Where to from here? Re-examining compulsory treatment in light of the findings of the Victorian Royal Commission into Mental Health

Dr Mikaela Brusasco1, Dr Lachlan Hegarty2

1The Prince Charles Hospital, Brisbane, Australia, 2Monash Health, Melbourne, Australia

Recently, we wrote and published on how appropriate use of compulsory treatment for patients with psychiatric conditions can provide long-term empowerment. Since the publication of this article, the Royal Commission into Victoria’s Mental Health System’s (RCMH) final report has been tabled in Parliament. Recommendation 55 of the RCMH, “Ensuring compulsory treatment is only used as a last resort”, seeks to address the feedback of consumers of mental health services, their families and healthcare staff. Specifically, this feedback is that authoritarian compulsory treatment regulations are liberally enacted and poorly regulated.

Certainly, Victoria faces a mental health crisis. The Victorian Mental Health system has one of the highest rates of compulsory treatment in Australia despite ongoing legislative requirements to provide ‘least restrictive care’. Consumers who have undergone compulsory treatment have further reported incidences of sexual abuse and extreme emotional distress.

In light of the findings of the RCMH, it is imperative we re-examine why compulsory treatment exists, and in which circumstances it is justified. The 2006 United Nations Convention on the Rights of Persons with Disabilities seemingly established that mental illness does not sufficiently justify subjecting someone to compulsory treatment. Opinion on this conclusion – both within psychiatric and ethical fields and beyond – is mixed.

Current prevailing thought is that compulsory treatment reflects a last resort in the preservation of patients’ and communities’ safety and as such its use is morally justified albeit subject to stringent safeguards. Compulsory treatment, when appropriately applied, acts within the boundaries of a patient’s best interests


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