Thread by @coopesdetat

Will be tweeting in a thread below from the joint @ranzcp-JSPN symposium on patient rights next #RANZCP2021

Our first speaker Neeraj Gill #RANZCP2021

Gill setting the scene #RANZCP2021

How does CRPD intersect with psychiatry? Involuntary treatment as a last resort, subject to safeguards. But CTO use in Australia high by international standards and rising, variation across states #RANZCP2021

Gill presenting data from Queensland on forensic orders, TSOs & involuntary tx orders, significant increases since new act came in aimed at minimising coercion under CRPD #RANZCP2021

What is behind these increases? Lack of appropriate alternatives, risk aversion, a paternalistic and restrictive culture in MH #RANZCP2021

We have to deal with prevailing stigma and discrimination and elevate human rights, concludes Gill #RANZCP2021

Hearing from Miki Ichiro Yano now on the situation in Japan and increasing/commonplace use of mechanical restraints #RANZCP2021

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Interesting historical overview of mental health and psychiatry in Japan from Yano #RANZCP2021

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Now hearing from John Brayley on supported decision-making #RANZCP2021

Lots of evidence for MH measures that enhance positive freedoms, less for those that engage negative freedoms, says Brayley #RANZCP2021

Attitudinal and environmental barriers contribute to decision-making Brayley says. Looking at CTOs - are they beneficial or harmful to patients? Says personal view is some instances they are required, but not in every case they are being used currently #RANZCP2021

In most states CTOs are steady or increasing (except WA) despite capacity changes to MH legislation, highlighted resourcing and cultural barriers to reform #RANZCP2021

Brayley highlighting significant missed opportunities in suicide, with data showing about a third have been seen by MH at the time or in 6 months preceding death and about half across their lifetime #RANZCP2021

Brayley talking about Urgent Mental Health Care Centre model, 50% staffed by peers, majority referrals from ambos, police, EDs and MH triage line. Recliners not cubicles. Only 11% requiring further hospitalisation for MH, 6% for physical health #RANZCP2021

Final talk from Shunya Kurokawa on patient rights in Japan. Length of stay and seclusion/restraint ongoing issues #RANZCP2021

Hearing about shitaku-kanchi, tradition of domestic custody and physical restraint of mentally ill people in Japan. Was abolished in 1950, but problems remained which endure to this day #RANZCP2021

Led to a situation where hospitals had too many patients and not enough doctors, reliance on physical restraint. Most facilities are still private, and receive a third of the funding compared to general hospital patients #RANZCP2021

Japan continues to restrain patients at rate of events per day 600 x more than Australia #RANZCP2021

Length of stay is decreasing, but some people have been inpatient for 10, 20, 50 years. Fear of leaving, prefer to die in hospital #RANZCP2021

Restraint slightly decreasing, but a priority for the future, along with abolition of 'special exception' allowing 1/3 staff #RANZCP2021