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Chapter 4 Section E: Right to maintain physical health when an involuntary patient

Issues often arise when an involuntary patient seeks treatment for physical illnesses or conditions, when they are under the ‘care treatment and control’ of a psychiatric hospital or unit.

The amendments to the Mental Health Act 2007 (NSW) were assented on the 28 November 2014 by way of the Mental Health Amendment (Statutory Review) Act 2014. These changes are now in force. The Mental Health Act 2007 (NSW), now states the primary objective of the Act to be ‘to provide for the care and treatment of, and to promote the recovery of, persons who are mentally ill or mentally disordered.’ The amendment to the Act removed the word ‘control’ from, and introduces the concept of ‘recovery’ to, the Objects of the Act, referring only to ‘care and treatment.’ This change may reflect a legislative intention to give greater weight to the views of consumers when decisions are being made about care and treatment under the Act.

Care in psychiatric hospitals or units tends to focus on treatment, usually by use of medication for mental illness. Sometimes there is concern that patients’ other medical conditions don’t get the proper care and attention 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 to many people with mental health conditions who require psychiatric medications to maintain a stable mental state is the physical health related side-effects that may be associated with some of these medications. This can include, in relation to some medications, increased appetite and associated weight gain, lethargy, impaired sexual performance and involuntary movements (shaking).

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

If you are experiencing a discomforting side-effect of a psychiatric medication prescribed for you, you should discuss this as soon as possible with the prescribing doctor or psychiatrist. 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 Mental Health Facilities. This issue is dealt with in Chapter 5 of this Manual.

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 allowed leave, you can ask for urgent leave to see your regular doctor, dentist, etc.

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) , but 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 HCCC 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 includes:

  • Advocacy;
  • Clarify appropriate linkages with other health care providers;
  • Build stronger partnerships with key stakeholders, including GPs, mental health consumers, families and carers;
  • Establish minimum expectations for the physical health care of consumers, together with a program to improve standards; and
  • Improve the physical health care of mental health consumers.

To read these Guidelines follow this link

Updated January 30, 2015