Introduction by Croakey: The Victorian Government should conduct a restorative justice process to address the harms caused by mental health services and then make public apologies, according to a landmark report released this week (and available in summary here).
Dr Caroline Lambert and Simon Katterl, co-authors of the report ‘Not Before Time: Lived Experience-Led Justice and Repair’, explain below why they hope it will start an honest conversation about mental health system harms experienced by consumers/survivors, and families, carers, kin and supporters.
“We ask that those in positions of obligation and authority consider the ways in which those harms can be heard and understood, acknowledged, and restored,” they write.
While focused on the Victorian context, the report’s analysis and recommendations clearly have wider relevance.
Caroline Lambert and Simon Katterl write:
Imagine the worst day of your life. Your heart feels like it weighs a ton. Your thoughts are swirling like a tornado. You feel worthless and you can’t see past the emotional turmoil you’re in.
You ask for help, or perhaps someone asks without your permission. Police come. You don’t know why. You’re dragged into a police van, taken to hospital. When there, nobody tells you what is going on. You’re told you’re going to get medication, but not told what it is or why you’re getting it.
You see posters around the place about your ‘rights’. Soon after you demand those rights, you find yourself strapped to a bed. Only the next day do you come out of the medicated haze you were put in. You ask fellow patients what is going on. They just tell you to be quiet, say yes, and you can get out.
This happens today. These are not occasional harms made from accidents, or vignettes from a bygone era. These harms are experienced every day by mental health consumers/survivors. And the harms are not limited to consumers/survivors, they are impacting families, carers, kin and supporters.
These harms are often caused by the overreach, or the under-reach of the Australian mental health system. The current mental health system can cause harm through its presence, by way of “gross human rights violations”, use of force, harmful practices like seclusion or restraint, unlawful actions, denial of lived experience expertise, and also by its absence – in not providing adequate support for carers and families – paradoxically leading to both their exploitation, and invisibalisation.
Both consumers and family, carers, kin and supporters can be left traumatised by the system.
These harms and restorations of injury are the subject of a lived experience led report ‘Not before Time,’ which has been released as part of sweeping mental health system reforms in Victoria, prompted by the 2021 final report of the Royal Commission into Victoria’s Mental Health System.
Background
In early 2022 the consumer state peak body, Victorian Mental Illness Awareness Council (VMIAC), met with then Minister for Mental Health, the Honourable James Merlino MP, to raise concerns from consumers that despite the value of the Royal Commission, harms had been largely unaddressed.
Arising from this meeting, the Victorian Department of Health commissioned what would become known as the ‘State Acknowledgement of Harm project’.
A Reference Group of ten lived experience leaders, seven consumer/survivors and three family carers was established and tasked with assessing and presenting best-practice approaches to a government acknowledgment of mental health system harm.
The Reference Group and project team worked closely with VMIAC, the carer peak body Tandem, and the Victorian Government throughout. The Reference Group was facilitated by a consumer and carer leader from outside Victoria.
Research for this project revealed that this is the first time a government has considered formally acknowledging harms caused by their publicly funded mental health system. This progressive thinking should be recognised and honoured.
While the Acknowledgment of Harm project recognised the damage that the system can cause to those working in the mental health system, we also recognised the importance of sequential acknowledgment – noting the gross human rights violations that have impacted consumer and survivors as a reason to prioritise their acknowledgement above families, carers, kin and supporters or, indeed those clinicians who choose to work in the sector.
However, before recommendations could be made, the Reference Group spent a significant amount of time identifying, and re-examining the harms experienced by both consumer/survivors and family, carers, kin and supporters.
While the process of re-prosecuting harms came at a personal cost for many of the group members, the potential significance of this report meant that it was a price worth paying.
‘To know where we are going, we need to know where we have come from’
Not only is this report a likely world-first, but the process has also been unique in that it has been led not by those in traditional seats of power and authority – government, clinicians, legal fraternity or business, but rather by people whose expertise is primarily based in their lived experience of the mental health system.
This privileging of lived experience expertise and insight, meant that the project leader, group facilitators and Reference Group members all have either lived or living experience of accessing mental health services, caring or supporting someone who accesses services, or both.
While the project recognises that this report is just the start of a public conversation, they also recognised that harms unequally dispersed. Therefore, Reference Group members included those with First Nations identity, diversity of genders, sexualities, cultures, and aged representations.
An additional 34 experts were consulted across a diverse range of backgrounds and disciplines, including young consumers, transcultural mental health workers, alcohol and other drug lived and living experience experts, lawyers, mental health workers, the Yoo-rrook Justice Commission, advocates from the Uluru Statement from the Heart, LGBTQIA+ and sexuality lived experience experts, commissioners, political and policy specialists, academics and transitional justice experts.
For the Reference Group members, this ‘early in the process’ task of unpacking harms, simultaneously highlighted the vast differences between survivor/consumers and family, carer experiences, and united us in the recognition that by shining a light on, and acknowledging our individual and collective suffering, we might prompt much needed retrospective systemic reflection and government acknowledgement, leading to radical and sustained system transformation.
It is uncertain if system reform alone, without a parallel process of a wider truth and reconciliation process and apology, will be enough to ensure that harms experienced remain in the past.
We know that for many families and carers, their experiences of the system has simply not shifted, people they care deeply for are still dying whilst waiting for available mental health services, whilst transitioning in or out of facilities or whilst under the management of a service.
Families and carers are still being co-opted by the mental health system to provide unpaid support, often causing relational trauma and fracturing familial bonds irreparably. Sometimes the care provision is around the clock, sometimes for decades, sometimes for a lifetime, with carers losing opportunities to engage in employment, education, and stable housing.
Recent experiences by one of the co-authors note that the private mental health system is similarly harmful, and while ‘grateful’ that they have been able to pay the $40,000+ a year in ‘therapeutic’ costs, we cannot pretend that the private system has not been complicit in the harms of its state system twin.
Using a combination of peer reviewed research, grey literature, expert opinion, the Royal Commission evidence and report, the Reference Group was able to explore some of the common harms in the mental health system.
Using the evidence as a springboard to discussion, Reference Group members collaboratively identified 14 harm themes: harmful practices, colonisation and racism in the mental health system, loss of personhood and identity on entering the mental health system, the impact of a narrow biomedical approach, being abandoned or neglected when asking for help, use of force within the system, unlawful practice and denial of justice, denial of lived experience knowledge and expertise, trauma (physical, sexual, cultural, financial, spiritual and psychological), co-opting of families, carers and supporters,loss of life, property, opportunity and future, failing systems and pathways between systems, invisible families, carers, supporters, and their needs, and exploitative use of carers.
These were hard conversations for both of us and for many of the members of the process. Discussions of harm, trauma, and identity are difficult at any time.
It was a visceral challenge to confront prioritising some groups over others, to work within timeframes and government processes, and to have to adapt to and challenge political realities.
While this burden felt great for many in the project, we know it has produced this report. And its recommendations.
Recommendations
The recommendations contained in the report are informed by principles of restorative justice, transitional justice, mad studies, human rights, critical pedagogy, relationality, critical approaches to violence and First Peoples’ calls for justice on this continent.
The first recommendation was that the Victorian Minister for Mental Health should request and fund, the Mental Health and Wellbeing Commission (Commission) to undertake a truth and reconciliation process, described in this advice as a Restorative Justice Process, to hear the harms in the system.
While acknowledging shared identities, the Restorative Justice Process should deal with consumer and survivor harms and family, carer and supporter harms separately.
In addition to the State Government formally hearing these harms and supporting reconciliation in the sector, the Restorative Justice Process should produce a report on the harms in the system, to be delivered to the Victorian Parliament.
Following this, the Victorian Government should formally apologise to the communities identified in the Restorative Justice Process report. The apology should only be delivered following the Restorative Justice Process and should be done in close consultation with those who are identified as being harmed in the report delivered to Parliament.
These recommendations could equally be translated across Australian States and Territories, and into a national landscape.
How can you help?
We have written this piece, hopeful that it will start an honest conversation about mental health system harms experienced by consumers/survivors, and families, carers, kin and supporters.
We ask that those in positions of obligation and authority consider the ways in which those harms can be heard and understood, acknowledged, and restored.
If you found this article distressing, please consider crisis supports listed beneath the tweets.
From Twitter
Crisis supports
13YARN is a crisis support line for Aboriginal and Torres Strait Islander people. Available 24/7. No shame, no judgement, safe place to yarn.
Phone 13 92 76
Kids Helpline provides free, private and confidential 24/7 phone and online counselling service for young people between the ages of 5 and 25.
Phone: 1800 551 800
Lifeline provides free suicide and mental health crisis support for all Australians.
Phone: 13 11 14
Beyond Blue provides free telephone and online counselling services 24/7 for everyone in Australia.
Phone: 1300 224 636
1800 RESPECT provides confidential sexual assault and family and domestic violence counselling via phone and webchat. Available 24 hours a day, seven days a week.
Phone: 1800 737 732
See Croakey’s archive of articles on trauma and health
