailed reasoning about why they consider the narrowed compulsory assessment and treatment criteria to apply
- requiring an independent review within a fortnight.
- incorporating self-determination and connection to culture, community and Country for First Nations consumers into the criteria
- prohibiting rolling community treatment orders
- improving transparency, data collection and public reporting of Mental Health Tribunal hearings.
We understand the review, which was commenced by an independent panel late last year, will now be finalised by the Department of Health.
As the largest provider of legal and non-legal support to Victorians within the mental health system, including through the recent increased provision of legal and non-legal advocacy, we see the review as playing a central role in shifting the Victorian mental health system’s focus from compulsory treatment to one that prioritises the rights, supported decision making, respect and personal recovery of consumers.
We encourage the department to continue to resource and prioritise this important work, and look forward to playing a role in informing the review, including through an upcoming project to work with consumers to share their stories and perspectives.
Reviewed 26 October 2023