State-based legislation governs the admission of people suffering a mental illness (“consumers”) to mental health inpatient units (“MHIU”). MHIUs are usually part of a public hospital.
Mental illness is a medical condition involving impairment in thought, mood, perception or memory. This does not include, of itself, intellectual disability, drug use, particular political or religious views, or membership of a particular cultural or social group.
A consumer may be admitted to an MHIU as a voluntary patient if they have provided informed consent, and they are generally entitled to leave at any time.
A consumer may also be admitted to an MHIU as an involuntary patient. To justify involuntary admission a consumer must pose a risk of harm to themselves or others. Harm is usually physical, including potential for deterioration in their condition, but may extend to financial or reputational harm.
While a consumer is admitted as an involuntary patient, they must be reviewed regularly by a psychiatrist to assess whether their continued admission is necessary or whether a less restrictive means of treatment is available. Community-based treatment is preferred unless involuntary admission is necessary to protect them or others.
Consumers can apply for review by the relevant state Tribunal on grounds including that they are not mentally ill, at risk of harm, or that a less restrictive treatment option is appropriate. Decisions of the Tribunal can be appealed to a superior Court.
Consumers admitted as involuntary patients have a right to:
information about their rights including to access legal and advocacy services – most states offer a free or subsidised legal service for consumers;
nominate a person who is empowered to act as their advocate;
privacy and confidentiality;
be given information about their treatment including risks and alternative options;
participate in decisions about their treatment so far as practicable;
respect for their cultural, religious and language needs;
continued participation in community life.
A consumer or someone concerned about their wellbeing can make a complaint about a breach of rights or standard of care internally to the MHIU, or externally, through the independent health services bodies, as well as privacy or anti-discrimination bodies. The rights of consumers, including to be treated to an adequate standard of care, should not be vitiated just because they are admitted as involuntary patients – a status which makes them particularly vulnerable and disempowered. These complaints bodies can be effective avenues to ventilate issues and seek policy change.