Experts call for a change in Australian law to aid people with schizophrenia

A group of Sydney researchers has shown that mental health law which focuses on "dangerousness" rather than the right to treatment can delay proper care for up to six months.

Schizophrenia affects one in one hundred Australians. People with schizophrenia may hear voices or wrongly believe that they are in danger or that others are trying to harm them. The illness often strikes in the teens or twenties and goes on to invade all aspects of its victim's life. One in ten will eventually commit suicide.

Schizophrenia can be treated, but early in their illness, suffers often don't recognise that they are unwell and may not agree to getting help.

In Australia, people with mental illnesses may only receive involuntary treatment if a doctor certifies that they are "a danger to themselves or others". Not all mental health law demands proof of dangerousness. In the United Kingdom, for example, it is only necessary to show that the person needs treatment.

The study, Mental health acts that require dangerousness for involuntary admission may delay the initial treatment of schizophrenia which is published online in the medical journal Social Psychiatry and Psychiatric Epidemiology, looked at the results of nearly 50 studies that had been published in 14 countries over the last 30 years.

The Sydney-based researchers (three psychiatrists and a lawyer) calculated how long people with schizophrenia went without treatment in places where the law demanded proof of dangerousness to receive involuntary treatment and compared that with how long treatment took in places that did not.

They found that, on average, people who had just become ill with schizophrenia went without treatment nearly six months longer if they happened to live in an area with a law that demanded a dangerousness certification.

University of Sydney Psychiatrist, Dr Chris Ryan, said: "Before this study, we knew already that when a person first suffers the symptoms of schizophrenia he may be sick for about a year before he gets treatment. That figure was distressing enough. Now we know that if that person happens to live in an area where doctors need to prove dangerousness to provide involuntary treatment, that person will wait 18 months, on average, before he gets proper care."

"Behind these statistics are thousands of stories of patients who become more and more unwell before getting help. A patient of mine, a former university student, began hearing voices in his early twenties. He dropped out of his course, lost his friends and eventually ended up living on the street. He could not see that he was ill though, and he only finally got treatment after he threatened a passer-by with a knife. That is how bad it had to get before he could get better. Only now, two years after his illness began, is he getting his life back on track".

"We know that doctors are not good at judging whether or not someone is dangerous. The problems of judging dangerousness in mental illness was one of the key points revealed in the inquiry into the Virginia Tech shootings. It would be better if people with these illnesses could receive the treatment they need before dangerousness becomes an issue".

http://www.usyd.edu.au/

Comment by Harold A. Maio

What is "revealed" by any committee is solely a consensus reached by that committee, ergo the constitution of that committee remains as important as any finding it promulgates. I am as displeased with this committee for its limits on membership, the narrowing of consensus a priori, as I was displeased by other committees "looking into" mental health issues whose limitations on membership limit consensus.

Sociology seems to enforce limit on inquiry, it often cannot be scientific, influenced by current sociological biases. Biases about mental illness are currently so powerful as to preclude scientific inquiry. The effect upon education is obvious.

In the US as elsewhere the strength of current sociological biases evidenced itself in failed "scientific" inquiry into the ability of women and people whose skin does was not of west European origin.

Currently in the US there are dozens of such limited membership committees, the "product" of their inquiries, what they "reveal," all influenced by who is not permitted membership. How one separates the political and the sociological ought interest researchers.

I watched an interesting example of consensus on a long defunct TV program I watched as a child in the 50s,"What in the World." On it were presented archeological findings for highly educated researchers to identify and discuss, on one, a prehistoric and very small bone carving. Everyone marveled at the artistic merit of the designs, but on that day, present also was a person with entirely different interests, an astronomer. The "artistic" carvings he recognized as a calendar. I saw the consensus change before my eyes.

I also witnessed the difficulty in changing sociological consensus when a woman here declined to change her seat on a a bus. Consensus placed her at the rear, and consensus changed, preceded by months of the most perverse violence, videotaped and sent around the world. World consensus changed America's, as the astronomer's changed the archeologists'.

I presently sit on a board whose membership is intended to be broad enough to include every aspect of mental health it can in reaching decisions, consensus. My role on that committee, matching language to intention is respected by some members, others trapped by their sociological biases, remain unimpressed that word alone can direct perception.

To the issue of deciding dangerousness:

It is an issue of last, not first resort. The introduction of the term "dangerous" is a sociological red flag to me. There are many issues of inquiry before that one arises in mental health, but it provides great pleasure and incentive, to a limited consensus, for avoiding them. The moment of dangerousness occurred when the judge did not communicate his order beyond the bench. The failure of a system often masks itself by focusing upon a failure outside the consensus.

How was Cho specifically failed? That would have been what I brought to that table. How will future "Chos" be specifically failed as a result of this document? Many of those failures, unaddressed, continue. Those failures continue, by "consensus," "unrevealed."

Harold A. Maio
Advisory Board
American Journal of Psychiatric Rehabilitation
Board Member
Partners in Crisis
Former Consulting Editor
Psychiatric Rehabilitation Journal
Boston University
Language Consultant
UPENN Collaborative on Community Integration
of Individuals with Psychiatric Disabilities
[email protected]

* Please note the article title was changed from "Experts call for a change in Australian law to aid schizophrenics" to the above on December 17th 2007.