My presentation at 'Health Law and Ethics Network Webinar on the Final Report of the Royal Commission into Victoria’s Mental Health System' at Melbourne University, 16 March 2021. A forensic psychiatrist's perspective.

1. LOCKED UP
AND LOCKED
OUT
Andrew Carroll
Forensic Psychiatrist
Andrew Carroll 2021

2. Disclaimer
Andrew Carroll 2021

3. Tribute to
Commissioners
• Immense and impressive body of work
• My comments on the Report are not a criticism
of Commissioners
• I want to highlight several limits on scope of
Recommendations, which arise due to a range of
complex factors
Andrew Carroll 2021

4. 100+
new
TEH
beds
ARC
Expansion
Post-prison
linkage
enhancement
Information
systems
Recommendations to be welcomed…
Andrew Carroll 2021

5. LOCKED UP AND LOCKED
OUT: prisoners
Andrew Carroll 2021

6. Focus on INTERFACES with general community
Andrew Carroll 2021

7. ARC at front end
Focus on INTERFACES with general community
Andrew Carroll 2021

8. ARC at front end
Focus on INTERFACES with general community
Enhanced linkage
services at exit
Andrew Carroll 2021

9. BUT very little about what
goes on INSIDE…
Andrew Carroll 2021

10. Failing the ‘community
equivalence’ principle ?
• access to non-
pharmacological care
for anxiety/ mood
disorders/ trauma
• dementia care
• cognitive disabilities
Andrew Carroll 2021

11. IMPLICATION :
• exclusion of prisoners
from the ‘wellness’
enjoyed by rest of the
community
• an outdated narrative
that ultimately harms
us all
Andrew Carroll 2021

12. The way ahead ?
• Community equivalence
• Destigmatising ‘the
prisoner’
• Access to evidence-
based treatment,
beyond
pharmacological, as per
community
• Medicare Access
• Media
• Public Opinion
• Politics
Andrew Carroll 2021

13. LOCKED UP AND LOCKED
OUT: those subject to Crimes
(Mental Impairment and
Unfitness to Stand Trial) Act
1997
Andrew Carroll 2021

14. CMIA : Locked Up and Locked Out
“Power imbalances that
disadvantage and marginalise
people living with mental illness
or experiencing psychological
distress are still apparent.”
Focus on minimizing/
abolishing coercion
FPs detained purely on basis of risk (eg
propensity to take drugs) – inconsistent with
Human Rights principles and discriminatory
No recommendations for change to
CMIA which is now 23 years old
New MHA being fast-tracked
7 years after the latest version
Certain powerless groups will remain
detained indefinitely in PRISON because
no access to secure clinical community
options : ID, ABI, dementia
Andrew Carroll 2021

15. Andrew Carroll 2021

16. WILL EVEN MORE
NOW
BE LOCKED
UP AND
LOCKED
OUT ?
Andrew Carroll 2021

17. EVEN WORSE ACCESS
FOR SOME OF THE
MOST NEEDY –
SEVERELY PSYCHOTIC
BUT NOT ACCEPTING
TREATMENT ?
BETTER ACCESS
FOR MANY
Effect of changing
‘least restrictive’ to
‘last resort’
Effect of more
Recovery-oriented
services
Andrew Carroll 2021

18. Trans-institutionalization ?
“paradoxically, the more health professionals withdraw from assertive
and involuntary treatment in the name of recovery, the more likely that
police and others operating outside the mental health system will be
called on to assume a coercive role.….”
“Recovery-Based Practice: Do We Know What We Mean or Mean What We Know?” Meehan et al, 2008
Andrew Carroll 2021

19. Andrew Carroll 2021