Dr. Atiqa Rafiq:

I am an old age psychiatrist. I will briefly highlight how we work. We see many people with new onset mental illnesses who present for the first time after 65 years of age. We see many people who may have dementia of all degrees. We treat BPSD. We have an outreach model. We see patients where they live, in their homes, in nursing homes and day centres.

It is a small fraction of patients who require the protection of the Mental Health Act in order that they can access treatment when they need it.

As Dr. Broderick said, and as Dr. Martin indicated in the submission, the old age psychiatrists have a particular concern about the change of the threshold of admission and, as the Senator just mentioned, balancing it with human rights. It should not be the case that the focus becomes so severely in its entirety on patient will and preference that you lose sight of years upon years of learning and good clinical practice guidelines which advise that you start the treatment as and when it is clinically indicated and you aim for full restoration of occupational social functioning of the adult.

Section 8, which deals with who can be admitted under the proposed legislation, deviates so much from the good practice guidelines in many ways that the fraction of patients with most severe mental illness who require treatment under the Mental Health Act and who can access such treatment under the Act will no longer be able to access it. If they do, if they were admitted so late, which would not be clinically or ethically right, in waiting for the time when that criteria was satisfied, within the course of recovery, the capacity and the insight may not recover. Then we are into a different round about continuing the detention of these patients. You cannot do it; you have to discharge the patient based on the current proposed legislation, which means there will be serious deterioration of the patient-doctor relationship falling out from the care plan and poor outcomes all along for the elderly person and for the patients in general for whom we are advocating.

There has to be a balance struck. We believe the current Mental Health Act to some degree absolutely respects that balance. There have been issues, and it is admirable to see the thinking and the incorporation of the emphasis on the patient’s will and preference. However, you cannot ignore years and years of medical research, good clinical practice guidelines and the right of the patient to get the treatment when they need it. That balance has to be struck. Section 8 needs to be amended.