Policy Futures: A Reform Agenda combines some of the best of the Churchill Fellows’ insights with the policy expertise of the University of Queensland Centre for Policy Futures.
This article explores three Fellows’ ideas in the area of vulnerable people in Australian society.
Safeguarding People in Detention and Care Settings
By Steven Caruana
Australia ratified the Optional Protocol to the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT) in 2017, fulfilling a pledge made during its Human Rights Council election campaign. Ratification was also a response to the Royal Commission into the Protection and Detention of Children in the Northern Territory which found evidence of widespread mistreatment at the Don Dale Youth Detention Centre.
OPCAT requires the establishment of an National Preventive Mechanism (NPM) – an independent monitoring mechanism empowered to conduct regular, preventive, and human rights focused visits to all places where the state does or may deprive people of liberty. OPCAT purposefully adopts a broad, open approach to what are considered places of deprivation. This means both traditional places, like prisons and police cells, as well as non-traditional places like aged care and disability group homes, fall within its scope.
Policy Issues
Three urgent policy issues need to be addressed to ensure effective implementation: expanding the scope of the NPM, enacting primary legislation, and providing appropriate funding.
NPM
The Australian government has formally restricted the NPM’s focus to ‘primary places of detention’ – adult prisons, juvenile detention centres, police lockups, legal mental health assessment centres, forensic disability units, immigration detention centres, military detention centres.
Aged care facilities are excluded.
The Australian NPM’s mandate should not be inhibited in this way, and it should be free to determine its own priorities.
Legislation
The Australian government has expressed the view that primary legislation is unnecessary. Legislation should be drafted through a transparent process including consultation with state and territory governments, the Australian Human Rights Commission, Commonwealth Ombudsman, proposed and designated NPMs, and civil society, including the Australian OPCAT network.
Policy Recommendations
To establish an effective NPM to meet its OPCAT obligations, it is recommended that the Australian Government should:
- Accept the interpretation of ‘deprivation of liberty’ adopted by the UN SPT.
- Enact primary legislation, developed in consultation with relevant stakeholders, to give practical effect to OPCAT in Australia.
- Ensure the NPM is properly funded and resourced.
Universal Registration is Key to Preventing Gambling Harm
By Dr Angela Rintoul
Australians are known as the largest per capita gambling ‘losers’ in the world; in 2019, we lost $25 billion on all forms of gambling or $1,277 on average per adult.
Electronic gambling machines (EGMs) and online wagering are higher-risk products where the regulation of gambling has not kept pace with advances in technology and marketing strategies. It is estimated that for every person who gambles at problematic levels at least six others are directly affected. Thus, costs significantly outweigh the revenue captured by state governments through gambling taxes, while the profits obtained from gambling have created a powerful industry lobby.
At its extreme, gambling harms manifest as suicide and suicidality. Shifting to a comprehensive public health approach would equip people who gamble to control the amount of time and money spent gambling and provide warnings about harms associated with gambling.
In 2010 the Productivity Commission recommended a mandatory pre-commitment system for EGMs. However, calls for widespread implementation of such as system has been overall unsuccessful. A campaign by industry groups during 2011-12 meant reform-focussed legislation was watered down. This experience highlights the ways in which political donations laws create a major barrier to effective reform.
A royal commission into gambling regulation in Australia that explores predatory practices, operator duty of care, and product design would further strengthen the case for reform.
International Lessons
Finland introduced universal (mandatory) loss limits for high intensity online gambling in 2018. Research undertaken with over 18,000 Veikkaus customers found that 75% of respondents reported that when their limit was reached they stopped gambling until it reset.
Principal Policy Options
Optional pre-commitment systems have repeatedly shown less than 1% usage. If deployed effectively, universal (mandatory) systems could be a powerful harm prevention tool for those not yet experiencing gambling problems.
If states are unwilling to regulate, the Australian government has the jurisdiction to act.
Policy Recommendations
- Prohibit political donations from gambling industry actors.
- Establish a federal anti-corruption commission.
- Establish a royal commission into gambling regulation in Australia.
- Transition to a centralised, universal, account registration system across Australia for wagering and EGMs.
- Coordinate state legislation to prohibit predatory promotions and practices, including inducements to gamble.
Gender Affirming Health Care
By Jeremy Wiggins
Almost two thirds (68.5%) of transgender young people report low levels of family support, according to Trans Pathways, the largest Australian study into the mental health of trans young people. Lack of family support was associated with ‘… higher rates of suicidal thoughts, wanting to hurt themselves, suicide attempts, self-harming, reckless behaviour, and diagnoses of eating disorders, anxiety, depression and PTSD…’ compared to those reporting higher levels of family support.
Almost half (48.1%) of transgender and gender diverse people aged 14 to 25 have reported that they had attempted suicide in their lifetime.
A study of 28,000 trans adults has shown that, when younger trans people are able to access gender affirming health care, their later life mental health experiences are improved significantly.
A key policy issue is the limited amount of funding available to community led family support organisations who can provide critical support.
Other policy issues include under resourced medical services, limited workforce capacity to deliver gender affirming care, and discriminatory consent procedures for trans youth, which in the event of a parental dispute, involve an application to the family court.
The Medico-Legal Landscape
Competence to consent to medical examination and treatment by all children under the age of 18 years is known as Gillick-competence.
Since 2004, decision making with regards to gender affirming medical and surgical treatment for trans young people has not been determined by a clinician’s assessment of the young person as Gillick-competent, as is the case for all other medical treatments, but by a legal process involving the Family Court of Australia.
A case decided by the family court found that those trans youth who have an absent parent, or a parent who objects, are now required to go through the court process to obtain court authorisation. Reform is urgently required to reverse inequity.
Policy Recommendations
- Governments provide appropriate funding to community led trans family support organisations to meet the growing demand of families requiring assistance.
- State and territory governments appropriately fund multi-disciplinary gender services for young people.
- The Australian Department of Health ensures trans young people and their families are included in health strategies.
- Change the law to stop medical consent discrimination for trans young people.
The full policy articles for these Churchill Fellows along with others features in Policy Futures: A Reform Agenda Issue 2, launched in the Churchill Policy Room at Parliament House on November 30. Learn more, receive a copy or request a policy presentation by our Fellows.
https://www.youtube.com/watch?v=lB6NFLlS4lY
