Abstract
For psychiatrists, the interests of patients and of potential patients, even if they are Australia's dishonoured guests, must always be paramount.
There are situations where this priority must override other important principles. This is the case when psychiatrists continue to work in inadequately resourced public services with insufficient staff, and inadequate skills in the staff they do have, or in settings where the circumstances of their patients prevent optimal management, as for example, in prisons. Neither of these circumstances are uncommon.
The plight of the immigration detainees and their children that has been of such concern to the College, and is eloquently underlined by the letter from a number of eminent Fellows, is a comparable situation.
In circumstances such as these, psychiatrists generally recognize that the withdrawal of their participation means that matters become even worse for those in need of their services. They recognize the obligation to advocate and work for improvement of the situation by all available means. Withdrawal is an action of last resort, to be used only when on balance more harm than good will result from continuation of an intractable status quo.
If pressure from the College has contributed to a recognition by GSL (Australia) Pty. Ltd, and by the Immigration Department as purchasers of their services, that mental health services to detainees need to be improved, it behoves us to support honest efforts toward such improvement. It might have appeared slightly more reassuring if the advertised panel was set up under the auspices of the Government rather than the company, and given some statutory authority, but with the current policy of both Government and the principal Opposition, the difference might not be great.
We may believe that the detainees should not be where they are, but the fact is that they are, and that they are in special need of mental health care.
The advertising, advocacy, or acceptance of positions on a ‘health advisory panel’ concerning the ‘management and oversight of the health services provided to detainees’, cannot be unethical, unless the terms and conditions of engagement are such that the psychiatrists appointed are unable to exercise both their expert judgement and their consciences. In particular, any restriction on investigation, or demand for silence on abuses or inadequacies that may be found, cannot be acceptable.
People concerned about conditions and care in immigration detention facilities have complained that they cannot gain access to the establishments, or sufficient confidential contact with detainees. Now there may be an opportunity to do those things. If those who take up the opportunity find their access still to be so restricted as to make their best advice meaningless, they should blow the whistle, and have the full support of the College in doing so. If they find that the Advisory Panel is merely window-dressing for the company, or a boxticking exercise to satisfy a Government equally interested in window-dressing, and that its best advice is not likely to be implemented, the ethical thing to do is to resign, and to do so noisily.
The ethical issue, in my opinion, lies in the use that is made of the position, not in the existence of it, the advertising of it, or the acceptance of it, subject always to the demands of professionalism and ethics.
Eric Ratcliff is Chair of the Ethical Practice Committee of the RANZCP but the views here expressed are his own and not necessarily those of the Committee.