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MENTAL HEALTH BILL

The Hon. J.D. LOMAX-SMITH (Adelaide—Minister for Education, Minister for Mental Health and Substance Abuse, Minister for Tourism, Minister for the City of Adelaide) (15:38): Obtained leave and introduced a bill for an act to make provision for the treatment, care and rehabilitation of persons with serious mental illness with the goal of bringing about their recovery as far as is possible; to confer powers to make orders for community treatment, or detention and treatment, of such persons where required; to provide protections of the freedom and legal rights of mentally ill persons; to repeal the Mental Health Act 1993; and for other purposes. Read a first time.

The Hon. J.D. LOMAX-SMITH (Adelaide—Minister for Education, Minister for Mental Health and Substance Abuse, Minister for Tourism, Minister for the City of Adelaide) (15:39): I move:

That this bill be now read a second time.

I seek leave to have the second reading explanation inserted in Hansard without my reading it.

Leave granted.

A world class mental health system depends on an effective legislative framework to ensure that society can fulfil its obligation to care for individuals with serious mental illness. There is an expectation in the community, and an obligation on the part of government, that where a person is unable to make an informed decision about their own mental health and welfare, and they are vulnerable or pose a risk to others, intervention can take place to ensure they obtain the assessment, treatment and care that is necessary.

The Mental Health Bill 2008 is designed to replace the Mental Health Act 1993 and provide a contemporary framework for the provision of services to people with serious mental illness who are either unwilling or unable to consent to their own treatment.

To ensure that our mental health legislation is based on up to date knowledge and research and contemporary standards, a thorough review of the Mental Health Act 1993 and related legislation was undertaken. This review commenced in August 2004 and was chaired by Mr Ian Bidmeade, Legal Policy Consultant and Solicitor.

The terms of reference for the review focussed on the extent to which South Australia ' s legislation provided a framework for the management of mental health issues for individuals in a manner consistent with contemporary standards.

The report of the committee ' s findings, ' Paving the Way - Review of Mental Health Legislation in South Australia April 2005 ' (the Report) was released for public comment by the Department of Health at the end of May 2005.

The Report was distributed to approximately 500 stakeholders and the recommendations received significant support.

The Report proposed a number of changes to modernise the legislation and improve responses to people with mental illness. These included:

· the need for a clearer articulation of the rights of people using mental health services and carers;

· greater emphasis on community care, not just hospital or institutional care;

· recognition of the particular circumstances of children;

· acknowledging the unique cultural perspective of Aboriginal and Torres Strait Islander people.

A majority of the changes recommended in the Report were supported by the Government and in December 2006 Cabinet approved the drafting of a Bill for a new mental health Act. The Report recommended the establishment of a Mental Health Tribunal to hear appeals currently heard by the Guardianship Board and the Administrative and Disciplinary Division of the District Court. The Government does not believe the establishment of a Mental Health Tribunal is necessary. Some of the issues regarding the hearing of appeals can be remedied through amendment of the Guardianship and Administration Act 1993 which the Government is progressing.

In October 2007 a draft Mental Health Bill was released for public comment. Fifty - five written submissions were received through to late December 2007. This process resulted in further refinements to the Bill.

The Government would like to thank publicly all of the individuals and organisations who participated in this process, and who have taken the time to formally submit a response to the review, or participate in subsequent consultation. Their input has been of immense value in developing this Bill. I am confident that the comprehensive consultation process has ensured the Government has been able to address key concerns, and their efforts will result in legislation which is clear in its focus while retaining a degree of flexibility.

I would also like to acknowledge the significant contribution former mental health advocate and review and reference group committee member, the late Trevor Parry, made to ensuring mental health legislation and services have become more effectively focussed on the people who use our services. Trevor was passionate about ensuring a balance between any new provisions for early intervention with additional safeguards and supports for people who become subject to involuntary treatment, and this Bill achieves that balance.

The Mental Health Bill 2008 incorporates provisions which bring South Australia into line with contemporary approaches to the management of serious mental health issues and includes innovations designed to assist people to obtain assistance in a manner which aims to minimise the extent to which their freedom is curtailed and to protect their rights.

The long title for the Bill states that it is a Bill for ' An Act to make provision for the treatment, care and rehabilitation of persons with serious mental illness… ' . This Bill is primarily about the use of powers to treat people with serious mental illness against their will and provides for the checks, balances and protections necessary for the transparent and accountable exercise of these powers. The objects of the Bill were refined following consultation an include to ensure that people with serious mental illness retain their freedom, rights, dignity and self-respect as far as is consistent with their protection, the protection of the public and the proper delivery of mental health services designed to bring about their recovery as far as is possible.

Most people with a mental illness are never subject to an order which requires them to have treatment. They are treated by their general practitioner, psychologist or possibly a psychiatrist, willingly seeking and obtaining treatment. The Bill which is before you today is designed to provide a framework for providing care and treatment, while protecting the rights of the small minority of people who are unwilling to accept treatment even though they may be placing their own safety or the safety of others in jeopardy. Research indicates that one in five or twenty percent of Australian adults will be affected by mental illness at some time in their life. Three percent will be seriously affected. It is primarily the three percent of the population who suffer from a major mental illness which seriously affects them that this Bill is concerned with.

The Mental Health Bill 2008 contains a set of principles which are designed to provide guidance to all persons and bodies involved in the administration of the Act. The following principles are included in the Bill:

· mental health services should be designed to bring about the best therapeutic outcomes for patients, and, as far as possible, their recovery and participation in community life;

· the services should be provided on a voluntary basis as far as possible, and otherwise in the least restrictive way and in the least restrictive environment that is consistent with their efficacy and public safety, and at places as near as practicable to where the patients, or their families or other carers or supporters, reside;

· the services should—

· be governed by comprehensive treatment plans that are developed in a multi-disciplinary framework in consultation with the patients (including children) and their family or other carers or supporters; and

· take into account the different developmental stages of children and young persons and the needs of the aged; and

· take into account the different cultural backgrounds of patients; and

· in the case of patients of Aboriginal or Torres Strait Islander descent, take into account the patients ' traditional beliefs and practices and, when practicable and appropriate, involve collaboration with health workers and traditional healers from their communities;

· there should be regular medical examination of every patient ' s mental and physical health and regular medical review of any order applying to the patient;

· children and young persons should be cared for and treated separately from other patients as necessary to enable the care and treatment to be tailored to their different developmental stages;

· the rights, welfare and safety of the children and other dependants of patients should always be considered and protected as far as possible;

· medication should be used only for therapeutic purposes or safety reasons and not as a punishment or for the convenience of others;

· mechanical body restraints and seclusion should be used only as a last resort for safety reasons and not as a punishment or for the convenience of others;

· patients (together with their family or other carers or supporters) should be provided with comprehensive information about their illnesses, any orders that apply to them, their legal rights, the treatments and other services that are to be provided or offered to them and what alternatives are available;

· information should be provided in a way that ensures as far as practicable that it can be understood by those to whom it is provided.

I will now go on to discuss the key provisions of the Bill.

The Mental Health Bill 2008 recognises the role of carers to ensure they can provide the best possible care and support to a person with a mental illness. The Bill includes a definition of a carer and refers to carers in the guiding principles as a category of people to whom information about the illness, any orders that apply, legal rights and the treatment and other services available to the person being cared for is to be given. The provisions regarding confidentiality and disclosure of information enable information to be disclosed to a carer, relative or friend of the person subject to an order if the disclosure is reasonably required for the treatment, care or rehabilitation of the person, and there is no reason to believe that the disclosure would be contrary to the person ' s best interests. If a person is subject to a Community Treatment Order or a Detention and Treatment Order, information reasonably required for their treatment, care or rehabilitation may be shared, despite their opposition to this. These provisions overcome the barriers identified by the Bidmeade review regarding the sharing of information. Carers, professionals and some of the people who use the services who were consulted as part of the Bidmeade review all expressed concern that information necessary for the appropriate care and treatment of a person was not able to be shared. The Mental Health Bill 2008 clarifies that information can be shared with the consent of the person concerned, or with a carer, relative or friend as described.

The Mental Health Act 1993 has been identified as lacking a sufficient focus on the rights of individuals using mental health services. The Bill, in contrast, articulates a number of rights for both voluntary and involuntary patients, as well as their carers, which are not included in the Mental Health Act 1993 . These include:

· Providing a copy of orders and a statement of rights to a guardian, medical agent, relative, carer or friend of the patient nominated by the patient for the purpose, as well as to the patient;

· Providing for the use of interpreters where available and appropriate;

· Entitling the patient to have another person ' s support;

· Entitling the patient to communicate with people outside of the treatment centre;

· Enabling information reasonably required for the treatment, care or rehabilitation of the person to be shared with a relative, carer or friend of the patient, where such disclosure is not contrary to the person ' s best interest;

· The right to a comprehensive treatment and care plan and to input into the plan for patients and their carers or other persons providing support to them.

In recognition of the different and broader concept of mental health in Aboriginal and Torres Strait Islander and Torres Strait Islander culture, the Bill establishes as a principle that services should take into account the patient ' s traditional beliefs and practices, and when practicable and appropriate, services should involve collaboration with Aboriginal and Torres Strait Islander health workers and traditional healers. The definition of relative used in the Bill recognises traditional Aboriginal and Torres Strait Islander kinship rules for determining who is a relative.

The Bill enables the Minister to determine that a specified place will be a Limited Treatment Centre for the purposes of the Act. This provision will enable some country hospitals which are suitably equipped, to be declared Limited Treatment Centres. This will enable them to detain and treat a person, if they meet the criteria for the order, for up to 7 days on a level 1 Detention and Treatment Order, rather than having to transport the person to Adelaide. During the 7 day period the illness may resolve itself. These provisions will be of benefit to all South Australians who live in country areas and, in particular, to Aboriginal and Torres Strait Islander people.

If further detention and treatment is deemed necessary, the person should be transferred to an Approved Treatment Centre. Currently the metropolitan public hospitals and 2 private hospitals are approved treatment centres and it is not anticipated that this will change in the immediate future.

The Mental Health Act 1993 does not contain provisions especially directed at children. The Mental Health Bill 2008 includes express provision about the application of the Act to children and includes a number of provisions designed to protect children ' s interests. These include principles that children and young people would be cared for and treated separately from other patients to enable the care to be tailored to their developmental stages and that the rights, safety and welfare of children and other dependants of patients should always be considered and protected as far as possible. The latter principle is designed to ensure that the needs of children and young people are considered and responded to when either or both of their parents have a serious mental illness. While it is not appropriate to include specific provisions for how the children of patients should be treated in the Bill, this principle will provide guidance to mental health and other staff dealing with children in specific circumstances. It is proposed that the Department of Health undertake a review of the current practices regarding the children of patients to ensure that their needs are being adequately addressed.

The Bill provides additional protections and safeguards for children under 18 but recognises that a child of 16 may consent to their own treatment, in line with the Consent to Medical Treatment and Palliative Care Act 1995. The long term orders on which a child may be placed, an infrequent occurrence, are shorter than those for adults and require more frequent review. These provisions are designed to provide greater protection for children.

The Bidmeade review recommended that provisions for electro - convulsive therapy (ECT) should be separate from the provisions for the other, much less commonly used treatments, the use of which is regulated by mental health legislation. This has been done. The Bill includes a requirement that consent, either by or on behalf of the patient, or by the Board, can only be given for a maximum of 12 episodes of ECT in a maximum period of 3 months. The use of ECT without consent is allowed in an emergency, however the psychiatrist administering the treatment in these circumstances must advise the Chief Psychiatrist of their actions within one working day. This requirement will enable the provision of emergency ECT to be monitored.

The term psychosurgery in the current Act has been changed to neurosurgery in the Bill. Psychosurgery is more tightly controlled than ECT and is currently unable to be performed if the patient cannot consent in writing. In practice, this part of the Act has never been used in South Australia. The Bill retains the requirement that neurosurgery has to be authorised by the person who will carry it out and 2 psychiatrists (at least one of whom is a senior psychiatrist), and the patient has to give written consent. If the patient is unable to consent, the Guardianship Board can do so. These provisions retain significant protection for patients but recognise that someone who may benefit from neurosurgery for mental illness is often unable to consent. Enabling the Guardianship Board to consent is designed to assist patients who may benefit from this treatment to obtain it.

The criteria for compulsory intervention for the purpose of mental health care and treatment are a critical component of any mental health legislation as they determine when an individual ' s wishes can be overridden, and assessment and treatment provided compulsorily. The criteria for detention under the current Act are that:

· the person has a mental illness that requires immediate treatment; and

· such treatment is available in an approved treatment centre; and

· the person should be admitted as a patient and detained in an approved treatment centre in the interests of his or her own health and safety or for the protection of other persons.

The concept of ' health and safety ' has proved problematic in practice, often setting the threshold for intervention too high to include people who are obviously deteriorating but have not yet reached the point where both their health and safety are compromised. The criteria included in the Bill for the issue of a Community Treatment Order or Detention and Treatment Order have been developed after giving close consideration to the review ' s recommendation, the United Nations Principles for the Protection of Persons with Mental Illness, the Model Mental Health Legislation agreed to by the Australian Health Ministers ' Council and submissions received during the consultation period. The criteria for both forms of order require decisions that:

· the person has a mental illness; and

· because of the mental illness, the person requires treatment for the person ' s own protection from harm (including harm involved in the continuation or deterioration of the person ' s condition) or for the protection of others from harm; and

· there is no less restrictive means than the particular form of order in question for ensuring appropriate treatment of the person ' s mental illness.

The intent of the criteria for intervention in the Mental Health Bill 2008 is to ensure that a person who needs a specialist psychiatric assessment will receive one. The intent is to broaden the basis for obtaining an order. In line with the recommendations of the ' Inquiry into the Circumstances of the Immigration Detention of Cornelia Rau ' (Palmer Report), initial orders for both detention and community treatment can be made where it ' appears ' to the medical practitioner or authorised health professional that the person has a mental illness. This is a lower threshold than in the current Act where even a medical practitioner who makes a first order, not only a psychiatrist who confirms an order, has to be satisfied the person has a mental illness.

This set of criteria is also intended to address the problems identified by Australian researchers of mental health law. According to their research, mental health laws which place the emphasis on involuntary intervention only when persons are assessed as dangerous to themselves or others result in poorer outcomes for these people. They convincingly argue that placing the emphasis on the dangerousness of the person often results in the period of time between the first onset of the mental illness, usually psychosis including schizophrenia, and the time at which the illness is diagnosed and treated, being longer than necessary. This delay in receiving treatment can lead to a poorer prognosis for the patient and potentially homicide.

Recent data from both New South Wales and the United Kingdom show that the risk of a patient committing homicide during their first psychotic episod e is in the order of one in 500 new cases. In contrast, the annual risk of homicide by patients who have received treatment is only about one in 10 , 000 per year. The researchers note that the lethal assault was usually preceded by frightening delusional beliefs and most of the victims were family members or close associates. Only 15 per cent of victims were strangers.

It would be remiss of me not to point out that most people with a mental illness are not violent and that patients with psychosis are not generally violent once they have been treated and can be safely managed in the community. However it is now clear that untreated psychosis in particular can lead to violence and that mental health law in general, and the criteria for involuntary intervention in particular, can reduce this risk. The greatest risk of potential harm for people with mental illness arises from the potential for suicide if they are not treated. The suicide rate for people with a mental illness is up to one in 10 c ompared to an average of one in 100 for the whole population. The criteria in the Bill place the emphasis on the person ' s need for treatment with the aim of ensuring that patients who need an assessment and treatment will fall within the new legislative scheme. Enabling people to obtain an early assessment, and treatment if required, is designed to reduce the risk of both suicide and homicide arising from untreated illness.

Part 9 of the Bill enables ' authorised officers ' to transport a person who appears to have a mental illne ss. This is in line with a 2006 Australian Labor Party election promise that mental health staff would be given the powers to do their jobs and police would be used where there was a danger involved.

Authorised officers are defined by the Bill as mental health clinicians, ambulance officers, and specific staff of the Royal Flying Doctor Service. Within this part of the Bill ' authorised officers ' and police officers have broadly similar powers. The differences in powers are that some authorised officers, that is, specific ambulance and Royal Flying Doctor Service staff, will be legally able to chemically restrain a person under the provisions of the Controlled Substances Act 1984 , while a police officer, unlike an authorised officer, will be able to break into premises under certain circumstances. These provisions are not new provisions, merely a clearer articulation of existing powers.

Currently, the Mental Health Emergency Services Memorandum of Understanding between the Department of Health, South Australian Ambulance Services, the South Australian Police and the Royal Flying Doctor Service signed in June 2006 provides a framework and specific guidance to staff transporting people with a mental illness. The Bill refers to the Memorandum of Understanding and states that authorised officers, police officers and other persons engaged in the administration of this measure should endeavour to comply with it. It is planned that the Memorandum of Understanding will be updated prior to the new Act coming into force. Practices, driven by the Memorandum of Understanding, are already consistent with the intentions of the Bill and have resulted in the safe transportation of people with mental illness. Police are no longer involved in inter - hospital transfers. The current Mental Health Act 1993 lacks clarity regarding the power of various professionals to transport a person with a mental illness. The Bill and the Memorandum of Understanding clarify that in the main, responsibility for transporting people with a mental illness rests with health staff, however when there is a danger, assessed in line with agreed methods of risk assessment, then the police will be there to assist.

Recent reforms of mental health legislation in other Australian States and Territories have emphasised the ' treatment plan ' as crucial to proper treatment, incorporating the involvement of both community services and hospitals as appropriate. The Bidmeade review argues that the treatment plan is the cornerstone of compulsory orders for treatment in the community or involuntary inpatient treatment, with the plans being individualised, multidisciplinary and comprehensive, not just focussing on medication.

Consistent with a focus on recovery from mental illness, treatment plans provide the means for clearly articulating the purpose of compulsory mental health orders and how treatment and care will be undertaken. The treatment plan, referred to as a treatment and care plan in the Bill to reflect the multidisciplinary nature of these plans, will specify the elements which are compulsory, for example, medication, and those which are voluntary, for example, counselling. While a treatment plan is a desirable component of a contemporary approach to the treatment of mental illness, the Mental Health Bill 2008 does not allow the absence of a treatment plan as grounds for an appeal against an order. This is to encourage a comprehensive approach to treatment and care plans rather than a minimalist or token approach simply to be able to demonstrate compliance with a legislative requirement.

Organisations representing the interests of patients and their carers have welcomed the requirement for treatment and care plans in the Bill and their involvement in the development of such plans. Since the requirement for treatment plans was prescribed in legislation in Victoria, reportedly all patients have treatment plans and, there has been a significant increase in constructive dialogue and interaction between service providers and service users.

The most significant change in the provision of mental health services in the last century has been the development of care in the community. Facilitated by the development of new drugs to treat psychosis, including schizophrenia, and other major mental illnesses, care in the community has enabled the majority of people with a serious mental illness to remain in the community rather than being detained. This minimises the extent to which a person ' s freedom is limited while ensuring access to appropriate treatment.

The current Act enables only the Guardianship Board to make a Community Treatment Order. It is entirely appropriate for the Guardianship Board to continue to make longer term orders for community treatment or detention and treatment and it is pointed out that the Guardianship Board ' s role in making Community Treatment Orders on receipt of an application remains unchanged. It is expected that in most cases Community Treatment Orders will result from applications made to the Guardianship Board.

However, currently, Community Treatment Orders are generally made only after a person has deteriorated to the point where they have been hospitalised. The general trend in mental health legislation nationally is for orders similar to Community Treatment Orders to be available as a first treatment option if appropriate for a particular person at a particular time. This is also consistent with the principle, contained in the Bill that services are to be provided in the least restrictive environment and the least restrictive way that is consistent with their efficacy and public safety.

To prevent the present situation whereby a patient is often admitted as an inpatient, prior to a Community Treatment Order being made, the Mental Health Bill 2008 enables medical practitioners or a few highly skilled and trained authorised health professionals to be able to make a level 1 Community Treatment Order for up to 28 days to facilitate early access to care and treatment if appropriate. The order must be confirmed by a psychiatrist or authorised medical practitioner within 24 hours or as soon as practicable.

The process used for the Board ' s review of a level 1 Community Treatment Order will, in fact, be similar to a Board hearing that is currently set up on receipt of an application by the Board for the Board ' s consideration of whether a Community Treatment Order should be made as only the Board can make a level 2 Community Treatment Order for up to 12 months.

Community Treatment Orders enable early intervention to occur with the aim of reducing the severity and impact of the mental illness. A level 1 order will be able to be made relatively quickly rather than taking up to 14 days for a hearing of the Guardianship Board as is the case at present. The current Act is also somewhat contradictory in enabling a person to be detained for up to 3 days by a medical practitioner, subject to confirmation of the order, but requiring the authority of the Guardianship Board for them to be treated in the community.

The criteria for both Community Treatment Orders and Detention and Treatment Orders contain common elements and the requirement that the order is the least restrictive means of ensuring appropriate treatment of the person ' s illness will mean that in appropriate cases a Community Treatment Order is made. This provision aligns with national and international approaches to managing serious mental illness.

The Chief Psychiatrist has a responsibility to ensure that a mental health clinician is responsible for monitoring compliance with the order which is aimed at preventing people falling through the cracks if they move to another area or even interstate. Rather than focussing narrowly on medication and medical treatment like the current Act, it is contemplated that a broader range of services will be included in a treatment and care plan under a Community Treatment Order.

In contrast to the other States and Territories, with the exception of Tasmania, the Mental Health Act 1993 only allows a medical practitioner to make an order for detention and treatment. The Bill enables ' authorised health professionals ' as well as medical practitioners to make both Community Treatment Orders and Detention and Treatment Orders. It is planned that ' authorised health professionals ' will be a few individuals with advanced skills, knowledge and training in mental health.

Currently, the power to confirm an order is restricted to a psychiatrist. The Mental Health Bill 2008 enables psychiatrists and ' authorised medical practitioners ' to confirm an order. An authorised medical practitioner will be a person who has undertaken several years of psychiatric training at a reputable training institution and has considerable psychiatric experience. These people will be selected by the Minister, on the advice of the Chief Psychiatrist.

The Bill, unlike the current Act, makes it clear that audio - visual conferencing can be used as the basis for making, confirming, extending, reviewing and revoking orders. This will reduce the need for people from remote areas to be transported to Adelaide for an assessment if they can be appropriately and safely examined via audio - visual conferencing.

The timeframes for involuntary treatment, particularly detention and treatment in the Mental Health Bill 2008 have been adjusted to more accurately correspond with the actual patterns of many mental illnesses and reflect a number of safeguards including specialist psychiatric and Board reviews. In contrast to the current Act all orders will expire at 2pm on a business day rather than at midnight.

The particular needs of children are addressed by provisions for shorter orders and more frequent reviews.

Patients can appeal at any time against any order and legal representation for appeals will continue to be provided. A range of people may make an application to the Board for a variation or revocation of a long term Community Treatment Order or a Detention and Treatment Order, both of which are made by the Board.

The Mental Health Bill 2008 provides additional safeguards for people in receipt of mental health services. The position of Chief Psychiatrist will replace t he existing position of a Chief Advisor in Psychiatry. The Chief Psychiatrist will have the authority to monitor and review the performance of mental health services with a focus on promoting continuous improvement and issue standards to apply in the treatment of patients.

The current Act is silent regarding the issue of how interstate orders apply in South Australia and how South Australian orders apply interstate and the current regulations deal only with transfer to and from the Northern Territory. The Bill deals with these matters in a comprehensive fashion. A Ministerial Agreement will be negotiated with the other States and Territories, on an individual basis. These agreements will provide greater clarity for all parties regarding the inter - state management of people on mental health orders.

Concerns were raised during consultation about the potential for patients not yet subject to an order for detention or treatment to be transferred long distances interstate for mental health examination and it was suggested that a requirement to transfer patients to the nearest facility should be imposed. It would, of course, be problematic to impose hard and fast rules given the need to consider multiple means of transport and routes and the many factors that properly affect a decision on the most appropriate facility for a person in need of mental health care in the particular circumstances.

The Bill includes a guiding principle that ' services should be provided...... at places as near as practicable to where the patients, or their families or other carers or supporters reside ' and it is the intention that these new provisions should reduce the distances that people have to travel for a mental health examination.

The Bill also requires that, in circumstances where action is being taken in accordance with a Ministerial Agreement, the action may only be taken if it is in the best interests of the patient or person concerned. Prudent administration will require records to be kept of the basis on which the action is taken.

The Mental Health Bill 2008 provides reforms which will complement the Government ' s recently announced $107.9 million mental health reform package to implement the Social Inclusion Board ' s recommendations. This reform package comprised funding for:

· 90 intermediate care beds;

· 73 supported accommodation places;

· 6 new community mental health centres;

· the employment of 8 new mental health nurse practitioners in the country;

· the establishment of a priority access service for about 800 people with chronic and complex needs, including those with drug and alcohol problems, a history of homelessness or who may be involved in the criminal justice system;

· the provision of non clinical community based support services by non-government organisations; and

· the establishment of an early intervention service for young people experiencing their first episode of psychosis.

The Social Inclusion Board also made recommendations about how care should be delivered in the future. The centre piece of their reforms was the stepped model of care which contains the following graduating steps:

· support across the community, including community mental health centres and care and support provided by non-government organisations

· 24-hour supported accommodation;

· community recovery centres;

· intermediate care beds;

· acute care beds; and

· secure care beds.

The Bill recognises the provision of care in the community to assist people leaving acute mental health facilities or to provide a place for early intervention. As a subset of the new stepped care system, the Government has already commenced the process of establishing community recovery centres and opened the first 20 bed centre at Mile End in June 2007. The second, the Trevor Parry Centre, was opened in January 2008 and the third facility at Playford opened in June 2008.

As a further commitment to mental health reform, the Government released the Glenside Concept Master Plan in September 2007 which outlined the development of the Glenside Campus into a new world - class 129 bed hospital for mental illness and substance abuse called: ' SA Specialist Health Services ' that will comprise:

· 40 secure rehabilitation beds;

· 6 mother and infant acute beds;

· 23 rural and remote acute beds;

· 20 acute adult beds;

· 10 psychiatric intensive care beds;

· 30 drug and alcohol acute beds.

In anticipation of the Bill ' s provisions for early access to care and treatment, a new Mental Health Triage Service commenced operation in December 2007, providing for a single entry point and emergency response across Adelaide in partnership with SA Ambulance Service.

The broad definition of mental illness has been retained in the Mental Health Bill in response to the Coroner ' s concerns that people should not be denied access to services, including short term intervention in a crisis, on the basis of diagnosis. The Government ' s capital works program is replacing old and outmoded facilities with new inpatient mainstream facilities such as the Margaret Tobin Centre at the Flinders Medical Centre, the Repatriation General Hospital Aged Care Centre, a new 50 bed facility at Lyell McEwin Health Service which is due for completion in late 2009 and a new 40 bed secure forensic mental health centre at Mobilong.

The Bill acknowledges traditional healers and recognises the cultural values and practices of Aboriginal people and the Government is working in partnership with Aboriginal Health Services to improve service access for Aboriginal people.

The importance of partnership cannot be over - emphasised. For example, it is partnership that underpinned the RAISE Wellbeing Program in Port Augusta between Pika Wiya Health Service and the local specialist mental health service that won a Margaret Tobin Award in 2006.

The Child and Adolescent Mental Health Service has commenced a visiting service to the APY Lands. The visiting team is comprised of a psychiatrist and a social worker. A number of services are provided on the Lands through the Nganampa Health Council and there are 2 Anangu men working in the APY Lands Men ' s Health Program which provides cultural and social, emotional wellbeing support for men at risk of mental health issues.

Housing resources for Aboriginal people with a mental illness who are homeless or at risk of becoming so are located in Adelaide, Port Augusta, Ceduna, Port Pirie, Port Lincoln, Whyalla, Berri, Murray Bridge, Mount Gambier and Coober Pedy.

The Australian Government is providing capital funding for a substance misuse facility for the APY Lands and the SA Government will provide recurrent funding to run the facility. A mobile drug and alcohol outreach service is currently operating on the APY Lands.

In line with the Bill ' s provisions for care in the community and in partnering with non - government organisations, the State Government is undertaking a training initiative for the non - government mental health sector to support the development of its workforce and build up its capacity to deliver high quality services. The Government has also provided funding to NGOs to enhance their governance arrangements as well as for the development of quality standards. These initiatives form part of a broader capacity building program to improve services to people with mental illness.

The Bill recognises the role of informal, unpaid, family carers as partners with service providers in providing care and treatment for people with mental illness. In line with the Carers Recognition Act 2005 , carers have choices and the Bill provides for the appropriate sharing of information with carers who care for a person with a mental illness who is subject to an order.

The Government values the important role that carers play and provides support funding for mental health carer respite and other support programs. A number of carer organisations receive funding from the Government.

The Australian Government is also rolling out a number of programs through the Council of Australian Governments National Action Plan on Mental Health 2006 - 2011. With the inclusion of the recent reforms and infrastructure initiatives, including the Glenside redevelopment, in the 2008 - 09 State Budget, the amount committed as part of the Council of Australian Governments National Action Plan on Mental Health 2006 - 11 is now $344 million. It should also be noted that a number of Australian Government funded services arising from the National Action Plan are now being provided in South Australia. Some of these service programs include Personal Helpers and Mentors, Support for Day to Day Living and Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule.

Most of the $107.9 million for the Social Inclusion Board Report initiatives, is over four years (2007 - 08 to 2010 - 11). An allocation of $600 , 000—of the $18.2 million—for intermediate care, will be spent in the fifth year (2011 - 12) and $13.84 million of the $25.92 million for the community mental health centres will be spent over years five and six, that is, until 2012 - 13.

The Mental Health Bill 2008 and the service initiatives I have described will provide a modernised legislative framework and integrated service system to ensure that society can fulfil its obligation to care for individuals with serious mental illness.

I commend the Bill to Members.

Explanation of Clauses

Part 1—Preliminary

1—Short title

2—Commencement

These clauses are formal.

3—Interpretation

This clause sets out the terms that are defined for the purposes of the measure.

The Board is the Guardianship Board established under the Guar dianship and Administration Act 1993 .

Mental illness is given a general definition—any illness or disorder of the mind. Schedule 1 sets out conduct that will not on its own be taken to indicate mental illness.

Prescribed psychiatric treatment is defined as ECT or neurosurgery for mental illness or any other treatment declared by the regulations to be prescribed psychiatric treatment.

4—Application of Act to children

This clause provides that the measure applies to children in the same way as to persons of full age, subject to the following:

· in the case of a child under 16 years of age, a right conferred on a person may be exercised by a parent of guardian of the child on behalf of the child;

· an obligation to give a document to a person is, if the person is a child under 16 years of age, to be treated as an obligation to give the document to a parent or guardian of the child, and operates to the exclusion of any further obligation to send or give the document to a guardian, medical agent, relative, carer or friend.

5—Medical examinations by audio - visual conferencing

This clause makes provision for medical examinations to be conducted by audio - visual conferencing if it is not practicable in the circumstances for the medical practitioner or authorised health professional to carry out an examination of the person in the person ' s physical presence.

Part 2—Objects and guiding principles

6—Objects

The objects of the measure are—

· to ensure that persons with serious mental illness—

· receive a comprehensive range of services of the highest standard for their treatment, care and rehabilitation with the goal of bringing about their recovery as far as is possible; and

· retain their freedom, rights, dignity and self-respect as far as is consistent with their protection, the protection of the public and the proper delivery of the services; and

· for that purpose, to confer appropriately limited powers to make orders for community treatment, or detention and treatment, of such persons where required.

7—Guiding principles

The Minister, the Board, the Chief Psychiatrist, health professionals and other persons and bodies involved in the administration of the measure are to be guided by specified principles in the performance of their functions.

These are as follows:

· mental health services should be designed to bring about the best therapeutic outcomes for patients, and, as far as possible, their recovery and participation in community life;

· the services should—

· be governed by comprehensive treatment and care plans that are developed in a multi-disciplinary framework in consultation with the patients (including children) and their family or other carers or supporters; and