The Victorian Department of Health (Department) last month released an Update and Engagement Paper (Engagement Paper) addressing the Final Report (Report) of the Royal Commission into Victoria’s Mental Health System (Royal Commission) delivered on 2 March 2021. The Engagement Paper describes the development of the new Mental Health and Wellbeing Act (new Act), expected to be in place by mid-2022, and proposals on policy issues that require more input to make sure they meet the Commission’s recommendations, which the Victorian Government has committed to implementing in full.
The Engagement Paper is divided into the following four key sections which respond to relevant recommendations of the Royal Commission:
- the objectives and principles of the new Act;
- non-legal advocacy, supported decision making and information sharing;
- compulsory treatment and assessment, seclusion and restraint; and
- governance and oversight in the new Act.
Objectives and Principles of the new Act
In light of the Royal Commission’s recommendations, the Engagement Paper states the primary objective of the new Act is to achieve the highest attainable standard of mental health and wellbeing for the people of Victoria.
The proposed Principles of the new Act are rights-based and aim to prioritise the views, preferences and values of people living with mental illness, as well as their families, carers and supporters.
Non-legal advocacy, supported decision making and information sharing
Non-legal advocacy
The Engagement Paper forecasts an opt-out system under the new Act that will ensure all consumers receiving, or at risk of receiving, compulsory treatment can connect with non-legal advocacy services.
In addition to a host of other protections, the new Act may also require mental health and wellbeing service providers to notify non-legal advocacy services as soon as practicable, within 24 hours, after the making of an assessment order or a temporary treatment order.
In addition, to better recognise non-legal advocacy, the newly established Chief Officer for Mental Health and Wellbeing will be supported under the new Act to issue operating guidelines for the provision of Independent Mental Health Advocacy (IMHA) by Victoria Legal Aid.
Supported decision-making
The Engagement Paper considers several mechanisms to be incorporated into the new Act to promote supported decision-making and improve practice among service providers. Namely:
- a statement of rights setting out a person’s rights when receiving mental health services;
- an advance statement that allows a person to document their treatment preferences on a broader range of matters;
- the mandating of nominated persons to support the person receiving mental health services to make their own decisions;
- more flexibility in how second psychiatric opinions can be provided; and
- greater oversight and monitoring.
Information collection, use and sharing
The Engagement Paper outlines proposals for the new Act to be guided by new principles for information collection and use, including greater focus on access for consumers and respect and dignity when dealing with consumer information.
The new Act may further enhance information sharing by making mental health service providers duty-bound to share information with families, carers or supporters and allowing information sharing with Ambulance Victoria in its role as first responder as well as other services.
Compulsory treatment, seclusion and restraint
Compulsory treatment
The Engagement Paper foreshadows a redesigned system for compulsory treatment and assessment under the new Act that may provide, among other things, that compulsory treatment only be used as a last resort and with the least possible restrictions on people’s rights.
Under the new Act, the criteria for compulsory treatment orders and treatment orders will be made more onerous. There will also be greater flexibility around who may be authorised to make a 28-day temporary treatment order beyond only authorised psychiatrists.
Seclusion and restraint
In light of the Royal Commission’s recommendations, the Engagement Paper flags changes under the new Act in respect of seclusion and restraint, including:
- greater transparency on the use of seclusion and restraint as a last resort; and
- introducing the regulation of chemical restraint
Governance and oversight
On the recommendation of the Royal Commission, the Engagement Paper confirms that the new Act will establish the following new entities / roles:
- Mental Health and Wellbeing Commission
The Commission will primarily be responsible for system-wide oversight of the quality and safety of mental health service delivery, advising government on areas of concern and improvement and play a key role in monitoring achievement of some of the Royal Commission’s key goals.
- Chief Officer for Mental Health and Wellbeing
The Chief Officer will principally develop mental health and wellbeing strategy, policy and guidelines and develop and support the mental health and wellbeing workforce.
- Regional Mental Health and Wellbeing Boards
The Regional Boards will provide a platform for greater integration across services beyond the mental health and wellbeing system, including both Victorian Government and Commonwealth Government funded services.
- Statewide and Regional Multiagency Panels
The Regional Multiagency Panels will aim to bring together different service providers to support collaboration and accountability in providing integrated treatment, care and support to this group of consumers. A statewide panel will be legislated under the new Act and chaired by the Chief Officer for Mental Health and Wellbeing. It will comprise the chairs of each Regional Multiagency Panel.
- Collaborative Centre for Mental Health and Wellbeing - (intended to be established in standalone legislation ahead of the new Act)
The Centre will aim to bring together people with lived experience and a broad range of multidisciplinary experts and researchers to deliver adult mental health and wellbeing services to a local population and to develop, translate and share best practice across the system.
Summary and next steps
The incorporation of the Royal Commission’s recommendations into the new Act is being facilitated by:
- a Mental Health and Wellbeing Act Expert Advisory Group to advise on policy and implementation issues required to deliver the new Act, to be chaired by one of our Principals, Michael Gorton AM;
- advice from clinical and lived experience experts to support development of the new Act; and
- feedback through this paper, which is available on the Engage Victoria website from 15 June to 4 July 2021.
The new Act will also incorporate the Royal Commission’s recommendation that a review of the Act be undertaken within five to seven years.
A copy of the Engagement Paper in full can be found here.
A summary of the Royal Commission into Victoria’s Mental Health System can be accessed here.
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