Authenticity and capacity in mandated treatment

Dr Kate SeearWhat are mandated medico-legal interventions and how can they affect people diagnosed as alcohol or other drug dependent? SSAC adjunct Dr Kate Seear addressed these questions recently in a presentation that formed part of a group of events on mandated medico-legal interventions in Australia. The events were part of a program of work being undertaken by Dr Seear, based in the Law School at Monash University, in collaboration with Monash Criminology’s Dr Claire Spivakovsky and Monash Psychology’s Dr Adrian Carter.

The main event was a two-day workshop supported by a workshop grant from the Academy of the Social Sciences in Australia. Held on the 1st and 2nd of September, this interdisciplinary event brought together academics, alcohol and other drug and mental health practitioners, lawyers and policymakers from around Australia to explore mandated interventions for people diagnosed with ‘addiction’, mental illness and/or cognitive impairments.

Kate presented findings from research being jointly undertaken with Claire Spivakovsky. The paper critically examined the advent of ‘problem-solving courts’ in Australia, looking at the concepts of addiction that underpinned the development of drug courts, as well as concepts of risk and dangerousness that figured in the development of specialist court systems designed for offenders with mental health concerns.

In particular, Kate’s research examined the parliamentary debates leading up to the establishment of the first Drug Court in the state of Victoria. In her presentation she argued that the debates treated drug ‘addiction’ as inherently criminogenic, with affected people (‘drug addicts’) positioned as lacking the capacity to make rational choices. Following the work of Bacchi and Beasley, Kate argued that this logic was used to justify the ‘illiberal treatment of some citizens’. As ‘addicts’ were constructed as irrational, subject to the whims of their bodies, constraints, restrictions and intrusions upon their ‘autonomy’ became both palatable and seemingly essential.

Kate’s work highlighted the important ways that ‘addiction rationalities’ are often used to justify seemingly novel mechanisms for the regulation, intervention and control of people understood to be experiencing ‘addiction’. A key point of Kate’s work is that addiction ‘logics’ are used to justify and enable long-term, intensive, medico-legal interventions into the lives of subjects that are often already marginalised and stigmatised.

Alongside Kate and Claire’s work, a diverse range of other papers were also presented. Participants explored the politics, ethics, rationales and assumptions that underpin the use of mandated treatments for certain populations (e.g. involuntary detention of people with intellectual disability, coercive treatment of people with mental illness, mandated rehabilitation of people living with ‘addiction’), with a focus on how the agency, capacity and authenticity of people subjected to such treatments is conceptualised by and shaped through such interventions.

The workshop focused on identifying opportunities for improving the operation of these interventions, and providing recommendations for policy and legal practice. A final report of the outcomes of the workshop will be made available in the coming months.

In addition to the workshop, the team also held a public forum that explored the question: Can human rights and mandated medical interventions co-exist?

This event was held at the Monash University Law Chambers on the 31st of August, and featured passionate debate on the ethics, politics and effects of mandated medical treatment. Held in partnership with the Castan Centre for Human Rights, the event attracted more than 240 researchers, students, mental health consumers, legal practitioners, government department representatives and community service workers.

Facilitated by Prof Ian Freckelton QC, Professorial Fellow in Law and Psychiatry, University of Melbourne, and Adjunct Professor at Monash University, event speakers were:

Cath Roper Consumer Academic, University of Melbourne

Professor Bernadette McSherry Foundation Director, Melbourne Social Equity Institute, University of Melbourne

Associate Professor Chris Ryan Consultation-Liaison Psychiatrist, Psychiatry and the Centre for Values, Ethics and the Law in Medicine, University of Sydney

Eleanore Fritze Senior Lawyer, Mental Health & Disability Law, Victoria Legal Aid

Mainly focusing on mandated medical interventions in mental health, the event also raised questions of relevance to the alcohol and other drugs (AOD) field. The audience was encouraged to reflect, for example, on why some ‘conditions’ (such as mental illness, but perhaps, also, ‘addiction’) are singled out for mandated treatment, and to consider the stereotypes and assumptions about risk, dangerousness and violence that are often employed as a rationale for such treatment. Cath Roper spoke with eloquence and passion about her lived experience of forced treatment, the importance of accepting diverse ways of ‘being in the world’, and the need to recognise mandated treatments as a form of violence exercised by the state against its citizens. The audience was asked to consider whether state-perpetrated violence can ever be justified and, if not, whether an apology to those who have received such treatment might be warranted. The panel also considered the adverse effects of mandated treatments; including a sense of being unsafe in the world, a sense of exclusion and more.

Associate Professor Chris Ryan also produced a piece for The Conversation to accompany the event. That piece can be found here.

Tweets from the public event and the workshop were captured on Storify (now discontinued), however you can search for #ASSA16 on Twitter.

The organisers wish to thank the Academy of Social Sciences in Australia, the Castan Centre for Human Rights and staff from the Faculty of Law at Monash University for supporting the program of events. Kate’s research is supported by an Australian Research Council DECRA Fellowship.