Mr GRIMLEY (Western Victoria) (14:27): I rise to speak on the Mental Health and Wellbeing Bill 2022. It is a bill that was born out of the Royal Commission into Victoria’s Mental Health System and acquits the government of its commitment to introduce the bill before the election, within the recommended time line of the royal commission. Whilst it is slightly flawed in some areas, in the opinion of our party, we will still be supporting this bill. There are many things to be optimistic about with the passage of this bill, including a more therapeutic approach to mental health issues and significantly more investment in the sector. It was an ambitious task to have this bill consulted on and drafted in the short time frame stipulated by the royal commission. There are feelings out in the healthcare community that the government are pushing this bill through now because they are sticking to the somewhat arbitrary time lines provided by the royal commission, but they are doing it at the expense of getting the bill perfectly right. I appreciate the desire to pass these reforms and start implementing their contents, but the reality is that this bill does not actually come into effect until September next year, so there would have been some time to fix up some of these issues.
Regardless, this brings me to the first issue with the bill, which is around consultation—or the lack thereof. This bill had two years of consultation before it was introduced, but there is a difference between receiving feedback and actually putting that feedback into the bill. The government have had to deal with competing interests, naturally, between the healthcare sector and the lived-experience advocates and carers. This is unenviable, but it is clearly still flawed, and the review in five years should not be pointed to as the time to fix current issues. One stakeholder told us they had one weekend to look over a section of the draft bill before feedback was expected to be provided before the bill was introduced. This meant that non-lawyers had a weekend to look over 500 pages of legal jargon. I hope that in the future there is a political will to fix the bill, which will inevitably need to change.
In relation to the bill’s move to the health-led response, as a police officer I have had the frequent duty of transporting and sitting with mental health patients, or as the force would be familiar with, section 351s. This refers to the part of the current act, the Mental Health Act 2014, that allows the apprehension of a mentally ill member of the community. The new health-led response will change the way that mental health episodes are responded to. Police will still have a role in the system—as they always will, in my opinion, as long as there are drugs and alcohol in the community—but this role will be complemented by others such as paramedics, psychiatrists, PSOs and future prescribed persons. This has not resulted in rejoicing from police officers saying, ‘One less job to do’, but police do recognise that they are often not the best people to deal with mental health patients.
Many patients have had negative interactions with the force. Many police members, whilst they are trained, do not have the level of training required for some patients where they perhaps pose no physical danger to others and can be treated or transported without apprehension. Further, they are not equipped with knowledge of the sector and the broad available help. Our job has been to try to deescalate, apprehend where needed and to transport to hospital. From there it is up to the hospital to deal with the patient. Frequently police have been held up for over 6 hours waiting with a patient for an admission at a hospital. In real terms that is 6 hours that a divisional van is off the road, almost an whole shift consumed guarding a mental health patient and not being able to provide the community with any law and order response, a recipe for disaster. It needs to change sooner rather than later.
There are a million and one questions about how this bill will play out in practice. Who will be the first port of call to respond to these incidents once 000 is called? The ESTA call taker likely will not know how serious the situation is. How do we know if the person has been affected by drugs or alcohol and could therefore be unpredictable? Who does the risk assessment on the patient? Who transports them, what restraints are able to be used and at what threshold? Who takes on the indemnity in such potentially volatile situations? Are psychiatrists and nurses and others without weapons, such as OC sprays et cetera, happy and willing to take on this role? Are we likely to lose healthcare staff, which we are already struggling to keep, by keeping them as the first port of call for mental health patients? This shows that there are unknowns that we believe should be figured out before this bill passes. There are questions that need to be answered, and I hope the minister representing the Minister for Mental Health will be forthcoming and answer those questions in the committee stage.
One of the more contentious parts of the bill is the rhetoric around restrictive interventions. This includes restraints, both physical and chemical, and the use of seclusion. I have to say that the voice from the healthcare sector has been united behind closed doors. While some of the public statements might be a bit more relaxed, they are collectively unsatisfied with the wording of elimination of seclusion and restraint and how it has been translated into the bill. They also reject claims in the bill that such practices serve no therapeutic benefits. What are the potential outcomes of these laws? Healthcare workers losing morale, walking off jobs potentially and refusing to deliver care? Unlikely. Mass resignations and/or increased healthcare worker injuries or deaths for those who run the gauntlet of providing care for what is being proposed? For instance, the AMA says:
Eliminating these practices entirely will inevitably result in mental health services being unable to meet the health needs of a small but significant proportion of seriously mentally unwell people.
In legislating on the reduction of restrictive practices, the support to mental health services and workforce needs to be considered and provided for.
This has not happened. The AMA called for the bill to be considered by a Legislative Council committee for further review and consultation. The National Association of Practising Psychiatrists was also very unsatisfied with this part of the bill.
Despite these bodies trying extremely hard to work with the government to make a few tweaks in respect to the above, the government has not introduced these as house amendments. Specifically, the clauses in the bill that they believe should have been reformed include the fact that the health secretary and chief officer for mental health and wellbeing are being tasked in the bill to set targets to reduce and ultimately eliminate the use of restrictive interventions in mental health and wellbeing services, as set out in clauses 254 and 261, and clause 81, which states that:
The use of restrictive interventions on a person offers no inherent … benefit to the person.
I would completely disagree on the latter as well. If a person is restrained to stop them from committing suicide, then I think it has a benefit. If a person is chemically restrained to prevent them from harming other patients or staff, that is absolutely of benefit. If a patient is secluded to calm down after a period of psychosis to prevent harm to themselves or others, once again there is a benefit. These restrictive interventions, whilst they should not be used as a first response, should not be condemned as having no therapeutic benefit. By preventing violence and harm and thereby preventing a criminal justice response, we are adding a huge benefit to the care of that patient. Put simply, it is the view of most healthcare bodies that Derryn Hinch’s Justice Party has spoken to that some new clauses and references to restrictive interventions need to be reconsidered.
That brings me to my next point: such practices will be considered by an independent panel from October. But the recommendations of the panel will not be handed down until after the new laws are fully functional. This panel was created by the former minister and there were a lot of issues that had not been resolved from the royal commission and that were not going to be finished in time for the bill. The minister said in his second-reading speech, and I quote:
… one theme we heard very strongly was a need to delve deeply into the laws around compulsory treatment and restrictive interventions. Key stakeholders … called for more time to work through these complex issues, outside the tight time frames for introduction of this bill. For this reason, we announced in December that an independent review panel would be established to examine best practice in modernising these laws for a future amending bill.
This means restrictive interventions will be considered by the panel—right? Well, I cannot tell you for sure, because the terms of reference for the panel will come in in October, after this bill is passed— ridiculous given that the panel was established last December, and shouldn’t the terms of reference have been established some time ago? Perhaps that is a question that can be asked in committee.
The government says that while the intention to conduct the review was announced in December 2021 the panel were only appointed recently, but they were announced in June and it is now August. Either things are moving slowly or there is something strategic, perhaps, about the timing of the release of the terms of reference. The people in charge of creating the terms of reference include three former patients, two carers and one peer-experience worker, likely another former patient. The AMA said there was likely an inherent selection bias in the application and selection process for this committee, as those who have strong opinions on compulsory treatment would have applied. They said this does not represent a true cross-section of professionals involved in treating psychiatric illnesses under the Mental Health Act. The AMA has made sensible recommendations about increasing the diversity of the panel, including representation from the emergency physicians and nurses who have no voice on the committee, and I would say to the government it should absolutely consider this.
On the issue of the definition of ‘paramedic’, my colleague Ms Maxwell will likely ask some questions in committee about the implications for qualified paramedics who do not work for Ambulance Victoria. This bill limits their scope of practice despite them being qualified. Whilst we understand there is future scope to include such community paramedics, we think this should be done expeditiously, because not only are they qualified but in many circumstances they are more qualified than other healthcare professionals who will be required to attend acute mental health incidents. Further, the workforce will require a boost, with numbers already dwindling.
Lastly, my colleague Ms Maxwell raised the issue of Forensicare and the startling statistics that people with serious mental illnesses are three times more likely to engage in offending and four times more likely to commit violent offences compared to other Victorians. We hold concerns over day-release policies for places such as Thomas Embling Hospital and would make the point that victims and their families should always be consulted and informed about such decisions where they may be affected.
I would like to think some of the key stakeholders who we consulted on this bill, including the Health and Community Services Union, the Royal Australian and New Zealand College of Psychiatrists, the Victorian Alcohol and Drug Association, the National Association of Practising Psychiatrists, the Police Association Victoria and the Australian Medical Association’s Victorian division. We also spoke to individuals in the healthcare sector who spoke in their personal capacity, some with over 40 years experience. I would like to thank all those who bravely contributed to the royal commission, including those who have lived experience and those who care for others with mental health conditions. You never know when you will be affected by mental health issues, either through our own experiences or someone we love, so this bill and the focus in Victoria are very much welcomed. I commend the bill to the house.