Lacking Insight - Community Law

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Lacking Insightactually have in some respects better processthan when we sit as a full board and I say thatin this way, I think that the full board is by far thebetter option, because I’m a great believer in themulti-disciplinary approach. I think in somethinglike mental health it’s vitally important. So thatI’m not for a moment suggesting that we oughtnot to have three member boards but I think interms of process some patients feel much morecomfortable with one person perhaps sittingaround not even a table in a very informal waythan they do across a table with three peoplefacing them and so on. So that’s where thedichotomy comes. I know from my own practicethat whilst some of my fellow members aren’t sokeen on sitting as single members I actually feeloften quite comfortable about it. That’s not to saythat sometimes I feel very uncomfortable too, itcan work both ways but I think in terms of tryingto have formality, I think formality is somethingwhich is needed on a certain level for frameworkreasons but beyond that it should be a veryflexible process which very much encouragespeople to be participating in the hearing process.That’s got a lot more to do with how good themembers are in terms of running the processthan it does about the process itself.Board PresidentIt’s not just what you say – or whenyou say it – but how you say itThe importance of allowing the consumer to speakfirst at the hearing is not lost on some BoardMembers. Many consumers spoke of a feeling ofbecoming lost during the hearing, of having difficultyfollowing proceedings and being able to clearly puttheir case forward when the time came for themto speak. A number of stakeholders stress theimportance of letting the consumer know that thehearing belongs to the consumer by encouraginghim/her to speak first.Once the chairperson has gone through thebasic explanations about why we are here, [that]we are independent from the hospital, [and that]we come from outside [the hospital] and try toexplain in simple terms what we do. I think it isvery important to [ask] the patient, “What do youthink about being on the order?,” “What has itbeen like in hospital?” or “How do you feel aboutthe CTO?” - I think it is very important to openthe hearing with those kinds of questions so thatthe patient can tell us where he is at, how hefeels about it, how things are going for him andthen the questioning develops from that. Somechairpersons will say to the patient, “Would youlike to go first?” or “Do you want the doctor to gofirst?”, which I think is a mistake myself becausethe majority say, “Let the doctor go first,” ’cause itis a bit intimidating.Board Member (Community)As well as encouraging consumers to speak first it isalso vital for the sake of inclusiveness to engage withthe consumer. A number of stakeholders describe analarming tendency of some clinicians to read aloudfrom the consumer’s file as though the consumer isn’tthere in person but, rather, in the details of the file. Thisconduct has led some Board members to questionwhether some doctors have any understanding of theperson other than as a set of symptoms.The doctor just reads out the report! We can allread! It distances the doctor from the patient. Itmakes the hearing really difficult because at theBoard you don’t want them just to read theirreport, it makes you wonder whether they reallyknow their patient and have engaged the patient,72
Part 4 > The Views of the Stakeholdersbecause they don’t talk to the patient as a humanbeing. “The patient is a 23 year old . . .” We haveread the report! It makes me very uncomfortableat the hearing because the patient is there.The patient is just someone. It makes it reallyunhuman and it is very uncomfortable becauseyou can’t ask the doctor a lot.Board Member (Community)Kept waiting . ... and waitingThe scheduling of hearings and excessive delaywere of concern to advocates as well as consumers.Presently, hearings at a particular venue on aparticular day are all scheduled at the same time.This may mean that consumers wait several hoursbefore their matter is heard. This delay may causea great deal of stress for the consumer, includingimpacting upon the consumer’s ability to then followthe proceedings once they finally begin.In addition, in rural Victoria, individuals may have totravel long distances to get to Board hearings. Anydelays can have a direct impact on other aspects oftheir lives; for example, affecting their return to work thatday or in collecting children from childcare or school.Another thing I just want to mention quickly,in the case of our hearings set down here inWarrnambool the Board’s not able to give, wellit is able, but it’s not prepared to give, a specifictime or timeframe for the commencement ofhearings and they say that’s because it’s verydifficult to do that because they don’t knowhow long each hearing is going to take and Iappreciate that, but perhaps they could allow agenerous amount of notional time for a hearingand if the hearing finishes earlier well everyonegets a break, the Board members get a break orgo off and do some other work.If it goes later well it obviously sets the other timesback, but at least you’d have a ball park time whenyour hearing was going to be conducted rather thanbeing told as you are at the moment that hearingscommence at 10.00 o’clock and if you’re lucky theadministrative staff at the hospital will tell you that‘at the moment you’re third or fourth on the list orfifteenth on the list’ and you’ve got little idea howlong you might have to wait before your hearing andthat can be very inconvenient and it can also createquite a bit of anxiety and stress. So I think there’sa technical point there in the administration of thehearings that they should try and address as well.Legal RepresentativeBody language and demeanourThe importance of a person’s demeanour cannot beoveremphasised. Advocates recount experiencesbefore the Board where the body language ofmembers has caused them a degree of frustration.These feelings have led them to wonder what impactsuch behaviour has on the way the review is beingperceived by their clients.. . . it’s not uncommon to see a psychiatrist – tosee any member on the Board - kind of sigh aftera while, or look kind of impatient or irritated whena client is perceived to have gone on too long ingiving their evidence.I had one Board member who fell asleep in ahearing, and then went to the toilet when theywere making the decision. Or you’re doing yourcross-examination and they let out a big sigh androll their eyes. Or the psychiatrist member looksat the doctor and rolls their eyes. It’s those littlethings that make such a difference in hearingsand that really just infuriate me.Legal Representative73
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Lacking InsightInvoluntary Patient
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14 years. Making the point that she
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ForewordWe have now ushered in a ne
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1 > Summary“[I felt] disempowered
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Lacking Insight• Encouraging cons
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Lacking Insight• The Board must g
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Lacking Insightmust, if a person ha
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Lacking Insight• Key participants
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Lacking Insight−−−−−−
Page 24 and 25: 2 > The ContextMental Health Review
Page 26 and 27: Lacking InsightThe Charter provides
Page 28 and 29: Lacking InsightThree cries for help
Page 30 and 31: Lacking Insightdeinstitutionalisati
Page 32 and 33: Lacking InsightThe Negative consequ
Page 34 and 35: Lacking Insightfor 8 weeks, the res
Page 36 and 37: Lacking InsightDuring my recent adm
Page 38 and 39: Lacking Insightthat they are treate
Page 40 and 41: 3 > The Involuntary Patient Experie
Page 42 and 43: Lacking Insight[Then], if it’s le
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Page 46 and 47: Lacking InsightDid you think it was
Page 48 and 49: Lacking Insightgive me your names?
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Page 67 and 68: One of the issues that I constantly
Page 69 and 70: Part 4 > The Views of the Stakehold
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Page 93 and 94: Appendices• Did you feel that you
Page 95 and 96: Office of the Chief Psychiatrist 20
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Lacking Insight - Community Law

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