Advocates & Allies: NSW Mental Health Tribunal Q&A
Q: I am a Carer for my son I have never been informed about any of my son’s hearing. The last one the case rang me one day before txt me to call him back but never made me aware there was a tribunal hearing. My son was disappointed too.
A: That must have been very frustrating for you both. Treating teams must make every effort to contact carers. Unfortunately, hearings are often only able to be organised the day before. This is generally about when the teams feel a person is ready to be discharged or because review dates have come around, and an up to date assessment must be provided. In fact, Tribunal members get the papers at 5.30pm the night before.
Q: Given evidence and data suggests a very high percentage of people accessing the public mental health system have experienced complex trauma, how do you include a consideration of a person’s trauma experience in your recommendations for treatment and hospitalisation within the Mental Health Tribunal? As a person who has supported vulnerable young people in their tribunal hearings, I have found the process to be inconsistent. Sometimes it has appeared fair, other times I have perceived the process to be top down, medical, punitive and unwilling to consider the trauma experiences of the young people concerned. The people on the Tribunal were often unaware of the young person’s experience and appeared to make decisions quickly and without collaboration. In my experience, a trauma informed approach was not always adopted through the tribunal process and really depended who was present on the Tribunal at the time.
A: The Tribunal recognises that trauma is frequently a part of a person’s experience, however they cannot specify a clinical intervention because this is not their role, and it would be inappropriate for them to make recommendations. However, they often ask about what else treating teams are looking at to support the person, and what referrals they might be considering, what is currently available to the consumer whilst in hospital or in the community; and probe their thinking. Panels often raise questions that hopefully highlight their concerns without distressing someone in the hearing. The Tribunal is a legal not a clinical panel, so the best we can do is probe treatment plans and make sure treating teams have trauma histories on their radar.
Tribunals only have the papers they have been given and some case notes provide more detailed historical and current information than others. Panels will vary of course, but as a consumer, worker or carer you can provide any information to the Tribunal which you can ask to be included confidentially prior to the hearing to make sure that panels are aware of a person’s lived or living experience of trauma.
Q: Where do you find a peer support worker. No one has made me aware of peer support. I feel sad that I haven’t been proactive to support my son.
A: You can request a peer support worker as part of a NDIS package. They are sometimes called Recovery Coaches. Mental health and the NDIS, NDIS Peer support workers are employed by many of MHCC’s members as NDIS Support Workers, Hasi/ CLS support workers and you could access information through their websites. Some LHDs have inpatient peer support workers for consumers when in hospital. You could also reach out to eFriend which is an online peer worker service.
Q: Families, carers, and patients are often advised the Tribunal will take place with very little notice. What are you doing to ensure fairness and equity to the tribunal process? Tribunals can be retraumatising if they are not conducted well, fairly and from a trauma informed perspective.
A: If consumers and carers feel that for some reason too little time has been provided for a hearing, you can always ask for an adjournment. This often happens if insufficient time to prepare or someone wants to attend not available on that day etc. Panels will also adjourn if they feel inadequate information has been provided.
Q: Having a Peer worker for the consumer and also a person with lived experience for the carer /family after the hearing would be ideal. As all too often the carer/parent is left with the overflow of the hearing, especially when it does not go how the consumer wishes.
A: Absolutely agree with you. We often ask if a peer worker is available to support the consumer after a hearing that has not gone as they might have wished.
Q: When and how does a person gain the trust to be taken off a CTO? Who decides?
A: By attending the hearings and presenting their perspective. By the evidence that the treating team gathers demonstrating that the person has developed an understanding of their illness and shown that they can manage their recovery and live well and safely in the community. That they will seek support when becoming unwell and remain engaged with services and their treatment plan without an order.
In which case Clinicians may decide not to reapply for a CTO and it therefore lapses. Or the Tribunal will decide that they evidence the treating team has provided for a further CTO does not support a further order.
Q: How do you apply a culturally sensitive lens to the Tribunal process for eg: Aboriginal people who have been involuntarily admitted to hospital?
A: Cultural competence is part of a Panel Member’s skill set. Many members have training and experience and are sensitive to cultural context.
Q: Can there be movement to involve peer workers on the tribunal as either the third panel member or potentially looking at creating a fourth panel member for a consumer/carer/peer worker position.
A: A person with lived experience with the appropriate background and experience in the mental health and related fields can apply to be appointed to the Tribunal. Application processes come around every 4 years and there are a number of current Members who are senior peer advocates, (both consumers and carers) working in the field. The Tribunal strongly encourages Peer Support workers to attend hearings and speak to the panel members.
Q: When and how will a recording of this presentation be made so that we can digest this information at our own leisure?
A: This webinar is freely available to anyone who would like to access it, find it here on our website, along with other reordered webinars in the Advocates & Allies series.