Introduction by Croakey: In the wake of the Royal Commission into Victoria’s Mental Health System, the State Government has launched an independent review to examine compulsory assessment and treatment criteria in the Mental Health and Wellbeing Act 2022.
Its terms of reference direct it to consider how involuntary mental health treatment criteria impacts different groups, including people of different sexes, gender identities and sexual orientations.
In the article below, Pan Karanikolas and Tessa-May Zirnsak say existing research demonstrates that lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ+) people are over-represented in mental health services and experience exceptionally high rates of mental distress, suicidality, and self-harm.
They say far more attention needs to be paid to research and data about LGBTIQ+ people’s experiences with coercion and involuntary interventions in mental health settings.
Pan Karanikolas and Tessa-May Zirnsak
Australia’s mental health in-patient units have recently come under scrutiny after United Nations Optional Protocol to the Convention Against Torture (OPCAT) officials were denied access to places of detention to conduct inspections, including a mental health in-patient unit in Queensland.
Of particular concern to mental health and lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ+) advocates alike is the overrepresentation of LGBTIQ+ people in mental health services and the exceptionally high rates of mental distress, suicidality, self-harm LGBTIQ+ people face. The first peer-reviewed study on the health of transgender Australian adults showed that 43 per cent have attempted suicide.
The Royal Commission into Victoria’s Mental Health System’s final report recognised the over-reliance on and restrictive practices (seclusion and restraint) and involuntary assessment and compulsory treatment in Victoria’s mental health system, which violate human rights under the UN Convention on the Rights of Persons with Disabilities (UNCPRD). Almost half of all people admitted to Victorian in-patient units do so involuntarily.
The Royal Commission recognised that the mental health system is “unresponsive” to the needs of LGBTIQ+ people and recommended the establishment of an after-care service for LGBTQI persons following a suicide attempt.
However, there is also limited research and data collection about LGBTIQ+ people’s experiences of human rights abuses within mental health in-patient settings, including experiences of compulsory treatment, restrictive practices, and coercion. As acknowledged by one recent Australian study on the gendered impacts of involuntary treatment’s impacts on women, existing research exploring the impacts of involuntary mental health services is frequently conducted without attending specifically to gender.
The Victorian Mental Illness Awareness Council’s most recent Seclusion Report found that no seclusion and restraint data is recorded by the Department of Health regarding LGBTIQ+ people. However, lived experience accounts and individual testimony tell us that there is a lack of personal safety onwards, that consumers experience harassment and vilification, and that there is real need for further attention be paid to issues of gender and sexuality in the context of coercion in mental health settings.
Disadvantage and the increased risks
Existing evidence shows that, in Australia and elsewhere, people from marginalised groups and disadvantaged background are more likely to be subject to coercion in psychiatric care. Research from Canada, the United States and the United Kingdom shows that racism plays a role in coercive treatment. Black people are four times more likely than white people to be detained and more than 11 times more likely (up from eight times higher in 2018) to be subjected to a Community Treatment Order (CTO) in England.
In Australia, Aboriginal and Torres Strait Islander people experience racism in mental health services. One survey found that 97 per cent of Aboriginal and Torres Strait Islander people experienced at least one instance of racism in a health setting the year before participating in the study. Aboriginal and Torres Strait Islander people and people from culturally and linguistically diverse backgrounds are more likely to be subjected to a CTO; the likelihood of forced treatment is increased for people from cultural and linguistically diverse and migrant backgrounds and is tripled in cases where an interpreter is needed.
Pathologising identity and experiences
There is qualitative evidence that trans and gender diverse people experience specific forms of coercion in mental health in-patient settings.
Experiences of sexual, gender and bodily nonconformity have long been pathologised within psychiatry, including specific diagnoses that target gender and sexual dissidence (such as homosexuality, gender identity disorder, and gender dysphoria) or through efforts from professionals to ‘convert’, change or suppress our identities.
LGBTIQ+ people can lack trust in mental health services and are often reluctant, or fearful, to engage with mainstream mental health services.
More data and reporting
We call for the rates of restrictive practices against LGBTIQ+ people to be counted and reported on, so that we can understand what is happening in mental health services regarding rates of compulsory treatment and use of restrictive practice, and so that issues can be identified and addressed.
The Victorian Government has established an Independent Review of Victoria’s compulsory treatment criteria and decision-making laws, which will review both the compulsory assessment and treatment criteria in the Mental Health and Wellbeing Act 2022 and will seek engagement on a consultation paper later this year, with a focus on key groups named in the Terms of Reference, which includes people of different sexes, gender identities and sexual orientations.
Readers can share their support for eliminating the use of conversion therapy by signing Equality Australia’s petition here.
About the Authors
Pan Karanikolas is a PhD candidate in Crime, Justice, and Legal Studies at La Trobe University.
Tessa-May Zirnsak is a consumer academic and PhD candidate at La Trobe University. Her PhD research explores theoretical approaches to the problem of violence against people with intellectual disability and mental illness.
See previous articles about #LGBTIQ issues
