Does mental health and guardianship legislation in Western Australia (WA) protect elderly persons from human rights abuse, and ensure procedural and substantive justice? Neville Francis Hills The University of Western Australia This thesis is presented for the degree of Doctor of Philosophy of The University of Western Australia The work presented in this thesis was performed in the Law School 2016 Thesis: Doctor of Philosophy – Mental Health Law Declaration This is to certify that this thesis does not incorporate, without acknowledgement, any material previously submitted for a degree or diploma from any university and that, to the best of my knowledge and belief, does not contain any material previously published or written by another person except where due reference is made in the text. Signed Name Neville Francis Hills Date December 1, 2016 i Thesis: Doctor of Philosophy – Mental Health Law Abstract This thesis addresses matters affecting the liberty, rights and welfare of older people in Western Australia (WA). Restriction of personal liberty to choose where to live, and who to associate with, is usually only permitted under criminal law, following legal processes. Mental health legislation also permits restraints on freedom of individuals, subject to legal oversight of the process. Admission into an aged care facility may restrict a person’s liberty, if placed in a locked area which they cannot leave without staff assistance. Laws regulating these procedures should be fair, open to scrutiny, and meeting international standards of law and good practice. In 2015 there were 16,350 Commonwealth funded aged care beds in 263 facilities in WA. Records indicating which of these facilities are locked always are not kept, although accreditation standards require attention to security and safety of residents. Over 50% of residents have dementia or related conditions, potentially affecting their decision-making capacity. The WA Public Guardian has sole decision-making responsibility for 1,383 individuals, not all of whom are in aged care, suggesting the majority are placed under informal arrangements. These informal admissions are not routinely monitored by any form of legal safeguarding or oversight. Some elderly people informally admitted to mental health facilities, also have no protection under mental health legislation, and no access to official advocates. Informal detention in aged care, has received substantial examination overseas and in other states of Australia. In WA, authorities up to now have shown limited interest in the ethical and human rights aspects. The ‘Bournewood’ case in England provoked ii Thesis: Doctor of Philosophy – Mental Health Law substantial attention and litigation, but the lessons derived have not received attention in WA. Unlike the UK, there is no Human Rights Act in WA, nor any right of independent appeal to an international court. The fact that mental health care and legislation is a state responsibility, while aged care is under Commonwealth government control, creates a gap in ownership of this problem. Laws regulating admission to psychiatric hospitals in WA, owe their origins to historical developments in English law and procedures, handed down in the colonial era. These have been modified in each jurisdiction with the passage of time and local influences. The extent of this divergence is examined in this thesis by two methods; a table of comparisons set out in chapter 3, and an opinion survey of psychiatrists in chapter 4, with further chapters discussing legal and practical issues. Current views on capacity and consent are discussed, followed by consideration of risks with non-consenting detention in aged care, including elder abuse and potential harm. The thesis examined the position up to November 30, 1915 while the Mental Health Act 1996 (WA) was in operation. There are comments in chapter 8 on the Mental Health Act 2014 (WA) and its ability to address some of these matters. English reports indicate serious problems with the costly and burdensome legislation adopted in that country. The thesis concludes with suggested measures which may assist in remedying some of the reported defects in current law and practice, while avoiding unduly complex and ineffective legislation. iii Thesis: Doctor of Philosophy – Mental Health Law Acknowledgements Thanks, are due to Daniel Stepniak UWA principal supervisor, and Brenda McGivern, who have encouraged me in this task, and tolerated with great equanimity, my efforts to adopt legal styles and accuracy in argument. Secondly, and not least I thank my wife Roberta, who has shown great patience and support in my many absences, both at home and away. Thirdly, I acknowledge the contribution to my understanding of law and psychiatry which I have received over many years from patients, carers and fellow workers. Assistance with editing from Ceridwen Clocherty was much appreciated. iv Thesis: Doctor of Philosophy – Mental Health Law Statement of candidate contribution This thesis is entirely my own authorship. The thesis is 90864 words in length, excluding footnotes, bibliography and appendices. v Thesis: Doctor of Philosophy – Mental Health Law Contents Declaration .................................................................................................................................................. i Abstract ...................................................................................................................................................... ii Acknowledgements ................................................................................................................................... iv Statement of candidate contribution .........................................................................................................v Contents ..................................................................................................................................................... vi Abbreviations .......................................................................................................................................... xiii 1 Introduction and review of the field .............................................................................................. 14 1.1 Introduction ................................................................................................................................ 14 1.2 What is the problem that this thesis addresses? ...................................................................... 14 1.3 Examples of a problem ............................................................................................................... 15 1.3.1 Case 1: WA ......................................................................................................................... 16 1.3.2 Case 2: England .................................................................................................................. 17 1.4 Australian Federal and State jurisdictions ............................................................................... 21 1.4.1 Structure of government ..................................................................................................... 22 1.5 Admission to hospitals and aged care homes ........................................................................... 23 1.6 Psychiatrists and law .................................................................................................................. 26 1.7 What is the place of law in relation to the rights and care of elderly people? ....................... 30 1.8 Common law ............................................................................................................................... 31 1.9 Necessity ...................................................................................................................................... 33 1.9.1 Human rights and international obligations ........................................................................ 34 1.10 Health and Mental Health Legislation ................................................................................. 34 1.10.1 Procedural justice (fairness) ........................................................................................... 36 1.10.2 Substantive justice .......................................................................................................... 36 1.10.3 Legal issues of relevance to WA .................................................................................... 37 1.10.4 What is already known on this subject that is relevant to WA? ..................................... 45 1.10.5 Neville Barber: civil commitment and review ............................................................... 46 1.10.6 UWA research theses ..................................................................................................... 47 1.10.7 Elder abuse ..................................................................................................................... 47 1.10.8 Psychiatric practice in WA ............................................................................................. 49 1.10.9 Legislation and procedures to protect the interests of the elderly .................................. 50 1.10.10 Literature ........................................................................................................................ 52 1.11 Guardianship ........................................................................................................................