Tuesday, January 27, 2004

Baume plan would keep ex-prisoners from hospitals

Privacy fear for locked-up patients

Patient and human rights advocates have savaged a plan that would dramatically broaden the criteria for holding people against their will in NSW hospitals and curtail their privacy protection.

Under the proposal, which takes effect from July and is intended to reduce suicides and murders by people with psychiatric disorders, patients who come to hospital would be detained if they were deemed high risk.

This would be defined as having at least three conditions from a five-item check-list, namely a diagnosed mental illness, signs of alcohol or drug use, suicidal thoughts, previous suicide attempts and a record of aggression.

Under Baume's proposal, anyone who meets 3 or more of the following

1) diagnosed mental illness
2) signs of alcohol or drug use
3) suicidal thoughts
4) previous suicide attempts
5) a record of aggression will be liable for involuntary detention if they roll up to a NSW hospital.

Allot of people would qualify for the locked ward under those conditions. If people decline to make disclosures they could probably avoid some problems. However most ex-prisoners would be likely to be caught in the net, because their history is a matter of official record.

Basically, any former prisoner (or former mental health patient) who seeks hospital services in NSW could be scheduled under this scheme.

The plan - contained in a new report by a former federal Liberal health minister, Peter Baume - has been accepted in principle by the NSW Health Department, said its mental health chief, Beverley Raphael.

"People may fear that everyone's going to be locked up if they have a depressive illness. That's not the intent at all," said Professor Raphael, the director of the NSW Centre for Mental Health.

A related plan - to secure all units where involuntary psychiatric patients are treated - was already possible in existing facilities, Professor Raphael said. "It's a matter of when the door's locked," she said, and balancing the rights of patients in the same unit who were free to leave.

The Government has been under pressure over the evaluation of the mentally ill after St George Hospital discharged Awale Mohamed two weeks ago. He subsequently stabbed a man in a random attack and was shot dead by police.

Dr Grace Groom, chief executive of the Mental Health Council of Australia, condemned Professor Baume's report - quietly released just before Christmas - saying it "maintains a law and order focus and shows little regard for improving the provision of mental health care or to advancing the rights of people living with a mental illness".

Ian Hickie, clinical adviser to the depression initiative beyondblue, said: "It recommends locking up all at-risk people, which is all people who would present to care. This approach is not clinically justified, further stigmatises and will discourage people presenting for care anyway."

There was no way of predicting which mentally ill people would harm themselves or others, Professor Hickie said. The only proven means of preventing death or injury was proper treatment of the mental illness and NSW had failed to commit adequate funds to improving treatment services.

The report also recommends that the families of people admitted to hospital with a mental illness should be told of their condition and allowed to give input into their care even if the patient does not want their involvement.

It says the Mental Health Act should be changed to let "active carers and guardians" be involved in all aspects of planning a mentally ill person's care.

Professor Raphael said this would not extend to the revelation of intimate details confided to doctors but would allow medical authorities to inform relatives of a person's admission and discharge.

The president of the NSW Council for Civil Liberties, Cameron Murphy, said

"the right to privacy is fundamental and it's important particularly to people who are vulnerable because of their illness". There should not be a blanket rule for informing relatives - cases should be decided on individual merit according to privacy principles, he said.

By Scheduled posted 27 January 04

THE GATEKEEPER: I guess that's one way to keep people away from hospitals and get their waiting lists and budgets back under control. Gate up chief?


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