On 26 May 1995 a letter from Dr Inge Southcott was published in the Sydney Morning Herald.[17] Dr Southcott’s letter told about her anguish as ‘the mother of a 20 year old schizophrenic man who now lives on the streets’. The purpose of Dr Southcott’s letter was to appeal for changes to be made to the New South Wales Mental Health Act so that her son, who she said was ‘harmless and not suicidal’, could be involuntarily incarcerated in a mental hospital and given treatment. Dr Southcott’s proposal was to have a stipulation removed from the Mental Health Act which required that a person had to be thought likely to cause serious physical harm to themselves or other people before they could be committed to a hospital involuntarily.
Her letter was followed five days later by an article in the same newspaper written by Anne Deveson. Deveson began with a reference to Dr Southcott’s letter and then proceeded to review her own similar experience with a schizophrenic son who, she says, ‘killed himself from an overdose of alcohol and sedatives while living on the streets, psychotic, malnourished, vulnerable’.[18] Deveson’s article went on to endorse Southcott’s concern about the difficulties that the requirement of ‘dangerousness’ causes to the relatives of mentally ill people.
Shortly afterwards two letters from doctors, written on the day Southcott’s letter was published, appeared in the Sydney Morning Herald. They were both supportive of Dr Southcott’s proposal to amend the Mental Health Act. One doctor argued that ‘the criteria for instituting compulsory treatment should be widened’[19] while the other, after affirming the difficulty of committing involuntary patients under the existing conditions, went on to demand more mental health resources.[20]
Five days later Dr Peter Macdonald, an Independent Member of Parliament and himself a medical practitioner, made a speech in the New South Wales Legislative Assembly outlining his intention ‘to lead a crusade’[21] on certain mental health issues over the next few years. He indicated that amendments to the Mental Health Act to widen the criteria for involuntary treatment would be central to his plan.
Macdonald complained to the parliament that the existing criteria for involuntary treatment gave patients too much right to determine for themselves whether they needed any treatment. He said the existing situation 'caused significant suffering to families'. He went on to explain his reasoning by describing what he called 'an ironic situation': 'psychotic patients do not learn from their mistakes ... have no insight and do not realise that they need treatment. By denying that they have an illness they are depriving themselves of the very treatment that will restore their capacity to recognise their illness'.[22] Irony indeed!
The Minister for Health, Dr Refshauge, also a medical doctor, responded sympathetically proposing to collaborate with Macdonald in his crusade to expand the use of forced treatment. However, in reference to the provision of drug treatments, further irony was added when Refshauge admitted to his parliamentary colleagues that 'we do not have the answers to mental illness at the moment'.[23]
Several months later, on 26 October 1995, Macdonald introduced into the New South Wales Parliament a Mental Health Amendment Bill 1995 which proposed to replace the requirement of dangerousness for involuntary hospitalisation with loosely worded criteria that would have allowed involuntary procedures to be invoked if a person was thought to be incompetent and in need of treatment.
To support his argument Macdonald referred to Dr Southcott's letter to the editor and quoted extensively from another letter she had written to him. In this correspondence Dr Southcott carefully detailed changes she wanted made to the Mental Health Act and said she had ‘last worked in psychiatry in Adelaide in the late 1970s’.[24]
In human rights terms, Inge Southcott’s campaign for legislative changes might be a matter of some concern. Whilst she has a legitimate role as an anxious mother she is also campaigning as a medical professional who is part of a co-ordinated effort to expand psychiatric coercion. Her letter indicated she was a member of a support group for relatives called the Schizophrenia Fellowship and that this organisation planned to set up a discussion group ‘to look at further amendments to the Act especially the scheduling clauses’.[25] The scheduling clauses are the parts of the Act which relate to involuntary incarceration.
It should be noted that Anne Deveson, the author of the Sydney Morning Herald article which supported Dr Southcott, helped to establish the New South Wales Schizophrenia Fellowship and then became the vice-chairperson of the national organisation, Schizophrenia Australia.[26] Deveson has been engaged in high-profile activity on mental health issues in New South Wales since the 1980s. She chaired a government-appointed committee set up in 1988 to review the Mental Health Act 1983, the findings of which ‘were integral to the final draft’[27] of the amendments to the 1983 Act. She was also the initial chair of the Mental Health Act (1990) Implementation Monitoring Committee[28] which was set up by the NSW government to report on the efficacy of the new mental health legislation.
Deveson stands out as one of the most influential figures directing recent New South Wales initiatives in mental health legislation. By occupation she is a film-maker/writer, and her expertise in the mental health area is largely based on her experience as the mother of a schizophrenic son. The story of her relationship with this son is poignantly told in her book Tell Me I’m Here. Her son died in 1986.
Deveson’s subsequent zeal to reform public policy on mental health issues is outlined in the proceedings of a Symposium on Schizophrenia and Human Rights jointly sponsored by the Human Rights and Equal Opportunity Commission and the Schizophrenia Australia Foundation,[29] held in Brisbane in February 1989. At the time there were daily newspaper reports emanating from the Chelmsford Royal Commission[30] exposing psychiatric malpractices. Yet, curiously, most of the speakers at the Symposium chose to focus attention on a perception that ‘the right to treatment’ should have precedence over ‘patients’ rights’.[31] This was despite the fact that the human rights principles summarised in the opening address by the Human Rights Commissioner, Brian Burdekin, as being the principles most closely related to mental health issues, did not include a right to treatment, nor rights for relatives to arrange for involuntary treatment, but were all concerned with the rights of the individual to avoid coercion and discrimination.[32]
Deveson’s contribution to the Symposium largely consisted of detailed advice on how members of support groups for relatives of schizophrenic people might be able to campaign in the mass media. She advised that ‘you can plan over a year the numbers of stories that you plant, you seed, on that particular topic. It’s no use just doing a one-off story. It’s an ongoing campaign that you have to plan and stage … there is a need for something to be done about the image of psychiatrists … we can lobby governments; so we can change political awareness … we need to start setting a national agenda, and state agendas’.[33]
Given the linkages in the sequence of events leading up to the tabling of Macdonald’s Amendment Bill, it might be fair to assume that Macdonald’s ‘crusade’ is closely associated with Deveson’s ‘ongoing campaign’.
On 29 November 1995 Macdonald arranged a meeting at Parliament House with a number of representatives from organisations with an interest in mental health issues. The purpose of the meeting was for Macdonald to consult with stake holders in order to gauge community support for his amendments. The Bill was still lying on the parliamentary table and Macdonald had to decide whether to bring the matter on for debate during the pre-Christmas session of parliament.
During the course of this meeting Macdonald acknowledged that he had drafted his amendments in consultation with the Schizophrenia Fellowship. A representative of the Schizophrenia Fellowship was at the meeting and presented an argument in support of the amendments by claiming that the removal of the requirement for dangerousness was necessary in order to save people from suicide. He argued that people who have suicidal relatives with mental illness are consistently failing to have them committed to mental hospitals. Being present at the meeting I observed that the urgency of his presentation seemed calculated to induce a belief that the requirement for dangerousness was causing a virtual epidemic of suicide.
However, there was already a provision in the Mental Health Act which dealt with suicidal people and permitted involuntary hospitalisation ‘for the person’s own protection from serious physical harm’.[34] But this is the very clause which Macdonald was proposing to amend. If it was true that people were having difficulty in committing their genuinely suicidal relatives to hospital, a more plausible cause would have been the inability of relatives to convince doctors and hospital medical superintendents that suicide was intended.
But even this possibility was not supported by statistical evidence. Normally a person is involuntarily committed to a mental hospital under the direction of a doctor’s certificate. But in emergencies, when there is no doctor close at hand to make the order, there is provision in the Mental Health Act for relatives and friends to take mentally ill people directly to hospital and ask for them to be involuntarily admitted.[35] In the years 1993, 1994 and 1995 a total of 174 people were presented at New South Wales mental hospitals in this way by relatives and friends.[36] Of this number only one person failed to be admitted for not meeting the existing criteria of being both mentally ill and dangerous.[37] It therefore seems likely that the issue of suicide was inappropriately raised in support of Macdonald’s Amendment Bill to give it more urgency.
Macdonald decided not to risk putting his amendments to the vote in the busy pre-Christmas session of parliament in 1995. Instead his plan was to negotiate support for the proposal over the new year break and to bring it to a vote when the New South Wales parliament sat again in April 1996. But he was overtaken by events.
Under instructions from the Labor government, which had observed the lobbying of Macdonald by secondary consumer groups, the New South Wales Department of Health set about drawing up its own plans for reform of the Mental Health Act. In May 1996 a public discussion paper,[38] including proposed amendments, was circulated, and comments from stake holders and the public were sought. When the government had determined that there would be no serious opposition to the erosion of civil liberties, legislative amendments were prepared which made involuntary commitment and longer periods of forced medication in the community much easier. In 1997 a government-sponsored amendment bill was passed which allows involuntary treatment of people who are thought likely to cause ‘serious harm’ to themselves or others. The change had been effected by simply removing the word ‘physical’ from the prior stipulation of ‘serious physical harm’ and then loosely defining ‘serious harm’ as being harm to a person’s social identity, including such matters as finances and reputation.[39] This perceived risk of harm can be applied to either the mentally ill person or others.
The changes in New South Wales are typical of a world-wide trend to provide conditions that will expand the numbers of people under the control of psychiatric drugs. The essential features of the New South Wales campaign are also apparent in similar campaigns in other parts of the world. These features include relatives' support groups campaigning with drug company funding, outspoken doctors and psychiatrists, and politicians responding to what they think is community pressure. The central argument that all these players use is that mentally ill people are being denied their human rights because there is not enough coercion to ensure they all receive treatment.
Next: Human Rights Supporting the Medical Model
[17] Dr Inge Southcott, ‘Anguish over mental health Catch 22’.
[18] Anne Deveson, ‘Towards a better treatment of serious mental illness’.
[19] Dr Kathleen Bocce, ‘Mental health patients’ families have few rights’.
[20] Dr Robert Dixon, Letter to the editor.
[21] Peter Macdonald, ‘Mental Health Support and Counselling Services’, NSW Legislative Assembly Hansard, 7 June 1995.
[22] Ibid.
[23] Dr. Refshauge, Ibid.
[24] Inge Southcott, Letter to Peter Macdonald April 1994, quoted by Peter Macdonald in ‘Mental Health Bill’, NSW Legislative Assembly Hansard, 26 October 1995, p. 1.
[25] Peter Macdonald, ‘Mental Health Bill’, op. cit., p. 1.
[26] Anne Deveson, Tell Me I’m Here, facing-cover page.
[27] The Mental Health Act Implementation Monitoring Committee, Report to the Honourable R. A. Phillips MP, Minister for Health on the NSW Mental Act 1990, ‘Preface’, August 1992.
[28] Ian W. Webster, Chairman of the Mental Health Act Implementation Monitoring Committee, Letter to the Hon. Ron Phillips MP, Minister for Health, attached to ibid.
[29] Human Rights and Equal Opportunity Commission, Schizophrenia: occasional papers from the Human Rights Commissioner, No. 1.
[30] This was a judicial inquiry into psychiatric malpractice at a private hospital in Sydney called Chelmsford.
[31] John Grigor, ‘The Right To Treatment’, in Human Rights and Equal Opportunity Commission, op. cit., pp. 7–14.
[32] Brian Burdekin, ‘Human Rights Issues relating to Schizophrenia’, in Ibid., p. 2.
[33] Anne Deveson, ‘The Social Stigma of Schizophrenia as an Obstacle to the Exercise of Human Rights’, in Ibid., pp. 48–9.
[34] Mental Health Act 1990, Section 9(1)(a), NSW Government Information Service, Reprinted as in force at 17 October 1994, p. 5.
[35] Ibid., Section 23(1), p. 10.
[36] Mental Health Review Tribunal, Annual Report, 1993 p. 76, 1994 p. 74, 1995 p. 58.
[37] Ibid., 1994.
[38] NSW Department of Health, Caring for Health: proposals for reform—Mental Health Act 1990, May 1996.
[39] Mental Health Legislation Amendment Bill 1997, Schedule 1, 1.1 [1], p. 3.