Page 3299 - Week 10 - Friday, 26 August 2005

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Yesterday, Mr Corbell tabled a progress report on the ACT mental health strategy and action plan for 2003-08. Page 3, under the heading “Advanced agreements”, states:

This initiative, which was highlighted in the ACT Mental Health Strategy and Action Plan 2003-2008 has completed its initial project phase and is in the process of being more widely implemented and assessed across Mental Health ACT.

It interests me that progress is occurring in that area, but the changes to the Powers of Attorney Act appear to be happening in parallel. I hope that there will be some connection soon.

Advanced agreements are really very important. They were highlighted by the Community Advocate in her farewell speech. That was in relation to another matter, but I think they have application here. They enable consumers when they are well, in consultation with their clinicians, their GPs, their carers and others if desired and as appropriate, to develop plans for how they would like to be cared for if and when they become unwell.

Such mechanisms are widely used in other jurisdictions, including Canada and New Zealand. If such a mechanism became available in the ACT it would, I have been assured, alleviate the anxiety of some individuals who feel vulnerable to changes in emergency health treatment provisions. Instead, we have a situation where a person with a mental health issue who is competent to make an informed decision about emergency treatment in advance decides to refuse ECT and nominates alternative treatments to be administered, but when they are admitted to hospital needing emergency treatment there is no mechanism by which their directives would be known and there is every risk that the decisions they have made in advance may be ignored or overruled.

As a society, we often find it difficult to accept that people can make and do make decisions that are contrary to medical advice or research. Nonetheless, we accept that it is their right to do so. Think of people who refuse treatment for life-threatening illnesses, of those who would refuse a blood transfusion on religious grounds, or of parents who choose not to have their children vaccinated against serious illnesses. These are controversial issues in our society. Nonetheless, we do allow those and we do show people respect for their decisions.

There is no reason why this begrudging respect for an individual’s right to make such choices should not include people who may be at risk of periodic mental illness requiring mental treatment. If we make it easier for clinicians to get approval to administer treatment, it is imperative for us to make it easier for patients to provide advance directives regarding the treatment options they would accept or refuse if they were competent at the time.

At this point, I would like to highlight the fact that the use of ECT as an emergency involuntary treatment is not without controversy and is subject to very strict safeguards in other jurisdictions. The World Health Organisation has concluded that emergency mental health treatment should not include ECT and that ECT should be administered only after obtaining informed consent.

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