From Guardianship to Supported Decision-Making: Still Searching for True North?

This article argues that asking whether guardianship has changed is the wrong question. It is the wrong question because guardianship does not exist in isolation from other institutions and legal instruments, such as enduring powers and nominee powers, or informal community arrangements of support or substituted decision-making. It is the wrong question because archetypical purity of guardianship as substitution and support as autonomy does not reflect real world experience of it as it is always a mixture of both, changing over time and decision type; and because change is very hard to pin down. In place of arid debates about whether guardianship should be modified or abolished, the better question to ask is where guardianship and its associated institutions fit within an ideally configured holistic package of formal and informal measures, and whether there are any indications of progress towards its realisation, or how that might be achieved.

Health care complaint journeys for system comparison.

PURPOSE: The "patient journey" technique is one that has been used by health care providers to investigate the strengths and weaknesses of their service delivery. The purpose of this paper is to discuss the experience of adapting this approach for use in an atypical context - the comparison of two systems for managing health care complaints and notifications. It highlights a number of relevant considerations and provides suggestions for similar studies. DESIGN/METHODOLOGY/APPROACH: The design and methods of the study are described, with commentary on the success of key aspects and challenges encountered. To enable comparison between the two systems, this study had a "paired" design, in which examples were selected from each system so that they matched on basic, prescribed, criteria. Data about each matter's journey were then collected from administrative records. FINDINGS: While, overall, the technique provided rich data on the processes of the systems under investigation, the type of data collected (related to administrative/communicative events) and the study's comparative purpose required consideration and management of a number of issues. These included the implications of using administrative records and the impact of differences between the systems on the paired design. ORIGINALITY/VALUE: This paper describes an attempt to apply the "journey" approach in a context that is uncommon in two ways: first, in its focus on regulatory processes (complaint/notification handling), rather than care provision to an individual patient; and second, in its objective of comparing two different systems. It is hoped this account will assist in further development of this technique.

Survey of Quasi-Judicial Decision-Makers in NSW and The National Registration Scheme for Health Practitioners.

This study is part of a larger, Australian Research Council-funded project studying comparative analyses of complaints and notification handling between the NSW system and National Registration and Accreditation Scheme (2010). This article explores the assessments and decisions made by Tribunal and other quasi-judicial decision-makers involved in the two schemes, including the key decision-management stages during a disciplinary process. Respondents recruited from both systems completed an online questionnaire comprising a series of closed and open-ended questions to case vignettes. While we found no significant difference between jurisdictions in relation to their decision-making processes in this case, the article provides insights into the rationales for their decisions and the outcomes or sanctions selected by decision-makers as being appropriate to the circumstances presented.

Assistive technologies for people with dementia: ethical considerations.

The sustainable development goals (SDGs) adopted by the United Nations in 2015 include a new target for global health: SDG 3 aims to "ensure healthy lives and promote well-being for all at all ages." Dementia care of good quality is particularly important given the projected increase in the number of people living with the condition. A range of assistive technologies have been proposed to support dementia care. However, the World Health Organization estimated in 2017 that only one in 10 of the 1 billion or more people globally who could benefit from these technologies in some way actually has access to them. For people living with dementia, there has been little analysis of whether assistive technologies will support their human rights in ways that are consistent with the United Nations Convention on the Rights of Persons with Disabilities. The aim of this paper is to examine the relevant provisions of the convention and consider their implications for the use of assistive technologies in dementia care. Assistive technologies can clearly play an important role in supporting social engagement, decision-making and advance planning by people living with dementia. However, concerns exist that some of these technologies also have the potential to restrict freedom of movement and intrude into privacy. In conclusion, an analysis of the implications of assistive technologies for human rights laws is needed to ensure that technologies are used in ways that support human rights and help meet the health-related SDG 3.

Les objectifs de développement durable (ODD) adoptés par les Nations Unies en 2015 intègrent un nouvel objectif de santé mondiale: l'ODD3, qui vise à « permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous, à tout âge ¼. Une prise en charge de bonne qualité de la démence est particulièrement importante, compte tenu des projections d'augmentation du nombre de personnes atteintes. Plusieurs technologies d'assistance sont proposées pour contribuer à une bonne prise en charge de la démence. Néanmoins, en 2017, l'Organisation mondiale de la Santé a estimé qu'à l'échelle mondiale, parmi le milliard de personnes -voire plus- susceptibles de bénéficier de ces technologies, seule une personne sur 10 peut effectivement y avoir accès. Peu d'analyses ont été réalisées pour déterminer si l'utilisation des technologies d'assistance pour les personnes atteintes de démence peut contribuer à l'application des droits de l'homme au sens de la Convention des Nations Unies relative aux droits des personnes handicapées. L'objectif de cet article consiste à examiner les dispositions pertinentes de cette convention et à considérer leurs implications pour l'utilisation des technologies d'assistance dans la prise en charge de la démence. Il est clair que les technologies d'assistance peuvent jouer un rôle important pour aider à l'implication sociale, à la prise de décision et à la planification anticipée des soins chez les personnes atteintes de démence. Mais des doutes existent aussi sur le potentiel de certaines de ces technologies à restreindre la liberté de mouvement et à enfreindre la vie privée. En conclusion, il est nécessaire d'analyser les implications de l'usage des technologies d'assistance à la lumière des législations sur les droits de l'homme, afin de s'assurer que ces technologies soient employées de manière à contribuer à l'application des droits de l'homme et à atteindre l'ODD3 lié à la santé.

Los objetivos de desarrollo sostenible (ODS) adoptados por las Naciones Unidas en 2015 incorporan un nuevo objetivo para la salud mundial: el ODS 3 tiene como objetivo "garantizar vidas sanas y promocionar el bienestar para todos y para todas las edades". Una atención a la demencia de buena calidad es especialmente importante dado el aumento previsto en el número de personas con dicha enfermedad. Se ha propuesto una gama de tecnologías de asistencia para apoyar la atención a la demencia. Sin embargo, la Organización Mundial de la Salud estimó en 2017 que solo una de cada 10 personas de los mil millones de habitantes o más que hay en el mundo que podrían beneficiarse de tales tecnologías en cierto modo realmente pueden acceder a ellas. Para las personas con demencia, se han realizado pocos análisis de si las tecnologías de asistencia apoyarán sus derechos humanos de forma coherente con la Convención de las Naciones Unidas sobre los Derechos de las Personas con Discapacidad. El objetivo de este artículo es examinar las disposiciones más importantes de la convención y considerar las consecuencias del uso de tecnologías de asistencia para la atención a la demencia. Sin duda, estas tecnologías pueden tener un papel importante a la hora de apoyar el compromiso social, la toma de decisiones y la planificación adelantada por parte de las personas que sufren demencia. Sin embargo, existen temores de que algunas de estas tecnologías puedan limitar la libertad de movimiento e invadir la privacidad. En conclusión, es necesario realizar un análisis de las consecuencias de las tecnologías de asistencia sobre las leyes de derechos humanos para garantizar que se utilicen las tecnologías de forma que respalden los derechos humanos y ayuden a lograr el ODS 3 relacionado con la salud.

How shortcomings in the mental health system affect the use of involuntary community treatment orders.

Objective The aim of the present study was to examine stakeholder perspectives on how the operation of the mental health system affects the use of involuntary community treatment orders (CTOs). Methods A qualitative study was performed, consisting of semi-structured interviews about CTO experiences with 38 purposively selected participants in New South Wales (NSW), Australia. Participants included mental health consumers (n=5), carers (n=6), clinicians (n=15) and members of the Mental Health Review Tribunal of NSW (n=12). Data were analysed using established qualitative methodologies. Results Analysis of participant accounts about CTOs and their role within the mental health system identified two key themes, namely that: (1) CTOs are used to increase access to services; and (2) CTOs cannot remedy non-existent or inadequate services. Conclusion The findings of the present study indicate that deficiencies in health service structures and resourcing are a significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntary and involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulating CTO implementation. What is known about this topic? Following the deinstitutionalisation of psychiatric services over recent decades, community settings are increasingly the focus for the delivery of mental health services to people living with severe and persistent mental illnesses. The rates of use of involuntary treatment in Australian community settings (under CTOs) vary between state and territory jurisdictions and are high by world standards; however, the reasons for variation in rates of CTO use are not well understood. What does this paper add? This paper provides an empirical basis for a link between the politics of mental health and the uptake and usefulness of CTOs. What are the implications for practitioners? This paper makes explicit the real-world demands on the mental health system and how service deficiencies are a significant determinant in the use of CTOs. Practitioners and policy makers need to be candid about system limitations and how they factor in clinical and legal justifications for using involuntary treatment. The results of the present study provide data to support advocacy to improve policy accountability and resourcing of community mental health services.

Public Health Emergencies of International Concern: Global, Regional, and Local Responses to Risk.

The declaration in 2009 that the H1N1 pandemic constituted a public health emergency of international concern (PHEIC) was the first such declaration under the revised International Health Regulations that were adopted in 2005. In the period since then PHEIC have been declared in relation to polio, Ebola, and Zika. This article evaluates initiatives that have been introduced globally, within the Asia-Pacific region, and within Australia, to strengthen preparedness for public health emergencies. Through analysis of evolving conceptualisations of risk, surveillance of zoonotic diseases, and development of public health capacities, the article argues that to date the global community has failed to make the necessary investments in health system strengthening, and that without these investments, global public health emergencies will continue to be an ongoing challenge.

Health complaints and regulatory reform: Implications for vulnerable populations?

Complaints and disciplinary processes play a significant role in health professional regulation. Many countries are transitioning from models of self-regulation to greater external oversight through systems including meta-regulation, responsive (risk-based) regulation, and "networked governance". Such systems harness, in differing ways, public, private, professional and non-governmental bodies to exert influence over the conduct of health professionals and services. Interesting literature is emerging regarding complainants' motivations and experiences, the impact of complaints processes on health professionals, and identification of features such as complainant and health professional profiles, types of complaints and outcomes. This article concentrates on studies identifying vulnerable groups and their participation in health care regulatory systems.

Corrigendum to: Approaches to management of complaints and notifications about health practitioners in Australia.

In 2005, the Australian Productivity Commission made a recommendation that a national health registration regimen and a consolidated national accreditation regimen be established. On 1 July 2010, the National Registration and Accreditation Scheme (NRAS) for health practitioners came into effect and the Australian Health Practitioner Regulation Agency (AHPRA) became the single national oversight agency for health professional regulation. It is governed by the Health Practitioner Regulation National Law Act (the National Law). While all states and territories joined NRAS for registration and accreditation, NSW did not join the scheme for the handling of complaints, but retained its existing co-regulatory complaint-handling system. All other states and territories joined the national notification (complaints) scheme prescribed in the National Law. Because the introduction of NRAS brings with it new processes and governance around the management of complaints that apply to all regulated health professionals in all states and territories except NSW, where complaints management remains largely unchanged, there is a need for comparative analysis of these differing national and NSW approaches to the management of complaints/notifications about health professionals, not only to allow transparency for consumers, but also to assess consistency of decision making around complaints/notifications across jurisdictions. This paper describes the similarities and differences for complaints/notifications handling between the NRAS and NSW schemes and briefly discusses subsequent and potential changes in other jurisdictions.

Approaches to management of complaints and notifications about health practitioners in Australia.

In 2005, the Australian Productivity Commission made a recommendation that a national health registration regimen and a consolidated national accreditation regimen be established. On 1 July 2010, the National Registration and Accreditation Scheme (NRAS) for health practitioners came into effect and the Australian Health Practitioner Regulation Agency (AHPRA) became the single national oversight agency for health professional regulation. It is governed by the Health Practitioner Regulation National Law Act (the National Law). While all states and territories joined NRAS for registration and accreditation, NSW did not join the scheme for the handling of complaints, but retained its existing co-regulatory complaint-handling system. All other states and territories joined the national notification (complaints) scheme prescribed in the National Law. Because the introduction of NRAS brings with it new processes and governance around the management of complaints that apply to all regulated health professionals in all states and territories except NSW, where complaints management remains largely unchanged, there is a need for comparative analysis of these differing national and NSW approaches to the management of complaints/notifications about health professionals, not only to allow transparency for consumers, but also to assess consistency of decision making around complaints/notifications across jurisdictions. This paper describes the similarities and differences for complaints/notifications handling between the NRAS and NSW schemes and briefly discusses subsequent and potential changes in other jurisdictions.

Involuntary psychiatric treatment in the community: general practitioners and the implementation of community treatment orders.

BACKGROUND: There are no data about general practitioners' (GPs') involvement in involuntary psychiatric community treatment orders (CTOs). We examined stakeholder perspectives on the GP's role in this area. METHODS: Semi-structured interviews were conducted around CTO experiences with 38 participants: patients, carers, clinicians and Mental Health Review Tribunal members. Data were analysed using established qualitative methodologies. RESULTS: Sixteen participants specifically spoke about GPs. The analysis identified four themes in their accounts: GPs as 'instruments' of CTOs; GPs as primary caregivers within a CTO; GPs as 'outsiders'; and practical challenges for GPs. Within these themes, participants identified the value of GPs in the provision of care for people living with severe and persistent mental illness, the challenges of coercive processes and the dangers of GPs being isolated from them. DISCUSSION: GPs play an important role in the implementation of CTOs. Failure to better integrate GPs in the care of people on CTOs appears to be a significant shortcoming of its implementation.

Regulating healthcare complaints: a literature review.

PURPOSE: The purpose of this paper is to explore approaches to the regulation of healthcare complaints and disciplinary processes. DESIGN/METHODOLOGY/APPROACH: A literature review was conducted across Medline, Sociological Abstracts, Web of Science, Google Scholar and the health, law and social sciences collections of Informit, using terms tapping both the complaints process and regulation generally. FINDINGS: A total of 118 papers dealing with regulation of health complaints or disciplinary proceedings were located. The review reveals a shift away from self-regulation towards greater external oversight, including innovative regulatory approaches including "networked governance and flexible or "responsive" regulation. It reports growing interest in adoption of strategic and responsive approaches to health complaints governance, by rejecting traditional legal forms in favor of more strategic and responsive forms, taking account of the complexity of adverse health events by tailoring responses to individual circumstances of complainants and their local environments. ORIGINALITY/VALUE: The challenge of how to collect and harness complaints data to improve the quality of healthcare at a systemic level warrants further research. Scope also exists for researching health complaints commissions and other "meta-regulatory" bodies to explore how to make these processes fairer and better able to meet the complex needs of complainants, health professionals, health services and society.

The lived experience of involuntary community treatment: a qualitative study of mental health consumers and carers.

OBJECTIVE: To describe the lived experiences of people subject to community treatment orders (CTOs) and their carers. METHOD: We recruited 11 participants (five mental health consumers and six carers) through consumer and carer networks in NSW, Australia, to take part in interviews about their experiences. We analysed the interview data set using established qualitative methodologies. RESULTS: The lived experiences were characterised by 'access' concerns, 'isolation', 'loss and trauma', 'resistance and resignation' and 'vulnerability and distress'. The extent and impact of these experiences related to the severity of mental illness, the support available for people with mental illnesses and their carers, the social compromises associated with living with mental illness, and the challenges of managing the relationships necessitated by these processes. CONCLUSIONS: The lived experience of CTOs is complex: it is one of distress and profound ambivalence. The distress is an intrinsic aspect of the experience of severe mental illness, but it also emerges from communication gaps, difficulty obtaining optimal care and accessing mental health services. The ambivalence arises from an acknowledgement that while CTOs are coercive and constrain autonomy, they may also be beneficial. These findings can inform improvements to the implementation of CTOs and the consequent experiences.

Participation and service access rights for people with intellectual disability: a role for law?

BACKGROUND: Supported decision-making and personal budgets for services are the new paradigms. METHOD: Supported decision-making proposals from the Australian State of Victoria are analysed against international trends to determine the viability of laws reflecting new international norms of the United Nations Convention on the Rights of Persons with Disabilities 2006 (CRPD). RESULTS/CONCLUSIONS: The article concludes that it is desirable to pursue supported decision-making and allied legal reforms, but the contribution of the law is small and the new supported decision-making paradigms have similarities to old paternalist guardianship, as well as possible unintended consequences. It is suggested that realising the equality, support, protection, and socioeconomic service aspirations of the CRPD raise important practical challenges for governments, for service providers, for families, and-centrally-for people with intellectual disability (ID).This article examines the limited contribution law can make to this enterprise.

Pandemic planning as risk management: how fared the Australian federation?

The role of law in managing public health challenges such as influenza pandemics poses special challenges. This article reviews Australian plans in the context of the H1N1 09 experience to assess whether risk management was facilitated or inhibited by the "number" of levels or phases of management, the degree of prescriptive detail for particular phases, the number of plans, the clarity of the relationship between them, and the role of the media. Despite differences in the content and form of the plans at the time of the H1N1 09 emerging pandemic, the article argues that in practice, the plans proved to be responsive and robust bases for managing pandemic risks. It is suggested that this was because the plans proved to be frameworks for coordination rather than prescriptive straitjackets, to be only one component of the regulatory response, and to offer the varied tool box of possible responses, as called for by the theory of responsive regulation. Consistent with the principle of subsidiarity, it is argued that the plans did not inhibit localised responses such as selective school closures or rapid responses to selected populations such as cruise ship passengers.

"I used to call him a non-decision-maker - I never do that anymore": parental reflections about training to support decision-making of their adult offspring with intellectual disabilities.

PURPOSE: A rights perspective proposes supported decision-making as an alternative to substitute decision-making. However, evidence about supported decision-making practice is limited. Our aim was to build evidence about building the capacity of decision supporters. METHODS: Eighteen parents of people with intellectual disabilities were trained in decision support using the La Trobe Support for Decision-making Practice Framework. Data from repeated semi-structured interviews and mentoring sessions were used to capture parental reflections on the value of training. RESULTS: The training acted as a catalyst for parent self-reflection and the Framework prompted them to adopt a more deliberative approach to supporting decision-making. Some parents perceived increased confidence of their adult offspring in expressing preferences resulting from their own changed approach. CONCLUSIONS: This study demonstrates the efficacy of this Framework and evidence-based training in building the capacity of parental decision supporters to be consistent with the rights paradigm. IMPLICATIONS FOR REHABILITATIONThe La Trobe Support for Decision-making Practice Framework is an evidence-based approach to decision support practice with an accompanying set of free online resources which can be used by individual practitioners or programs to inform their practice and build the capacity of supporters.Parents of adults with intellectual disabilities value training in the La Trobe Support for Decision-making Practice Framework, which they consider helps to develop their decision support skills and self-reflection.Parents also value individual mentoring following training to assist them to apply the principles of the practice framework to the everyday support for decision-making they provide to their adult son or daughter.Training in support practice should be accompanied by individual mentoring or other strategies to assist parents of adults with intellectual disabilities to discuss and solve the difficult issues they confront in providing decision support more aligned to the rights paradigm.

Using artificial intelligence for personal protective equipment guidance for healthcare workers in the COVID-19 pandemic and beyond.

Background: Current procedures for effective personal protective equipment (PPE) usage rely on the availability of trained observers or 'buddies' who, during the COVID-19 pandemic, are not always available. The application of artificial intelligence (AI) has the potential to overcome this limitation by assisting in complex task analysis. To date, AI use for PPE protocols has not been studied. In this paper we validate the performance of an AI PPE system in a hospital setting. Methods: A clinical cohort study of 74 healthcare workers (HCW) at a 144-bed University teaching hospital. Participants were recruited to use the AI system for PPE donning and doffing. Performance was validated by the current gold standard double-buddy system across seven donning and ten doffing steps based on local infection control guidelines. Results: The AI-PPE platform was 98.9% sensitive on doffing and 85.3% sensitive on donning, when compared to remediated double buddy. On average, buddy correction of PPE was required 3.8 ± 1.5% of the time. The average time taken to don was 240 ± 51.5 seconds and doff was 241 ± 35.3 seconds. Conclusion: This study demonstrates the ability of an AI model to analyse PPE donning and doffing with real-time feedback for remediation. The AI platform can identify complex multi-task PPE donning and doffing in a single validated system. This AI system can be employed to train, audit, and thereby improve compliance whilst reducing reliance on limited HCW resources. Further studies may permit the development of this educational tool into a medical device with other industry uses for safety.

Swine flu, doctors and pandemics: is there a duty to treat during a pandemic?

The swine influenza (H1N1) outbreak in 2009 highlighted the ethical and legal pressures facing general practitioners and health workers in emergency departments in determining the nature and limits of their obligations to their patients and the public. Health workers require guidance on the multiple, overlapping, and at times conflicting legal and ethical duties owed to patients and prospective patients, employers and fellow health workers, and their families. Existing sources of advice on these issues in Australia, by way of statements of medical ethics and other sources of advice, are shown to be in need of further amplification if health workers are to be provided with the certainty and guidance required. Given the complexity of the issues, Australia would therefore benefit from more extensive consultation with the variety of stakeholders involved in these questions if pandemic plans are to smoothly deal with future crises in an ethically and legally sound manner.

Management and outcomes of health practitioner complaints in Australia: a comparison of the national and New South Wales systems.

OBJECTIVE: The aim of this study was to summarise the process and outcomes of complaints from five regulated health professions in Australia, and to compare these between the national and New South Wales (NSW) systems. METHODS: This is a retrospective cohort study of all complaints lodged from 1 July 2012 to 31 December 2013 for medicine, nursing and midwifery, dentistry, psychology and pharmacy registered practitioners. Data were extracted from the Australian Health Practitioner Regulation Agency, the NSW Health Professional Councils' Authority and the NSW Health Care Complaints Commission databases. The main outcome measures were frequencies and percentages of process decisions and outcomes. RESULTS: Systems differed in classification of complaints as conduct (national 47%; NSW 22%) and performance (national 45%; NSW 71%). Thirty-eight per cent of complaints were investigated or managed through a health or performance stream (national 40%; NSW 34%), but the national system investigated more matters (national 35%; NSW 6%). Over 50% of complaints resulted in 'no further action' (national 60%; NSW 70%). The most common action was caution or counsel (national 12%; NSW 15%), followed by conditions, (national 10%; NSW 5%). Practitioner registration surrender was more common with the NSW than national system (national 0.1%; NSW 1.3%), but registration suspensions or cancellations were similar (national 0.6%; NSW 1.0%). CONCLUSION: The main difference between the two systems is the administrative decision as to how complaints are assessed. In NSW, a classification of a complaint as 'performance' usually means the complaint is not investigated; rather, the practitioner is assessed by peers and may be required to undergo further education and training. Reaching agreement and understanding of complaints that should be investigated and those appropriate for performance review would strengthen a national approach to health complaint regulation. What is known about the topic? The national system of managing healthcare complaints is relatively new (since 2010) compared with the NSW system (since 1993). Annual reports of the regulatory authorities provide summaries of types and outcomes of complaints separately for each profession, and separately for NSW and the national system, but we do not know how the two systems directly compare in terms of complaint management or their outcomes. What does this paper add? This study examined how different types of complaints are managed between the two systems and whether there are any differences in outcomes. The types of complaints are almost identical between the two systems, but classification of complaints as 'performance' or 'conduct' differed. Immediate action is more common in the national than NSW system, especially for health impairment and boundary crossing. Health impairment complaints are much less likely to be discontinued at the assessment stage in NSW compared with the national system. The NSW and national systems are similar in terms of complaints proceeding to either an investigation or performance or health assessment, but the national system investigates more than the NSW system. For many types of complaints the outcomes were similar between systems, but there were clear differences for some types of complaints, such as health impairment and boundary crossing. What are the implications for practitioners? An efficient and fair regulatory system is crucial for maintaining practitioner trust, as well as trust of the public. This study shows that there are many similarities between the national and NSW systems in terms of process and outcomes, but there are differences in the way some types of complaints are assessed between the two systems. This knowledge may assist regulatory authorities in their efforts to achieve a nationally consistent approach to complaints.

Profile of the most common complaints for five health professions in Australia.

Objective The aims of this study were to profile the most common complaints and to examine whether any demographic factors are associated with receiving a complaint for five health professions in Australia. Methods A national cohort study was conducted for all complaints received for medicine, nursing/midwifery, dentistry, pharmacy and psychology from 1 July 2012 to 31 December 2013 (18 months). Data were collected from the Australian Health Practitioner Regulation Agency (AHPRA), the New South Wales (NSW) Health Professional Councils' Authority and the NSW Health Care Complaints Commission. The frequency and risk of complaints were summarised for the five professions and by demographic information. Results There were 545283 practitioners registered with AHPRA between 1 July 2012 and 31 December 2013, consisting of 20935 dentists, 101066 medical practitioners, 363040 nurses/midwives, 28370 pharmacists and 31872 psychologists. During the study period there were 12616 complaints, corresponding to an annual rate of 1.5 per 100 practitioners. Complaints were most common for doctors and dentists (5% per annum per practitioner) and least common for nurses/midwives (0.5% per annum per practitioner). Sex (P<0.01), age (P<0.01) and country of birth (P<0.01) were all associated with risk of complaint. The most common complaints were clinical care (44% of all complaints), medication (10%) and health impairment of the practitioner (8%). Types of complaints varied by profession, sex and age. Conclusions The risk of a complaint is low, but varies by profession and demographics. The types of complaints also vary by profession and demographics. Differences between professions is most likely driven by their different work tasks and work environments. What is already known on this subject? Although complaints are summarised annually from state and national health regulators, no overall national summary of complaints across professions exists. Thus, it is difficult to examine which complaints are most common, how professions differ from each other or what factors may be associated with risk and type of complaint. Previous studies have primarily focused on a single profession, such as medicine, where, for example, the number of prior complaints, sex, doctor speciality and age have been found to be associated with recurrent complaints. What does this paper add? This paper is the first of this kind to provide a national summary of all complaints from five of the most common health professions in Australia. We found that regardless of profession, men were at least twice as likely to have a complaint made against them than women. We also found that the types of complaint differed between men and women. There were similarities across professions for the most common types of complaints, but clear differences between professions were also noted. Not surprising, clinical care was typically the most common type of complaint for the five professions, but somewhat surprising was the inclusion of health impairment as one of the most common types of complaints. What are the implications for practitioners? Identifying the most common complaints, and the factors associated with these, may assist practitioners to understand their risk(s) of complaint and could potentially assist educators and regulators develop education programs that help reduce complaints.

Involuntary Treatment and Quality of Life.

The issues centering on the involuntary treatment of severe and enduring anorexia nervosa are daunting. There is a general consensus that people with this illness are likely to have high levels of disability, be underemployed/unemployed, and receive welfare. Anorexia nervosa shows a similar degree of impairment to those with depression or schizophrenia on quality-of-life measures. It is possible to mount a cogent argument as to why a rehabilitation model of care needs to be considered for those with persistent eating disorders. In such cases, harm minimization and improved quality of life should be prioritized and involuntary treatment used judiciously.