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.
The mental health service crisis of neoliberalism -- an antipodean perspective.
Major transformations in forms of governance of the liberal state have been wrought over the course of the last century, including the rise of neoliberalism and 'new public management.' Mental health too has witnessed change, with pharmacological treatment displacing residential care, a shift to community-based services, mainstreaming with general health care, and greater reliance on civil society institutions such as the family or markets. This article considers whether mental health law, and its court/tribunal 'gatekeepers' have kept pace with those changes. It argues that the focus of the liberal project needs to shift to measures which will better guarantee access to mental health services, and keep a more watchful eye on both 'hidden' coercion of people on community treatment orders, and passive neglect of human need.
PLC or TLC: is outpatient commitment the/an answer?
The lively debate over mandated community treatment in general and outpatient commitment laws (OPC) in particular has raised many issues. At its core, the debate is over how and to what extent laws should be formulated to persuade, leverage or coerce (PLC) persons with severe mental illness living in the community to comply with medications that mental health professionals believe they need. The alternative to PLC is what we call TLC (tender loving care): a strategy of using benefits - improved patient-centered treatment, entitlements and service delivery, including assertive outreach - rather than penalties or conditions on access to services, to induce compliance. We examine three aspects of the debate: (1) the empirical case for the need for OPC court orders to maintain revolving-door severely mentally ill persons in the community; (2) the normative argument over whether such orders constitute coercion, and, if so, whether that coercion is justifiable; and (3) the incentives such orders create to leverage community providers to augment resources and tailor treatment and services to entice patients to become willing participants in the management of their disorders.