Journal of Psychiatric and Mental Health Nursing, 2014, 21, 289–295
Mental health recovery and voting: why being treated as a citizen matters and how we can do it S . L AW N 1,2,3 P h D , Z . C O M L E Y 3 BCS, MHSM, FRANZCP
MSW,
Di
p
Ed
, Di p PC, Ce r t
J . M C M I L L A N 4 Ph D, BA ( Ho n s ) 3 5 Ed , A . S M I T H B A & J . B R AY L E Y BA,
Ph
il,
BM,
BS,
1
Associate Professor, Department of Psychiatry, Flinders Human Behaviour and Health Research Unit, 2Mental Health Carer, 3Mental Health Service User, CARE Inc (Citizens Advocacy Research and Education for Mental Health), 5Public Advocate, Office of the Public Advocate, Associate Professor, Health Management, Flinders University, Adelaide, SA, Australia and 4Professor, Bioethics Centre, University of Otago, Dunedin, New Zealand
Keywords: capacity, human rights,
Accessible summary
involuntary patients, mental health, recovery, voting
•
Correspondence: S. Lawn
•
Margaret Tobin Centre Flinders University GPO Box 2100 Adelaide SA 5001 Australia E-mail:
[email protected] Accepted for publication: 24 August 2013 doi: 10.1111/jpm.12109
• •
It helps people with mental illnesses to recover if they are not deprived of their rights of citizenship. The right to vote is an important marker of citizenship. Ensuring citizenship through the right to vote is especially important when someone is committed under mental health legislation, yet it is unclear how and whether this occurs in practice. This paper discusses what occurs for this population in Australia and overseas and reviews the role of capacity and supported decision making in the context of the right to vote. Solutions are offered for how mental health practice can protect the interest that Australians with mental illnesses have in voting.
Abstract A central feature of recovery-based practice for people with mental illness is that they are able to exercise rights and experience membership of a community. This notion of citizenship is especially important when someone has had rights removed after being committed under mental health legislation. The right to vote is a central marker of citizenship. Supporting a person’s right to vote is important for recovery-based practice. In this paper, we review the issue of voting for people who have been committed under mental health legislation, why it matters for recovery, and what occurs from the Australian and international perspective. We briefly review the concepts of capacity and supported decision making in the context of the right to vote. We also consider the usefulness of the American ‘Doe Standard’, which has been used with the Competency Assessment Tool (CAT-V), to determine capacity to vote. Some solutions are offered that would protect the interest that Australians with mental illnesses have in voting.
Introduction Recovery-based practice involves thinking creatively about the environment within which mental health services are provided and paying attention to activities that are likely to have significance for service users as they work towards © 2013 John Wiley & Sons Ltd
recovery. Borg & Davidson (2008) argue that a central feature of recovery-based practice for people with mental illness is that they are able to exercise rights and experience membership of a community. By extension, knowing that one is still a citizen and also a member of that community is important, especially when someone has had some of 289
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their rights removed by being committed under mental health legislation. Being able to exercise one’s right to vote is a central marker of citizenship and may play a significant role in creating an environment that supports recovery. This is more than symbolic because being able to vote is an important act that acknowledges the person as a citizen. This paper begins by exploring the importance of recoverybased practice and the relationship between it and the ability to vote in Australian elections. In the second section, we will outline what tends to happen internationally, and within Australia. We will then focus on South Australia, which is the context with which we are most familiar. The third section of the paper considers solutions that protect the interests that Australians with mental illnesses have in voting.
Why being able to vote matters Recognition as a citizen is an important part of being acknowledged as a human being and is a precondition for agency (Fisher 2012). While judgments about capacity to consent to treatment and research can serve to label people as vulnerable or remove their right to make decisions, in the case of voting where this right is often not respected, supporting people to vote and drawing attention to their capacity to do so is important. Central to mental health recovery is the person’s capacity for agency; how they are enabled to maximize a positive sense of self as a citizen, and minimize threats to agency by what Fisher describes as ‘being done to’ within systems of care (p. 12). One of the most frequently used definitions of recovery is by Anthony (1993) who states,
mentally ill tend to be socially marginalized and therefore perceived as ‘vulnerable’. Fisher (2012) argues that this leads to an overemphasis on the protection of their negative rights, such as ensuring their informed consent to be research participants. However, Fisher (2012) goes on to argue that this socially constructed protective measure can inadvertently undermine the promotion of voice, agency and active citizenship for marginalized groups by stifling their recognition and positive sense of self as citizens in their own right. It can, ‘contribute to the reinforcement of subordinate identities by restricting valuable opportunities for participation and resistance’, maintaining dominant power structures (Fisher 2012, p. 4). A similar claim has been made by Farkas (2007) who sees active participation in community life as a citizen as central to recovery. Others have argued that active participation as a citizen is important for redefining a positive sense of identity that is founded on hope, empowerment and self-determination (Andresen et al. 2003, Rickwood 2004). Nash (2002) argues that, ‘social inclusion cannot be adequately addressed unless this fundamental and democratic principle [voting rights] is included more extensively’ (p. 697). A citizen is a person who is ‘entitled to enjoy all the legal rights and privileges granted by a state to the people compromising its constituency and [who] is obligated to obey its laws and to fulfil his or her duties as called upon’ (Everett 2010). In Australia, this includes the right and duty to vote. Citizenship incorporates three types of rights: civil, political and social. The political rights relevant to this discussion are,
Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness (p. 13).
The right to participate in the exercise of political power, either as a member of a political authority or an elector. Citizenship is rooted within community and society. Citizenship is a status bestowed on those who are full members of a community. All those who possess the status are equal with respect to the rights and duties with which the status is endowed (Marshall 1950, p. 28).
Anthony’s definition is important because he emphasizes that recovery is a personal journey where people reconfigure and reconstruct their lives. This naturally leads to giving thought to the kind of environments which facilitate the journey and in which positive rights are maximized. In Australia, mental health service guidelines also point to the centrality for recovery of living a meaningful life in the community while striving to achieve full potential [Substance Abuse and Mental Health Service Administration (SAMHSA) 2004; SA Health 2013]. A central tension for mental health services and the recovery movement appears to be how people with mental illness are viewed in relation to positive and negative rights. The
The right to vote, without discrimination, is propounded by the International Covenant on Civil and Political Rights (article 25) and the International Covenant on the Elimination of Racial Discrimination [article 5(c)]. Australia is a signatory to both these treaties. See also the Universal Declaration on Human Rights (article 21) [Australian Human Rights Commission (AHRC) 2010]. We recognize, as others do, that, ‘In a democratic society, the right to vote is one of the most valued civil rights because it is considered essential to the protection of other rights’ (Raad et al. 2009, p. 624; Office of the United Nations High Commissioner for Human Rights 2011, p. 4). Moreover, the International Covenant on Civil and
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Political Rights, and the Universal Declaration of Human Rights on which it is based, ‘recognizes and protects the right of every citizen to take part in the conduct of public affairs, the right to vote and to be elected and the right to have access to public service’(Office of the United Nations High Commissioner for Human Rights 2011, p. 3). These covenants are supported in Australia by the Australian Human Rights Commission which states that, ‘Political participation is the basis of democracy and a vital part of the enjoyment of all human rights. The right of all people to vote in elections, without any discrimination, is one of the most fundamental of all human rights and civil liberties’ (AHRC 2010). The person on the street does not have their right to vote questioned, even though that person may decide to spoil their ballot paper in some way [Australian Electoral Commission (AEC) 2011] or vote on the looks or dress of the politician, and vote accordingly, rather than based on policy.
What currently happens? A survey of political and public participation of people with disabilities across 60 countries (Office of the United Nations High Commissioner for Human Rights 2011, pp. 9–10) found that, in many of these countries, voting is linked to a person’s legal capacity. Some countries have automatic exclusions for those under guardianship, and others have no exclusions (for example Austria) or partial exclusions (for example Canada and the UK), such as when the person is detained. In his study of deinstitutionalization in four countries (Australia, the UK, Italy and Brazil), Hazelton (2005) found that Australian and UK mental health reforms shared similar ‘hardening’ features that emphasized risk and worked against citizenship. Italian reforms, however, reflected a strong citizenship orientation by providing significantly more and adequately funded psychosocial supports (such as housing, employment and independent living skills support) in the community. Brazilian reforms also reflected heavy investment in psychosocial supports that foster citizen participation and human rights. Some researchers argue that, for people with mental illness, ‘the partial protections of citizenship are extended by the more universal safeguards of human rights’ (Hazelton 2005, p. 232). Yet, voting is one example of a citizenship right that is treated variably for people with mental illness, and this treatment appears to have little to do with their human rights as citizens. Article 29 of the United Nations Convention on the Rights of Persons with Disabilities states that, ‘This right is of crucial importance for ensuring equality of opportunity for person with disabilities and their full and effective participation and © 2013 John Wiley & Sons Ltd
inclusion in society. Through its exercise, persons with disabilities assert their individual autonomy, which includes the freedom to make one’s own choices, and their right to be recognized as persons before the law’(Office of the United Nations High Commissioner for Human Rights 2011, p. 5). In the United States, jurisdictions have regarded people with mental illness and their capacity to vote quite differently. Some have constitutional provisions that deny the right to vote to all people under guardianship because of their mental disabilities (Bazelon Center for Mental Health Law/National Disability Rights Network 2008; Raad et al. 2009). Others have moved towards the use of a functional standard to assess competency to vote. Raad et al. (2009) report that psychiatrists in some states in America use the ‘Doe Standard’, which has been operationalized with the Competency Assessment Tool (CAT-V). The Doe Standard arose following a court case in Maine in which the court determined that, ‘persons are considered incompetent to vote only if they “lack the capacity to understand the nature and effect of voting such that they cannot make an individual choice” ’(Raad et al. 2009, p. 625). In a recent study testing capacity to vote in mental illness, the CAT-V tool was administered to 52 patients with serious mental illness attending outpatient and day treatment services in New York (Raad et al. 2009). Their performance was assessed according to four standard decision-making abilities: understanding, choice, reasoning and appreciation. Of significance, the mentally ill person’s performance did not correlate with cognition, verbal IQ or symptom severity. The researchers concluded that the CAT-V was an easy and efficient method of determining voting capacity according to the Doe Standard. More importantly, the researchers concluded that ‘persons with serious mental illness do not manifest a substantial incidence of incapacity to vote’ (p. 628). Importantly, the United States has a number of key legal principles surrounding voting rights, including the following: • ‘A state does not need to require a voter to demonstrate competence . . . • If a state chooses to impose a voter-competence requirement, that requirement must be applied to all voters. It cannot single out a particular group of voters, such as people who are the subject of guardianship proceedings ... • In virtually all states, only a court can find that a person is not competent to vote . . . • Service providers, such as nursing homes, hospitals, assisted living facilities and group homes, cannot bar residents from voting based on staff or administrators’ decisions that residents are not competent to 291
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vote’(Bazelon Center for Mental Health Law/National Disability Rights Network 2008, p. 3).
Voting and mental illness: the Australian perspective The right to vote and decisions about competence to vote appear to create complexity for mental health service staff, particularly when played out in psychiatric settings with involuntary patients. Consider the case of Mr Paulin, reported recently in an Australian newspaper: Mr Paulin, 61, is articulate and politically engaged. He also has a history of mental illness, the incidence of which he likens to ‘occasional doses of flu’. With a professional background that includes being a disability advocate, he is deeply disturbed that his health status was apparently used to deny his right as a citizen [to vote] (Farouque 2012).
The Commonwealth of Australia Constitution Act (Section 41-Rights of Electors of States) says that no one should interfere with a person’s right to vote: No adult person who has or acquires a right to vote at elections for the more numerous Houses of Parliament of a state shall, while the right continues, be prevented by any law of the Commonwealth from voting at elections for either House of Parliament of the Commonwealth . . . resources must be allocated to determine whether those who failed to vote have valid and sufficient resources to vote (Parliament of Australia 2012, Chapter 1: The Parliament).
To help address this, the Australian Electoral Commission makes provision in Special Circumstances for those citizens who cannot attend a polling booth on the day of an election. This involves selected hospitals and nursing homes being visited by mobile polling teams. Alternatively, postal vote application forms are made available from any hospital or nursing home reception (AEC 2012). There is no legal standard in South Australia or any Australian other jurisdiction for determining when a person has the capacity to vote (Mental Health Council of Australia 2012, pers. comm.; Parliament of Australia 2012). However, reference to voting by people with mental illness is made in some jurisdictions. In Western Australia, for example, its information brochure for involuntary detained patients states, You have the right to: vote in any election, unless your psychiatrist feels that you are presently not capable. He or she may then, through the Chief Psychiatrist, get your right to vote suspended. Application can be made to the Mental Health Review Board to have your right to vote reinstated (Office of the Chief Psychiatrist, Western Australia 2011). 292
While there is guidance for Western Australia, the legal basis upon which this is based is less clear. In Australia, generally, people are disqualified from voting in an election if they: are in prison serving a sentence of three years or more; are of unsound mind (incapable of understanding the nature and significance of voting); and have been convicted of treason or treachery and have not been pardoned (AHRC 2010). However, no objective criteria appear to be used consistently in Australia’s psychiatric settings.
Voting and mental illness in South Australia In the United States, objective and reasonable criteria were central to determining the Doe Standard, and the CAT-V that arose from it, as discussed above. However, Australian states apply no such consistent criteria to a person’s right to vote. Likewise, the South Australian Mental Health Act 2009 makes no mention of a patient’s right to vote. Nor does it offer consistent guidance to mental health staff in assisting people with mental illness to vote. The closest mention of this right is a reference to the patients’ rights to communicate with others outside treatment centres. The Act also notes that there are no restrictions on visits by certain people, including Community Visitors or Members of Parliament (South Australian Government 2010). In 2012, a group of South Australian mental health advocates were in conversation with the state’s Public Advocate who told them that, after an election, he and his peers in other states receive complaints from mental health consumers who have received fines for not voting when at the time of the election they were detained under the Mental Health Act in a closed psychiatric ward (Brayley 2012, per. comm..). Following this conversation, the group contacted Nursing Unit Managers at two local psychiatric inpatient units, based within large general hospitals, who stated that approved treatment centres must ensure polling booths are made available to detained patients. The group also contacted the hospitals’ administration units, and the local division of the State Electoral Commission (AEC) responsible for the conduct of elections in the region, to ask whether mobile polling booths were available to patients during the 2009 federal election and 2010 state election. All those contacted stated that that a mobile polling team from the AEC attends the inpatient psychiatric units at election time so that patients can participate in voting. However, they each had to confer with their staff to confirm this. The divisional clerk of the AEC said that the mobile teams were directed to speak with the nurse in charge of the ward at the time. Using the print out of the patient lists provided, the nurse usually then identified which patients were capable of voting. For patients deemed incapable of voting, an inability to vote form was completed for them. © 2013 John Wiley & Sons Ltd
Involuntary patients’ right to vote
This suggests that inpatient settings’ mental health staff are making substitute decisions for patients, with regard to voting, without checking whether some patients could themselves make these decisions. This may be because there is no common law or statute-based test of capacity to vote in Australia. Hence, it appears that mental health staff have no process for judging whether a patient has the ability to vote. Instead, they rely on their own judgements about how unwell the person is, and practical considerations about the time available for voting and when the electoral officer comes to the ward door. While there is no reason to think that staff will do this other than the best way that they can, it is too idiosyncratic for something with the symbolic importance of voting. It is unfair because all citizens should be presumed to have the right to vote. Just as is the case for the right to make medical decisions, until a well-grounded judgment about their capacity has been made, they should have this right.
Staff practices in ascertaining patients’ desire and capacity to vote are unclear It is unknown and unclear whether nurses approach patients to confirm whether they want to vote, or not, or how they make their decision about who is competent, or not. It is also unclear whether the electoral officers go to all inpatient psychiatric wards, as the local AEC contact person could not recall whether their visits included locked wards. Enquiries to the state AEC confirm that mobile polling booths do visit closed psychiatric wards but that they enter, according to their safety risks. This is a determination that they make in collaboration with staff of the ward, on the day. Of note, the Mental Health Directorate, which drives the establishment of policy and procedures in South Australian mental health services, could not confirm whether they have a policy pertaining to voting by psychiatric inpatients. Also, according to the policy manager for the Chief Psychiatrist in South Australia, ‘There is no policy regarding voting in approved psychiatric treatment centres’ (2012, pers. comm.). The AEC representative also mentioned that AEC staff attends only to selected hospitals during election periods.
Discussion What we could do to make things better The right to vote and implications for recovery and citizenship This paper has provided one example of how voting rights are embedded within social relations that can either support or undermine a person’s dignity and human rights © 2013 John Wiley & Sons Ltd
as a citizen. We have used the example of detained psychiatric patients as an extremely marginalized group, to demonstrate how being denied the right to vote during hospital admission relates to broader issues of inclusion, citizenship and human rights. For people with mental illness who are detained, being denied the right to vote offers a number of insights into how the concept of recovery can be undermined. This is because it provides a stark example of how they are perceived and ultimately treated as human beings. Fisher (2012) eloquently describes this process, arguing that once rights of citizenship are removed, people tend to be viewed as non-citizens and are likely to suffer abuse. Capacity, supported decision making and the right to vote The concept of capacity is important to consider because denying a person’s right to vote suggests some incapacity on their part to make decisions. According to Article 12 of the UN Convention on the Rights of Persons with Disabilities, ensuring and enhancing personal autonomy and selfdetermination are fundamental to its goals for people with disabilities. Where possible, the goal is, ‘for people to make decisions for themselves, rather than have a decision made for them’ (Brayley 2009, p. 1). This is what is meant by supported decision making rather than substitute decision making. Article 29 of the Convention (participation in political and public life) states that parties shall guarantee to persons with disabilities political rights and the opportunity to enjoy them on an equal basis with others. They can do this by: 1. Ensuring that voting procedures, facilities and materials are appropriate, accessible and easy to understand and use; and 2. Guaranteeing the free expression of the will of persons with disabilities as electors and to this end, where necessary, at their request, allowing assistance in voting of their own choice (United Nations 2006). This fits with our understanding of a person’s interest in being able to vote. Agencies have been shown to have the capacity to be flexible in thinking of the needs of people with serious mental illness. A clear example of this flexibility followed the 2007 Australian federal election, with the Joint Standing Committee on Electoral Matters recommendation that the Electoral Act be amended to incorporate a definition of homelessness to facilitate enrolment of homeless persons and persons living in crisis accommodation and transitional accommodation, and to allow more flexible mobile polling. The Committee also recommended that electoral staff be provided with appropriate training on how to communicate effectively and with sensitivity to the needs of electors with special needs. However, these recommendations have not yet been incorporated into the 293
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law (AHRC 2010). There has been much focus in the AHRC submissions on prisons and prisoners with mental illness. Unfortunately, there has been none on people in psychiatric hospitals (AHRC 2010). One clear solution would be to use a voting capacity assessment tool that already exists, such as the CAT-V, and which is internationally recognized. However, its developers caution that it should only be considered in exceptional circumstances as a guide when the person’s capacity to vote is called into question. They also suggest that we would be safe to presume capacity, given that their study confirmed that even persons with serious mental illness are capable of voting. In addition to this, we argue for the acknowledgment within national mental health standards to guide mental health services in relation to voting by people with a mental illness who are detained. Greater measures need to be taken to provide people with mental illness with the support they might need, with assistance of others of their choosing, in order to exercise their political rights (Office of the United Nations High Commissioner for Human Rights 2011). This involves supporting capacity, rather than seeking incapacity, and fits with recovery-based practice principles. Also, similar to the agreed sets of clinical outcome measures used routinely in mental health services across Australia and in many other countries, mental health services could and should also be evaluated in terms of citizenship and human rights principles (Hazelton 2005). However, a conundrum may exist for mental health staff in having no universally accepted definition of social inclusion to guide their practice. This requires resolution at a broader structural level. It involves overcoming the social, economic and political structures that have created social exclusion in the first place (Clifton et al. 2013). One solution for the post hoc way that decisions about which patients are able to vote would be for the Director of the service to issue a directive for staff concerning elections and how to facilitate and support patients to vote during their hospital stay. One problem that we believe may be influencing this situation is that, in South Australian inpa-
References
tient units, as with mental health care in Australia generally, as noted above, ‘Risk management has emerged as a dominant discourse’ (Hazelton 2005, p. 233). Hazelton (2005) refers to this as a ‘hardening’ of institutional mental health care, ‘with psychiatric inpatient facilities becoming much more secure places and staff becoming increasingly concerned with risk management’ (p. 238). It is within this context that decisions about voting capacity of people with serious mental illness are made. Emphasizing the positive effects for recovery that voting and being recognized as a citizen might have for patients is a way to prevent excessive focus on risk assessment and management dominating decisions.
Conclusion Every citizen who has the capacity to vote should have the right to do so, and this right should not depend upon or alter because of any political view they might have: The right to vote implies the right to hold political views, and this is an important aspect of citizenship. The right to vote is particularly important for people recovering from mental illness. It is embodied in international conventions to which Australia is a signatory. However, Australian laws are silent on these matters and practices within some psychiatric institutions appear to not comply with these conventions. In view of the importance of voting to the well-being of patients, it is imperative that Australian laws and practices change to reflect the tenor of these conventions.
Conflict of interest The authors have no conflict of interest to declare.
Acknowledgments We thank Professor Andrew Alston and Mr Kynan Rogers from the Flinders Law School, Flinders University for their advice on a draft of this paper.
Australian Electoral Commission (AEC) (2011) Analysis of Informal Voting, House of Representatives, 2010 Federal Election – Key findings.
Andresen R., Oades L. & Caputi P. (2003) The
Available at: http://www.aec.gov.au/about_aec/
by all Australians. Available at: http://www .hreoc.gov.au/human_rights/vote/index.html (accessed 29 April 2013). Bazelon Center for Mental Health Law/National
experience of recovery from schizophrenia:
Publications/Strategy_Research_Analysis/
Disability Rights Network (2008) Vote. It’s
towards an empirically validated stage model.
paper12/key-findings.htm (accessed 29 April
your right. A guide to the voting rights of people
Australian and New Zealand Journal of Psy-
2013).
with mental disabilities. Bazelon Center for
Australian Electoral Commission (AEC) (2012)
Mental Health Law/National Disability Rights
Australian Electoral History. Available at:
Network. Washington, DC. Available at: http://
http://www.aec.gov.au/Elections/australian
www.bazelon.org/News-Publications/
illness: the guiding vision of mental health
_electoral_history/ (accessed 29 April 2013).
Publications/CategoryID/12/List/1/Level/a/
service system in the 1990s. Psychosocial Reha-
Australian Human Rights Commission (AHRC)
chiatry 37, 586–594. doi: 10.1111/j.14401614.2006.01921.x. Anthony W.A. (1993) Recovery from mental
bilitation Journal 16, 11–23.
294
(2010) The right to vote is not enjoyed equally
ProductID/5.aspx?SortField=ProductNumber ,ProductNumber (accessed 5 July 2013).
© 2013 John Wiley & Sons Ltd
Involuntary patients’ right to vote
Borg M. & Davidson L. (2008) The nature of
Fisher P. (2012) Questioning the ethics of vulner-
recovery as lived experience in everyday experi-
ability and informed consent in qualitative
ence. Journal of Mental Health 17, 129–140.
studies from a citizenship and human rights per-
doi: 10.1080/09638230701498382.
spective. Ethics and Social Welfare 6, 2–17. doi:
Brayley J. The Public Advocate, SA) (2009) Sup-
10.1080/17496535.2011.591811.
ported decision making in Australia. Presenta-
Hazelton M. (2005) Mental health reform, citizen-
tion to the Victorian Office of the Public
ship and human rights in four countries. Health
Advocate and staff of the Victorian Law Reform
Sociology Review 14, 230–241. doi: 10.5172/
Commission, December 14, 2006, Melbourne,
hesr.14.3.230. Marshall T.H. (1950) Citizenship and Social Class.
Australia. Clifton A., Repper J., Banks D., et al. (2013)
Cambridge University Press, London.
Available
at:
http://ps.psychiatryonline.org/
data/Journals/PSS/3878/09ps624.pdf (accessed 29 April 2013). Rickwood D. (2004) Recovery in Australia: slowly but surely. Guest editorial. Australian E-Journal for the Advancement of Mental Health 3, 1–3. doi: 10.5172/jamh.3.1.8. SA Health (2013) Framework for RecoveryOriented Rehabilitation in Mental Health Care 2012. SA Health, Adelaide. Available at: http:// www.sahealth.sa.gov.au/wps/wcm/connect/ c17e5f804eb00bcaac5aeee39488de5b/
Co-producing social inclusion: the structure/
Nash M. (2002) Voting as a means of social inclu-
agency conundrum. Journal of Psychiatric and
sion for people with a mental illness. Journal of
Rehab+Recovery+Framework-mental+health-
Mental Health Nursing 20, 514–524. Epub
Psychiatric and Mental Health Nursing 9, 697–
20130108.pdf?MOD=AJPERES&CACHEID
703. doi: 10.1046/j.1365-2850.2002.00539.x.
=c17e5f804eb00bcaac5aeee39488de5b
ahead of print 7 August 2012. doi: 10.1111/
Office of the Chief Psychiatrist, Western Australia
j.1365-2850.2012.01953.x.
&CACHE=NONE (accessed 29 April 2013).
Everett M. (2010) Response to the keynote; Helen
(2011) Involuntary detained patients. Available
South Australian Government (2010) South Aus-
Glover – ‘Consumer or citizen: when do I leave
at: http://www.chiefpsychiatrist.health.wa.gov
tralian Mental Health Act 2009. Available at:
one identity and adopt the other? Blog Post by
.au/docs/pamphlets/Involuntary_Detained
http://www.lexisnexis.com.au/lexisweb/
Michelle Everett Tuesday 6 September 2011 –
_Patients.pdf (accessed 29 April 2013).
legislation/sa/SA_ACT_2009-28/mental-health-
Consumer Forum Program The Mental Health Services
Conference
Office of the United Nations High Commissioner
act-2009 (accessed 2 November 2012).
–
for Human Rights (2011) Thematic study by the
Substance Abuse and Mental Health Service
http://mentalhealth
(TheMHS)
2011
Office of the United Nations High Commis-
Administration (SAMHSA) (2004) National
connect.com.au/wordpress/keynote-helen-
sioner for Human Rights on participation in
Consensus Statement on Mental Health Recov-
glover-consumer-or-citizen-when-do-i-leave-
political and public life by persons with disabil-
ery. Unites States Department of Mental Health
one-identity-and-adopt-the-other/ (accessed 29
ities. Available at: http://www.ohchr.org/EN/s/
Services.
April 2013).
Disability/Pages/
(accessed 29 April 2013).
Adelaide.
Available
at:
Farkas M. (2007) The vision of recovery today: what it is and what it means for services. World Psychiatry 6, 68–74. Available at: http://
ParticipationPoliticalAndPublicLife.aspx (accessed 29 April 2013). Parliament of Australia (2012) Commonwealth of
www.ncbi.nlm.nih.gov/pmc/articles/
Australia Constitution Act. Available at: http://
PMC2219905/ (accessed 29 April 2013).
www.aph.gov.au/About_Parliament/Senate/
Farouque F. (2012) Patient denied vote seeks law review. The Age, May 7: 2012. http://
at:
www.samsha.gov
United Nations (2006) The Convention of the Rights of Persons with Disabilities. Available at: http://www.un.org/disabilities/convention/ conventionfull.shtml (accessed 29 April 2013).
Powers_practice_n_procedures/Constitution/ par4cha1 (accessed 29 April 2013).
www.theage.com.au/victoria/patient-denied-
Raad R., Karlawish J. & Appelbaum P.S. (2009)
vote-seeks-law-review-20120506-1y70l.html
The capacity to vote of persons with serious
(accessed 29 April 2013).
mental illness. Psychiatric Services 60, 624–628.
© 2013 John Wiley & Sons Ltd
Available
295
