Health Legislation Amendment Bill 2017

7th February 2018

Mr GREG PIPER ( Lake Macquarie ) ( 12:13 :29 ): I support the vast majority of measures contained in the Health Legislation Amendment Bill 2017. The bill deals with a number of public health issues by seeking to amend various Acts, being the Health Administration Act 1982, the Health Services Act 1997, the Human Tissue Act 1983, the Mental Health Act 2007, the Mental Health (Forensic Provisions) Act 1990, the Government Sector Employment Act 2013, and the Government Information (Public Access) Act 2009. It is not my intention to deal with all of the amendments individually. Some of them are not controversial and the Minister dealt with them comprehensively in his second reading speech.

I have been informed also by the contributions to this debate made by the Minister for Mental Health, Minister for Women, and Minister for Ageing, the Hon. Tanya Davies, and the shadow Minister for Mental Health and member for Bankstown, Tania Mihailuk. Having indicated that I will not speak about all aspects of the bill, I will focus on issues relating to mental health provisions in the bill, particularly the application of electroconvulsive therapy [ECT]. I also will briefly discuss amendments to the Government Information (Public Access) Act 2009, known as GIPAA.

Mental health and wellbeing groups, in particular the New South Wales consumer advisory group known as Being, have indicated some opposition to proposed amendments to the Mental Health Act. Specifically, this amending bill provides that the Mental Health Review Tribunal will be able to conduct a review of an involuntary patient or hear an application for electroconvulsive therapy in the absence of the patient. That has caused concern in some quarters who insist that the person must be present for such a hearing or review. Some groups have told me that this provision amounts to a further and unnecessary restriction on the human rights of a person. I accept that conducting mental health reviews and inquiries are complex and at times difficult. Invariably, those procedures are traumatic for people who are confused or greatly depressed.

With the indulgence of the House, I indicate I speak from experience as a former psychiatric nurse at Morisset with responsibility for admissions and administering electroconvulsive therapy. Whenever the term "electroconvulsive therapy" is mentioned, people become quite concerned. The very thought of electroconvulsive therapy is confronting because of depictions in various types of media, including movies, and because people have heard terrible stories. But those depictions relate to the darker and earlier stages in the development of electroconvulsive therapy and similar therapies. Patients now receive a modified version of electroconvulsive therapy that is invariably safe and frequently is lifesaving treatment.

The physiological and neurological changes effected by the administration of electroconvulsive therapy are not fully understood, but they are certainly well documented and widely known. Although I do not advocate for electroconvulsive therapy or promote it, I certainly defend it and argue that it is a very important clinician's tool for assisting people with deep-rooted depression, in particular. Patients who undergo electroconvulsive therapy may be those suffering from psychotic depression, bipolar illness or very acute and very deep reactive depression. People speak of patients being in a state of catatonia. Not many members of this House would have experienced people in a deep catatonic state, but I have. I have seen the life-threatening situations in which those sufferers are placed and the concern of their families and loved ones. I also have seen the amazing changes resulting from the application of electroconvulsive therapy when no other treatment could have achieved the same result.

I strongly support the use of ECT and a reduction in the salacious discussions about it. It should be seen as simply another treatment that should be used only after due consideration. That is the question the Mental Health Tribunal should consider. Although these matters are complex, this bill addresses them appropriately. I have had discussions about these issues with the Minister's staff. During those discussions I suggested that, because people who undergo ECT do so over a long period and in accordance with an established regime, the Government might consider introducing a process similar to an advanced care directive. The introduction of such a process might allow these people to make a more formal decision about their treatment when they are lucid, and it could inform any subsequent interventions. That issue may have been considered but, if it has not, I ask the Government to do so. The Minister is correct in saying that some mental health patients are too unwell to attend a hearing, and they can also refuse to attend.

The bill does not unduly restrict a person's human rights, certainly not more than and perhaps less than other socially sanctioned interventions that are seen to be in the best long-term interests of an individual and therefore society. The bill also provides appropriate safeguards to ensure the safety and welfare of patients and to address their concerns. In addition, a patient's carer or representative would be made aware of any review. I understand the objections that have been raised, and I commend the intention and quality of the submission lodged by Being. However, the bill contains appropriate safeguards and will deliver a better result for patients and their loved ones, all of whom struggle with the effects of severe mental illness. I was pleased to have a discussion with the Minister for Mental Health's representative, who advised that Being believes there has been some softening of concern about those issues.

The Opposition raised concerns about the transparency of the changes to the legislation as they relate to the Government Information (Public Access) Act. Having not been afforded a briefing on the matter by the Government, it is not immediately evident to me that these changes will be detrimental, but I always err on the side of caution in such matters. Therefore, like others, I will be looking to the Minister to address those issues in his speech in reply. It is reasonable for the Government to support sensible amendments proposed in the other place, although I do not believe any amendments have been circulated. I certainly have not seen them. Despite my qualification with regard to the Government Information (Public Access) Act, I will be supporting the bill. I congratulate those who have been involved in the drafting of this legislation.

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