Mental health reforms are dying at the altar of politics

Light a candle for our dying mental health reforms.

I’ve had many discussions with clinical directors of mental health services who assert that, though compulsory treatment can be harmful, clinicians only every practice within the law. Having spent a lot of time with these services, I have a different view. My response is often ‘I’ve never seen a lawful decision made under the Mental Health Act, including in your service’.

Even if people are detained under mental health laws, they have rights to protect them against further restrictions on their liberty. They are laws, like our road rules, that determine your conduct, should you want to use the road, or in this case, provide mental health treatment. I believe that these laws are ultimately unjust and should be substantially reformed for greater consumer (patient) rights. Still, in the meantime, their protections should be dutifully followed by service providers.

Unfortunately, our mental health laws are routinely broken. I saw it with my own eyes working for people who had been involuntarily detained and treated. In fact, research I was part of found that mental health laws were breached with such regularity as to render rights ‘illusory’.

These breaches are to be expected. There are few meaningful feedback loops for clinicians who practice unlawfully. This contrasts how we navigate our daily life in the community.

When I was 18, I was given a handsome fine and docked several demerit points for speeding between Cairns and Townsville in my 1993 Ford Festiva. The officer asked me whether I had considered wellbeing of my friend, sitting next to me, when I made the decision to speed and endanger her and others’ lives. I hadn’t. But now, the economic and moral imperative meant I would.

By contrast, Victorian mental health services have never had this feedback loop. In nine years of operation, the Victorian Mental Health Complaints Commissioner has received well over 12 000 complaints (using 2020 numbers, this will have increased). A majority of these complaints contain possible human rights breaches. In that time, it has never issued a single compliance notice requiring services to follow the law. In the four years of working at and advising the Commission, I saw a complete abdication of their role.

That context was why the recent announcement by the Andrews Government regarding the new Mental Health and Wellbeing Commission – to replace the current Commission – left me reeling. In addition to two new Commissioners, the same two Commissioners from the current body would be transferred over, presumably to handle complaints about mental health laws. Commissioners from the body that has been asleep during a human rights crisis.

It has left myself and others in the mental health space dejected about the prospects of real reform. Policy reform risks dying at the altar of politics.

The Andrews Government has flipped traditional political forces in Victoria by continuing Labor landslides. One of the key mechanisms to do that has been to manage political risks that could interfere with the government’s capacity to hold political narratives. Appointments to key roles such as the Commission represent a broader trend towards politicising independent offices that could hold the government to account.

This makes sense in short-term political logic. But the vice-grip on political risk also strangles the capacity for real innovative reform on the areas that the Andrews Government professes to care about, principally social policy. Creative tension is needed between Parliament, independent offices and the community in order to generate new possibilities in areas marred by outdated cultures and practices.

That tension is evaporating in Victoria. This is concerning. It means that when the political winds change, there will be little beyond cosmetic policy announcements to show for this time in government. It means the Andrews era will have no positive, enduring legacy.

Many in the mental health sector know that the window for real reform has closed. We just hope the government and the community can learn these lessons when it opens again.