It’s Always Stage 4 in Locked Mental Health Wards

By Simon Katterl
"Feeding The Black Dog" by Michelle Robinson
"Feeding The Black Dog" by Michelle Robinson

Simon Katterl takes us inside a public mental health hospital where it’s a daily battle for power and control.

Victorians have emerged from lockdown with renewed appreciation for ordinary freedoms. 

Everything once small seems big; seeing friends, having a drink, going to the shops.

2020 has been a test of our collective mental health and wellbeing. 

While we are all in this together, not everyone has been impacted equally. And while many of us are now experiencing these greater freedoms, spare a thought for those whose life and liberties remain locked behind closed wards.

Indigo Daya still has nightmares from her treatment. 

 “It is 10 years since I was last admitted to hospital against my will and forced to take psychiatric medication and 18 years since I was secluded and had ECT (electroconvulsive therapy),” she states in her evidence to the Royal Commission. 

Rather than help her during distress, Indigo said she was traumatized by the system. 

“I have a terror of seeking help from any health practitioner, for fear I may end up subjected to these practices again … For mental health services did enormous long-lasting harm.” 

That was 10 years ago, but how far have we really come?

An average day in a cordoned-off room of a public mental health hospital in Melbourne usually starts with me telling the group:

“I don’t work for the hospital. I’m here to tell you that even if you’re on a compulsory treatment order, you still have rights.”

If people stare blankly, I know to shift gears.

In Victoria, you can be placed under a compulsory treatment order if a mental health clinician – usually a psychiatrist – believes that you have a mental illness that requires immediate treatment to prevent a serious deterioration your mental or physical health or to prevent serious harm to you or another person. 

It’s not as uncommon as you think.

Between 2018-2019, there were 6,297 treatment orders and a staggering 592 electroconvulsive treatment orders made by the Mental Health Tribunal – a tribunal set up to make decisions about compulsory treatment. 

But there is a lack of publicly available data for the more routine treatment orders, such as “temporary treatment orders” meaning the true number is much higher.

Back in the room, somebody usually kicks it off by saying: “The doctor is not listening to me!” 

A chorus of agreeing groans follow. 

Everyone’s got a story about a doctor who won’t listen and we talk through their concerns. 

Not being listened to might not sound like much, right? And usually it isn’t. However, when not being listened to means you have relinquished control of your body and mind, it’s a pretty big deal.

The “consumers” – both a mindset and a term many of us who have accessed mental health services prefer to use rather than patient because it denotes agency – might be preparing for one of the most important meetings of their life, but it’s business as usual for everyone else. 

Generally, the consultations are all one way; consumers have no information about the competency of their assessors, but the assessor know everything about them. Consumers’ thoughts are considerations at best (“delusions” at worst), while the assessor’s opinions are facts. If the consumer is angry at the absurdity of the situation, it is clinical aggression, and the use of force is therapeutic. The consumer is bound by compulsory treatment laws, while the assessors see human rights as optional.

Unfortunately for consumers they are often excluded from decisions about their own treatment. When asked, they reported experiences of “power” and “control” from the mental health system.

Sometimes, I’m just quietly relieved if a fellow consumer isn’t one of the many Victorians who get secluded – a traumatic process where the person is confined to a room or closed space and not allowed to leave. 

It happens far too often, and in Victoria it happens at higher rates than the national average.

Mental health systems should be built on compassion, support and human rights.

Only by confronting these challenges, will we make systems that help, rather than hurt, people who are in distress.

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