Dr. Imelda Whyte:

The Senator talked about reasons and who would lose out in this increased threshold. I work with young people and people who are reaching the age of majority. When we consider the prognostic implications for the young person, there is a whole lot of evidence to support that the duration of untreated illness in presentations such as psychosis has very direct implications on how one manages the prognosis and recovery. The greater the duration of untreated illness, the greater the risks. From what I see day to day, this is a cohort who would be at risk of not being included in the context of requiring treatment. I know there is talk of them maybe taking their medication at home, but for the small group of people we are talking about who have these difficulties this is not an option because they are too unwell and they do not have insight. The Mental Health Act is very important for this small group. Mr. Geiran has said that hard cases make poor law, but we do have a responsibility for the most vulnerable and the most severely unwell. In this instance we are not talking about the vast majority of people who attend community services or even those who attend inpatient services. We are talking about a very small number of people who require this and for whom, without that care and treatment, would not get it.

Especially as it pertains to children, the way that it is done is a court process and a legal process. It is not about a tribunal. One applies to a judge in a District Court. It is a very comprehensive way of dealing with it.At times, if one is going into court it might be for a young person with an eating disorder and we might be going back very regularly because the young person with the eating disorder might be in hospital for a period of nine months. It is extremely important because it is due process and everybody's views get heard. We are ensuring that somebody independent is weighing up the evidence around what the person needs, what the person wants, what their parents want, and what the guardian ad litemis recommending.

I repeat the concern around the threshold, that there would be people who do not get the care and treatment they need.

We need to remember that the vast majority of people who attend mental health services attend as outpatients. We could have hundreds of outpatients and there may be four, five or six inpatients at a given time, and maybe even fewer. Many of the patients will not be on medication. We need to get away from the notion that the doctor is all about prescribing. Management of mental health in the modern context is a biopsychosocial model. It is delivered by a trained multidisciplinary team and, as we discussed earlier, with everybody bringing their own particular skill set and training. However, to come back to the point about hard cases making bad law and using extreme examples, these are the examples we work with. These are the people who are going to be affected by this legislation. The 400 people that I have in my outpatients will, by and large, not be affected by an amended Mental Health Act other than maintaining standards of mental health facilities. They will never need to be involuntarily admitted, and most of them will never even need to be admitted, full stop. This legislation pertains to the illest of our patient load and, of the people who attend us, to the ones most in need of care.

The other point is that people will, hopefully, get better. If they come in as an involuntary patient, we treat their illness, provide them with the requisite medication and all the other appropriate multidisciplinary supports. The care plan continues into the community and, all going well, they will return to live a life that is functional and meaningful, and is back with their families, loved ones or carers. The idea of somebody going into hospital for months on end is really not something that generally happens. On a very rare occasion, one will find somebody with such an intractable illness that they will require long-term hospitalisation. That is absolutely the exception. It is important to remember that this legislation relates to the illest and the most vulnerable of individuals. It should confer upon them every necessary protection but also every necessary right to have that illness treated, treated properly by trained professionals, and in a multidisciplinary fashion that will enable them to live the best possible life they can. What we want for our patients is that through the ministrations of our treatment - in the broader context, not just doctors - and they would then go on and have an optimal quality of life. The legislation is pertaining to those very vulnerable patients and this is something we cannot lose sight of.