Presenter: Wayne Bucklar
Guest: Matthew Carroll
Guest Bio: Matthew is a lawyer with extensive experience in the field of human rights and anti-discrimination gained from roles in both Australia and overseas. Matthew was appointed President of the Mental Health Review Board and Chairperson of the Psychosurgery Review Board in 2010. Immediately prior to taking up these appointments he was manager of the Human Rights Unit at the Victorian Equal Opportunity & Human Rights Commission. Upon commencement of the new Mental Health Act on 1 July 2014 Matthew became President of the Mental Health Tribunal.
Segment overview: In today’s Health Supplier Segment, Matthew Carroll shares valuable information about the Mental Health Tribunal. They are an independent statutory tribunal established under the Mental Health Act 2014. The Tribunal is an essential safeguard under the Act to protect the rights and dignity of people with mental illness. The primary function of the Tribunal is to determine whether the criteria for compulsory mental health treatment as set out in the Mental Health Act 2014 apply to a person.
Health Professional Radio
Wayne Bucklar: You’re listening to Health Professional Radio with Wayne Bucklar. Today my guest is Matthew Carol, president of the Mental Health Tribunal. And Matthew joins me on the phone from Victoria in Australia. Welcome to Health Professional Radio Matthew.
Matthew Carol: Thanks Wayne.
W: Matthew, most of our audience are clinicians in one sense or another. Many of them work in the health profession, in hospitals. I made the assumption when I started in this job that everyone in the health profession knew everything else about the health professions but in fact I find that’s not safe. That there are big gaps, it could be from one discipline to another and even I have to say in some cases from one ward to another. So today we’d like to chat you about what it is that Mental Health Tribunal does and just provide a background for some of our colleagues. Can you tell us what it is that Tribunal does and how it came into existence?
M: Sure. As you’ve mentioned in the introduction Wayne, I’m from Victoria and talking about the Victorian Mental Health Tribunal. Given the broad … of your audience, I think it’s probably of value to point out that every state and territory in Australia has its own mental Health Review Board or Mental Health Review Tribunal. I am the president of the Victorian Tribunal. There are a lot of similarities about how we work, that’s often the case. Different states have different legislation and so it’s not identical across the board. But in broad terms, the role of any Mental Health Tribunal or its equivalent here in Australia is to the examining situations where itself necessary to treat a person experiencing severe mental illness on a compulsory basis. So that is where they’re on an order requiring them to have treatment for severe mental illness, be that in the hospital or in the community. The role of the Tribunal is to look at whether or not those orders should be made and whether or not person continues to meet the criteria to be on such an order. And we also have a particular to find their role in a relation to ECT for patients who are unable to provide informed consent themselves in both situations, we’re called upon to decide whether or not to make an order allowing for ECTs to be treated to be used in the treatment of a person.
W: Now ECT is “Electro Convulsive Therapy” digging back into my deem darkness in training. Why do you draw that as a separate issue?
M: Look, it’s I suppose take a step back at from the specifics in when Mental Health Tribunals or Mental Health Review Boards are deciding whether or not to make or continue an order requiring a person to have a compulsory treatments for severe mental illness. Their role is, our role isn’t to make the specific treatment decisions so we’re there to decide whether the order facilitates treatment and then it’s a matter of discussion and negotiation between a treating team and the individual consumer or patient – that’s what that treatment includes. So the particular medication that might be used and whether or not it’s in an oral form or an injectable form, there are issues that are worked out as I said between the treating team and the consumer and not decided by the Tribunal. But generally in Victoria was one of the last state to introduce this, where ECT has been proposed to be used as part of the person’s treatment and they are not themselves able to provide informed consent. The Tribunal is a safeguard or may perform in which is to decide whether or not ECT can be used. And look, the reason for that – the reason for taking a particular approach to ET is that it is a treatment that there is a great deal of I suppose a degree of suspicion and a degree of misunderstanding about in the broader community and it’s a thought that the treatment that requires a higher level of regulation than some other forms of treatment.
W: I see. Now the Tribunal is a statutory body meaning it’s created by legislation.
M: That’s right.
W: Do you have other view about the benefit one particular party? Are you a patient advocate? Can you explain to me how you fit with the various parties involved?
M: Sure. Now that raises some really important points. So the Tribunal even an advocacy body, we’re an impartial and an independent tribunal. And we conduct hearings in order to make decisions on the issues we’re required to determine. And we facilitate, and conduct both hearings on impartial basis and we hear I suppose in a form for in a very legally, we hear evidence, we tend to talk more about information and perspectives more so than evidence simply because we how to avoid legalistic language in jurisdiction but treating teams will make an application through the Tribunal saying that “We believe this particular person requires compulsory treatment for a given period of time. And these are the reasons why we think that’s the case.” And there’s specific criteria that there in the Mental Health Act which govern whether or not compulsory treatment is allowed. The treating team provides their perspective on why it’s on criteria to meet. The consumer or the patient then provide their perspective and they may be assisted by a legal representative or a non-legal advocate perhaps a peer worker or a friend or some other advocacy service. The role of the Tribunal is to hear that material or hear that information impartially and to ask questions, to take the issues out, to seek to understand everyone’s perspective as fairly and as fully as possible and then make in its own independent decision upon whether or not a treatment order should be made. So in that respect we’re not an advocacy body but in terms of who do we serve, our starting point or the primary objective is to be there as a safeguard for consumers and patients to ensure that compulsory treatment is only used where the criteria are set down in the legislation and met. But in performing that role, I think we also provide a useful form of assistance or a useful forum for clinicians as well because it’s a forum in which matters that often very strongly disputed can be discussed. It’s tribunal that take some responsibility from making their decision, it’s not the treating team themselves that making the decision. And then once the decision is made, we step out of the picture leaving the treating team and consumers to then interact with each other or either a compulsory or voluntary basis.
W: That’s a very significant point. I think I’ve not ever been in the position of having to make that sort of decision because I’m not a clinician but I imagine that there is often elements of unethical dilemma where some sort of forum to get an impartial examination of the issues and facts would be very helpful. Is a tribunal relevant to health professionals in other ways?
M: Look, I suppose the Tribunal’s role is quite specific and quite deliberately narrow and I’m even in relation to mental health, we have a very narrow range of focus. Compulsory treatment is a very significant and important aspect of the overall delivery of mental health services within the community but it’s one’s moral aspect itself and interesting to reflect on the fact that so much of the public discourse is about mental health is quite right were about the lack of access to or lack of sufficient access to treatments and people are seeking to access services that finding that not as it should be in many instances, whereas we are working with a very particular group of patients and they’re a group of patient who are within the services and are receiving treatment that made time to be quite opposed to that and not wanting it. So it is I suppose a very niche or particular area that we’re involved with.
W: You’re listening to Health Professional Radio and my guest this morning is Matthew Carroll, president of the Mental Health Tribunal from Victoria in Australia. Matthew can you give me some sense of the numbers involved or I’m just trying to get my head around how frequently mandatory orders are made?
M: Sure. We’ve just gone through significant changes in Victoria so the Tribunal has only been in operation for since July of last year. But prior to that, there was a Mental Health Review Board and for a number of years the Mental Health Review Board had a very stable case load where it was conducting in the vicinity of 6,000 hearings per annum. So 6,000 hearings where they’re deciding whether or not a particular individual should continue to be an involuntary patient. That pattern has actually and it comes to us as a little bit of surprise that that pattern has continued with our new Mental Health Act in the new Mental Health Tribunal. So as of the end or as I have check some cases … before the interview, so as of the end of March this year so let’s record a mark for our first year of operation -the Tribunal had made 3,600 treatment orders. It had revoked just over 300 orders, so technically a revocation means that at the end of the hearing, the Tribunal decided for the person should no longer be a compulsory patient and at the ethical code has occurred in treat over 300 cases to date and we also made just under 400 ECT orders. So again like the former board we’re on a path to and the collecting to conduct about in the vicinity of 6,000 hearings for the full year, first full year of operation.
W: And from my ignorant perspective, I’m surprised at just how big that number is. It’s one of the things I guess you don’t see a lot of exposure to unless you’re I guess actively involved in that field.
M: One of the objectives of the new Mental Health Act that started in July of last year is that we should be at the time we’re reducing our reliance upon the level of compulsory treatment orders and that voluntary treatment should always be preferred. And because one of the ways that it was intended for the Act to do that would be that the Tribunal would see patients much earlier their compulsory admission than the former Board did. We actually thought that particularly now in our first year of operation, we might have a quite significant spike in the number of hearings we were conducting so opposite the Board, how to stable case load of 6,000 and we’re looking at the same case load so given that that spike hasn’t occurred, it would seem that they’re bound to be many explanations for that and there hasn’t been time to particularly comprehensive or in depth research into it as of yet. But the initial indications are that the new Act has had an immediate impact in terms of pulling back or wanting back the level of the use of compulsory treatment orders.
W: That’s interesting to hear. And given that it is a new Act and you’re a relatively new body, what are the current events or issues or strategies that are occupying your time now?
M: Look, the focus is still very much on the implementation of the New Act, the new Act towards the product that many years of consultation with the community or this is particularly consumers and carers and also mental health doctors and experts as well. In some respect, the new Act was catching up with more contemporary practices in mental health service delivery but it was also making those contemporary practices more mandatory rather than discretionary. So it is intended to encourage a new approach which is a very much centered around patient participation in decision making, recognizing the role of carers, the integral role of carers, and the need to consider their perspective, really pushing a recovery approach to mental healthcare and treatment, and also supported decision making. Now these sorts of changes don’t happen within the first 9 to 12 months of a New Act’s operation is a process of cultural change that will take many years so I suppose the focus now is on the fact that we have gone through a quite successful commencement period where the transition has been reasonably smooth and now it’s a matter of focusing on the culture change and making sure the momentum on that is maintained and that those changes become embedded overtime.
W: Matthew, congratulations on the implementation of the earlier phase of that and we wish you well with that implementation over time. Can I say thank you for talking with us today. It’s been a fascinating chat and an insight into something that doesn’t often get our attention here on Health Professional Radio so thank you for that. If you just joined us, you’ve been listening to Matthew Carroll president of the Mental Health Tribunal in Victoria Australia. A transcript of this interview and a SoundCloud archive are available on the Health Professional Radio website at www.hpr.fm. My name is Wayne Bucklar, you’ve been listening to Health Professional Radio.