In July 2015, The Queensland Health Minister officially announced that a Commission of Inquiry would be held into the closure of the Barrett Centre with Retired Justice Margaret Wilson to oversee proceedings. The Premier then later indicated that the Inquiry would run from 14 September 2015 to 14 January 2016. This was modified when access to evidence necessitated a time extension and Oral Evidence then ran from 15 February 2016 to 11 March 2016.
Although a Commission of Inquiry is a step towards recognition and justice for bereaved and severely affected families and may lay the foundation that will lead to greater understanding and ultimately better service provision, for those dealing with severe and complex adolescent mental health issues, it can never be forgotten that three young lives have been lost.
We remember Talieha, Will and Caitlin. And we recognise that those who love them will never truly recover – whatever the future holds.
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18 July Premier, Health Minister and Commissioner release public volume of report and the government’s response
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13 July Barrett families attend briefing prior to release of finding and recommendations
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24 June Premier receives report from Commissioner
The Premier’s office released a Media Statement announcing receipt of the Commission’s report. As expected, information about the contents won’t be forthcoming until the Premier and relevant parties have the opportunity to read the report and determine if any action should be taken and in what form. A post on the Premier’s website states:
“At the Commissioner’s request, the Government will carefully consider the report before publicly releasing it with the Government’s response due in the next few weeks.
We will be offering the families involved an opportunity to attend a briefing prior to any public release. If you are a family member involved in the Commission of Inquiry, and would like to attend the briefing, please express your interest by calling 3719 7000 or via email at: firstname.lastname@example.org.”
It is hoped that the statement that the Palaszczuk government is “determined to respond to all of the Commission’s findings and recommendations” leads to outcomes that will promote the most healing.
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Summary information on each day of Public Hearings follows with most recent at the top.
15 April Presentation of Written Submissions Day 3
Counsel for Dr Kingswell (Director of Mental Health, QH), Mr Duffy, highlighted some additional aspects of his written submission including the fact that Dr Kingswell had been frustrated by the ECRG recommendations because, rather than use the language of the National Mental Health Services Planning Framework (NMHSPF), the group, he said, had in effect come up with its own terminology i.e. Tier 3 and Dr Kingswell is of the strong belief that that terminology has created confusion. Mr Duffy also claims that what the ECRG referred to was the antithesis of the Barrett model. The Commissioner commented that the evidence that has been given throughout the Inquiry indicates that most if not all adolescent psychiatrists seem to accept that there is a small subset of mentally ill adolescents for whom some form of sub-acute inpatient care is appropriate. Justice Wilson also stated that the way the whole issue – of the closure, transition etc. – evolved caused a whole lot of confusion and that she didn’t think that Dr Kingswell’s evidence goes any further than saying that this subset could be dealt with in a Y-PARC facility. The Commissioner later commented that she was of the mind that, with reference to the NMHSPF, to rely on something that is in draft form – as Dr Kingswell seems to do – isn’t a reliable practice.
When the issue of adverse findings was raised, Paul Freeburn (Counsel Assisting) indicated that if there are to be adverse findings against anyone, those parties will be notified prior to the report being published. A letter from Mr Springborg that was received by the Commission this morning was entered into evidence and then followed discussion on (a) whether or not it was appropriate for parties to examine the operations of the Commission and (b) regarding the research material made accessible by the Commission on the Inquiry website (i.e. whether parties knew about the research aspect of the Commission). Both Mr Freeburn and the Commissioner indicated that it had been clear for some time that research would be an element of the Commission’s activities i.e. on the first day of hearings, Counsel Assisting presented a document indicating research had been underway; it was known that there were research staff at the Commission; it is a known practice of Commissions of Inquiry to undertake research; and that it was no secret that Commission staff had even made visits to the BAC site and to Lady Cilento Children’s Hospital under supervision from the relevant officials. It was also made clear that it is not the place of interested parties to examine or question the operations of the Commission particularly since the process is not adversarial but factfinding and it is the Commission that undertakes the factfinding, not any other parties.
Other representatives of various parties then undertook to make presentations regarding their written submissions. These included:
- Ms Wilson of Crown Law for the State of Queensland providing references regarding the communication between WMHHS and CHQ over availability of the new suite of services;
Ms MsMillan for West Moreton Hospital and Health Service clarifying that the WMH Board believed it was the Minister’s decision to close the BAC and explaining that the lack of ‘FastFacts’ information sheets between May and August 2013 was because communication with families was being undertaken at “Executive” level and via direct interaction – which WMH believed was more appropriate;
- Ms Rosengren for Dr Sadler referring to the statments of Professors McDermott and Martin and of Dr Fryer to highlight that there was no evidence either way as to whether community based or inpatient care is preferable. (During this, the Commissioner raised the issue of whether “evidence-based” practice is valid anyway.);
- Ms Robb for 13 former BAC nurses emphasising those staff members experienced a very difficult time and the best support they had during that period was to support each other; and
- Mr McMillan for Debbie Rankin, who referred to testimony provided by individuals on the patient transition panel that suggested that education staff had not responded positively to the separation of health and teaching staff or the transition procedure in order to indicate that the Acting Principal of the Barrett School had not be named in any such testimony.
This concluded the oral proceedings of the Commission of Inquiry.
Justice Wilson is required to present her findings in a report to the Premier by 24 June 2016.
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12 April Presentation of Written Submissions Day 2
Counsel for Lawrence Springborg presented some aspects of his written submission – one of which was to respond to the assertion made in Counsel Assisting’s submission that the decision to cancel the Redlands project was a political one made by the former Health Minister without any formal evidence of input from experts. When Mr O’Sullivan was critical of this assertion, the Commissioner indicated that she was not herself currently of the view put forward by Counsel Assisting and her perspective at this time was that the decision was one that Mr Springborg was in a position to have made and that he was not fully advised by his staff when he made that decision. Justice Wilson indicated that she remains open to other submissions on that issue and will not throw out the contention of Counsel Assisting. When the issue of whether the BAC is considered to be a contemporary model of care and/or recommended by the National Mental Health Services Planning Framework (NMHSPF), the Commissioner asked for submissions on that issue. Mr O’Sullivan for Mr Springborg put forward the evidence that Dr Kingswell’s (Queensland Health) reading of the NMHSPF is that it recommends a Y-PARC service as a replacement for the Barrett Centre. [Y-PARCs in Victoria allow for stays of up to 28 days, don’t accept self-harming or involuntary patients and have a minimal rehab component.] Mr O’Sullivan also asserted that the Planning Group that added considerations to the ECRG’s recommendations had similarly recommended Y-PARC and that the services planned by SWAERTI were not for the Barrett patients but for future patients, with the transitioning Barrett patients to be provided with individualised wrap around care packages i.e. a 2 stream process. The Commissioner raised concerns about what the former Health Minister said about the closure and availability of replacement services during his radio interview on 6th August 2013 e.g. “we expect to have the options available to people in early 2014” and Mr O’Sullivan responded that since it was expected that Y-PARC service would be up and running by that time, that his client was consistent with the opinions of Dr Kingswell and the Planning Group. Justice Wilson indicated that she was of the opinion that Mr Springborg said what he did during that interview ‘in good faith’ but he was either not briefed enough or briefed incorrectly. She quoted the Minister saying that “the transition will start in the early part of 2014” but Mr Springborg’s barrister responded that ‘transition’ in that context could refer to the state moving from one kind of service delivery to another. Both the Commissioner and Mr Springborg’s lawyer however agreed that even though the Minister said numerous times in the interview that he had “put on hold the closure of Barrett when I became Minister”, the evidence presented indicated clearly he hadn’t done that. The presentation of other aspects of parties’ written statements was held in closed court to avoid the identification of patients.
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11 April Presentation of Written Submissions Day 1
Counsel Assisting the Commissioner, Paul Freeburn and Cathy Muir, presented some key aspects of their final written submission. These included ascertaining whether the ECRG’s recommendations were for a ‘bricks and mortar’ facility or simply a service – they submit that it was for ‘bricks and mortar’ due to a number of references including to “inpatient” and a “design-specific and clinically staffed bed-based service”. They have also examined whether the experts in adolescent mental health that have appeared/provided evidence believed that such a facility/service was still required after the implementation of Queensland Health’s continuum of care and concluded that all experts have said that a small number of young people will still need access to something else in the area of extended care – with only Dr James Scott not being unequivocal. Mr Freeburn also put it to the Commissioner that communication with patients and families about the closure and transition had been conflicting and inconsistent, citing an email from Dr Mary Corbett to a Barrett parent in August 2013 indicating that “Children’s Health Queensland will provide the leadership for a new model for adolescent services. In the meantime the Barrett Adolescent Centre will continue to provide services until this model is operational.” Lawyers for Queensland Health and for Anthony O’Connell, Michael Cleary and Dr Anne Brennan then spoke to some of these issues and others including – whether the opening of the EFTRU service at The Park factored into the decision to cancel the Redlands relocation (this matter has been adjourned until Friday to allow counsel to review evidence); the timing and development of replacement services through AMHETI and whether these met the needs of the former Barrett patients; and how the former Director General Tony O’Connell concluded that the cancellation of the Redlands relocation was appropriate etc. Counsel for parties including the former Health Minister Lawrence Springborg will continue tomorrow with points relating to their own written submissions and those of others.
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FOR REFERENCE, WITNESS INFORMATION RELATING TO HEARINGS SUMMARISED BELOW IS AVAILABLE ON THIS DOCUMENT COMPILED BY THE COMMISSION OF INQUIRY
11 March Public Hearing DAY 20
Witnesses: Dr Stephen Stathis continued on the stand with cross-examination from his own legal representation i.e. Crown Law, and was given the opportunity to outline the current activity of the Youth Mental Health Commitment Committee which has begun preliminary planning for the Commission’s recommendations (in order to fulfil the government’s pre-election promise to for an extended care facility for adolescents). Dr Stathis explained that the Committee has just begun to look into ways of ascertaining the best model of care e.g. service/population mapping of Queensland and that they are considering different options for bed-based unit/s as well as focussing on the obvious gaps in service provision for both 18-24 year olds and patients with dual diagnosis. Dr Michelle Fryer, a member of the ECRG, corroborated the recommendations of the ECRG that a Tier 3 facility was essential and indicated that there had been no clear understanding at the time that a Planning Group would add caveats to those recommendations. Dr Graham Martin, a retired Professor of Child and Adolescent Psychiatry, reasoned that the lack of extensive compelling evidence for extended inpatient treatment comes only from the fact there is no evaluation or outcomes process in place for reference. Professor Martin stressed that is also little evidence-based outcome research supporting other treatment programs and that there needs to be a significant change whereby self-evaluation becomes a major aspect of psychiatric work and data analysis must be properly incorporated to achieve a continuous improvement process. Professor Martin also indicated that the needs of the patient should be considered ahead of chronological cut-offs so that, where appropriate, 18-25 year olds should be able to access young people’s services. Ingrid Adamson, the Project Manager who liaised between WMHHS and CHQHHS and remains involved in the development of new CHQ services in an administrative role, explained that the sub-acute hospital beds (Mater/Lady Cilento) were considered “tier 3” with onsite schooling by the SWAETRI/AMHETI committee (as per the ECRG recommendations. Under cross-examination, Ms Adamson was asked to review her comment that the parents who had presented to the SWAETRI committee were “speaking on behalf of themselves as well as presenting their young people” as the parents how attended had been representing the parent body as a whole and had provided a written – as well as oral – submission to that end. In her evidence, Ms Adamson also revealed that since March 2015, concern from CHQ has been raised in regards to the current Premier’s commitment to ‘replace the Barrett Centre’ due to “an absence of clinical justification” for “a new Barrett“.
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10 March Public Hearing DAY 19
Witness: Dr Trevor Sadler‘s cross examination continued with his clarifying what he considered to be the most positive aspects of the Barrett model as it existed under his directorship. He stated that they could:
“both integrate treatment and rehabilitation interventions, that we could do that on a daily basis and reinforce and generalise across various settings, so – so from a group to various other activities in which they were involved. … for instance, a person with social anxiety might go on an outing or – and this is the first time they had linked with the community for more than 12 months or so, this desensitised them to the community. Then when they went on leave we would encourage them to continue going out to a local shopping centre, for instance. But we would take them to various outings on the weekday and the weekend. So that’s one activity of exposure which is very important in treating social anxiety.“
As regards the aspects that could have been improved, Dr Sadler explained that he thought that inpatient care should be reserved primarily for those who required full nursing staff. However, the lack of accommodation or Step Down facilities kept some adolescents as inpatients who could have lived in accommodation offsite that would provide them with skills while they accessed treatment and rehabilitation programs during the day. He also repeated that he would have liked to have had better input for family therapy. Dr Sadler was able to clarify his concerns about the proposed 6 month length of stay recommended for the program to be provided at Redlands relocation by explaining the despite intensive interventions, there were some adolescents who didn’t engage in treatment until four or five months after their admission so, in essence, their treatment only began that period. He emphasised, though, that the minimum length of stay was the ideal so a clinical review after 6 months would be valuable. Dr Stephen Stathis, Children’s Health Queensland’s (CHQ) Clinical Director of Child and Adolescent Mental Health, answered questions relating to the suite of services that began planning and development following the Barrett closure announcement. Dr Stathis headed the planning of the continuum of care which had included a Tier 3 bed-based unit at least until December 2013 when he presented his model to Barrett parents but he explained that he and his colleagues had been unable to find evidence-based research confirming such a stand-alone facility as contemporary so it was ultimately not included in the final model. The Commissioner raised the Walker (NSW) and Bentley (WA) Units as examples of functioning extended treatment facilities but Dr Stathis emphasised that stays in those units were likely not as long as some patients stayed in the Barrett Centre. The Commissioner also discussed the Redlands relocation during Dr Stathis’ time on the stand, recalling that the proposed model aimed for shorter stays that had been occurring at Barrett. Under cross-examination, Dr Stathis stressed that although documentation seemed to indicate that the sub-acute beds available at the Mater were not available until mid-2014, that service had been available earlier in the year based on an informal agreement. He could not recall a conversation with Dr Anne Brennan where she raised the issue that she had not known about that option when she was managing the transition of Barrett patients. Dr Peter Steer, the Chief Executive of CHQ at the time that governance for adolescent mental health services was handed to that HHS, commended Dr Stathis on his work in a video link from London where he has relocated to take up a role at Great Ormond Street Hospital.
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9 March Public Hearing DAY 18
Witness: Dr Beth Kotze, the co-author of the report into the transition gave her insights on the process, acknowledging that, in many cases, there were no suitable services for some of the Barrett patients. She agreed on the need for an extended stay service but was of the opinion that such stays should not exceed a year as remaining in a facility with no opportunities for community interaction for an extended period is not recommended. Dr Trevor Sadler continued giving evidence and explained the careful process undertaken to transition the hundreds of patients that the Barrett Centre had discharged through the years. This often included a collaborative arrangement with a new service to facilitate engagement with new practitioners, provide support in areas not covered by the new service, assist with integration into the new situation etc. Dr Sadler indicated that the 6 August 2013 closure announcement presented many difficulties as the young people were experiencing great instability and needed to be as well as possible to transition to other services. However, there was no information regarding what services would become available for patients to transition to. Dr Sadler was able to clarify that after he raised serious concerns about the lack of wraparound care at the fourth meeting of the Planning Group (the group that made caveats to the ECRG recommendations), he was not included in any future Planning Group meetings nor was he provided with the minutes of that May 2013 meeting during which he felt the issue of wraparound care remained totally unresolved – necessitating his emailing Dr Kingswell afterwards.
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8 March Public Hearing DAY 17
Witness: Vanessa Clayworth, who had undertaken a number of nursing related roles at BAC over several years and was community liaison officer prior to the closure announcement, explained the work she did to provide support for staff and patients through the closure and transition process. She stated the Executive of West Moreton Health had instructed staff following the stepping down of Dr Sadler that no one was to contact Dr Sadler – making it challenging for the incoming Dr Brennan to be properly briefed on the status of patients and the transition process. Ms Clayworth also indicated that changes in the sharing of information occurred once Dr Brennan began undertaking the transition plans – with health staff on the transition panel no longer able to provide certain clinical information and unable to discuss transition planning fully with education staff. In addition, Case Coordinators were advised that their knowledge of transition plans should be limited in order to maintain a positive therapeutic relationship with patients and families. Because staff across BAC had previously enjoyed full and open interaction, this meant a change in atmosphere and dynamics within an environment where distress and concern were already heightened due to uncertainty over the future.
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7 March Public Hearing DAY 16
Witness: Moira McLeod, a member of the BAC nursing staff, stated that towards the end of the centre’s operations that many of nursing staff provided may have been experienced mental health nurses, but had little or no experience in caring for adolescent patients with complex mental health problems. Dr Jeanette Young, the Chief Health Officer of Queensland gave evidence that the decision to cease the Redlands project left the state with options to 1) leave the Barrett Centre as it was; 2) build another facility; or c) change the model of care. However since Dr Young had signed off on a document from the Health Minister’s office reassigning the funding that included the allocation for the Redlands project to the renovation of 12 rural hospitals and Dr Young’s personal view was that the Barrett Centre needed to close, a change in the model of care was clearly the favoured – if only – option. Dr Young indicated that moving young people from an inpatient service to a NON-inpatient service would be a “very big, fundamental change” for which there should be procedures or policies in place in order to ensure such decisions are made on a sound policy footing and a process for seeking expert advice should be deployed. As regards the decision regarding replacing Barrett with alternate services, Dr Young believed that the Director of Mental Health, Dr Bill Kingswell, would have sought advice informally before initiating consultation with her regarding the cessation of the Redlands project.
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7 – 9 March Public Hearing DAYS 16, 17, 18
Closed hearings allowed patients, families and some clinicians to give evidence – discussing individual experiences and specifics that could identify patients. There were some parts of sessions in open hearings when witnesses who had been unable to be questioned in on previous days took the stand or when the evidence being given by staff and others would not identify patients.
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4 March Public Hearing DAY 15
Witness: Dr Anne Brennan’s testimony indicated that the role of Director of the Centre had been a more challenging one then she had anticipated when it was first offered to her. On her first day at Barrett, Dr Bill Kingswell had stressed the need to transition patients out of the Centre as soon as possible. This was to be done in an atmosphere of crisis that was accentuated by the removal of Dr Sadler. In addition, an embargo on communication with Dr Sadler meant that a handover never occurred. Dr Brennan stated that she had no knowledge of sub-acute beds at the Mater nor of the Interdistrict transition documentation referred to in the Kotze report. Challenges with Barrett staff whose distress at the turbulence and the welfare of the patients were identified by Dr Brennan as an additional impediment. Despite a new role being created for the documentation of the planning of transitions, no detailed plans exist to present to a forum such as the Inquiry – however, Dr Brennan does not believe that affected the process. Dr Brennan believes that transition placements were “adequate and appropriate having regard to services available” but under questioning from Counsel Assisting described supported accommodation for people with mental illness that currently exists as “extremely limited and the accommodation that is available in my opinion is extremely poor”.
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3 March Public Hearing DAY 14
As the hearings move closer towards the specific operations of the Barrett Centre, closed hearings were being utilised more frequently. The evidence given in open hearings on this day of hearings encompassed that from 4 clinicians.
Witnesses: Padraig McGrath, Nursing Director, Secure Services, The Park Centre for Mental Health who outlined the deployment of nursing services to the Barrett Centre was also able to emphasise the problems that the transition panel had in finding accommodation for the transitioning Barrett patients. Dr Elisabeth Hoehn, whose psychiatric expertise was utilised to support Dr Anne Brennan when Dr Brennan took over the role of Clinical Director, also spoke of the challenges that she and Dr Brennan experienced when undertaking their roles at the Barrett Centre during it’s closure period. Dr Terry Stedman, Director of Clinical Services at The Park explained that his role in relation the transition of patients was to escalate recommendations for particular placements when Dr Brennan required it and Carol Hughes, a social worker who was on the patient transition panel, explained that she undertook some liaison with families as well as assisting with an awareness group to help patients with relapse identifications skills and with transitioning patients to new service arrangements. There was also debate on issues relating to parliamentary privilege as it relates to evidence presented to the Commission.
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2 March Public Hearing DAY 13
Witnesses: Professor Patrick McGorry was able to add his expert opinion to those emphasising the need for a full suite of services for adolescent mental healthcare that includes inpatient facilities that allow longer stays and provide rehabilitation services. He indicated that steps to move away from institutionalisation worldwide had sometimes been “irresponsible” and that “closing a facility caring for the most severely ill and disabled without an alternative approach” was demonstration of that. His work has also shown that, with the pervading issues of delayed development in young people with mental health conditions, the future services must ensure that such patients over 18 years are not assigned to adult services where the environment would be wholly unsuitable. Ashleigh Trinder, a clinical psychologist at BAC, and Kevin Rodgers, the Principal of Barrett School for 26 years, both attested to the productive collaboration between the multidisciplinary team at the Centre prior to the removal of the Director in September 2013. They also described an atmosphere of distress and chaos following the closure announcement. Mr Rodgers shed light on some of the approaches of the education program, indicating that young people needed to experience success in order to deal with more challenging issues so a special purpose school must offer flexible, student-centred learning experiences rather than adhering to a strict curriculum that includes NAPLAN testing and other stressful undertakings that are likely to reinforce failure in students who have not engaged in education for an extended period. Mindfulness was also a valuable principle to promote in young people who suffered severe anxiety (and were concerned about the future) and those who’d experienced trauma (who were burdened by the past) – so encouragement to experience the present without those impediments was always something that would assist with healing.
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1 March Public Hearing DAY 12
Witness: Dr Trevor Sadler, former Clinical Director of the Barrett Centre, explained the Centre’s model of care to the Commission, outlining a collaborative approach that included not only the multidisciplinary team of professionals but the young people themselves. (The aim of giving as much input to the teenager as possible in their treatment fostered a united approach to recovery and placed value in the young person as well as encouraging the development of autonomy within a safe, supervised environment.) However, his expertise allowed Dr Sadler to assess the multiple complexities involved in extended inpatient care for this cohort and the incorporation of new processes could only occur within the practical parameters of the model. Dr Sadler indicated his serious concerns at learning the Centre was to close and did what he was able to ensure continuity of care – looking to source alternative sites for a relocation, reaching out to the small network of psychiatric specialists in the state and advocating for the best interests of the young people in his care and those likely to need support in the future. When Dr Sadler was stood down four months prior to the Centre’s closure, his concerns had not been abated as there were highly unwell patients, including some who had attempted suicide, who he believed could be at risk if transferred to less well-equipped services.
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29 February Public Hearing DAY 11
The hearing began with discussion around the amount to which aspects of the transition of patients were to be included in the Inquiry. While some barristers argued that their preparation was based on information relating up to the date of patient’s transition, the Commissioner clarified that it would be difficult to assess the transition process and the adequacy of available services, even from a broad perspective, without taking into account the services to which patients were transitioned. The general view concluded that there must be a ‘line in the sand’ following the adolescents’ transition where the Commission’s investigations would end as, after a period of time, it is impossible to adjudge whether a patient’s trajectory was still related to the closure of the Barrett Centre and their transition process. Because legal teams were not prepared for cross-examination of witnesses on the subject of the transition based on these parameters, those witnesses scheduled to appear today who had information of this area were deferred to another day.
Witnesses: Speech Pathologist Angela Clarke described a collaborative and secure working environment when she outlined her role at the Barrett Centre. She was also able to explain the AMYOS services to the Commission as she has begun some work with this Mobile Outreach Service. Anne Reddie, the principal of the Rivendell school in NSW, appeared briefly to explain the situation in regard to education’s collaboration with mental health specialists i.e. that the contact occurred more at a local than a regional level with schools or groups of schools raising issues at scheduled forums with local mental health clinics. Then Registered Nurse Matthew Beswick outlined the challenging atmosphere that pervaded the Centre once the closure was announced and the difficult circumstances staff were put in, particularly in relation to the transition process and William Brennan described the changes in staffing in the nursing area when the announcement was made that the Barrett Centre was to close. Mr Brennan – who had been in role of Director of Nursing at The Park – indicated that some experienced nursing staff who wanted to remain in child and youth services realised that their options were going to be limited within West Moreton so had taken up positions elsewhere.
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26 February Public Hearing DAY 10
Witness: Former Health Minister Lawrence Springborg told the Inquiry that he had not read the ECRG Report until very recently, saying he relied on advisors for assurances that health services were in place following the closure of the Barrett Centre. The responsibility for responding to families who contacted the then Minister with concerns and warnings prior to the closure was also assigned to others within the Health Department. Mr Springborg today repeated the assertion aired in other forums that the Bligh government had ordered the closure of the Barrett Centre and, under questioning regarding the scrapping of that government’s relocation of the service to Redlands, the former Minister explained that he was dependent on the recommendations of senior bureaucrats to take that action.
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25 February Public Hearing DAY 9
Witness: Dr Michael Cleary (former Deputy Director General within the Health Department) confirmed what other witnesses have revealed in testimony – that the Newman government’s budget cutting agenda was a significant factor in the cessation of the closure of the Barrett Centre and the cessation of the relocation to Redlands. Dr Cleary was able to add that when Lawrence Springborg became health minister in 2012, he “specifically requested that any decisions about major changes to service provision be referred to him through the director-general so that they could be given active consideration”. Former Barrett School teacher, Justine Oxenham, was able to give insights into the vital role that education played in multidisciplinary approach to healing that was undertaken at the Barrett Centre. While education and health staff had clearly defined roles, they were able to collaborate effectively to facilitate patient recovery. However, Ms Oxenham revealed that from November 2012 when the threat of closure hung over the Centre, health staffing levels began to decline and the instability had a negative effect on patients. When the closure was announced and transition planning was undertaken, there was a divide between health and education staff that had not previously existed and the lack of special education facilities in Queensland that would specifically cater to adolescents with severe and complex mental health issues meant that there were minimal opportunities for young people to continue their education once the Barrett Centre closed. Debbie Rankin, Acting Principal of the Barrett Adolescent Specific Purpose School, explained that having the school onsite with the residential treatment facility allowed educators to capitalise on the learning opportunities with young people when they arose. It ensured that students clinical and safety needs were immediately able to be met but when they could engage with other activities, they benefitted significantly from exposure to education. In addition, Ms Rankin was able to share her experiences visiting similar co-existing treatment and education facilities overseas as well as outlining a possible model that could support young people throughout Queensland.
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24 February Public Hearing DAY 8
Witness: Dr Bill Kingswell decisive and adamant in regards to his opinion of the Barrett Adolescent Centre in his testimony. His belief that it was a “failing institution” and a “violent and very, very difficult place” informed his conviction that it should be closed and not relocated elsewhere. He expressed frustration that community based services were not in place earlier but that time constraints over budget cuts required under the Newman government gave minimal opportunity for investigation and consultation regarding the closure.
An email was sent to signatories of the CommunityRun petition following this day’s proceedings (click left to read)
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23 February Public Hearing DAY 7
Witnesses: Queensland Health Directors General Dr Tony O’Connell and Ian Maynard gave testimony today. Dr O’Connell indicated that the scrapping of the Redlands relocation was due – amongst other factors – to budgetary constraints. When the Newman government came to power, Dr O’Connell was given three months to find $100 million of savings. Despite the cancellation of the Redlands plan, Dr O’Connell acknowledged that there would always be a need for a residential service as well well as community-based services for the Barrett cohort. As Ian Maynard came to the Director-General’s role following the closure decision, his knowledge was limited. In fact, he had only read the ECRG summary recommendations within the last week. He acknowledged that he had met with Barrett parents in November 2014 and that they had raised considerable concerns about the ongoing lack of services and support and that he had written back to them early in the following year. He left the role not long after that. Former Chief Executive of WMHHS, Lesley Dwyer, stated that “the fact that the ECRG identified alternative options for the care of this cohort of patients and endorsed that the risks for this patient cohort could be effectively managed if BAC closed.” She clarified this under questioning when she indicated that she acknowledged that the ECRG recommended a Tier 3 facility should be in place that she believed that none of the patients at the Barrett Centre at the time the closure was undertaken were in the group that needed such a service. Ms Dwyer said although there had been no formal consultation process with parents/carer prior to the 6 August 2013 closure announcement that WMHHS did establish “a parents and carers group once the ECRG was actually put in place.” She also clarified that the reason she believed that the Barrett Centre did not include rehabilitation in its service model was because of the extended stays of patients. When cross-examined over if she could recall it ever coming to your attention that one of the other reasons for the longer stays was the lack of appropriate Step Down facilities, Ms Dwyer said she thought that that was assumed. Ms Dwyer said she could see that a decision to exclude the school staff from meetings and communications about the future of the centre might cause the school staff and, indeed, the clinical staff to feel that they’d been divided but that division within the previously collaborative groups had not been the intention.
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22 February Public Hearing DAY 6
Witness: Sharon Kelly, Executive Director of Mental Health and Specialised Services at WMHHS, noted in her statement that “The decision to close was made by the Minister for Health”. When questioned by Council Assisting, Paul Freeburn, she indicated that in a meeting with Dr Bill Kingswell, Dr Jagmohan Gilhotra (Queensland’s Chief Psychiatrist) and Dr Leanne Geppert in October 2012, it was made clear that Barrett was not considered by the Mental Health Alcohol and Other Drugs Branch (MHAODB) of Queensland Health to be part of the service model for delivery of adolescent mental health services going forward. The led her to email some key staff the following day (26 Oct 2012) stating that “closure is not optional“. However, the ‘Fast Facts’ documents put out by her office between 30 November 2012 and 21 May 2013, regularly stated that no final decision has been made. e.g.
Is the Barrett Adolescent Centre closing?
No final decision about Barrett Adolescent Centre (BAC)
has been made. 30 Nov 2012
In addition, she indicated in her statement that, in response to the ECRG’s recommendation that “Interim service provision if BAC closes and Tier 3 is not available is associated with risk” that she believed that “the risks associated with this could be managed effectively.” Questioning also revealed that, following the official announcement of the closure in August 2013, Barrett Education staff were not included in Ms Kelly’s meetings/communication with Centre employees regarding how things would proceed.
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19 February Public Hearing DAY 5
Witness: Dr Leanne Geppert, Chair of the Expert Clinical Reference Group tasked with recommending the best models of care for adolescents with severe and complex mental health issues when the Barrett Centre’s future was uncertain, explained that a replacement facility was not an option at that time because there was a “commitment by the government at that time to identify efficiencies and bring the budget back into a balanced state”. Dr Geppert indicated that although a Tier 3 service was recommended as essential, that there could be ways beyond ‘bricks and mortar’ to provide a service for those with complex needs but that there were no funds for capital projects at that time. She acknowledged awareness of the shelved Redlands relocation plan but said that she believed there had never been a ‘signed off’ final model of care for that facility. Dr Geppert also agreed that the clinical team responsible for transitioning patients from the closing Barrett Centre had raised concerns about the placement of some young people when they experienced difficulty finding services to accept them.
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18 February Public Hearing DAY 4
Witnesses: West Moreton Hospital and Health Service Board Chair Dr Mary Corbett and Deputy Tim Eltham indicated that the Board had been assured by their Executives (Lesley Dwyer/Sharon Kelly) that the Barrett Centre could close even if a Tier 3 service was not available even though the Board also had the recommendations of the ECRG that a Tier 3 service was essential. Dr Corbett stated that WMHHS Board did not have the power to close the Barrett Centre and that once that decision had been made and the centre moved towards closure, that they were assured that there was no gap in service provision by a) their Executives, b) by liaison with the Health Department and c) by the absence of any concerns.
. . .
17 February Public Hearing DAY 3
Witnesses: Dr James Scott and Professor Philip Hazell, both members of the Expert Clinical Reference Group (ECRG), indicated that they believe that a Tier 3 service remains an essential part of Queensland’s mental health treatment for adolescents. (Dr Scott explained that the combination of community-based care, acute facilities and an NGO residential facility were not adequate for the young people served by the Barrett Centre. He also explained that long stays in acute facilities were problematic due to young people seeing other patients coming and going while they remained – leading to a sense of hopelessness. So if longer inpatient services are required, it’s detrimental for them to be within acute facilities.) Amelia Callaghan, the former Queensland Manager of Headspace, also on the ECRG, said that discussions held within the Group that met between December 2012 and May 2013, were within parameters communicated by the Chair, Dr Leanne Geppert, that included that there was no money to build a new service to replace Barrett (that the funding for Barrett was to be re-directed) and that recommendations for services needed to take into account the move to a less restrictive environment outlined in the Mental Health Plan. She also acknowledged that the ECRG recommendations were formulated with the understanding that the Health Minister had flagged the closure of the Centre in early 2013).
. . .
16 February Public Hearing DAY 2
Witnesses: During Professor David Crompton‘s questioning, documentation revealed that the reasons to cease the Redland relocation included multiple delays, exceeding budget and changes in the model. However issues subsequently put forward publicly as reasons for the halting of the project seemed to have been resolved i.e. Oct 2009 – water flow issue resolved; Sept 2010 – plans were adapted to accommodate koala habitat; and July 2010 – Model of Service had been finalised. Professor Brett McDermott and Dr Aaron Groves were both able to emphasise that sub-acute beds in acute wards are not places for rehabilitation with highly scaffolded but more homelike environments considered more appropriate as a step-down facililties. Professor McDermott indicated that there will be a consistent need for a small number of bed for individuals who have profound levels of need who shouldn’t be in a step-down facility but that he has concerns about extended inpatient care beyond 6 months to mitigate institutionalised behavior. However he believes that there is very little proper evaluation of mental health services in Queensland so it is difficult to assess the actual value of different services. Dr Groves had recommended a Mental Health Commission model that had its own budget and was not directly answerable to the Health Minister to ensure total independence – two characteristics not borne out in the legislation that put the Queensland Mental Health Commission in place.
. . .
15 February Public Hearing DAY 1
Counsel Assisting the Commissioner made opening statements revealing the timeline from the planned moved to Redlands (outlined in 2008) to the closure of BAC at Wacol without another Tier 3 facility in place in January 2014. A cessation document from 2012 indicated that Dr Bill Kingswell of Queensland Health recommended closure of Barrett, with the funding for its relocation to be diverted to rural hospitals. A May 2013 document from the West Moreton HHS Board raised concerns for closure when “there is currently no alternative for consumers”. Paul Freeburn QC indicated that documentation revealed that although a flexible closure date was mentioned publicly that there was no evidence that flexibility was considered and there was no review of the alternative services in place, neither was there a detailed analysis prior to the decision to close. Cathy Muir outlined the issues relating to the transition following closure including the confusion and anxiety that existed from November 2012 to January 2014, the changes in staff structure and the breakdown of the previous collaboration between clinical, nursing, allied health and education staff during that period and that evidence seemed to indicate that the view of West Moreton HHS was that once the Barrett Centre no longer existed, there was no need for follow-up of the patients who had been transitioned to other services.
Witnesses: Dr Cary Breakey (the inaugural Director of the BAC) and Dr David Ward (a social worker with extensive experience in adolescent mental health whose doctoral thesis research was conducted at the BAC) described the value of the service Barrett offered and the lack of suitable replacement services that still exists. Dr Breakey stressed the need for staff consistency and more than Mon-Fri availability of care in the treatment of adolescents with severe and complex issues and Dr Ward indicated the entrenched pathology suffered by young people is now occurring at younger ages making the need for an extended treatment option even more vital. It was revealed that the Mental Health Commissioner, Dr Lesley van Schoubroeck had received a confidential briefing by Queensland Health on the closure of BAC prior to taking up her role. She stated during her testimony that when any concerns were raised by the public, she had advised either Dr Kingswell or Dr Cleary of Queensland Health. Her response to the public indicated that the Commission was not a decision-making body but one that dealt with broad systemic issues. However, when questioned, Dr van Schoubroeck agreed that she did have the power to advise government and the capacity to suggest that a closure could be paused to look further into the matter.
. . .
28 January 2016
The final hearing prior to witnesses appearing dealt with how the Inquiry will proceed and updated issues that had been raised in previous sittings.
Counsel Assisting the Commission, Paul Freeburn, indicated that a Witness List would be uploaded to the Commission’s website within the next 24 hours (now available here) and clarified that it would contain the names of 45 potential witnesses – a subset of the total number of witnesses who have given statements. This list will continue to be updated as proceedings progress.
On issues of confidentiality, Mr Freeburn explained that some full statements and some parts of statements will not be made publicly available, particularly in relation to patients and their medical treatment and the same principle will be applied to hearings i.e. some will be closed and some will have segments closed to the public. At this stage, there are 2 full days of closed hearings planned where patients and families will give evidence.
Submissions by Mr Freeburn and following, by Ms Wilson of Crown Law representing the government, indicated that as regards issues of outstanding disclosure of information, only one item remains (a Capital Division document which is to be suppled by 1 February). Mr Freeburn explained that, in relation to the emails (which has been a previous cause for delay) that Commission and Crown Law staff had prioritised certain accounts and that those had now all been supplied.
Ms Wilson (Crown Law) then proposed some amendments – one to ensure the earliest possible provision of witness statements and information to all legal representatives prior to the relevant sitting (which the Commissioner undertook to consider) and two others in relation to ensuring confidentiality for participants (specifically those who had attended BAC, the school and their families), particularly in relation to ensuring identifying information is not made public. In order to fully discuss this issue with legal representatives, the Commissioner closed the hearing to the public at this point.
On resumption, issues were raised by the legal representative for Mr Lawrence Springborg in relation to the provision of witness statements and information to parties prior to witness appearances to allow adequate time for preparation and for cross-examination decisions.
The Commissioner undertook to consider the submissions, stressing that all parties will be treated evenhandedly and whatever scheme is settled will apply to everyone.
Following an adjournment, the Commissioner ruled that amendments be made to the Practice Guidelines in relation to non-publication orders to ensure that identifying information of specific kinds (e.g. gender, period of time as inpatient, treating clinician etc.) will be withheld. Justice Wilson also foreshadowed amendments to ensure the provision of information on areas of interest and documentation 4 business days prior to a particular witness being called to all parties and confirmed that Counsel Assisting will provide all parties with a list of key issues to be covered in Oral Evidence by 15 February.
. . .
22 January 2016
Meeting with Media
Because the non-publication order and the Commission’s confidentiality and redaction processes will restrict the publication of much of the information relating to former Barrett patients, the Commission facilitated a meeting to assist parties with leave to appear in raising any issues/concerns with journalists and answering questions that journalists might have. Journalists were invited on the basis that the meeting was for their background only, and the information and views provided were not to be reported. It was stressed too that meeting was also not for legal debate or the provision of legal advice.
At the meeting, the Commission promoted the guidelines and resources produced by the national Mindframe initiative to encourage appropriate media reporting of suicide and mental health. (Details can be sourced at www.mindframe-media.info.)
Barrett families in attendance stressed the need for care in reporting, bearing in mind the vulnerability of the people involved in this issue and the challenges they continue to face. Accuracy and balanced coverage must be a priority along with a clear understanding of the position of those who wish their and their family’s privacy be maintained.
With that in mind, some basic advice for those attending hearings who don’t wish to part of any media coverage is as follows:
If approached by a member of the media, clearly tell the journalist(s) that you don’t wish to be photographed, filmed or interviewed. They should all be well aware of your rights and particularly of the vulnerability of many people involved in this issue so they should immediately respect your wishes.
Do what you can to avoid walking out of the court close to one of the key witnesses at that hearing. (If you’re nearby you could unavoidably be included in a photograph or film.)
Be mindful of what you say in and around the proceedings. It’s advised that if you want to discuss anything you wish to remain private that you speak to your friends quietly somewhere where there is no one else close by who could overhear you.
The Commission of Inquiry continues to emphasise that people’s privacy and confidentiality are important issues in this whole process so even though the media should already be aware of people’s rights in respect to being included in reporting, it’s hoped that they will be even more diligent in this case. The efforts the Commission is making in this regard can be seen as reassuring.
. . .
11 December 2015
Barrett Centre Inquiry Hearing Dates Announced
Dates for hearings of the Barrett Centre Commission of Inquiry were posted on the Inquiry website.
The dates are as follows:
28 January 2016
At this Hearing, Counsel Assisting will tender witness statements, identify witnesses likely to be called to give oral evidence and give an indication of the likely order in which they will be called. Once witness statements have been admitted into evidence, unredacted copies will be made available to the parties (subject to appropriate conditions about non-publication and confidentiality) and redacted copies will be placed on the web.
This Directions Hearing will also provide an opportunity to canvas issues such as the management of witness statements and other documents, outstanding questions relating to confidentiality and closed hearings, as well as any further conditions to be imposed on the leave to appear which has been given to various parties. The Commission proposes to make available to each witness in advance of the public hearings:
a bundle of documents relevant to that witness (to the extent those documents are not included in the witness’s statement); and an indication of the Commission’s areas of interest in that witness’s evidence, identifying the Terms of Reference, subject matter and time period likely to be focussed upon.
The Commission’s website states that all parties should rest assured that:
- a party giving notice of proposed cross-examination of a witness will be required to identify any document they anticipate showing to the witness; and
- where a party or a witness has insufficient time to prepare, or is otherwise prejudiced, the Commissioner will make appropriate adjustments to the hearings.
15 February – 11 March 2016
21 – 24 March 2016
As a result, the previous 14 January date recorded in the Terms of Reference as THE DATE BY WHICH THE COMMISSIONER MUST SUBMIT HER REPORT TO THE PREMIER, has been extended to 24 June 2016 by a Commissions of Inquiry Amendment Order made by the Governor in Council on 10 December and gazetted on 11 December 2015.
. . .
19 November 2015
The resumption of the hearing relating to document compliance heard Counsel Assisting Paul Freeburn indicate that 5 of the 7 departments from whom documentation remains outstanding have committed to compliance by specified dates. The majority will supply documents by the 22 November with those from the Department of Premier and Cabinet that are the subject of any privilege chain taking a little longer (generally within a few weeks).
The significant issues that remain are with the Health Department and with the Department of Education and Training. The Director General of DET has indicated that while some documents can be provided to the Commission of Inquiry by 23 November, others will take until 11 December to provided to Crown Law for assessment/screening (before the relevant documentation can then be supplied to the Commission). The major issue, however, lies with the compliance of the Health Department, whose Director General’s affidavit outlined that although a number of documents could be supplied by the 22 November, the use – until relatively recently – of a now “obsolete” email system which requires that email accounts be ‘restored’ before they can be searched for valid content has presented serious problems. The hearing heard that 14TB of email data has already taken many months to restore and another 14TB is yet to be restored. (It was estimated that in order to restore and then search/screen all email accounts flagged as being possibly relevant would take until August of 2016 and would cost “millions of dollars”.) The representative of Crown Law present at the hearing indicated that 10 of the 14 accounts identified as ‘priority’ had already been restored with the balance of the priority accounts to be supplied by 24 January.
The only course of action suggested by Counsel Assisting Paul Freeburn and confirmed as a directive by Justice Wilson in her later summation is for Commission staff to meet with Crown Law and Queensland Health representatives to undertake a cost-benefit analysis as to whether a compromise can be reached on the value of accessing a proportion of non-priority accounts and whether alternative sources for some of the information can be sought. This meeting is to take place before 26 November.
Overall, the Commissioner acknowledged that considerable effort had gone into the compliance issue within the last week and that although progress had been made, the provision of documentation from the Health and Education departments were still a significant cause for concern. Justice Wilson concluded that the pervasive force of emails as the foundation form of communication and information provision in current work environments – even in respect to reports, advice etc. – has overtaken the technology being utilised within the government for a medium that plays such a key role.
A legal representative for one of the potential witnesses to the Inquiry queried the Commissioner as to if would be possible for a general indication as to when hearings might take place based on the current status of information-gathering (bearing in mind that a number of people who are likely to play key roles in these hearings are in limbo, not knowing when they may need to be available or how their lives could be impacted.) The Commissioner responded that although nothing could be confirmed at this stage, there was an unlikelihood that hearings would start before Christmas and that matters had been flagged to the Attorney General regarding the possible need for an alteration to the date the Commission’s report is to be supplied to the government but a response was yet to be forthcoming.
The issue of compliance was then adjourned until a date to be determined. (The full transcript of this sitting is available here.)
. . .
12 November 2015
Queensland Government departments (7 in total with the majority of documentation required from the Health Department and the Department of Education and Training) have yet to comply with notices from the Commission even after being granted a number of extensions since initially being served on 14/15 September. Counsel for the Queensland Government indicated that the volume of documentation to search and IT issues had been providing considerable problems adding to the significant challenges in accessing archived emails (which would take another 3 months to de-archive / 4 – 8 weeks for the priority accounts). In addition, cabinet and parliamentary privilege documents required high level approval. (However, when queried by the Commissioner regarding when the process had begun to access these documents, Crown Law’s assisting solicitor supplied a date of 9 November.)
Justice Wilson stated that even though initial notices issued by the Commission in mid-September had provided clarity on documentation required under various headings and types and that they had indicated they would accept documentation in non-compliant formats (e.g. USB sticks, CDs etc.) prior to their availability in compliant formats, a significant number of important documents had still not been supplied. The Commissioner made it clear that they would be “regularly updated” in relation to the process of availability of cabinet documents was “not good enough” and the fact that current projections for compliance in other areas also remained uncertain was “unreasonable and can’t be allowed to continue“. She indicated that she understood the challenges but that notice had been served with time given to comply and that other parties (including a number of the individually represented Hospital and Health Services) had been able to do so. After citing the Commissions of Inquiry Act 1950 in relation to compliance, non-compliance and resultant penalties, Justice Wilson stressed that the Inquiry had a strictly limited timeframe and that she was conscious of the sensitive nature of the issues they were dealing with as well as the vulnerability of persons associated with the closure of the Barrett Centre so it is now essential that a realistic program for compliance is set in place and must be followed. The Commissioner then directed that:
- having been informed that a large number of documents should be able to be made available by 21 November, that she expected that to occur;
- in relation to cabinet and parliamentary privilege documents, that the Commission must be given a date for compliance of provision of those documents by 16 November;
- discussions must begin between Crown Law and Commission staff by 16 November in order to construct a plan (to be provided to the Commission by 18 November) for the provision of email evidence;
- the hearing be adjourned until Thursday 19 November at 2pm and if, at that time, the plan for the provision of any documentation extends beyond a projected date of 27 November, there must be affidavit evidence from the Directors General themselves as to why this is the case.
. . .
15 October 2015
The second day of public hearings (full transcript available here) dealt with issues of confidentiality, as raised by initial submissions from the Queensland government and from the Child & Adolescent Psychiatry Faculty of the RANZCP. Other submissions have subsequently been made and lawyers representing the state government and the related health department services (who collaborated on a document available here), the families of the young people lost to suicide following the Barrett Centre closure, 6 Barrett Centre mental healthcare nurses and the former Health Minister Lawrence Springborg were all present. A discussion paper had been produced by Commission staff following the submissions and proposed amendments to orders in relation to confidentiality/privacy issues (e.g. regarding medical records, the vulnerability of young people suffering mental health issues, the means by which specific patients could be identified through evidence etc.) were outlined. ‘Counsel Assisting’ Paul Freeburn indicated that following the submissions and discussion on this issue, Commission staff have prepared a Confidentiality Protocol, now available on the Inquiry website.
[Update: additional documentation on issues of confidentiality have been provided to savebarrett.org and are available here ->
A useful INFORMATION PAPER which provides clear and concise answers to basic concerns about confidentiality re: providing info/docs to the Inquiry;
The DISCUSSION PAPER circulated to lawyers re: Confidentiality/Non-Publication Orders (referred to during the 15 October public hearing); and
The DRAFT ORDER TO PROHIBIT PUBLICATION OF EVIDENCE – summarising decisions made and issues still under consideration following the 15 October public hearing.]
Justice Wilson then gained clarification on some issues, indicating that the option of closed hearings (i.e. not public) would be enacted when appropriate and that a number of matters under the confidentiality orders would be under ongoing review.
A letter from Dr Stephen Stathis of Children’s Health Queensland advocating that protection be extended to include current and previous Queensland Health staff was then introduced by counsel representing the Queensland government and the Commissioner agreed to consider this along with other questions adjourned pending further written submissions.
Counsel for the bereaved families indicated that his clients were particularly concerned about confidentiality in relation to other patients and families and fully accepted the need for closed hearings on some evidence that may present a risk to those with mental illness but wanted their children’s cases to be held in open and transparent hearings.
Commissioner’s Summary of Work To Date
Justice Wilson indicated that of 58 notices to produce documents to departments, institutions and individuals:
– 13 had been responded to with partial compliance
– 44 had no compliance so far
– 1 had the response that no documents of the nature called for existed.
The Commissioner acknowledged the challenges of producing documents (e.g. archived emails) and indicated that extensions had been sought and granted. Although thousands of documents have already been received, it is estimated that the full amount, when obtained, could exceed a million documents.
In addition to the notices for documents and receipt thereof, there have been 40 notices to provide information/written statements and staff have been spending considerable time interviewing potential witnesses and taking statements.
With the volume of work still to be undertaken, Justice Wilson stressed that there was no certainty hearings would begin on the projected date of November 16.
. . .
30 September 2015
The first public hearing of the Barrett Centre Commission of Inquiry sought to outline the parameters of the Inquiry and allow the legal representation of those involved to seek leave to appear before the Inquiry on their clients’ behalf. (The official transcript is available here.)
Justice Wilson’s opening statement clarified that the Inquiry should be seen as a clearly different procedure from the coronial inquest already underway in that the Commission of Inquiry would be investigating the decision to close the Barrett Adolescent Centre as well as the broader systemic issues surrounding that. Examination will include issues such as:
- the grounds for the closure decision
- the arrangements made for transitions to alternative care (planning and implementation)
- the adequacy of care, support and services for patients, families and staff
- alternatives for replacement services and why these were not adopted and if other services options should have been considered
- contravention of the Mental Health Act in relation to patient safety and confidentiality
- recommendations for clinical options for the intensive care and treatment of severe/complex adolescent mental health issues
Justice Wilson clarified that the tempo and volume of information gathering has been rising daily with a number of submissions already made and applications for documentation submitted to various government bodies. She stressed that before public hearings, a careful analysis of documentation must be undertaken, indicating that it was likely that such hearings would begin on 16 November and run for approximately 4 weeks, however these dates would only be able to be finalised once more analysis had been completed.
It was made clear that persons providing information to the Inquiry may ask for the Commission to treat what they say/provide as confidential and this is particularly likely due to the great sensitivity of the issues under examination. There is information on the Inquiry website outlining the protocols on confidential information but Justice Wilson also announced that there would be a hearing on issues of confidentiality following submissions from the State of Queensland and from the Faculty of Psychiatry of the RANZCP on confidentiality concerns (the RANZCP emphasised the need for extreme care in relation to public information regarding mental health issues). The Commissioner indicated that the Inquiry would seek to do all that it could to investigate the issues while still demonstrating the appropriate care and respect for the sensitivity of the issues under consideration and for the welfare of the young people involved.
Hearings will be live-streamed on the Inquiry website and transcripts will be available except when issues of confidentiality and required anonymity have made it appropriate to halt coverage or redact content.
Justice Wilson was keen to stress that the Inquiry process was one that was inquisitional, not adversarial but that cross-examination may occur by counsel representing the various parties involved. She stated that no findings will be made on any individual or corporate body unless that person/body has had the opportunity to be heard.
Council Assisting Justice Wilson, Mr Paul Freeburn QC then reiterated the Terms of Reference and suggested that when public hearings began, it may be possible that they would be split into issues examining 1) the Closure decision and 2) the Transition – but that delineation is still to be determined.
He also indicated that there were arrangements with Uniting Care Community for that organisation to supply trained support counselling (either at the Commission’s hearings or to assist with interviews) for those involved with the Inquiry so those who wanted to pursue that should contact Mr Ashley Hill, Executive Director, Barrett Adolescent Centre Commission of Inquiry on (07) 3239 6040 or via email at email@example.com.
Justice Wilson then heard from legal counsel seeking leave on behalf of their clients to appear before the Inquiry. Those represented included:
- All State of Queensland Hospital and Health Services other than those with individual representation
- West Moreton Hospital and Health Service and the Board of WMHHS
- Metro North Hospital and Health Service and the Board of MNHHS (in relation to transition arrangements only)
- Metro South Hospital and Health Service
- Lawrence Springborg (Queensland Health Minister at the time of the closure)
- Dr William Kingswell (Queensland Director of Mental Health at the time of the closure)
- Dr Anne Brennan (Acting Clinical Director of the Barrett Centre from 11 September 2013)
- Dr Trevor Sadler (Clinical Director of the Barrett Centre from 1990 to mid September 2013)
- Six Mental Healthcare Nurses (staff at the Barrett Centre prior to the closure)
- Parents of the three former Barrett Centre patients who passed away following the closure.
The public session was then closed with extensive examination of evidence, submissions and documentation to continue prior to the scheduled November public hearings.
. . .
Upcoming Initial Public Sitting of Inquiry
As the Barrett Inquiry website indicates, the Commission will hold an initial public sitting on Wednesday 30 September at 9.30 am (Courtroom 34, Brisbane Magistrates Court building, 363 George Street, Brisbane). There will be some opening comments from the Commissioner, Margaret Wilson, and further information about the Inquiry will be provided (including likely future public sitting dates). In addition, the session is also an opportunity for people/parties to ‘seek leave to appear’ at the later Hearings.
Ways to Provide Information
Comprehensive information on providing information to the Commission is now clearly outlined in the Practice Guidelines at the Inquiry website. Some of the ways that people can contribute include:
- formally ‘seeking leave to appear’ at public hearings (see Practice Guidelines for info)
- being determined by the Commission to have information of value so being requested to formally appear / subpoenaed
- being invited – or initiating contact yourself and arranging – to meet with Commission staff in their offices to provide background information informally
- submitting information/documentation electronically (via the Commission’s website or on disc/drive provided to Commission staff.
For clarity on anything, you can contact the Commission directly on:
Phone: (07) 3239 6040
Postal address: Barrett Adolescent Centre Commission of Inquiry, PO Box 13016, George Street Post Shop QLD 4003
And, of course, seeking advice from legal experts could also be invaluable when considering contributing to this process.
The staff at the Inquiry are doing all they can to find out as much as they can in a relatively short time (the final report is due in January 2016) so anything that anyone is able to do to assist them will mean that any recommendations that are made or conclusions that are drawn will be based on a full and accurate picture of events.
. . .
14 September 2015
Commission of Inquiry Underway and Open for Submissions
The launch of the Barrett Inquiry means that the Commissioner and her team are now gathering information related to the closure of the Barrett Centre. So from 14 September, submissions can be made by anyone who believes they have something to contribute. The easiest way to do this is by going to the website www.barrettinquiry.qld.gov.au where a form can be completed that will ensure that information goes directly to the Inquiry team. The link to the Terms of Reference is in the post below and now at the Inquiry website and a set of Practice Guidelines are available there too but if you think that you might have some useful input/comments to make or a story to tell that will ensure that Justice Wilson gets the most complete picture possible, this is the opportunity to provide that. If conclusions and recommendations are to come that are fair and just, the Commissioner needs to know:
- what happened (anything related to the closure – the time, the deadline, the procedure, the communication …)
- how that affected people (patients, families, staff, community …)
- how things were handled – good or bad (planning, patient/carer engagement, transition options and schedules, provision of wrap-around care, post-transition follow-up …)
- how government representatives – from the Premier and Health Minister to the West Moreton Health Executive and Board to the Clinical Transition Team to the Mental Health Commissioner – responded to anyone on the issue of the closure
- what people tried to do to minimise the harm of the closure and transition (warnings to government, contact with West Moreton HHS, support for patients/families …)
- what is still happening that is the result of the closure of the centre, the transition process and the government’s approach to the provision of appropriate health services
- what should have happened (input from professionals with relevant training/experience who can assess the decisions, process and management and indicate if alternative more appropriate approaches were available but not utilised)
So if you think you have anything to contribute, this is the chance to do so. If everyone affected, involved or associated provides their input, then finally, the true story of the Barrett community will be heard. Only then can Queenslanders suffering due to severe and complex adolescent mental health issues begin to have hope that the decline that began with the possibility of closure of Barrett might be able to be halted.
. . .
Commission of Inquiry
The Health Department has provided some information on how the Inquiry into the Closure will proceed. The Terms of Reference have been released – made public here in the Government Gazette (at the page labelled 561/page 23 of the PDF document) from which we’ve extracted the relevant text to create a document that can be downloaded here. Then when the Inquiry officially begins, it’s expected that the Commissioner will make a “call for information”, and any member of the public will be able to make a submission if they feel they have relevant information. This is likely to be done as it has been for other Inquiries i.e. via a dedicated website which will provide information and have a webform for input and the facility for documents to be attached (e.g. as per that utilised for the the Grantham inquiry). So we’ll post a link to the site relating to the Barrett Inquiry here as soon as it becomes available.