Police to decide mental health treatment

By Julie Robotham, Medical Editor
October 28, 2004

A diagnosis of mental illness could be made over the phone instead of in person, and involuntary psychiatric patients could lose the right to have their case reviewed by a magistrate, under proposed changes to NSW mental health laws.

As well, police and nurses could order emergency medication for involuntary patients without a doctor being present, under options being considered to address a chronic shortage of psychiatrists and judicial officers outside major centres.

Beverley Raphael, director of the NSW Health Department's Centre for Mental Health, said changing legislation was not ideal. "We certainly don't pretend that's the principal solution to the shortage of professionals," Professor Raphael said. She added the state would fast-track specialist mental health training for regional and rural doctors.

But NSW could not meet the requirements of the present Mental Health Act - which governs how patients are diagnosed and reviewed - amid a continuing worldwide dearth of psychiatrists, she said.

Also on the table is an expansion of the categories of people who can be detained for extended periods. For the first time, people who are not mentally ill but who have drug or alcohol problems or are in the grip of an acute personal crisis could be held under the same terms as those suffering psychiatric illnesses.

The options are contained in a discussion paper for a review of the act, for which public submissions close on Saturday. A spokeswoman for NSW Health said it was expected draft legislation would be presented to the Health Minister, Morris Iemma, early next year.

Extending ongoing involuntary care to the "mentally disordered" would "effectively supersede the current definitions of a mentally ill person" and potentially erode patients' civil rights, the discussion paper acknowledged. "One concern that is raised by some clinicians is that increasingly broad interpretations are being given to this term to use the [law] as a tool to control difficult or dangerous individuals who, for various reasons, cannot be dealt with by other agencies."

Likewise, the paper pointed out that shifting responsibility from a magistrate to a tribunal for the first review of a person held against their will would "substantially dilute the protections the act currently provides".

And a further option to consider extending the 12-hour maximum time a person can be detained before their first psychiatric assessment "makes inroads into the liberties of the patient".

Barbara Hocking, executive officer of the Sane charity and advocacy group, said the proposals put expediency ahead of patient welfare. It was "appalling that because we're offering third-rate services we adjust the law accordingly", she said.

Louise Newman, chairwoman of the NSW branch of the Royal Australian and New Zealand College of Psychiatrists, said police needed powers to take people to hospital for assessment, but said that should not extend to matters of medical judgement such as describing a person's symptoms to a psychiatrist by phone so that drugs could be authorised.

"The issue of police making clinical decisions, we'd be very cautious about ... resource issues are impacting on clinical decision making," Dr Newman said. It was "fundamentally unethical" to compromise recognised standards of patient care because of practical difficulties meeting them, she said.