Mental Health Legal Centre Inc.

Lacking Insight - Part 1: Summary

PART 1: SUMMARY

Aims  

Recommendations  

Methodology

 

“[I felt] disempowered, absolutely disempowered, hijacked and totally wilfully misrepresented”

(JM - Consumer)

“[On] each occasion before the Board I have felt lost and alone”

(PF - Consumer)

“. . .If the person feels they've been given an opportunity to be heard and be understood during the course of the Board's hearing, that's probably the only opportunity they've ever had during their entire stay . . ..”

(Legal Representative)

 

Aims

This research marks the first Australian analysis of the processes of the review of civil detention and involuntary treatment from the perspective of those detained.

Significantly, the study was initiated by people who have been the subject of involuntary detention and treatment and who have appeared before the Mental Health Review Board (‘the Board’). In response to their experiences, the Mental Health Legal Centre (‘the Centre’) successfully secured funding from the Reichstein Foundation to investigate the efficacy of the review process.

The reflections of consumers of mental health services in this report speak of the humiliation and feelings of degradation experienced by people who are involuntarily detained and treated against their will under the Mental Health Act (‘the Act’). They speak of the powerlessness of appearing before the Board. They speak of how difficult it is to argue that involuntary detention is unwarranted, and to assert the right to make one’s own treatment decisions, in opposition to the views of mental health professionals.

Thus, there are a number of aims of this report:

• To document the experience of the mental health review process from the perspective of involuntary patients. David Webb, in his article Bridging the Spirituality Gap (2005), presents a compelling argument that we will never totally comprehend what is needed to adequately understand mental distress until we ask the people who experience it;

• To contextualize the Board process, so that the hearing could be understood as an event taking place in a wider theoretical and practical realm. It was considered important to provide information about ‘therapeutic jurisprudence’, deinstitutionalisation, and a number of other key developments that help to explain the climate in which the Board operates;

• To document the experience of the mental health review process from the perspective of other stakeholders, including carers, Board members, community organizations and professional groups;

• To document the role and perceived impact of representation, both legal and lay models, in Board hearings, from the perspective of the person whose involuntary status is being reviewed or appealed, as well as from the perspective of other stakeholders;

• To identify and explore special issues relevant to the mental health review process for those living in rural Victoria;

• To identify possible issues for the improvement of the mental health review process, requiring change at either a procedural or legislative level.

 

Recommendations

As this research shows, there are a number of aspects of the current review system that are inadequate. As well as the practical measures that can be taken to reduce the negative impact that a hearing can have on a person, there are also procedural and legislative changes that must be made. This section of the report first sets out the recommendations which flow from the concerns raised by the consumers interviewed. The report then considers the views of other stakeholders.

Inquisitorial v. adversarial and “rubber stamped”

Board members should conduct hearings in a way which fulfils their inquisitorial role and lessens the experience that consumers have of an uneven adversarial battle and a predetermined outcome by:

§ Acknowledging that the consumer’s contribution and evidence is pivotal to the conduct of the hearing, and allowing enough time for that evidence to be presented;

§ Allowing the consumer to tell their story;

§ Clearly stating that they are independent and that the psychiatrist Member does not work at the service, confirming that they will carefully consider the information they are given, and make an independent decision;

§ Conducting hearings so that this independence is apparent throughout the hearing;

§ Encouraging consumers to attend accompanied by a support person or advocate ( through promotional material available through clinics and information provided prior to a hearing);

§ Acknowledging that the rationale for involuntary detention, on the day of the hearing, must be justified by the treating team;

§ Actively testing and questioning the evidence of the treating team;

§ Ensuring that the evidence of the treating team is examined, without prejudice, by careful questioning – e.g. (to reporting doctor) “Can you explain why you think this person should be on an involuntary order?”

§ Ensuring in their interaction with the treating team they are professionally detached, not overly friendly and familiar;

§ Identifying conflict situations - e.g. is it appropriate for the same Board to review an individual consumer’s detention over and over again?

§ Ensuring that members of the treating team do not have any discussions or audience with the Board in the absence of the consumer;

§ Making sure they ask for the consumer’s views on key issues and seek expansion where appropriate, and that they take notes of the consumer’s evidence;

§ With the consumer’s permission, making active inquiries where relevant of other parties such as relatives or other people supporting the consumer;

§ Only asking questions that are relevant to the Board’s inquiry;

§ Clearly stating the decision at the end of the hearing - honestly and without disguising it in other closing remarks or social chat;

§ Clearly informing the consumer of their appeal rights and their right to a statement of reasons;

§ Ensuring statements of reasons include reference to views and facts contrary to those of the treating team and to positive evidence or observations.

Access to information

• When people are advised of their hearing date they must also be advised they can access their file and assisted to contact the person who can arrange it;
• The case manager should be required to tell the person they can access the file and offer to arrange this;
• Access should be available soon after notice of the hearing is given – not merely 24 hours before the hearing - and should never be solely on the same day as the hearing;
• Consumers should be offered a realistic period of time to peruse their file, two hours being the minimum;
• Consumers should be offered the opportunity to return and view the file again if required;
• The process for exempting certain entries from the consumer and the appeal rights to access exempted documents should be explained;
• If the file or parts of the file are being withheld it is appropriate for the Board to adjourn the matter to give the consumer the opportunity to appoint a representative to view these parts and to make submissions on his or her behalf;
• Consumers should be offered assistance, provided with explanations, and offered debriefing with their preferred member of the treating team after they have accessed the file;
• The Board should always ask if the consumer has had a chance to look at the file and adjourn the matter to the next sitting if they have not and they want to;
• The Board should note when a person has not accessed their file and if the order is extended encourage the person to exercise this right before the next hearing, also informing them of the right to an advocate to assist;
• Reports provided to the Board must also be provided to the person giving ample time for them to prepare a response; the person should be encouraged to seek advice and support to assist in reading the report and in preparing a response;
• The Board must provide ongoing information and training to mental health clinics and services to ensure that these services understand their obligations in relation to providing access to files and files are available.

Consumers’ level of understanding of the review process

• All consumers should be told by their case manager how to access independent advice and/or representation from Victoria Legal Aid or the Centre, handed a copy of the booklet “Patients’ Rights: A self help guide to the Victorian Mental Health Act”, and offered a viewing of the Board’s explanatory DVD when they are advised of their hearing date;
• All consumers should be told how they can get an explanation of the information they have received about their hearing, and provided with the name of the contact person who will provide assistance, an explanation and debriefing;
• All consumers must be informed of their rights under the Victorian Charter of Rights and Responsibilities, immediately they encounter mental health services;
• All consumers must be informed of the requirements of the Board for submissions under the Charter, including the requirements of the Board’s Practice Direction. Information must include how to get support and assistance in order to comply with Board directions;
• Board members should give their name and an outline of their role at the start of the hearing, and explain how the hearing will be conducted;
• Board members should summarise the criteria for involuntary treatment and the treatment plan considerations at the start of the hearing, and clearly signpost the elements as the hearing progresses;
• The Board should clearly and honestly announce the decision.
• If the person is discharged the Board must not attach conditions to this discharge or give a warning that links further behavior with involuntary detention, but suggest the person consult a lawyer if they want advice about implications of the discharge;
• The Board should tell consumers at the end of hearings that they have a right to request a Statement of Reasons and that they have the right to appeal either to the Victorian Administrative Appeals Tribunal (VCAT) or the Board. They should advise the time restrictions involved with these requests;
• The Board should tell consumers at the end of hearings that they can get legal advice and representation for future reviews/appeals and to ask their case managers for details.

Rituals of a hearing

• The Board should ensure that consumers waiting for a hearing are informed of the progress of other matters so that they have the opportunity to feed the meter, get a drink or lunch etc;
• A Board member (not always the community member) should greet the consumer and accompany the person into the hearing room, rather than sitting and waiting for the consumer to enter the room. This Board member should confirm the seating arrangements with the consumer, to ensure they are comfortable;
• A practice should be adopted whereby a member of the Board offers to arrange for a hot or cold drink for the person and sits and has a brief introductory talk with the consumer before accompanying him or her back into the hearing room;
• The Board, consumer and other parties should if possible, sit at a round table, rather than on opposite sides of a large rectangular table, or at the back of the room;
• There should always be sufficient room at the table for consumers to organize relevant papers. The Board should provide pens and paper for consumers to take notes during the hearing;
• The Board should take care to avoid excessive formality in the way members speak to parties;
• The Board should be alert to non-verbal communications e.g. members should not slouch and turn towards the practitioner and away from the consumer;
• The order of proceedings should be that the consumer (or the consumer’s advocate) gives evidence first, unless the consumer does not wish to;
• The Board should observe basic courtesies and measures to ensure the consumer is at ease:
  • Smile and shake hands;
  • Ask the consumer how he or she wishes to be addressed and ensure all members then do as requested;
  • Encourage the consumer to take notes, assure them that an opportunity will given for them to ask questions and provide this opportunity;
  • Do not interrupt or respond impatiently;
  • Do not sigh, yawn or use inappropriate body language such as eye-rolling;
  • Do not be condescending;
  • Invite the consumer to ask for a short adjournment if they need one;
  • Be attentive and alert and make direct eye contact.
• The Board should ensure proceedings are not rushed;
• Every effort should be made to ensure people do not have to wait for lengthy periods before their hearings;
• Interpreters must be available for all hearings for those who require assistance and must remain present for the entire hearing;
• The Board should always ask how long the consumer has waited and indicate they understand how frustrating a long wait must have been;
• The closing words must be respectful, give some clear explanation for the decision and emphasise positive aspects of the consumer’s situation and/or achievements;
• The Board should clear the room of all parties at the end of the hearing and not engage in any further discussion with any party.

The experience of Koori consumers

• The Board should be trained to be aware of issues that are of concern to Koori consumers, in particular their views and experiences of mental illness
• The Board should explore with the Koori community and mental health team whether there is a role for an elder to educate the Board and/or assist with its decision making.

The experience of consumers from culturally and linguistically diverse backgrounds

• The Board should be aware of cultural differences in relation to how mental illness is viewed and accepted by different communities;
• The Board should be mindful of the need for expertise on and an awareness of the experience of consumers from culturally and linguistically diverse backgrounds when appointing Board members and conducting training;
• The Board should be trained to use interpreters and be sensitive and aware of language that may be stigmatizing and harmful when translated.

The experience of rural consumers

• Use of videoconferencing should be avoided wherever possible;
• Where videoconferencing is used, the consumer should always have a support person with them who has been briefed on the technology, and who can provide reassurance;
• In the way it conducts a videoconference hearing, the Board should always be mindful of the difficulties it may be creating and take all possible steps to put the person at ease;
• Board members need to be particularly mindful of the distances rural consumers may travel to get to hearings and the pressures this can create in terms of responsibilities such as picking up children from school.

Effects on consumers’ lives

• Board members must be mindful of how hearings can affect consumers:
  • Consumers report being left feeling powerless in the hearing process;
  • Consumers feel intimidated and alienated;
  • Consumers feel distressed;
  • Consumers report that they were not given sufficient time to give their evidence;
  • These feelings can continue long term.
• The Board should ask consumers how their experience of previous hearings has been and commit to improving it this time;
• The Board must gauge whether the consumer needs a break, and offer a short adjournment;
• Mental health service workers must offer follow up support and debriefing to people after their hearings;
• The Board and mental health service workers must endeavour to ensure the Board process leads to improvement in the person’s situation, not mere maintenance;
• Board members must receive ongoing training to ensure that they do not become desensitized to the impact of involuntary treatment on people;
• Board members must conduct hearings and ask questions in a way which holds the service accountable;
• Board members must not be unnecessarily repetitive, probing or insensitive in the way they ask questions – rather, they should focus mainly on the issues in dispute and avoid unnecessary questioning about symptomology or other sensitive matters;
• The performance of Boards varies. Board members should be required to observe each other and review the performance of peers.

Legal representation

• Legal and other advocates should act in accordance with their primary duty - to act in an ethical manner on client instructions;
• Free legal representation should be available to all consumers who wish to have it;
• Existing forms of advocacy should be extended and free legal advocacy made available to all consumers before, during and after hearings to facilitate a range of good outcomes and explore less restrictive options to involuntary treatment;
• Legal advocacy services must be resourced to ensure that all consumers have access to the protections of the Charter;
• Legal advocacy services must be resourced to ensure that Koori consumers and consumers from culturally and linguistically diverse backgrounds have access to specialist mental health representatives who are sensitive to their cultural issues;
• Advocacy and mental health services should adopt practices that actively facilitate people’s access to representation e.g. case managers phoning legal services when with the consumer at the case management appointment;
• Legal representatives should be adequately trained in terms of the legal and service system context of hearings and principles of human rights and therapeutic jurisprudence;
• If an order is extended twice the Board should recommend to the consumer that they obtain legal advice and should confirm that the consumer has access to information about available legal services and assistance from the case manager to arrange representation if required;
• The Board should continue to work in a collaborative way with specialist legal services to achieve best outcomes for consumers.

Increased participation by community members

• Community members should take a more active role in the hearing process.
• The role of community members should be recognized and optimized through special education and peer support meetings;
• Community members have an invaluable role to play in terms of improving a consumer’s experience of Board hearings by:
  • Acknowledging and showing interest in the consumer’s broader social context;
  • Encouraging and giving consumers credit for their achievements whether strictly relevant to the involuntary treatment criteria or not;
  • Providing advice/suggestions as to ways in which a consumer’s situation may be improved, including in terms of non-clinical supports and services which may be available and exploring with the treating team least restrictive options;
  • Educating other Board members as to the broader context of people’s lives and the support and service system; and
  • Encouraging other members to maintain a strong human rights focus and apply the Charter.
• The Board should develop clear guidelines as to the Community Member role and recruit and train community members accordingly;
• Community members should be up to date with the range of community services available to assist people living independently in the community including housing employment and educational services and supports for parenting;
• Community members with lived experience of psychiatric disability should be actively recruited as Board members. These members should be involved a in training the membership as a whole. In consultation with relevant consumer and advocacy a minimum quota of consumer members with the lived experience should be established

Second opinions

• A system to facilitate access to independent second opinions for use at Board hearings should be developed;
• Unlike psychiatric assessments, reports and letters to patients and referral letters prepared by doctors and specialists for general medical matters form part of the service and are covered by Medicare. Psychiatrists need to be challenged to provide their reports as part of their consultation service free of charge;
• It is the practice of some public mental health services to charge for psychiatric reports. Psychiatrists employed in the public sector must provide a service that includes the provision of reports without additional payment;
• It should be mandatory that the Board requires an independent second opinion when the Community Treatment Order has been extended twice;
• The possibility of the Royal Australian and New Zealand College of Psychiatrists coordinating a scheme whereby members must provide a certain number of such opinions for involuntary patients should be investigated;
• Provisions should be considered such as those contained in Section 190 of the Queensland Mental Health Act (2000). That Act requires that the Tribunal must, if a person has been subject to involuntary status for more than 6 months, consider “whether an examination and report should be obtained from a psychiatrist other than the psychiatrist responsible for the patient’s treatment”.

Timely Review

• The 8 week review time period should now be shortened to within 48 hours, ensuring that all consumers detained and involuntarily treated are reviewed by an independent body;
• The 12 month review time period should be reduced to 6 months consistent with the review times in other jurisdictions;
• A review, initiated by the consumer, should be listed within 2 weeks and there should continue to be no limit to the number of times that consumers request such a review.

Treatment Plans

• Consumers must be actively involved with the preparation of treatment plans, and have access to an advocate or support person if requested;
• Consumers must be properly advised of the risks attached to proposed treatment;
• Information on treatment which highlights the likely benefits and risks should be available for all consumers prior to their signing a treatment plan. The information provided by the Psychotropic Drug Advisory Service would be a good resource;
• Consumers should be able to oppose a treatment plan and this should be noted on the plan;
• An advance directive made prior to the person being assessed as mentally unwell, must be respected ;
• Consumers’ views about the use or non use of ECT must be respected and incorporated in the treatment plan;
• Relevant contents of an advance directive must be incorporated into the treatment plan;
• Relevant sections of the individual program plan should be combined with the treatment plan, respecting the consumer’s direction as to whether to exempt some sections to respect their privacy;
• Treatment plans must include the least restrictive means of treatment which is being worked towards and include timelines and nominate a person responsible for each action;
• Clinicians who prepared the treatment plan must be available at time of the hearing;
• A combined treatment plan is essential to a holistic approach to treatment and provides the Board with information essential for exploring less restrictive alternatives.

Statement of reasons

• Consumers must be informed of their right to request a Statement of Reasons at the closure of each hearing;
• Statements of reasons must be provided in each matter where the order has been extended more than once;
• Review hearings should be taped, and the tapes made available to the consumer upon request.

Training and review of Board members

• Appointment of Board members should be dependent upon specific criteria which includes: proven knowledge and expertise of mental health services; communication skills of the highest order, particularly the ability to communicate openly with people with mental illness and treat them with dignity and respect; a commitment to ongoing professional development to ensure knowledge of current services and less restrictive options to involuntary treatment;
• Interviews for Board members should be conducted by a panel of people with at least one consumer member;
• Participation in regular training must be a mandatory condition of ongoing Board membership;
• Member training should include:
  • Presentations by consumers who have experienced Board hearings to generate greater awareness of the lived experience of mental illness or alleged mental illness;
  • Communications skills including body language, courtesy, empathy, listening; and self reflective practices;
  • Up to date information on mental health services and community supports;
  • Education on least restrictive alternatives to involuntary treatment and how this can be achieved;
  • Presentations by specialist mental health advocates;
  • Preparation of statements of reasons;
  • Moot hearings;
  • Current information on relevant human rights jurisprudence under the Charter;
  • Current information on practices at other mental health review tribunals; and
  • A requirement that Board members consider the consumer and stakeholder views and recommendations of this report.
• An optimum system for review of Board members’ performance should be implemented. A peer review model should be seriously considered.

Training of mental health workers and advocates

• Mental health practitioners should be educated to:
  • develop collaborative therapeutic relationships and to allow the consumer to take the lead in the review hearing;
  • develop plans, timelines and identify supports - to assist the consumer to work towards the least restrictive alternative, independence and autonomy in managing mental health;
  • prepare reports that are free from derogatory statements and value judgments, with sourced material dated and available to be scrutinized;
  • understand when it is appropriate to apply to the Board to exempt documents; and the seriousness of withholding evidence or misleading the Board
• Reports to the Board must be factual and allegations of risk must be substantiated;
• Authors of reports to the Board must be available to attend the hearing;
• Mental health workers must attend ongoing sessions on the Board and its processes;
• Key participants in the hearing process - treating teams and advocates/legal representatives - should be required to read the recommendations and consumer and stakeholder view sections of this report.

Further research

Stakeholders identified production of Statements of Reasons as an area of concern. Consumers did not provide significant feedback on this issue – probably largely because most did not procure a Statement of Reasons. Further research should be conducted to ascertain the value of Statements of Reasons in their present form, by obtaining the views of consumers who have received Statements of Reasons, by analysing an appropriate sample of Statements, and by investigating in greater depth the experience of advocates who have requested a significant number of statements.

A number of consumers, alleged to be non-compliant, told researchers that they objected not to treatment, but to the way it is delivered, in a stigmatising and punitive way. Consumers want to have access to alternative therapies and consumer-run services. Further research should be conducted into these models of service delivery in the context of choice of treatment options.

Advance Directives, documents that consumers can create while they are well (that is they possess ‘capacity’ in legal terms), which stipulate all that they would like done for them in the event they become unwell later on, and which are in a fledgling state of development in Victoria, will challenge the Board to respect a person’s wishes and interests. Upcoming research will address the role the Board has in giving effect to Advance Directives.

Is the existing Victorian Board structure the best model of review? Further national research is at present being conducted – an Australian Research Council funded comparative study of Mental Health Tribunals in NSW, Victoria and ACT. However, research needs to be conducted to assess the efficiencies of the present Victorian review model, to compare the costs and benefits of single member boards and other review models.

Consumers identified the need for further first person experience research as a follow up to this project in 3 years time, to review the progress of recommendations and evaluate the Board in the context of the Mental Health Act review, the implementation of the Department of Human Services (“DHS”) plan Because mental health matters and the application of the Charter.

As discussed later in the report, further research efforts would be worthwhile to:

• Speak with Koori consumers with experience of the Board to obtain their views on the review process and explore ways to ensure they have meaningful participation; and
• Speak with more consumers from culturally and linguistically diverse backgrounds to ascertain the needs o f the majority who were unable to participate in this research.

Methodology

Who is a ‘consumer’? An explanation of terminology in the report.

The word 'consumer' is used throughout the report. This is the terminology chosen by the Advisory Group. For explanation see Footnote 1, Page 2.

Methodology and research tools

The project is a qualitative study using an action research model where data collection and evaluation proceed simultaneously. This model enables broad scoping of the major issues as they arise and captures a range of experiences in depth, allowing participants to ‘tell their story’ from their individual viewpoint. It provides the opportunity to re-evaluate and make adjustments in the focus of the project as the data is evaluated in a series of feedback loops (Punch 1998). Interview and discussion group prompts were revised and modified in light of ongoing data analysis as a part of the project’s interactive process.

Project guidance

A Steering Group of key stakeholders was established (see appendix); it included an Advisory Group of four people with experience of involuntary status, with experience of mental illness or alleged mental illness and with the capacity to represent those who have been involuntary patients. This group of four people met separately with the researchers and assisted with networking among consumers and with the development of the interview schedule.

Ethics

Ethics approval for the research project was granted by the Human Research Ethics Committee from Department of Human Services (‘DHS’). All participants have been de-identified during the transcription process and tapes destroyed.

Sampling Design

The project used a snowball technique to identify interested participants. This involved making contact with relevant people or bodies involved with consumers who had appeared before the Board as involuntary patients. Consumers interested in participating were targeted by promotional material, widely distributed through consumer networks and area mental health services. Participants for discussion groups were recruited from a variety of sources to avoid situations where they may have discussed the issues together previously. Care was taken wherever possible, to prompt involvement of people who were not active mental health consumers and those who may not have participated actively in a hearing.

A purposeful sampling framework was utilised in selecting participants through the application of minimum sample criteria limits. This sampling design was broadly indicative of various factors including characteristics of the caseload of the Board. Within the budgetary and logistical constraints of the project no significant source of variance was missed. The project aimed to capture a cross section of diversity of people who had an involuntary patient experience, and to include the following characteristics:

Site of treatment

• Inpatient treatment

• Community Treatment Orders

Types of psychiatric diagnosis ~ consumers with experience of:

• Mood disorders

• Psychotic disorders

• Other diagnoses

Type of treatment

• Medication types and methods

• Electro convulsive therapy (ECT)

• Seclusion and restraint

• Additional attributes

• Rural and Metropolitan (Variety of suburbs)

• Security Patients

• Gender

• Age (to include youth 18-24 years, 25-60 and 60+)

• Culture

• English as a Second Language (ESL)

• Other minority groups identified through project analysis

The project thus completed a purposeful sample group including:

• 30 observations of Board hearings
• 25 in-depth interviews with consumers
• 10 in-depth interviews with carers and consumer consultants
• 10 in-depth interviews with stakeholders and decision makers
• A series of discussion groups in metropolitan and rural Victoria with consumers and carers attended by 15-20 consumers, 5-10 carers (none of whom were interviewed in-depth)
• 3 discussion groups with Board members attended by 15-20 members
• In-depth interviews and discussion groups with advocates (both legal and lay) attended by 5-10 advocates

Data sources

The study utilised a variety of data sources including a literature review, discussion groups and in-depth interviews with individuals with experience as involuntary patients appearing before the Board and other stakeholders in the Board hearing process, observations of Board hearings and a examination of Board Statements of Reasons. This data triangulation was designed to avoid or limit unintended bias in the study and provide a broader understanding of findings.

• Discussion groups

The project aimed to conduct discussion groups in various regions. However, it was found that most consumers were uncomfortable discussing their experiences in a group setting and preferred one-to-one interviews.

• Interviews

Semi-structured in-depth interviews were conducted with 25 people who have experience of involuntary treatment and who had appeared before the Board. Promotional material was widely distributed through consumer networks and through clinics. People contacted the project workers if they were interested in being interviewed. Many participants wished to be involved who had heard of the project from other consumers (snowballing research method). An interview schedule was devised by the project research team and interviews conducted.

Key stakeholders from the mental health system and other parties with a significant stake in the Board’s process, such as carers and legal representatives, were identified and interviewed by the project workers. Some Board members and carers who had also heard of the project contacted the research team requesting involvement.

Interviews were conducted by research workers who are highly skilled, sensitive and experienced with the methodology and able to identify and appropriately refer participants to an appropriate source for legal advice or debriefing.

• Observations of hearings of the Board

Observations were undertaken by the researchers to give context to current procedure and practice of hearings, to inform the project workers’ understanding of the review process, and as background for facilitating the interviews. Observations had a dual purpose, to set the scene for the project workers, to assist them to identify hearing rituals and other formalities and to assess the accessibility of the environment.

Data Analysis

The project researchers developed a subtle coding methodology utilising qualitative linking, shaping and searching. Consumer and stakeholder interviews were then analysed by identifying prevalent themes and issues and extracting representative comments.

International and National Research – Literature Review

An extensive literature review of existing research was undertaken by the researchers. There has been little research into the operation of mental health tribunals in Australia. Research completed internationally in recent years, which looked at the process and interactions occurring in mental health tribunals, has confirmed that a health rather than a legal paradigm dominates the hearing process.

Analysis of Statements of Reasons

A preliminary analysis of Statements of Reasons (the documents which set out the reasons for the Board’s decisions) highlighted inadequacies and inconsistencies in the quality of these documents and confirmed the need for more rigorous research and analysis of the documents of Board decisions. This aspect of the research was deemed to be a stand-alone project and requires further funding. Thus preliminary findings are not included in this report.

 

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