The Final Report of the Royal Commission into Victoria’s Mental Health System (the Commission) was tabled at a special setting of Parliament last week. The report sets out a template for the transformation of Victoria’ s mental health system. The careful and comprehensive analysis of Victoria’s mental health system contained in the Commission’s Interim and Final reports articulates a practical framework that will ensure that timely accessible, accessible, appropriate and acceptable care of high quality is provided to people with mental health problems. The obligation to provide good mental health care is a core requirement of international human rights law. It is an obligation that has been systematically overlooked in Victoria and in the rest of the developed world.
Harrowing and intimate accounts of a broken system heard by the Commission
The Commission has placed respect for human rights at the core of its analysis. Central to its logic is a commitment to honour those who presented evidence to the Commission in hearings, consultations and submissions. The Commission’s hearings were often intimate and harrowing accounts of experience in a broken system: a system that relies on limited acute interventions accompanied by high rates of seclusion and restraint.
Too often the system failed to intervene. Too often the system failed to deliver recognised best practice – respect for autonomy, respect for family, trauma-informed care, recovery-oriented practice, and access to peer support. Too often, the interventions failed. Too often the system caused harm.
“Too often the system failed to deliver recognised best practice – respect for autonomy, respect for family, trauma informed care, recovery-oriented practice and access to peer support.”
The Commission acknowledges that the use of compulsory mental treatment, enforced by seclusion and restraint breaches human rights. It acknowledges the importance of ensuring people who seek mental health assistance are empowered to make their own decisions about treatment and care. It acknowledges the impact of excluding families and carers. It acknowledges disregard for the special needs of children and young people. It acknowledges disregard for the safety of women. It acknowledges the impact of stigma and discrimination.
A new framework to deliver compassionate, respectful evidence-based care
In response to the evidence presented to it, the Commission has set out a framework to deliver compassionate, respectful evidence-based care. It recommends that the mental health systems be rebuilt as two, aged-based parallel systems. Young people will not enter the adult system until age 26. The new system will be based in communities. Services will be strong and needs based, with a ‘broad front door’ leading to a stepped and integrated system. A consumer-led service will be established. Peer support will be reinvigorated. In addition, the workforce will be reviewed, and new systems of law, governance, oversight, and accountability will be created.
Victorian Government Immediately Committed to Implementation
In short, the Commission’s report promises fundamental transformation. Its 65 wide ranging recommendations are fulsome and compelling. Commendably, the Victorian Premier, Daniel Andrews has committed to their implementation.
Respect for human rights will now be at the core of the Victorian government’s approach
From the perspective of sustainable reform, perhaps the greatest contribution of the report is its articulation of what it means to adopt a human rights approach to the design of an entire sector. Unlike the previous attempts at reform, the human rights values at the core of the report give it substance. If that focus can be maintained, there is a possibility that the aims of the Commission might be realised. Maintaining the integrity of the human rights approach set out by the Commission, however, will require a sustained community commitment. The obligation falls on all of us to ensure that human rights continue to shape the coming reforms. We need to create a dedicated open dialogue and mental health and human rights. This may prove to be the key to sustainable system reform. Whether or not we succeed the legacy of this report will be it undoubted influence on mental health system reform in Australia and beyond.
This piece was originally published on the RMIT Business and Human Rights Centre Blog. Visit the Blog here.
