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A Brief History Of Official Visiting In NSW

Official Visitors have made a significant contribution for more than 165 years to improving the conditions and treatment of patients with a mental illness in NSW. Official Visitors have been appointed to psychiatric hospitals in NSW since the earliest days of the colony and first appeared in NSW Legislation in the Dangerous Lunatics Act, 1843. People who were incarcerated comprised a broad population group that included those with dementia, people with a developmental disability, and people with alcohol dependence problems (“inebriates”).

The first Official Visitors were appointed by the Governor to a limited number of hospitals. They had independence from the administration of individual hospitals. In the mid 19th century, ‘lunatic asylums’ as they were then known, were overcrowded, housed in “gloomy, ill-constructed buildings, with poor administration, inadequate systems of patient classification, unpleasant and poorly-maintained buildings, with a want of proper outdoor employment and recreation for patients”…” Food, water, sewerage and accommodation presented recurrent problems. Monthly inspections by Official Visitors to each hospital revealed serious deficiencies in services facilities and conditions. In the 1880s visitors frequently complained of inadequate accommodation and equipment” (Garton, S., 1991).         

Since that time however, the care, treatment, and control of people with a mental illness has undergone significant changes. These changes include: the de-institutionalisation of people with a mental illness (thus reducing the numbers of people in inpatient facilities); separation in the care of people with a mental illness from the care of those with a developmental disability; and significant changes to the definition of a mentally ill person. The practice of Official Visitors being appointed by the NSW Governor of the day continued until the enactment of the NSW Mental Health Act, 1990.

Old photographs

Official Visitors Under the Mental Health Act

The Mental Health Act, 1990 made some notable changes to the role of Official Visitors:

• Removed the requirement that one Official Visitor must be a magistrate or a lawyer;
• Official Visitors were no longer required to review the cases of involuntary and forensic patients and to order discharge of patients; by transferring these responsibilities to the Mental Health Review Tribunal;
• Official Visitors are appointed by the Minister for Health rather than the Governor of NSW;
• The Principal Official Visitor position was created to provide leadership in the exercise of their functions and report to the Minister;
• Included the provision for Official Visitors to visit health care agencies (centres gazetted to administer community orders for involuntary treatment under the Act).

The NSW Official Visitors' Advisory Committee (OVAC) was established by the Minister in 1994 and the first meeting was held on 29th August 1994. The OVAC acts as a consultative body about all aspects of the Official Visitors program, including policy and practice. Members of OVAC are nominated by Official Visitors and appointed by the Principal Official Visitor, to reflect a balance of rural and metropolitan and clinical and non-clinical expertise.

Amendments to the Mental Health Act during 1997 included:

• Changes to the appointment of Official Visitors to an Area Health Service rather than individual hospitals or health care agencies;
• The frequency of visits to a health care agency was amended, so that these could occur once every six months;
• The time within which an Official Visitor must be informed of a patient’s request to make contact was reduced from seven to two days.

A new Mental Health Act was enacted by the NSW Parliament in November 2007. New features of the 2007 Act include additional objectives to be applied in the provision of care and treatment (s68), including:

• Care and treatment should be designed to assist people with a mental illness or mental disorder, wherever possible, to live, work and participate in the community;
• Every effort that is reasonably practicable should be made to involve patients in the development of treatment plans and plans for ongoing care;
• The role of carers for people with mental illness or disorder and their rights to be kept informed should be given effect;
• Community Treatment Orders (CTOs) will be able to be made for people living in the community without need for inpatient admission.

Notable changes to the role of the Official Visitors Program under the Mental Health Act 2007 are:

• The Act allows appointment of non-medical clinical visitors (psychologists, nurses, social workers, occupational therapists, speech therapists. The panels that visit Mental Health Facilities now must have either a medical practitioner or a non-medical clinical member, plus another suitably qualified person;
• Official Visitors are now appointed by the Minister as Official Visitors and not to any particular Area Health boundaries;
• The Principal Official Visitor now allocates facilities to Official Visitors and ensures that 2 or more Official Visitors visit each mental health facility, at least once a month for an inpatient facility and at least every 6 months for an outpatient facility;
• The Act now includes a statutory function focussing on advocacy and quality of service. It also gives Official Visitors a statutory function to raise any significant public mental health issues or patient safety issues;
• There is now a provision for carers to contact Official Visitors directly;
• The Principal Official Visitor’s functions are more clearly defined, giving the position a greater clarity and range of functions.

A dedicated Official Visitor Phoneline was established in 1999 to increase patients' access to the Program.  The NSW Mental Health Association currently provides the answering service for a free call 1800 Phoneline, which is promoted through posters and leaflets distributed to all mental health facilities. These are available from our Downloads page. This website for the NSW Official Visitors Program was launched in July, 2008. Official Visitors are located across NSW.

Official Visitors try to resolve issues at the local level but also work directly with Area Health Services to address significant issues. They retain their independence from the health system but are accountable for the service they provide to patients.

The NSW Official Visitors Program continues to ensure that standards of treatment and care and the rights and dignity of people being treated under the NSW Mental Health Act (2007) are upheld.

Reference.

Garton S. ‘Palaces for the unfortunate: Lunatic Asylums in New South Wales 1880-1940’. Journal of the Royal Australian Historical Society Vol 76, pt 4 (April 1991)

Official Visitor Code of Ethics

On appointment all NSW Official Visitors sign the Code of Ethics, below. The Code encapsulates the role and principles by which Official Visitors perform their duties.

As an Official Visitor, my main responsibility is to make enquiries into the standards of treatment and care and the rights and dignity accorded people being treated under the NSW Mental Health Act 2007, while maintaining an independent community perspective.

In performing my duties as an Official Visitor, I am guided by the following principles, namely that:

• The welfare and interests of patients are paramount;
• The cultural needs of patients must be specifically addressed;
• As an Official Visitor, I will maintain my independence from the public and private mental health care systems;
• I will remain committed to the patient’s best interests, even when issues raised conflict with my own personal beliefs;
• The patient/Official Visitor relationship is strictly confidential and in line with this and Section 188 of the Mental Health Act 2007, I must not disclose any information unless the disclosure is made:
  (a) with the consent of the person from whom the information was obtained; or
  (b) in connection with the administration or execution of this Act; or
  (c) for the purposes of any legal proceedings arising out of this Act or the regulations or of any report of such proceedings; or
  (d) in accordance with a requirement imposed under the Ombudsmen Act 1974; or
  (e) with other lawful excuse.

I undertake to perform my duties as an Official Visitor and report on my findings in accordance with the principles and objectives set out in this Code.