Advocacy and Participation in Mental Health Cases: Realisable Rights or Pipe-Dreams?
This article discusses Australian experiences of mental health clients, legal advocates and other stakeholders in the mental health review system. We review forms of advocacy, the reactions to these, and the contribution lawyers make to protecting rights within this field. Based on our fieldwork we suggest a mixed model of advocacy, one that includes legal representation that goes beyond simple 'following instructions', but also self-advocacy, systemic advocacy and mobilisation of support networks. We suggest that Jan Brakel was right to recently call for a re-conceptualisation of mental health advocacy, and indicate ways this might be achieved.
Should Supported Decision-Making Replace Substituted Decision-Making? The Convention on the Rights of Persons with Disabilities and Coercive Treatment under Queensland’s Mental Health Act 2000
In 2013, and again in 2014, the UN Committee on the Rights of Persons with Disabilities (CRPD) has recommended that Australia abolish its existing mental health laws which authorise involuntary treatment and detention, and replace them with a regime of supported decision-making. The Australian Law Reform Commission has also recommended the introduction of supported decision-making to replace mental health and guardianship laws. This paper critically evaluates the concepts of autonomy and discrimination and the social model of disability which provide the theoretical underpinning of the CRPD. Focussing on coercive treatment of adults with severe mental illness under Queensland’s Mental Health Act 2000, it then evaluates the advantages and disadvantages of supported decision-making, and concludes that the proposed abolition of involuntary treatment laws is not justified.
Commentary on Judith Fingert Chused’s “An Analyst’s Uncertainty and Fear”
Chused’s lovely clinical report is not only a cri de coeur from the trenches by a master clinical analyst. With her honest description of her ongoing countertransference experience and her sensitivity to telling nuance and detail, she provides us with a rare document that allows us to consider the unfolding of the transference-countertransference and intersubjective matrices of the analytic process in all their messiness, complexity, and moment-to-moment unfathomability. Chused avoids the preprocessed, neatly shrink-wrapped reports of momentary countertransference experiences, seemingly quickly thought through, sanitized of their inevitable infiltration by still-unresolved intrapsychic conflicts of the analyst, and transformed into mutative interpretations—in short, the kind of report that we sometimes see in our literature—and instead allows us to focus on a different but equally important realm of intersubjective experience: the enmeshment of irreducible or only partially reducible aspects of the analyst’s and the patient’s intrapsychic lives, as well as their fate in the analytic process and in the post-termination self-analytic reflections of both. Partly because of the richness of Chused’s report, and partly because of the always tentative quality of understanding that may be reached as