Australia's unethical deportation practice discriminates against New Zealanders with mental illness: 'Everybody needs good neighbours!'

In this article, we explore Australia's deportation of people with mental illness from an ethical and human rights perspective. We outline the legislative framework regulating migration policy in Australia, focussing on Section 501 (s.501) of the Migration Act 1958 (which makes provision for deportation of non-residents on character grounds) and on the recently issued Direction 99 (which provides guidance on visa refusal and cancellation under s.501). We find the definition of a failed character test embedded within the legislative framework to be discriminatory, in that it conflates mental illness with character attributes. We present recent data on s.501 deportees sourced from the New Zealand Police and Manatu Hauora (the New Zealand Ministry of Health). Drawing on our clinical experiences working in forensic psychiatry and rehabilitation services, we describe some of our patients' experiences and the detrimental effects of deportation on their health and well-being. We argue that deportation of people with mental illness contravenes principles of psychosocial rehabilitation and recovery, is discriminatory and constitutes a moral wrong. Furthermore, while we recognise that recent policy changes reflect a tempering of the previous hard-line policy stance, it remains to be seen what effects they will have in practice. We question whether the new guidance will be enough to improve the treatment of and outcomes for those with mental illness, or whether the changes represent a case of too little, too late.

Clinically, what ought we to believe?

OBJECTIVE:: To question the status of the randomised controlled trial (RCT) in the hierarchy of evidence. CONCLUSIONS:: The RCT provides important and clinically relevant information, particularly in psychopharmacology. However, and as with other methodologies, RCTs too are flawed and automatic abdication to their conclusions, especially in complex social interventions, is unwise. A clinical example with conflicting and polarising views, each with their evidence base, is described alongside a suggested clinical strategy for resolving differences of opinion.

Trainee welfare: a New Zealand perspective.

OBJECTIVE: To explore key sources of stress experienced during training by psychiatry registrars and identify which coping strategies they found helpful or unhelpful. METHOD: We used three data sources: a) 'stress' vignettes written by Stage 3 trainees; b) minutes of regular registrar meetings; c) focus groups. We analysed these using abbreviated grounded theory, generating themes. RESULTS: The main sources of stress during training were disempowerment, adverse events, difficult supervision and cultural perspectives. Other themes included difficulties in after-hours work, and organisational issues. Stressors may differ in impact according to training stage. Peer support and a good supervisory relationship reduced stress. Conversely, a poor supervisory relationship compounded stress. Trainees were motivated to address modifiable problems. CONCLUSIONS: A variety of stressors influence training at all stages. Trainees, the College and employers each have a role in promoting trainee welfare. Interlinking cultural dimensions are not currently addressed in the training curriculum and require attention. A good supervisory relationship can buffer many stressors for trainees.

What do doctors know about assessing decision-making capacity?

AIMS: To survey hospital doctors (HDs) and general practitioners (GPs) on what they know about assessing capacity, and to determine their educational needs. METHOD: A mixed-methods, cross-sectional survey was administered to a convenience sample of HDs and GPs. Respondents were asked about their roles, the prevalence of older patients they had seen, specific questions about capacity assessment, difficulties encountered and their preferred format for further education. RESULTS: 152/980 (15%) HDs and 74/4,000 (2%) GPs responded. Most had been concerned about a patient's capacity in the past year, but had not received training in assessing capacity since graduation. The average responder scored below 70% on knowledge questions. Lack of legal knowledge and time pressures were among difficulties encountered. One-third of respondents lacked confidence to assess capacity to a standard high enough to present in court. Many doctors were willing to improve their skills, requesting tutorials or short courses. CONCLUSION: Respondents demonstrated gaps in their knowledge on assessing capacity, and a lack of confidence in their opinions. The findings of this survey suggest that further clinical and legal education of doctors in performing capacity assessments would be valuable.