Following last week's article on the visit of the UN Subcommittee for the Prevention of Torture (SPT) to Australia, which was terminated because of the refusal of the Queensland and New South Wales state governments to allow access to their facilities, I started the process of lodging an application under Qld's Right to Information Act (RIA). Quite apart from the cost, I learned that in December, the state Attorney General introduced legislation to allow such visits to take place.

The Bill will remove the legislative barriers that prevented the UN Subcommittee from physically accessing inpatient units of authorised mental health services and the Forensic Disability Service during its recent visit to Australia.

That's very nice but a bit unexpected, as the Minister has always had the authority to permit such visits. In fact, the Director of Mental Health Services (MHS) and deputies never had the authority to block them. S383 (e) of the Qld Mental Health Act 2016 (MHA) relates to "the power of administrators of authorised mental health services to exclude particular visitors to the service." This is clarified in S408 "exclusion of visitors."

... (4) This section does not permit the administrator to refuse to allow either of the following to visit a patient of the service—(a) a person performing a function under an Act, including, for example, a community visitor performing a function under the Public Guardian Act 2014; (b) a legal representative or health practitioner requested by the patient to visit.

Anybody who is refused permission to visit must be given the reasons in writing and advice on how to appeal (S. 408 (3) (1) - (c). As it happens, the UN SPT inspectors were indeed "performing a function under an Act," specifically the OPCAT Accession Act of 2017, so it would appear they were unlawfully excluded. "Aha," say the administrators, "but they were covered by a Federal Act. This is Queensland." And, yes, we know that, because in fact, Ss.555-559 give the chief psychiatrist the power to appoint people as inspectors of mental health facilities "... to investigate, monitor and enforce compliance with this Act ..." S.3 of the Act, "Main objects of the Act," says:

... (2) The main objects (of the MHS) are to be achieved in a way that— (a) safeguards the rights of persons; and (b) is the least restrictive of the rights and liberties of a

person who has a mental illness; and (c) promotes the recovery of a person who has a mental

illness, and the person’s ability to live in the community, without the need for involuntary treatment and care.

"Safeguards their rights... least restrictive environment... recovery and independent life..." It doesn't say anything about inspectors being Australian citizens, all they needed was a signed notice from the chief psychiatrist and hey presto, nobody could refuse them entry. Which they weren't offered.

So this is the game, as anybody who has been caught up in the mental health industry knows. All that is lacking is good faith. It would have been in this country's interest to have opened the doors but we all know what the inspectors would have found: prisons, where people have essentially no rights. I will press on with my RIA application. I have another one in progress, going back about eight months.

Early last year, I wanted to know how much it cost to run the Qld Mental Health Review Tribunal (MHRT). This is the body, set up under S.28 and various other sections of the MHA, that supervises detention and involuntary treatment of patients. Each tribunal consists of a lawyer, a psychiatrist and a lay person, whose role is to review applications by hospitals to detain patients and treat them against their will. A typical hearing consists of the three members, two or three hospital doctors, a nurse or two, probably a social worker, maybe a psychologist and often a lawyer for the hospital. I've been in hearings where there were fourteen people present. Oh, and sometimes the actual patient is present, too. But they don't have to go, and quite often they don't because they know the whole thing is a foregone conclusion: the hospital will get whatever it asks for. As for lawyers for the patients? 97% of patients do not have a lawyer at a hearing that can suspend practically the whole of their human rights for as long as somebody wants.

A lot of people would say the whole thing is a charade. Compare it with the process when I graduated in West Australia many years ago. A single medical officer examined the patient and then signed a form detaining him or her for review by a psychiatrist in a mental hospital. One person, known to the patient, had the personal responsibility of locking him up. Get it wrong, and you were in trouble. Nowadays, responsibility is diffused through a multi-layered bureaucratic process which has total authority over the patient but, when it comes to the crunch, nobody is responsible. So I decided to check the MHRT Annual Report to Parliament to see how much this costs. $19million. Year after year, and prices only ever go up.

As far as rubber stamps go, it would pay for a lot of public housing. I'm not aware that there has ever been a cost-benefit analysis of the MHRT, whether it does the job it's supposed to do, whether the patients are in fact better off than they were before it was turned into a lawyers' party (written by lawyers, of course), but something else in the report caught my eye. They run an educational program for the people on the Tribunal which included a lecture on ECT. That's interesting, I thought, I wonder if they were given any of the bad news about ECT? So I contacted their office to ask for a copy of the lecture. Back came the response: "No, you can't have it." Are you people serious? You can't just decide on a whim to conceal scientific information. So I lodged a formal application under RIA, which was rejected on the basis the lecture related to the Tribunal's "quasi-judicial functions" which are exempt from the RIA. I appealed on the basis scientific material is not "quasi-judicial" by nature. If they're saying it is, then their definition is so broad as to be meaningless: even the directions to the toilets in their building would be kept secret. My application has gone back and forth half a dozen times and is now with some high keeper of the sacred troth who needs three months to ponder it. But we all know why they're so determined to keep this stuff secret, don't we.

I'll let you know the outcome. My critical review of ECT, which shows that every claim made on its behalf is false, it's totally unnecessary and is driven largely by financial pressures, is here:

McLaren N (2017). Electroconvulsive Therapy: A Critical Perspective. Ethical Human Psychology and Psychiatry 19: 91-104. DOI: 10.1891/1559-4343.19.2.91

What's with all the legalistic stuff? From time to time, we hear politicians and other clever people going on about the "stigma of mental disorder" and how it should be reduced. But how can ordinary citizens be expected to change their attitudes, when the same attitudes are cemented in by Acts of Parliament? If there is ever going to be change, it starts at the top. If mental health acts around the world set up a system whereby ordinary citizens can be stripped of their rights and, without ever breaking the law, be treated worse than criminals, then that's where the stigma originates. As long as they are treated as less than human by the larger society, there is zero prospect of that stigma fading away. As the Chinese proverb puts it, "Fish rot from the head down." The Army boys have a much more pungent expression but this is a family blog so we'll pass on it today.

At some stage, I would like to start a database of cases where people on psychiatric drugs have suddenly committed acts which are completely out of character for them. This includes homicides and suicides, self-injury, assaults, arson, disappearances and so on. There was a database in the UK some years ago but this related to suicides and antidepressants, whereas the problem is actually very much larger. The idea I want to test it this: psychiatric drugs cause akathisia, and, apart from feeling like torture, akathisia drives people to do things which are completely out of character. Why is this necessary? Because the drug companies and institutional psychiatry carefully write this out of their narrative that their drugs are safe, reliable, effective - and merciful.

Unfortunately, data bases cost money, so it may be necessary to ask for contributions but we'll cross that bridge when we get to it. Why bother with this project? Because Critical Psychiatry asks the questions that mainstream psychiatry would rather everybody forgot.

I have been asked several times lately if I know of a psychiatrist in Australia who can supervise drug reduction by tapering. I'll make some enquiries but meantime, we're not able to provide any individual advice to people.