An Australian proposal to eliminate forced psychiatric practices such as restraints should be immediately implemented and is vital also for patients in the U.S.

By Jan Eastgate
President CCHR International
June 29, 2022

A new mental health reform to protect human rights is being paved in Australia and, if successful, could be recommended for the U.S. and implemented worldwide. The proposed law in Victoria, Australia, will eventually abolish restraint use. It will also require patient advocacy services to be notified when any person is forced to undergo psychiatric treatment to ensure patients are aware of their rights. With similar abuse found in psychiatric and behavioral facilities throughout the U.S. CCHR is calling for similar reforms but which prohibit all forced treatment and restraints.

Judge Shane Marshall, a former Australian federal court judge, will lead a review into the criteria used for coercive practices, a necessary action a Victorian government royal commission inquiry recommended after finding that human rights were being breached by having mental health patients locked away or handcuffed. The inquiry also recommended practices like seclusion and restraint be phased out within a decade.[1]

However, the Victorian Mental Illness Awareness Council (VMIAC) called on the Victorian government to immediately end the compulsory treatment practices of seclusion and restraint in mental health wards. The group’s damning report, published in June 2022, revealed that physical restraint of children had increased by 32% in 2020-2021 compared with the previous year.[2]

Immediate cessation is absolutely needed. You don’t “phase out” harming people; you immediately stop it.

Abuse is rampant in the U.S.:

• Reports suggest that 37.5% of child or adolescent inpatients in mental health facilities in the U.S. have been secluded or restrained in some manner.[3] This is despite the fact that in 2010, the Joint Commission had warned of more than 200 deaths related to seclusion or restraints over a prior five-year period.[4]

• In 82% of 61 deaths reported in the U.S. National Review of Restraint-Related Deaths, restraint either directly or indirectly contributed to the person’s death, some as young as 9 years old.[5]

• African Americans are over-represented in restraint-related deaths, accounting for 22% of the studied deaths while comprising 13% of the U.S. population.[6]

• Involuntary hospitalizations are estimated to account for about 54% of admissions to U.S. psychiatric inpatient settings. Patients involuntary treated are billed for treatment they don’t want, according to an article published in the American Journal of Psychiatry in 2020. The authors said such billing can foster “outright exploitation.”[7] They found involuntary psychiatric treatment is incredibly costly, with inpatient stays that averaged just over $7,000 for about a week of treatment. Many hospitals also charge about 2.5 times more for inpatient psychiatric care than it costs to deliver that care.[8]

The need to abolish coercive psychiatric practices is entrenched in international human rights covenants and reports. In April this year the United Nations High Commissioner for Rights report said that coercion, involuntary treatment and forced placement are incompatible with human rights.[9] A similar UN Human Rights Council report in 2018 said laws should be repealed that permit the use of coercion and forced interventions, including the use of restraints, electroshock, psychosurgery, and forced medication.[10]

• 2013: Juan E. Méndez, the then UN Special Rapporteur on Torture, called for an “absolute ban on forced and non-consensual medical interventions” including, “the use of restraint and solitary confinement, for both long- and short-term application.”[11]

• 2015: The UN Committee on the Rights of Persons with Disabilities issued guidelines to protect the security and personal integrity of persons with disabilities “by eliminating the use of forced treatment, seclusion and various methods of restraint in medical facilities, including physical, chemical and mechanic restrains.”[12]

• 2021: The World Health Organization’s “Guidance on Community Mental Health Services” recommended to “eliminate practices that restrict the right to legal capacity, such as involuntary admission and treatment, and to replace these with practices that align with people’s will and preferences, ensuring that their informed consent to mental health care is always sought and that the right to refuse admission and treatment is also respected.”[13]

Many psychiatrists, reliant upon coercion, will balk at any such reforms, or they will spin calls for them to their own agenda. There are definitely mental health programs from Australia that should never be adopted in the U.S. or elsewhere, especially where it involves children or teens that are too young to consent. As non-consenting individuals, such, psychiatric “medication” is essentially forced upon them, in violation of international human rights conventions.

In general, Australian law recognizes that individuals aged 18 years and over can consent to their own health care.[14] It is similar for most states in the U.S.[15] If patients are younger than 19, forced treatments have to be considered “coercive psychiatric practices” and, even torture.

Australian psychiatrist, Prof. Patrick McGorry, responded to the proposed Victorian reforms, saying he supported expediting the phasing out of the seclusion and restraint practices but stressed they were symptomatic of “neglect” in the mental system. “The system has been allowed to just collapse on itself,” he said.[16]

Hardly! For decades McGorry and others have ensured billions of dollars have been poured into mental health in Australia that should have prevented any so-called “collapse.” More than a decade ago, he and fellow psychiatrist, Prof. Ian Hickie, were instrumental in developing a “ten year-plan” and blueprint for mental health for the Australian federal government.[17]

One would expect this should have addressed any “neglect” in the system and prevented it in the future.  At the time, the 2010-2011 budget for one of the psychiatrists’ initiated programs, Headspace: Youth Mental Health Services, which had been operational since 2006, was $19 million (US$19.2 million), with an additional $39 million (US$42 million) for 2011-2012.[18] Headspace was to receive almost $200 million (US$215 million) for 30 more Headspace centers to treat 12–25-year-olds each year.[19] Yet, in 2012, McGorry, Hickie and another colleague made the startling admission that psychiatrists and health authorities could not produce any outcome reports for the $5.5 billion already spent annually from past mental health budgets.[20] Over $263 million (US$181 million) in the Federal Budget of 2019–2020 was allocated for future spending over seven years on Headspace.[21]

The money has kept rolling in and with it, coercive practices have been allowed to continue. Improvement in the now financially flush mental health system seems non-existent. Professor Tony Jorm, a University of Melbourne population mental health researcher, emeritus wrote a 2015 report on internal studies produced by Headspace and found their services may have “little or no effect.” He said that decades of increasing funding for Headspace had resulted in no improvement in mental health for those under the age of 24.[22]

In spite of ineffective results and apparently beguiled by promises of better mental health for the country, in 2021, the Australian federal government earmarked another $278.6 million (US$202.6 million) in the 2021-2022 budget for another 10 Headspace clinics.[23] Other mental health professionals questioned the budget committed to Headspace, when the service was seen as an “abject failure” because the rate of youth suicide had risen markedly since it began operation.[24]

Indeed, on June 26, 2022, The Daily Telegraph reported that prescriptions of antidepressants for Australian children have tripled in the 10 years to 2020, triggering calls for government subsidies for the drugs to be banned. The Federal Health Minister has asked his department to review prescribing of the drugs and develop new guidelines for their so-called “safe” use—a misnomer in and of itself. The country’s Therapeutic Goods Administration (TGA)—the equivalent of the U.S. Food and Drug Administration (FDA)—hasn’t approved their use for those younger than 18.[25] But that doesn’t prevent doctors and psychiatrists from prescribing them.

In a report published in April 2021, the TGA claimed that while the increasing use of antidepressants in young people was a concern, the “current evidence” was not sufficient to conclude that prescribing of antidepressants was causing an increase in the rate of youth suicide.[26]

This underplaying of the facts was in response to a 2020 study, wherein three Australian experts—Martin Whitely at John Curtin Institute of Public Policy in Perth, and Melissa Raven and child and adolescent psychiatrist Jon Jureidini at the University of Adelaide’s Critical and Ethical Mental Health Research Group—found the top method for self-harm and suicide in younger age groups in Australia is overdosing on antidepressants. They found: “There is clear evidence that more young Australians are taking antidepressants, and more young Australians are killing themselves and self-harming, often by intentionally overdosing on the very substances that are supposed to help them.”[27]

On June 21, 2022, the researchers, supported by other Australian experts, commented on the TGA report: “Irrespective of semantics, the data in the TGA’s Antidepressant utilization and risk of suicide in young people reinforces our fundamental finding that…more young Australians are taking antidepressants, and more young Australians are killing themselves.’” Further, “We stress that we concluded that ‘causal relationships cannot be established with certainty until there is a vast improvement in post-marketing surveillance,’ but that the evidence we outlined was more consistent with ‘the hypothesis that antidepressant use increases [rather than reduces] the risk of suicide and self-harm by young people.’”[28]

They called for the Australian government to cease Pharmaceutical Benefits Scheme (PBS) subsidies for antidepressants and other psychiatric drugs that are prescribed off-label [not TGA-approved] to Australians aged under 18 years by GPs.[29]

The fact that the TGA took the position that it did on its study is not surprising. As the researchers had earlier pointed out: “There have been numerous examples of these influential organizations [e.g. Orygen, in collaboration with eleven other organizations, including Beyondblue, the Black Dog Institute and Headspace] and individuals incorrectly interpreting or reporting evidence, resulting in inaccurate claims that antidepressant use has been associated with decreased risk of youth suicide.”[30]

Orygen is a McGorry research institution.

Vikki Ryall, executive director of McGorry’s Headspace, told The Daily Telegraph that “psychological therapies and social supports are the first line of treatment for young people experiencing depression.”[31] But Headspace has been faulted for its high use of antidepressants, with critics charging that this may have contributed to the increasing youth suicide rate in the country. An audit of prescribing practices at Orygen’s Headspace clinic, for example, exposed that “the majority of young people (74.5%) were prescribed an antidepressant before an adequate trial of psychotherapy was undertaken.”[32]

Headspace continues to be funded without accountability for results—which should be dramatically reduced numbers of teens with mental health diagnoses and lowered suicide rates, especially since the 2015 independent study of the program revealed a 75% failure rate in improving teens.[33] A study published in the Journal of the Canadian Academy of Child and Adolescent Psychiatry in 2021 similarly concluded: “Headspace has expanded rapidly due to successful political advocacy….” But, “In spite of consuming considerable resources, there has been limited evidence of effectiveness.”[34]

American officials and parents should be concerned. Dr. Thomas Insel, while director of the U.S. National Institute for Mental Health (NIMH), endorsed the Headspace program after visiting Australia in 2011.[35] As reported in January 2022, in the US, the “allcove program,” developed through the Stanford Psychiatry Center for Youth Mental Health and Wellbeing, opened its first two centers in 2021, “inspired and supported by Headspace Australia.” The State of California has committed seed funding for a further five centers.[36]

Oversight and accountability are vital for the mental health industry. Criminal accountability should exist where patients are harmed.

Under Victoria’s Prevention of Cruelty to Animals Act, any person who commits an act of cruelty that wounds, mutilates, abuses, worries, torments, or terrifies an animal, can be fined up to $45,435 (US$31,466) or imprisoned for up to 12 months. If the cruelty results in death or serious disablement of an animal, the offender can be fined up to $90,870 (US$63,000) or imprisoned for up to 2 years. In stark contrast, mistreatment of psychiatric patients continues without any criminal penalty under the Mental Health Act in Victoria.[37]

There needs to be far greater accountability for coercive psychiatric practices that harm, which includes damage from physical and chemical restraints and even suicides or attempted suicides from the prescription of antidepressants and other psychotropic drugs.

The real “neglect” in the mental health system is that psychiatrists have been able to get away with these coercive practices and administering unworkable and potentially harmful treatments with impunity.

Advocacy groups similar to CCHR are needed, independent of the professionals and hospitals harming patients and can investigate incidents of coercion. Criminal and civil accountability for any harm that patients suffer from coercive practices must be legally enforced.

References:

[1] “Victoria to conduct review into coercive practices in mental health system,” The Guardian, 23 June 2022, https://www.theguardian.com/australia-news/2022/jun/23/victoria-to-conduct-review-into-coercive-practices-in-mental-health-system

[2] “Victoria to conduct review into coercive practices in mental health system,” The Guardian, 23 June 2022, https://www.theguardian.com/australia-news/2022/jun/23/victoria-to-conduct-review-into-coercive-practices-in-mental-health-system

[3] Wanda K Mohr, PhD, RN, FAAN, et al., “Adverse Effects Associated with Physical Restraint,” Can J Psychiatry, Vol 48, No 5, June 2003, https://www.crisisprevention.com/CPI/media/Media/Blogs/adverse-effects-associated-with-physical-restraint.pdf

[4] “Comparative Effectiveness of Strategies to De-escalate Aggressive Behavior in Psychiatric Patients in Acute Care Settings,” Agency for Healthcare Research and Quality, 6 Oct. 2013, https://effectivehealthcare.ahrq.gov/products/aggression/research-protocol

[5] https://www.cchrint.org/2021/02/23/cchr-supports-congress-members-wanting-youth-behavioral-centers-investigated/#_edn5; “National Review of Restraint Related Deaths of Children and Adults with Disabilities: The Lethal Consequences of Restraint,” Equip for Equality, 2011, https://www.equipforequality.org/wp-content/uploads/2014/04/National-Review-of-Restraint-Related-Deaths-of-Adults-and-Children-with-Disabilities-The-Lethal-Consequences-of-Restraint.pdf

[6] https://www.cchrint.org/2020/06/09/naacp-inglewood-south-bay-executive-and-cchr-calls-for-ban-on-restraints-in-psychiatric-hospitals/; https://www.equipforequality.org/wp-content/uploads/2014/04/National-Review-of-Restraint-Related-Deaths-of-Adults-and-Children-with-Disabilities-The-Lethal-Consequences-of-Restraint.pdf

[7] “Involuntary Commitments: Billing Patients for Forced Psychiatric Care,” The American Journ. of Psychiatry, 1 Dec. 2020, https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.20030319

[8] Javier Rizo, “Billing Psychiatric Patients for Involuntary Treatment is Unethical,” Mad in America, 18 Feb. 2021, https://www.madinamerica.com/2021/02/billing-psychiatric-patients-involuntary-treatment-unethical/

[9] Annual report of the United Nations High Commissioner for Human Rights and reports of the Office of the High Commissioner and the Secretary-General, 49th session, Human Rights Council, “Summary of the outcome of the consultation on ways to harmonize laws, policies and practices relating to mental health with the norms of the Convention on the Rights of Persons with Disabilities and on how to implement them,” 28 February–1 April 2022

[10] Report of the United Nations High Commissioner for Human Rights, Mental health and human rights, 24 July 2018, A/HRC/39/36, https://documents-dds-ny.un.org/doc/UNDOC/GEN/G18/232/93/PDF/G1823293.pdf?OpenElement

[11] “Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez,” UN Human Rights Council, 1 Feb. 2013, http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf

[12] Council of Europe DH-BIO/INF (2015) 20 of 9 December 2015, COMMITTEE ON BIOETHICS (DH-BIO) Additional Protocol on the protection of the human rights and dignity of persons with mental disorders with regard to involuntary placement and involuntary treatment – Compilation of comments received during the public consultation, pp. 20-22, https://rm.coe.int/16805ab6fe

[13] https://www.cchrint.org/2022/01/09/cchr-launches-mental-health-rights-policy-to-prevent-patient-torture/#_edn2, citing: “Guidance on Community Mental Health Services: Promoting Person-Centered and Rights-Based Approaches,” World Health Organization, 10 June 2021, p. 6, https://www.who.int/publications/i/item/9789240025707 (to download report)

[14] https://www.findlaw.com.au/articles/432/age-of-consent-to-medical-treatment.aspx

[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008301/

[16] “Victoria to conduct review into coercive practices in mental health system,” The Guardian, 23 June 2022, https://www.health.vic.gov.au/news/working-towards-a-new-mental-health-and-wellbeing-act-for-victoria

[17] https://www.cchrint.org/2021/06/06/brave-new-world-australian-psychiatrists-mcgorry-and-hickey-want-criticism-of-psychiatry-silenced/; “Australia’s ‘Draft Ten Year Roadmap for Mental Health Reform,’” CCHR Australia, January 2012, https://cchr.org.au/australias-draft-ten-year-roadmap-for-mental-health-reform, citing: “National Mental Health Report 2010: Summary of 15 Years of reform in Australia’s Mental Health Services under the National Mental Health Strategy 1993-2008,” Commonwealth of Australia 2010

[18] Kelly Patricia O’Meara, “Drugging Kids in Anticipation of Future Mental Disorders? Australian Psychiatrist Patrick McGorry, Focus on Soaring Antipsychotic Use in Aussie Youths,” CCHR International, 28 Apr. 2015, https://www.cchrint.org/2015/04/27/drugging-kids-patrick-mcgorry/

[19] https://www.cchrint.org/2021/06/06/brave-new-world-australian-psychiatrists-mcgorry-and-hickey-want-criticism-of-psychiatry-silenced/; https://www.dailytelegraph.com.au/sanity-prevails-as-mental-health-care-dominates/news-story/1ec63198be9618796d3e540fb2526b4b

[20] “Australia’s ‘Draft Ten Year Roadmap for Mental Health Reform,’” CCHR Australia, January 2012, https://cchr.org.au/australias-draft-ten-year-roadmap-for-mental-health-reform

[21] Jeffrey C.L. Looi, MBBS, MD et al., “Headspace, an Australian Youth Mental Health Network: Lessons for Canadian Mental Healthcare,” J Can Acad Child Adolesc Psychiatry. May 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056954/

[22] Finbar O’Mallon, “Mental health experts question $280m for ‘abject failure’ Headspace,” Financial Review, 12 May 2021, https://www.afr.com/politics/mental-health-experts-question-280m-for-abject-failure-headspace-20210512-p57r7j

[23]

https://www.theguardian.com/australia-news/2021/may/11/budget-2021-mental-health-package-reform-adult-youth-child-headspace-head-to-health-clinics-suicide-prevention-services-australia-federal; https://rpassistants.com.au/news/funding-boost-for-headspace-services/

[24] Finbar O’Mallon, “Mental health experts question $280m for ‘abject failure’ Headspace,” Financial Review, 12 May 2021, https://www.afr.com/politics/mental-health-experts-question-280m-for-abject-failure-headspace-20210512-p57r7j

[25] “New TGA review as number of children prescribed antidepressants doubles in 10 years,” The Daily Telegraph, 26 June 2022

[26] https://www.tga.gov.au/alert/antidepressant-use-and-youth-suicide

[27] https://www.cchrint.org/2020/12/15/cchr-hails-australias-study-of-antidepressant-link-to-youth-suicide/#_edn9, citing: https://bigthink.com/surprising-science/antidepressants-suicide?rebelltitem=1#rebelltitem1; “Antidepressant Prescribing and Suicide/Self-Harm by Young Australians: Regulatory Warnings, Contradictory Advice, and Long-Term Trends,” Frontiers in Psychiatry, 5 June 2020, https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00478/full

[28] “Suicide and Antidepressant Use among Young Australians,” Summary of the TGA’s and other significant responses to Whitely et al. (2020), https://www.psychwatchaustralia.com/post/issue-update-suicide-and-antidepressant-use-among-young-australians,

[29] “New TGA review as number of children prescribed antidepressants doubles in 10 years,” The Daily Telegraph, 26 June 2022

[30] “Antidepressant Prescribing and Suicide/Self-Harm by Young Australians: Regulatory Warnings, Contradictory Advice, and Long-Term Trends,” Frontiers in Psychiatry, 5 June 2020, https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00478/full

[31] “New TGA review as number of children prescribed antidepressants doubles in 10 years,” The Daily Telegraph, 26 June 2022

[32] https://www.cchrint.org/2020/07/14/group-warns-parents-that-eugenics-is-being-repackaged-as-mental-health-care/ citing: Martin Whitely, et al., “Antidepressant Prescribing and Suicide/Self-Harm by Young Australians: Regulatory Warnings, Contradictory Advice, and Long-Term Trends,” Frontiers in Psychiatry, 5 June 2020, https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00478/full

[33] “Is headspace making a difference to young people’s lives: Final report on the independent evaluation of the headspace program,” UNSW, Prepared for the Australian Government, 2015, pp. 2, 3, https://headspace.org.au/assets/Uploads/Evaluation-of-headspace-program.pdf

[34] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056954/

[35] “Post by Former NIMH Director Thomas Insel: Travels Abroad Reveal Impressive Investment in Science,” NIMH, 25 Oct. 2011, https://web.archive.org/web/20210410073120/https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2011/travels-abroad-reveal-impressive-investment-in-science.shtml

[36] Patrick McGorry, Eóin Killackey, et al., “Designing and scaling up integrated youth mental health care,” World Psychiatry, Feb. 2022, Vol. 21, Issue 1, https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20938

[37] https://cchrvictoria.org.au/the-victorian-mental-health-act-is-under-review-2/, citing: Victorian Prevention of Cruelty to Animals Act 1986, s9, s10, pp. 17, 19, 20; Mental Health and Wellbeing Act: Update and engagement paper, p. 41