Submission to the Review of the Mental Health Act September Provided by the Youth Affairs Council of South Australia Inc.

Transcription

1 Submission to the Review of the Mental Health Act 2009 September 2014 Provided by the Youth Affairs Council of South Australia Inc. The Youth Affairs Council of SA (YACSA) was established by the youth sector in 1980 and is the peak body representing the views and interests of young people and the youth sector in South Australia. Level 4, 182 Victoria Square GPO Box 2117 P Tarndanyangga Adelaide SA 5001 F Adelaide SA 5000 ABN E yacsa@yacsa.com.au

2 Introduction The Youth Affairs Council of South Australia (YACSA) is the peak body in South Australia representing the interests of young people, youth workers, organisations and networks throughout the nongovernment youth sector. Policy positions are independent and not aligned with any political party or movement. YACSA s aim is to encourage young people, and those working with them and for them, to achieve meaningful improvements in the quality of young people s lives. YACSA is again pleased to have the opportunity to provide comment on the South Australian Mental Health Act review as we believe that a responsive and appropriate mental health system is vital in improving the health and wellbeing of many within the community, particularly young people. Statistics show that poor mental health is a significant issue for young people and many chronic mental health issues first present in our early years. This experience of poor mental health early on can impact on most aspects of young people s lives both now and into the future and is a significant contributor to our overall health and wellbeing. For many young people, mental health issues run the risk of negatively impacting on psychosocial development and their educational and occupational attainments. Young people in context YACSA advocates for the fundamental right of all young people to participate in and contribute to all aspects of community life, particularly decision making processes which impact upon them directly. Young people s involvement in society is vital in ensuring the development of relevant, forwardthinking and representative policy, programs and services. YACSA advances that young people are the experts in their own lives, and it is young people to whom decision-makers should turn when considering solutions to the problems young people face. However, it is more often the case that young people are excluded from decision making, particularly where those decisions affect them the most. Young people are expected to assume many responsibilities in our society and that same society can devalue their contribution and marginalise their role as stakeholders in civil, political, economic, social and cultural life, simply because of their age. We live in a world where our perceptions are often shaped by the media and by our politicians, who provide us with an on-going, often negative commentary that serves to limit the roles available to young people. Young people are variously portrayed as the victim, as the criminal, as lazy, as despondent, as disconnected or the symbol of what is wrong with the world today. Young people are seen as adults in the making, which suggests they are somehow less capable, less insightful, less intelligent and less valuable than adults. This gives rise to the notion that young people are unable to make proper decisions or contribute in a meaningful way until they are older. YACSA advocates strongly for young people to receive the support they need, when they need it, and that their needs, opinions, knowledge, experience, and participation are acknowledged. 2

3 Key points The following presents the key areas of the YACSA response to the Review of the Mental Health Act (2009). This submission relates to young people from the ages of 12 to 18; YACSA maintains that the Mental Health Act must be underpinned by the United Nations Declaration of Human Rights and the United Nations Convention on the Rights of the Child in specific and measurable ways informed consent must be a foundation of the Act to demonstrate good clinical practice young people detained under the Act should receive youth specific services in youth-centric facilities as a matter of course YACSA would also like access to sexual health and relationships education recognised in the Act and recommend that the principles and articles of the IPPF Sexual Health Declaration underpin the Act, particularly Article number eight self-determination should be the cornerstone of any health care provision in South Australia but for those young people under 16 years, the decision-making cascade should include consent from parents, guardians or the Guardianship Board if applicable, and; gender diversity and sexual orientation should be included in the Act to guide understanding, planning and service provision. Capacity and Consent We know that an individual s capacity to manage their own health is driven by a range of factors including health literacy, education, drug and alcohol use and their experience of mental health. Health literacy is one of the most powerful drivers of our capacity to manage our own health. When patients are appropriately informed they can make decisions about their own health that are based on evidence and an understanding of treatments, outcomes and consequences. We suggest that every effort should be made to inform and engage those with mental health issues, with their care and treatment. YACSA agrees with recommendation number 5 that a guiding principle should be introduced to the Act requiring that the directions, wishes and consent of individuals with a mental illness should be taken into consideration when treatment options are decided. However, we are concerned with how the terminology as far as reasonably practical and appropriate may be translated on the ground. With health services working at capacity or over-capacity in South Australia we would not want to see a situation where the thoughts, wishes and consent of a young person with a mental illness was forgone for the sake of expediency. Without any legal mandate or procedural guidance assisting mental health professionals to decide what is reasonably practical or appropriate, actions could be undertaken on a subjective and ad hoc basis. Children and Young People YACSA still has concerns regarding the detainment and forced treatment of young people and where that detainment and treatment occurs. In Section 7 (e) and (f) of the Mental Health Act it stipulates; (e) children and young persons should be cared for and treated separately from other patients as necessary to enable the care and treatment to be tailored to their different developmental stages, and; (f) the rights, welfare and safety of the children and other dependants of patients should always be considered and protected as far as possible; 3

4 The imperative for services to treat young people separately to adults goes much further than ensuring that services can be tailored to the needs of young people. The Children's Protection Act 1993 (SA) (Section 8B), requires that individuals who work with children and young people (under the age of 18) in the government, community and private sectors go through a screening process to ensure that they pose no danger to those young people who access their service 1. The safety of those aged under 18 years treated in mental health facilities should be given the same importance, particularly while they are in a state of increased vulnerability. While YACSA believes that the Act should mandate the separate treatment of young people (aged under 18 years) from adults, we acknowledge the limitations of a system that includes just one inpatient service for children and young people which services the whole of South Australia (the Boylan Ward) 2. Nevertheless, the protection of vulnerable young people with a mental illness should be paramount for government particularly as evidence links adverse health effects with young people being treated in facilities with older adults (particularly with chronic mental health disorders) 3. Youthcentric inpatient and youth friendly outpatient services need to exist and be accessible (in both metropolitan and country areas) to encourage more young people to seek the identification and treatment of mental health issues. Restrictive Practice Following on from the previous section, YACSA advocates for medical treatment and the treatment of mental illness to be provided in an informed and voluntary basis. This way the individual is free to accept or reject treatment at any time based on their informed understanding 4. If, however young people need to be detained, restricted and treated because of reduced capacity or danger to other people, we advocate strongly for those individuals to be treated in youth specific services and facilities. Guiding Principles YACSA supports the inclusion of the cultural 5 and developmental stages of young people in the Act (7(1)(cB). This acknowledgement is significant and should underpin care and treatment plans so that the cultural and developmental needs of young people are met. YACSA also supports the recognition of gender and gender identity in the Act that provides a basis for service delivery. However, we also call for similar inclusions regarding same-sex attracted people. It is important to acknowledge the experience of exclusion and invisibility that many gay, lesbian, bisexual and gender diverse individuals face within services and in their everyday life. Historically, societal experiences of homophobia have created a fairly significant barrier to self-disclosure of sexuality or gender identity based on a fear of being treated differently by service staff. This goes beyond sexual safety and works to recognise diverse gender identities and sexualities. This recognition is important in appreciating that this group has specific needs and will act as a guide to combat the invisibility that many gender diverse and same-sex attracted people still experience. 1 Children's Protection Act 1993 (SA). 2 Women and Children s Health Network, Boylan Ward, viewed 19 September 2014, 3 P McGorry, A Parker & R Purcell, Youth Mental Health Services, in inpsych, August B McSherry, Rethinking our mental health laws, The Conversation, 21 June viewed 11 October It is important to acknowledge that culture is not simply a description or identification with ethnic background. Culture can describe personal attachment or identification with places, people, activities, ways of life or beliefs. 4

5 Provisions within legislation compelling service providers to acknowledge gender, diverse gender identities and sexual orientations therefore will go a long way in ensuring the provision of appropriate services to people regardless of background 6. Prescribed Psychiatric Treatment YACSA agrees that the decision-making cascade for individuals 16 years and over on the use of Electro-Convulsive Therapy (ECT) should reflect that of general health practice. However that decisionmaking cascade should be undertaken dependent on the individual capacity of the young person and their understanding (informed consent) of the treatment and the potential side-effects of that treatment. For those young people under 16 years of age, consent from the young person should be sought initially but the decision-making cascade should include consent from parents, guardians or the Guardianship Board if applicable. Importantly, YACSA concurs with the review document that the use of ECT should remain a rarely used treatment option for children and young people. Rights YACSA continues to call for the Mental Health Act to be underpinned by both the United Nations Declaration of Human Rights and the United Nations Convention on the Rights of the Child. This underpinning is of vital importance as the Act provides for the mandatory detention and forced treatment of individuals including children and young people. This human rights foundation assists in the development of ethical services to safeguard individual protection and care. YACSA would also like recognition in the Act of the importance of ensuring that all people and especially young people with mental health issues have access to sexual health and relationships education. As such, it is vitally important that mental health workers have the capacity to competently address the sexual and reproductive health needs of the people in their care and to provide information, and referral to sexual health education and related services as needed. The right to express your innate sexuality in a safe environment and have access to information and services is inextricably linked to human rights and contributes to the freedom, equality and dignity of all people. YACSA recommends the incorporation of the principles and articles of the IPPF Declaration of Sexual Rights in the Mental Health Act and in particular article number eight 7. Again, as children and young people under the age of eighteen can be forcibly detained and treated under the provisions of this Act, YACSA seeks assurances that individuals under 18 will be detained and treated in child and youth specific, and/or youth friendly facilities. This separation of young people between the ages of 16 and 18 and adult populations/services is still not clear within the review or the legislation. Conclusion The Mental Health Act 2009 should be the underpinning of an accessible, appropriate and inclusive mental health system in South Australia. For this to occur however the legislation must ensure the 6 R Cannon, ACSA submission into the Productivity Commission Caring for Older Australians Inquiry, viewed 4 September 2014, data/assets/pdf_file/0013/107311/subdr571.pdf, International Planned Parenthood Federation, Sexual Rights: An IPPF Declaration, viewed 9 September 2014,

6 rights of all who access it either voluntarily or involuntarily are paramount. Self-determination, human rights, informed consent and youth specific care and treatment are cornerstones of a functioning and appropriate mental health care system for young people. With the knowledge that early experiences of poor mental health acts as a significant precursor to mental health issues later on in life, it is imperative that mental health amongst young people becomes a priority for governments and that legislation and service provision protects and responds effectively to young people experiencing mental health issues. 6