SUB.001.00864_01_0001
Unit 6, 18 Harvest Terrace, WEST PERTH WA 6005 M HAS
T: (08) 6234 6300 | Freecall: 1800 999 057 | F: (08) 9226 3977
W: www.mhas.wa.gov.au E: contactus@mhas.wa.gov.au e
Submission of the WA Chief Mental Health Advocate, Debora Colvin,
to the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability — 24 February 2021
Synopsis
| am the retiring Chief Mental Health Advocate and | would like to draw the attention of the Royal
Commission members to people with psychosocial disabilities caused or contributed to by their mental illness and in particular to the:
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care of people who are residents of some types of licensed private psychiatric hostels in Western Australia, where there are examples of violence, abuse, neglect and exploitation which has been uncovered over past years; and
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lack of services generally for people with complex mental health, intellectual disability and behavioural issues which could be considered a form of neglect. These include:
a. people with complex mental health needs, intellectual disability and/or challenging behaviours;
b. people with co-occurring conditions including autism; people in prison; and people on Custody Orders.
ao
The Chief Advocate’s Annual Reports to the Minister, which must be tabled in State Parliament, have raised many of these issues over the years. See MHAS website: https://mhas.wa.gov.au/
Background
The Chief Mental Health Advocate (Chief Advocate) is a statutory position established under Part 20 of the WA Mental Health Act 2014 (the Act) and the holder is also the Chief Advocate under Part 10 of the Declared Places (Mentally Impaired Accused) Act 2015 (the Declared Places Act).
Pursuant to the Act the Chief Advocate has established the Mental Health Advocacy Service (MHAS) and must engage advocates who have advocacy and investigation functions designed to protect the rights of “identified persons” as defined by the Act.
Identified persons include many people with psychosocial and cognitive disabilities including:
e people on involuntary treatment orders in authorised hospitals and the community or on referral orders for compulsory examination by a psychiatrist (often detained in emergency departments);
e residents of private psychiatric hostels (as defined by the Private Hospitals and Health Services Act 1927 Part IIIB);
¢ people on Custody Orders (found unfit to stand trial or not guilty by reason of unsound mind) who are in authorised hospitals or the community; and
e children in, or seeking admission to, mental health wards.
Pursuant to the Declared Places Act, Advocates have similar functions and powers in relation to residents of the Disability Justice Centre (DJC) which is a “declared place” under the Criminal Law (Mentally
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Unit 6, 18 Harvest Terrace, WEST PERTH WA 6005 M HAS
T: (08) 6234 6300 | Freecall: 1800 999 057 | F: (08) 9226 3977
W: www.mhas.wa.gov.au E: contactus@mhas.wa.gov.au e
Impaired Accused) Act 1996 (CLMIA Act). DJC residents have been found unfit to stand trial or not guilty by reason of unsound mind where their prime impairment is intellectual disability and not mental illness.
Hostel Residents
Based on the experience and reporting of MHAS Advocates, residents of private psychiatric hostels (hostels) are a group of people with significant psychosocial and other disabilities including cognitive impairment who are particularly vulnerable to violence, abuse, neglect and exploitation.
MHAS has many examples of violence, abuse, neglect and exploitation involving hostel residents which have been uncovered over the past 10 years and there are concerns about ongoing issues. Examples include violence between residents which is not handled well by hostel management, bullying by staff, poor hygiene, restrictive and questionable practices, poor complaint handling, lack of sexual safety, sub standard living conditions including dirty furnishings, air conditioners not being turned on and hot water being turned off in the evening, low staffing levels, poor quality meals, failure of management to comply with regulations requiring provision of toiletries and clothing.
While the residents come within the role and function of the Chief Mental Health Advocate, limits on funding and other legislative priorities which are not discretionary, as well as the lack of alternative options for such residents, severely limit the ability of MHAS to protect hostel residents. The regulation of these facilities is also complex with three bodies involved.
The fear of eviction is a constant for the residents because of the lack of alternative supported accommodation which discourages complaints.
There are wide variations in funding which is part of the issue. There are 37 licensed hostels (723 beds) in WA which range in style from large institutional facilities ranging in size up to 92 beds which generally get the lowest funding per resident, to community supported residential units and community option homes (with the highest level of funding).
Eight hostels which are large group homes are run privately with the remaining operated by non government agencies (NGOs). The funding varies widely from about $12,000 per bed/person to $195,000 per bed/person per year. In the most highly funded hostels the buildings are also owned and provided by the Government and the license holder is a not-for-profit NGO; in the lowest funded hostels the buildings are owned by the holder of the hostel licence or a related entity and are “for-profit”.
People with complex needs
The lack of secure, stable accommodation and timely, appropriate, consistent, integrated and holistic care for people with complex mental health, intellectual disability and behavioural issues could also be considered a form of abuse and/or neglect.
The MHAS experience of these cases arise from the mental health wards where a person may be inappropriately detained for months. There is a major shortage of appropriate care in the community, particularly supported accommodation, for people with complex needs due to dual and multi diagnosis mental health, cognitive, intellectual or developmental disabilities and challenging behaviour issues. The lack of appropriate care leads to people being:
e Onacute mental health wards for months e On general wards in hospitals with security guards.
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Unit 6, 18 Harvest Terrace, WEST PERTH WA 6005
T: (08) 6234 6300 I Freecall: 1800 999 057 I F: (08) 9226 3977 W: www.mhas.wa.gov.au E: contactus@mhas.wa.gov.au
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Discharged into homelessness or inappropriate “backpackers” and boarding houses without support
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In prison - because of issues arising out of the lack of care and/or not able to get bail because there is no suitable care.
MHAS understands a major issue in these cases is a lack of providers willing or able to provide services including transition care. It is also complicated by multi-departments, agencies and services being involved and a general lack of co-ordination and communication, mixed with a view that everyone has to wait to see what NDIS will provide and ongoing delays in the NDIS decision process. A belief that NDIS will “fix everything” is also a problem.
People with autism, dual diagnosis
MHAS Advocates have dealt with a number of cases of children and young people with autism detained on mental health wards simply because no provider or accommodation can be found for them in the community. It has been told of parents who have had to take their son or daughter to an emergency department and leave them there for fear of harm to themselves or other children. The mental health system and particularly acute wards are not trained or set up to deal with such cases. Further harm (both physical and emotional) is done to the young person (and often other people on the wards) as a result. The same applies to those cared for on general wards.
People on Custody Orders
People on Custody Orders have been found not guilty of a crime (which ranges in seriousness) due to unsound mind or were not fit to stand trial pursuant to CLMIA Act. In WA they currently have limited options and the CLIMIA Act badly needs reform, which is under way though not guaranteed. Many more people are in prison serving time for a crime where their lawyers have advised to plead guilty rather than use the CLMIA Act because Custody Orders do not have an end time limit.
For those who are on Custody Orders, apart from the Disability Justice Centre established under the Declared Places Act, which has been beset by controversy due to its location in the community, prison or the high security acute mental health wards in the Frankland Centre are the only options. Less restrictive beds on an open ward on the Graylands Hospital campus were reduced from 8 to 4 beds and the 4 beds were moved to a ward which is far more institutionalised and has resulted in a loss of freedom and living skills for the people concerned.
Prisoners
Prisoners wait weeks, even months, to get admitted to a mental health inpatient bed in WA 1. Many of
these patients have severe and ongoing mental illness as well as other cognitive and intellectual
disabilities. MHAS is also aware of people (including children) who have been kept secluded in what are described as cages in prison for up to a month due to their behavioural issues - which behavioural issues can be explained by intellectual and developmental disabilities including foetal alcohol syndrome disorder (FASO). It is understood there have been improvements for children in recent years and a forensic mental health youth unit is planned.
1 Inspector of Custodial Services, Prisoner access to secure mental health treatment, 27 November 2018, https://www.oics.wa.gov.au/publications/review/ and MHAS experience.
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