Suzie a hearing with a magistrate is held to protect the inpatient's human rights, and they may have legal representation and advocates present. Also, the inpatient unit submits an application if opposing release, for a continuation of inpatient care or, if it supports release with compulsory treatment, a community treatment order (or sometimes CCO) is submitted. Relatives and others who are concerned about the person being in or out can also state their case.

All of this is a good way to ensure that psychiatry isn't used as a form of state control in the ways that have tainted its history. For example, in Russia activists against some state policies were deemed insane for opposing communism and were forcibly detained even if they hadn't broken any law. You would already be aware of cases (we still see quite a few of them) where women were kept in state psychiatric institutions for being non-conformist and whatnot.

So, basically it's a way for an inpatient to have a voice to the outside and for them to have independent scrutiny of their care and treatment options.

Thanks for that Pynchme, I guess that sounds fair enough.

What I would suggest is that there are not enough mentally ill people put through this process as there should be.

I have dealt with many people in the community and in residential care who should be involuntary patients!

I haven't had much to do with psychiatric units as such for many years, so maybe I am being too harsh here.
However, sometimes I think the medical profession aren't doing enough for the mentally ill because of human rights issues?

I am not sure what problem comes first!
Does that make sense?

Suzie: <"... sometimes I think the medical profession aren't doing enough for the mentally ill because of human rights issues? ">

I'm not sure Suzie. The medical profession does all that it can and human rights - well I don't know whether people would want to forgo those to have treatment imposed on them. The basic criteria for forced intervention is whether the person poses a risk to themselves or to someone else.

People having treatment in the community also have hearings conducted over any CTO or CCO by a mental health tribunal which is often comprised of some sort of combo like a medical person, a client advocate and a lawyer.

I don't know if it's fact but my impression has been that inpatient stays have become shorter; there are fewer community treatment orders and when they exist people aren't kept on them for as long as they used to be. Mostly it seems to me that people have benefited from not receiving extensive intervention, but I am sure there are exceptions and that not everyone would agree with my (current) opinion.

Contributions that have contributed towards changes in MH practice and law include client and community consultation; research and overseas experience that recovery is possible and at better rates than was previously thought; politics; costs of maintaining inpatient care perhaps. Dollars usually count in these decisions somewhere. There are also state variations.

In any case, less restrictive care is good in some ways and for some people; and not good in others. Basically people have the right to be eccentric and get around being 'odd', I guess. A lot of people loathe anti psychotic and other sorts of meds as you'd know.

Government delivered services seem to have shrunk and a lot of functions have been outsourced but I am not sure whether it's been for the better or not. In some ways it's better; in others it isn't - the services seem very fragmented and barriers to accessing help seem different but just as evident as they ever were. The (non) system is more confusing than ever.

I see what you mean in some ways Pynchme, because mental health has never been exactly a stable area of medicine!

It seems to me that there are far more suicides and killings due to mental health disorders than there have been in the past.

Or maybe it is just that we never heard about the true number of suicides in the past- due to the stigma behind that act (eg- they go straight to hell, or their family won't get insurance if it is a proven suicide?

In any case, we certainly need more effective mental health services in Australia. They seem to have gone from the past appalling conditions in 'insane asylums', to almost no help at all!

Just a quick comment on why having a independent ear (a Magistrate) to review cases of involuntarily hospital admission quickly is a very desirable thing.

A recent case was in the media. A young woman with no English came here to an arranged marriage and found herself in an abusive situation. With no knowledge of how to seek help, her emotional distress ended up with her being admitted to hospital. Fortunately a translator was brought in who was cluey enough to realise that the woman needed help, but it was of the community support kind and she was released into the care of the community. A Magistrate would be on the lookout for such situations. If she had been forced to wait for weeks without a pro-active translator or doctor, her confinement may have been further abuse.

I also personally know a doctor who was leant on to have 'Granny' committed by her family. Granny seemed to doing just fine in her life in the doctor's opinion, and he refused. He diagnosed that the problem with Granny is that she wasn't shuffling off this mortal coil fast enough for a family who wanted control of what they saw as their money, their inheritance.

It may have been that Granny was doing things that genuinely raised the family concern and another doctor would have had her committed. But if this had happened and she was in no need of hospitalisation, then after 4 - 5 weeks being in mental unit her mental health condition may have been disasterous for that reason. Having a Magistrate would have given her a chance to put her case for returning to her home and normal life.

No system is perfect. People may stay in hospital who shouldn't be there and others who should be there probably aren't. But the change from removing a visit from the Magistrate for what maybe is simply a matter of cost or convenience, cheats the community.

Another few thoughts. I would have thought that there was more value in having a Magistrate do the review than even an experienced lawyer member of the Mental Health Review Tribunal. A Magistrate should bring a different and critical eye into play having presumably dealt with challenging situations that arise in the community before in court. A lawyer member might not necessarily have the same experience or might see things more along medical lines.

If Grandma from my last post had said to an examining doctor that her children were trying to 'steal her money' the doctor would of course keep in mind that it might be true, but still might give more weight to it maybe being a sign of paranioa as they deal with looking for signs of illness. A Magistrate dealing with all sorts of nasties in court like elder abuse, might give the statement a different weighting, especially if the elderly person seemed to be living a happy independent life in the community as well.

Apart from this a doctor might be constained somewhat by professional courtesies. If one doctor has diagnosed bi-polar in a patient, then it would have to given serious consideration and the diagnosis not changed without thought so a independent person to review is valuable.

Then not sure about this, maybe a Magistrate has more grunt? A Magistrate having found Grandma should be in the community might be more in a position to order a social worker visit her regularly for support. Anyway my two cents.