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Chapter 4 Section J: Right of involuntary patients to maintain physical health

Issues can arise when an involuntary patient seeks treatment for physical health conditions, when they are receiving care and treatment in a psychiatric hospital or unit.

Care in psychiatric hospitals or units tends to focus on treatment, usually through use of management of medication for symptom control of mental illness. Sometimes patients are concerned that their other medical conditions don’t get the appropriate care and attention they need in these circumstances. However, this should not be the case.

The Mental Health Act 2007 (NSW) provides that a person who is detained on a Schedule 1 Medical Certificate may be treated for a serious condition or illness, other than a mental illness or other mental health condition prior to being admitted to a mental health facility for further assessment, and prior to being presented to a Mental Health Inquiry. For example, if a person has been detained on a Schedule 1 Medical Certificate following an incident of serious self-harm (such as an attempted suicide) they are able to be treated for any serious physical injuries prior to being admitted to a Mental Health Facility.

One key issue of concern for many people living with mental health conditions who require psychiatric medication/s to maintain a stable mental state are the side-effects on their physical health that may be associated with some of these medications. Some side effects of antipsychotics can include increased appetite and associated weight gain, lethargy, impaired sexual performance and involuntary movements (shaking known as tardive dyskinesia, which makes certain muscles move uncontrollably). They can also cause blurred vision; low blood pressure and seizures.

Health care professionals have an important responsibility to work with you to avoid, or at least to minimise these side effects. This might include the provision of lifestyle and nutrition advice, changing the time of administration or the dosage, trialling alternative medications that may not produce these side effects or prescribing a non-psychiatric medication to combat the side effect.

If you are experiencing one or several discomforting side-effects from the psychiatric medication/s prescribed for you, you should discuss this as soon as possible with the prescribing psychiatrist and the treating team. If this does not result in a resolution of the problem, you may want to obtain, or request, a second medical opinion.

The Mental Health Act 2007 also sets out the processes that must be followed, and the approvals that must be sought, for surgical procedures required by both voluntary and involuntary patients of public mental health facilities.

If you think you need to see a doctor or another health care professional, such as a dentist, you should tell the staff. If you are have leave privileges, you can ask for urgent leave to see your regular doctor, dentist, etc. If you are only allowed escorted leave, the treating psychiatrist will need to give permission for a support person/staff member to take you.

If you think you are not getting proper treatment or care for a medical condition, or that the treatment for your mental illness is affecting your medical condition and you want the treatment checked, you should ask to speak to the Medical Superintendent of the hospital and/or ask to urgently speak to the Official Visitor.

You could also call the Health Care Complaints Commission (HCCC), However, because complaints to the HCCC must be in writing, urgent problems are not quickly resolved, including concerns or complaints about failure to provide other medical treatment or care. After you are discharged from hospital you may wish to write to the Health Care Complaints Commission to put your concerns about your care on the record.

NSW Health have developed the Physical Health Care of Mental Health Consumers Guidelines to provide a framework and, where available, evidence-based guidance to assist NSW Health mental health services to recognise their role in the physical health care of consumers. This guidance includes provides information about:

  • advocacy;
  • clear and appropriate links with other health care providers;
  • building stronger partnerships with key stakeholders, including general practitioners, mental health consumers, families and carers;
  • establishing minimum expectations for the physical health care of consumers, together with a program to improve standards; and
  • improving the physical health care of mental health consumers.

To read these Guidelines follow this link here

Updated February 20, 2020