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Doctors warn Andrews government’s mental health reforms flawed and put lives at risk

The Andrews government’s proposed mental health reforms fail to strike the right balance between protecting acutely ill patients and keeping healthcare workers safe, Victoria’s peak medical group has warned.

The government has proposed banning the controversial practices of restraining and secluding seriously mentally unwell patients, but Roderick McRae, Victorian branch president of the Australian Medical Association, says this will put lives at risk in the community and among healthcare workers.

Dr Roderick McRae said the government should withdraw its new mental health bill.Credit:Joe Armao

“The [plan] is idealistic and right up there with pink elephants flying,” McRae told The Age.

If the legislation is rushed, and the state gets it wrong, it would lead to tragic results for people, he said. “As regrettable as it is, just like COVID-19 cannot be wished away, neither can profoundly serious mental illness.”

Following a key recommendation from the Royal Commission into Victoria’s Mental Health System, the government has moved to end restraint and seclusion within a decade. The changes are contained in its new Mental Health and Wellbeing Bill.

Mental health advocates argue the archaic practices traumatise vulnerable patients, impinge on their human rights and punish people. They want the ban far sooner, but said the draft legislation was “overwhelmingly” positive.

McRae said while he shared the royal commissioners’ concerns of the “overuse” of restrictive practices, such as locking people away or handcuffing them, eliminating those measures was “dangerously flawed” and put the lives of patients, the community and healthcare workers at risk.

He cited the example of a physically built adult who has been admitted to the emergency ward and is throwing around medical equipment – or is armed with a weapon – in the midst of a psychosis.

“How are we meant to manage these people if we can’t use medical or chemical restraints?” McRae said. “We are going to end up with bad legislation if this goes through Parliament, and it will suddenly become quite unworkable. In the process, there will be deaths – not only patients and healthcare workers, but innocent bystanders.”

However, Victorian Mental Illness Awareness Council chief executive Craig Wallace said the mental health system needed to be reformed to ensure that acutely unwell patients were receiving support before it reached the point of psychosis.

“Any instance of restraint and seclusion is harmful and traumatising for those who at the greatest hour of need come to a service to be looked after, to receive a compassionate and humane response,” Wallace said. “Instead they are being punished and traumatised.”

McRae has claimed the government had undertaken little consultation with the medical community, and urged for the draft legislation to be withdrawn or referred to a parliamentary committee to be scrutinised further.

The opposition does not yet have a formal position on the government’s proposed changes, which will be debated in the upper house in coming months. Derryn Hinch’s Justice Party say they will move amendments to remove plans to eliminate seclusion and restraint within 10 years.

Opposition mental health spokeswoman Emma Kealy said McRae’s assertion the government had not consulted widely was “more evidence” Labor relied on health advice in line with its political agenda.

“Actions speak louder than words,” Kealy said. “Victorians deserve a government delivering a positive plan to fix Victoria’s health crisis, but remember this November that Labor’s only obsessed with control, spin and the politics of COVID.”

A Victorian government spokeswoman said the new bill laid the foundations for reforming the mental health system, and acknowledged that locking people away and restraining them offered no therapeutic benefits.

“Work on the recommendations of the royal commission is well under way to build a new, more responsive and compassionate mental health system that upholds the rights of anyone receiving mental health and wellbeing treatment and care,” she said.

Orygen Youth Health executive director Patrick McGorry said it was possible to eliminate restraint and seclusion because other countries had achieved it.

“The first principle is intervention,” McGorry said. “You want to dramatically reduce the number of people who get to that acutely unwell state.”

Orygen Youth Health executive director Patrick McGorry.

Justice Party’s Stuart Grimley said the government was “living in la la land” based on its draft laws.

“The safety of healthcare workers needs to be paramount when changing laws dealing with unpredictable and sometimes psychotic patients, but that has not been done in this case.”

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