Psychiatrists' Perceptions of Administrative Review: A Victorian Empirical Study

Abstract

In 1987, the Mental Health Review Board commenced operations under the Mental Health Act 1986. Its principal purpose was to provide an independent review of persons involuntarily detained for treatment of mental illness. These legislative changes reflected a governmental desire for greater accountability and transparency in the provision of involuntary treatment and care, and a much greater focus on the protection of the rights of people with serious mental illness. At that time, independent review of psychiatric decisions was novel in Victoria, and was met with a degree of hostility and resentment by some public sector psychiatrists. In 1995, I conducted interviews with 22 senior public sector psychiatrists from across Victoria, in order to determine whether, and if so how, administrative review had impacted on them and their psychiatric practice between 1987 and 1995. I revisited the research in 2004 in interviews with 15 psychiatrists. In general terms, the 2004 findings reflected an increased level of support for the functions of the Board, and a significant increase in those who considered Board procedures and decisions had impacted on their clinical practice. Consistent with the 1995 findings, the 2004 research confirmed the legitimating effect of the Board for some psychiatrists, and also suggested an increase in those who may seek either to devolve responsibility for decision-making to the Board in difficult cases, or to share a degree of responsibility in such cases. The majority of those interviewed remained sceptical about the capacity of administrative review to raise standards of treatment and care or bring about positive therapeutic outcomes for patients. In view of this finding, it is argued that there is a role for increased education of, or promotion to, clinicians and Board members concerning the positive therapeutic potential of administrative review.