The Mental Health Tribunal

John Read
11
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I am trying to demonstrate, in a series of installments, how in the 21st century we still often fail to establish effective safeguards for the rights of people who end up in our psychiatric systems.
This particular example is taking place in 2016, in Melbourne, and involves over 50 consecutive electro shock ‘treatments’ and multiple, sometimes very lengthy, periods of being tied to a bed.

This nine-minute TV clip provides more background to this very sad story.

In the last installment, I presented my failed attempt to persuade the Office of the Chief Psychiatrist to live up to its website’s claim that it “promotes the rights of people receiving mental health treatment.” In over a month now I have had no response whatsoever to my formal request to be sent the research that justifies 50 consecutive ECTS, or to my allegation that the Chief Psychiatrist rewrote Victoria’s ECT guidelines to retrospectively provide a defense for Eastern Health management and staff by stating that a series of 12 ECTs can be immediately followed by the commencement of the next one, and so on.

In this third installment, I offer my interactions with another body who is supposed to protect our rights when under the ‘care’ of psychiatrists, the Mental Health Tribunal [MHT].

Its website opens with:

“The Tribunal is an essential safeguard under the Mental Health Act 2014 to protect the rights and dignity of people with mental illness.”

Later, it states:

“The Tribunal will also determine whether ECT can be performed on a compulsory patient if they are considered to not have capacity to give informed consent to ECT, or if they are under the age of 18.”

To begin on a positive note, the MHT is to be commended on keeping excellent records and on making them public. The excessive frequency with which ECT is being used in Victoria, and the extent to which Victorians are doing their best to refuse it, can be seen from the MHT’s most recent report. We read that in the last three months of 2015 alone, psychiatrists applied to the Tribunal 176 times for permission to give ECT to someone who had stated they did not want it and had been strong enough to somehow resist all the psychiatrists’ attempts to talk them into it.

Of these 176 hearings, the Tribunal had turned the psychiatrists down 14 times (8%). So in Victoria, our chances of the organisation explicitly established by law to “safeguard our rights and dignity” actually doing so (versus safeguarding the rights of psychiatrists to administer electric shocks to us to cause general seizures) is about 12 to 1 against.

I will first allow my initial correspondence with the Tribunal speak for itself, and then bring you up to date.

  1. January 11: My written research-based submission to the MHT for the January 12 hearing
  2. February 2: My formal complaint and call for independent investigation following that hearing
  3. February 3: Initial response from MHT
  4. February 16: My mail (subsequent to the psychiatrists asking for another hearing to extend even further the ECT treatments) to try to prevent MC and BM sitting on this hearing

 

1. My written submission to the MHT for consideration at the January 12 hearing (Jan 11)

January 11, 2016
SUBMISSION TO MENTAL HEALTH TRIBUNAL HEARING (12.1.2016) REGARDING MR G D, BY PROFESSOR JOHN READ, AT THE REQUEST OF MR D’s FATHER.
[accompanied by two research papers: Sackeim et al. (2007) and Read & Bentall (2010)]

CREDENTIALS
I practiced as a Clinical Psychologist, and manager of mental health services, in the USA, UK and New Zealand for approximately twenty years, before working for 19 years in the Psychology Departments, as Director of Clinical Psychology, of the Universities of Auckland (NZ) and Liverpool (UK). I have published five books, and over 120 peer-reviewed research articles on mental health issues, including two book chapters and two research reviews on ECT. I am currently Professor of Clinical Psychology at Swinburne University of Technology, Melbourne.

I am not commenting on the clinical condition of Mr GD, whom I have never met. I will contain my submission to the research evidence regarding the appropriateness, efficacy and safety of administering ECT beyond the internationally recommended number (6 to 10).

I have been invited by Mr BD [father] to attend the Tribunal hearing on 12th January in order to summarise the relevant research and to answer any questions regarding this written submission.

EFFICACY OF EXCESSIVE USE OF ECT
If an evidence-based approach is taken, as it should, to the decision facing the tribunal, it would need to be established that there is research supporting the belief of the prescribing psychiatrist that continually administering ECT beyond the internationally recognised recommendation of six to ten consecutive treatments is effective. There is none.

In fact, my peer-reviewed review of the efficacy research (published in an international peer-reviewed journal, with Professor Richard Bentall of the University of Liverpool, UK) found that there is no evidence that ECT has any benefit compared to placebo (simulated ECT, where the general anaesthetic is administered but the electric current is not) beyond the end of the treatment period. The temporary lift in mood experienced by some patients during treatment is typically followed by relapse. Thus ECT has no lasting benefit, in either depression or psychosis, or suicide prevention, compared to placebo (Read & Bentall, 2010). There is certainly no evidence that continuing ECT beyond twenty treatments has any benefit to the patient, while exposing her/him to considerable risk of memory loss and a much smaller risk of death (see below).

The case before the Tribunal is rare in the extreme. I have never experienced, or heard of, the continuous use of ECT beyond 25, let alone 40 or more. This is presumably related to the lack of evidence to support such an approach. Occasionally some psychiatrists will try what is known as ‘maintenance ECT’ but this is almost always after a relapse following a temporarily successful initial course of treatment. This does not seem to apply here and the evidence in support of this approach is, anyway, also very weak (Read & Bentall, 2010)’

As an example of the accepted international position, I submit the following, typical, statement on the website of the Royal College of Psychiatrists in the UK, as recently as July, 2015:

“A course will on average be 6 to 8 treatments, although as many as 12 may be needed, particularly if you have been depressed for a long time. If, after 12 treatments, you feel no better, it is unlikely that ECT is going to help and the course would usually stop.”
http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/ect.aspx (July 2015, extracted January 10, 2016).

In summary there is no evidence to support the request to continue applying ECT to Mr GD.
In addition, the information provided to me by GD’s father suggests that the approach taken thus far to his son’s treatment contravenes the widely accepted need to leave a gap of at least two to three days between ECT administrations. I read that on at least ten occasions two ECTs were administered on the same day. This is most unusual and not, to the best of my knowledge, recommended by any professional or government body. This approach, in the absence of consent, could be seen as punitive from a human rights perspective. It is my belief that the majority of even the most ardent advocates of ECT would find the administration of ECT four times in a single day quite unacceptable (even if this occurred because of failure to elicit a seizure). According to the records shared with me this occurred to Mr GD on 20th October 2015.

SAFETY
It is well established that among the various adverse effects of applying electricity to the human brain to induce a seizure (ECT), the most common is memory loss, in the form of both anterograde amnesia (inability to retain new information) and retrograde amnesia (loss of memory of past events) (Read & Bentall, 2010; Sackeim et al., 2007).

It is also widely accepted that the most rigorous study to date is that conducted by ECT advocate Dr Harold Sackeim and his colleagues in the USA. This study not only found a range of cognitive deficits (memory and attention) immediately following ECT but that the number of ECTs given was the strongest predictor of gaps in autobiographical memory (retrograde amnesia) six months after the end of the treatment:

“Greater amnesia for autobiographical events (AMISF scores) was significantly correlated with the number of ECT treatments received 6-months earlier (Table 5). In the confirmatory analyses, there were significant linear relationships between the number of treatments administered and post-ECT AMI-SF scores for each of the three electrode placements.” (Sackeim et al., 2007, p. 250).

Furthermore the relationship between number of treatments and memory loss was particularly strong for bi-temporal electrode placements (compared to unilateral). The record shown to me states that Mr GD is receiving bi-temporal ECT (although his father tells me that one of the psychiatrists involved told him it was unilateral).

In summary, if the Tribunal were to permit further use of ECT in this case it would be condoning the exposure of a patient to significant risk of further long-lasting or permanent memory loss beyond that which the research suggests has probably already occurred. And it would be doing so in the absence of any reason to suppose that there is likely to be any benefits to the patient against which that risk could be weighed in a cost-benefit analysis.

Finally there is a small but significant mortality risk associated with every ECT administration, partly because of the usual small mortality risk associated with general anaesthesia and typically resulting from cardiac arrest or stroke (Pippard & Ellam, 1981; Read et al., 2013; Shiwach et al., 2001). The continued administration of ECT to Mr GD therefore exposes him, unnecessarily, to this small risk of death, which may increase with the number of administrations if the voltage is steadily increased to overcome the increased resistance to seizure which can occur during a course of ECTs.

CONCLUSION
If either an evidence based approach is adopted by the Tribunal, and/or what is considered usual practice is taken into account, this extremely unusual request to administer more than 40 ECTs continuously to a patient will be declined, and the wishes of the patient and his family will be respected. This might then lead to discussions regarding what alternative, evidence-based, support and treatment might be offered to Mr GD.

REFERENCES
FOSSE, R., READ, J. (2013). Electroconvulsive treatment: Hypotheses about mechanisms of action.
Frontiers in Psychiatry, 4, 94-103.
PIPPARD, J., ELLAM, L. (1981). ECT in Great Britain. London: Royal College of Psychiatrists/Gaskell.
READ, J. BENTALL, R., JOHNSTONE, L., FOSSE, R., BRACKEN, P. (2013). Electroconvulsive therapy. In J Read, J Dillon (eds.) Models of madness: Psychological, social and biological approaches to psychosis. London: Routledge, pp.90-104.
READ, J., BENTALL, R. (2010). The effectiveness of electroconvulsive therapy: A literature review. Epidemiology and Psychiatric Sciences, 19, 333-347.
SACKEIM, H., et al. (2007). The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology, 32, 244–254.
SHIWACH, R. et al. (2001). An analysis of reported deaths following electroconvulsive therapy in Texas, 1993-1998. Psychiatric Services, 52, 1095-1097.

Professor John Read

2. My formal complaint and call for an independent investigation following the Jan 12 hearing, and for MC and BM to be stood down during the investigation (Feb 2)

FORMAL COMPLAINT TO THE VICTORIA MENTAL HEALTH TRIBUNAL Re: Conduct of Mr MCl (Tribunal Chair) and Dr BM (Tribunal member) on Jan 12, 2016
Professor John Read
Feb 2, 2016
At the request of the patient’s father I attended the Mental Health Tribunal hearing on January 12, 2016 regarding the ongoing use of ECT on Mr GD. Prior to the hearing I had submitted a summary of the research on the efficacy and safety of ECT, and on the research showing that the best predictor of long-term brain damage is the actual number of ECTs given (Sackeim, 2007).

The patient was not able to exercise his legal right to attend because he was, yet again, tied to his bed. The members of the Tribunal made no effort to question the legitimacy of this, even though their own record of the meeting confirms that there had been no ‘critical incident’ prior to his being tied up, yet again (Statement of Reasons, 1.2.2016). The Tribunal is supposed to have an interest in (a) least restrictive practice and (b) the rights or patients not to be prevented from exercising their legal rights by psychiatrists with a vested interest. Failure to even question the need, or motive, for the psychiatrists’ behavior was disappointing.

The psychiatrist on the Tribunal panel went to the ward and quickly assessed that BD was, yet again, not competent to refuse consent to ECT (even though an independent psychiatrist’s report said he was fully competent), but informed us all that he had nevertheless given consent to some medication that he had previously refused. So it seems he is incompetent when he disagrees with them but competent when he agrees.

One of the treating psychiatrists, Dr SM, admitted that part of the reason that he was incompetent to withhold consent was because his memory was impaired, as a result of the ECT (acknowledged in Statement of Reasons), so they had to keep giving it to him against his will to try to get him better to the point where he might be able to consent to have more of it rather than have to have it against his will. When I tried to point out the various logical flaws in this line of reasoning the supposedly neutral psychiatrist on the Tribunal panel, Dr BM, not only failed to question the curious reasoning (as any unbiased Tribunal member would have done), she actually tried to come to Dr SM’s defence, making several points on her behalf, to try to make her sound more logical (she failed). This constitutes clear bias and suggests ignorance of, or wilful neglect of, her role as a Tribunal member.

Meanwhile the Eastern Health barrister, Mr PH, sat at the back of the room openly (ie he did not stop when I turned round and observed him) controlling the chair of the hearing panel with nods and shakes of his head – about who could speak, who should go to see Mr D on the ward, etc.. I witnessed this on two separate occasions. On one, the chair of the hearing panel paused, looked over to Mr PH, waited for his signal and then proceeded in accordance with that signal. This is clearly unethical conduct on the part of the chair, and is of particularly grave concern because the chair of this particular hearing was the Chair of the Mental Health Tribunal as a whole, Mr MC.

No member of the panel asked any questions or showed any interest in the research I had submitted demonstrating that there was no precedent or rationale for the conduct of the treating psychiatrist (Dr SM) and the Clinical Director (Dr PK), and showing that every additional administration of ECT increased the risk of permanent brain damage (memory loss) and, to a lesser extent, of death. When I tried to exercise what I experienced to be my professional/ethical responsibility to ensure the panel was aware of the risks of what they were considering, by asking to briefly summarise my research submission, the chair instructed me to be silent.

Despite pleas to stop the ECT, from the person himself, and his father, mother, and brother, and a family friend, the Tribunal granted the psychiatrists clearance to give 12 more ECTs.
The record of the meeting, the Statement of Reasons, is similarly biased. I will be happy to point out precisely how at an investigation hearing.

I respectfully submit this as a formal complaint, and one of sufficient gravity that it must be investigated independently.

I further request that pending such an investigation both Mr MC and Dr BM be immediately suspended from any duties relating to the Mental Health Tribunal.

The case of Mr GD and Drs SM and PK involves such an extreme and blatant negation of basic human rights, and the complicity in this situation of a State institution supposed to provide some minimal protection to vulnerable and distressed Victorians is so alarming, that I am making this complaint public. I do so in the hope that this might hasten some action of a humane and logical nature from someone in authority which has been sorely lacking for some time in this case.

Professor John Read

3. Email from MHT February 3

Dear Professor Read
My name is MS and I am the Tribunal’s Executive Officer.
XXXX referred your complaint to me as I generally respond to complaints and feedback received by the Tribunal. As your complaint relates to conduct of members at a hearing, I have referred the matter to the Tribunal’s acting Deputy President, TB, to investigate and respond to you.
I attach the Tribunal’s Feedback and Complaints Guide which is available on the Tribunal’s website.
Regards
MS
Mental Health Tribunal
Level 30, 570 Bourke St, Melbourne Victoria 3000 Australia
T +61 3 9032 3200 F +61 3 9032 3223 T 1800 242 703 (Toll-free)
E [email protected] W mht.vic.gov.au

4. My follow up email (Feb 16) (subsequent to the Upton House psychiatrists asking for another hearing to further extend the ECT treatments – to try to prevent MC and Dr BM sitting on this hearing)

Dear M
Thank you for informing me that my formal complaint against Mr MC and Dr BM is now under investigation.
Please assure me that during the investigation of such a serious complaint (attached again, with my original submission to the Tribunal) neither Mr MC or Dr BM will sit on any Tribunal panels.
In particular please assure me that neither will be on the panel on Feb 18th for the hearing of the same case in relation to which their alleged misconduct occurred (Mr GD).
Please also explain how it is possible for the Tribunal’s acting Deputy President, TB, to conduct an independent investigation when one of the two people accused of misconduct is effectively her boss?

Kind Regards

Professor John Read

cc Minister for Mental Health (Victoria)
Minister for Health (Victoria)
MHCC
Office of the Chief Psychiatrist
Australian Human Rights Commission
Ms Katherine Moorhouse-Perks (solicitor)

Outcome of the MH Tribunal on February 18

A request by the Eastern Health psychiatrists for permission from the Tribunal to give yet another series of 12 ECTs. Neither MC nor BM were on the panel. The MHT wrote to me, however, to explain that this had nothing to do with the ongoing investigation of my complaint but was because of rostering that had taken place months ago (although the hearing had only been scheduled the preceding week).

The MHT hearing on Feb 18 (without MC and Dr BM) ruled that Dr PK and his subordinates could NOT administer any more ECTs to GD, and even went so far as to cancel the two outstanding ECTs from the previously approved series of 12.

The reason for the reversal?

GD was now better, perhaps cured by the ECT, and did not need any more?

No.

Administering more than 50 ECTs is almost bound to cause brain damage and is potentially life-threatening?

No.

The psychiatrists and hospital management had been punitive and/or negligent?

No.

The previous panel had been biased?

No.

The reason stated is that they were “not satisfied that there is no less restrictive way for the patient to be treated.”

This needs thinking about. They did not say how, since the hearing just one month previously, ECT had suddenly become a more restrictive treatment than other treatments, or what new less restrictive treatments had suddenly become available. (I suppose it is possible that Upton House had just discovered clinical psychology, psychotherapy or peer-support groups?) So this was a straightforward repudiation of the previous panel’s decision.

The father informed me that the psychiatrists’ response to the MHT’s denying them the right to continue with the ECTs was to immediately cancel GD’s pre-arranged leave (citing concern for his mental health if not having ECT) which meant he could not attend a long-awaited photography course.

Outcome of my complaints against the MHT and its President

The investigation was indeed conducted by the Acting Deputy President of the MHT (TB), who wrote to me on February 26, concluding: “I consider there are no grounds for the members involved in the hearing on 12 January 2016 to cease performing their duties as members.” The letter made it clear that the process chosen to determine the accuracy of my allegations was nothing more or less than asking the accused whether they thought they were guilty or innocent. It turns out they were either definitely innocent or could not recall.

“All members present at the hearing [i.e. MC, BM and one other] strenuously deny your allegation that the counsel for Eastern Health controlled the presiding member by nods and shakes of his head and that the presiding member waited for counsel’s signal before acting.”

“Dr BM was not able to recall any aspect of her contribution in the hearing which could be considered as coming to the defence of the treating psychiatrist.”

It seems no other evidence was gathered. None of the following five people present at the hearing, and therefore witnesses, were contacted by the investigation: GD’s father, GD’s mother, GD’s brother, a family friend, and GD’s legal representative.

A curious form of investigation, but one that is consistent with all my interactions with all the agencies involved in this case.

To be fair to the individuals involved, I have started to wonder by now whether these failures to apply even the most basic standards of natural justice are so systemic and long-standing in the Victoria’s government agencies, that the individuals might never have seen these standards in operation and therefore simply would not know how unethical their conduct was. Alternatively, they know exactly how unethical it is and have an accurate assessment of the probability of anybody in authority caring.

Just as I was finishing this installment (on February 29th), GD’s father rung me to tell me that GD had just been tied to his bed yet again and that the psychiatrists have re-applied to the MHT for permission to restart the ECTs. Words fail me sometimes.

11 COMMENTS

  1. John,

    Thank you for the public service of exposing this outrageous situation, and showing a tragic, reprehensible example of where public officials are unable or unwilling to honor their oaths to protect the public. Unfortunately, too many immature, vindictive, uncaring people people work within power positions in the “mental health” field, and we are seeing a few of them here in your narrative.

    If I had my way in a case like this, I would break through the hospital walls with an Abrams tank in a scene straight out of an Arnold Schwarzenegger Terminator movie, free the “patient” from their restraints, and take him to a quiet healing place where these creeps could never get their hands on him again. Unfortunately, in real life we can’t do that so it falls to the public and people like yourself to speak up against these atrocities… and hopefully, to lawyers knowledgeable about mental health law (of whom we are greatly in need of more) to bring lawsuits against the psychiatrists and officials involved. This case certainly seems to me to be one where monetary and criminal damages should be sought against the psychiatrists.

    I encourage you to refer the family to legal services if you have not already. I hope I will be seeing these psychiatrists’ name as people who’ve been fined for malpractice, and ideally as practitioners who are disbarred and thrown in the Big House.

  2. “To be fair to the individuals involved, I have started to wonder by now whether these failures to apply even the most basic standards of natural justice are so systemic and long-standing in the Victoria’s government agencies, that the individuals might never have seen these standards in operation and therefore simply would not know how unethical their conduct was. Alternatively, they know exactly how unethical it is and have an accurate assessment of the probability of anybody in authority caring.”

    Yep.

    From IMHO the MHT in Canberra is the same. I have called it a “kangaroo court” before now, although I didn’t experience the same degree of torture as poor GD.

    Words fail me also, but I am not surprised, as psychiatrists here in Australia ARE God. Totally untouchable through tribunals and medical boards regardless of what they may do. In fact, totally supported by tribunals and medical boards to do whatever they like to their patients,once they have declared them “dangerous”. In Canberra, even the Human Rights Commission and its legislation, the ACT Human Rights Act, supports them.

    There need be NO proof of dangerousness, and the victim may have evidence to support their case, but it will not be admitted, and they will not be allowed to see the evidence against them….standard procedure, it would seem.

    Keep up the fight.

  3. I wonder what would happen if this was a court of law dealing with a political prisoner? Surely Amnesty International would be up in arms about both the treatment of person detained, strapped down and forced to endure ECT but also about the lack of a fair process in the tribunal.

  4. The psychiatric industry is an iatrogenic illness creation system, filled with psychiatrists that don’t want to confess their drugs create their DSM illnesses, and the governments are giving these psychiatrists free reign to murder whomever they want, for any reason. GD was misdiagnosed, initially, according to the DSM. And these psychiatrists want to murder him to cover up their malpractice.

    It was confessed to me by an ethical pastor that “the dirty little secret of the two original educated professions” is that psychiatry’s historic function is to cover up medical malpractice for the incompetent doctors and child abuse for the religions. And your research, John, does indicate these are still the primary functions of the psychiatric industry. Is such an industry actually beneficial to the majority of humanity? No.

  5. “Formal Investigation” – the gathering of information with the sole aim of ‘white anting’ the legal narrative, and ensuring that no action can be taken.

    When I made an allegation that my detention was unlawful and that criminal offenses had been committed, I was treated to one of these “formal investigations”. A two paragraph letter arrived stating that the Community Nurse had a job to do. I assume they didn’t investigate far enough to find out whether he had actually done that job, or committed the offenses I had alleged.
    An FOI application revealed that this two paragraph letter was the only document available from this “formal investigation” which seemed strange to me, given the seriousness of the alleged crimes.

    Oh, one other outcome from this “formal investigation”. If you remove the documents demonstrating the offense of Intoxication by Deception, and then send a set of fraudulent documents to the victims lawyers, they look like a paranoid delusional.

    And the community trusts these people with the health of their loved ones?

    • In addition to a post I made in the last article regarding the failure to perform a Duty as a Public Officer being a criminal offense, consider this section of the Public Sector Management Act.

      http://www.austlii.edu.au/au/legis/wa/consol_act/psma1994235/s7.html

      It is difficult to reconcile this standard with what is actually observed when attempting to have complaints investigated with something that resembles due diligence. This lawlessness will have effects on our communities.

      • “action taken, without excessive formality and with a minimum of delay” PSMA

        Letter from the Chief Psychiatrist. Apologies for the 14 month delay but the manager of the hospital was away over the Christmas period. lol I did suggest that our State logo was changed to have the motto “Sorry for the delay”. Think of the savings which could be made if Public Servants were not required to type this at the start of every letter to the public, and it was part of the letterhead?

  6. “The more often he feels without acting, the less he will be able ever to act, and, in the long run, the less he will be able to feel.”
    ― C.S. Lewis, The Screwtape Letters
    This I refer to all involved, the 3 doctors, the officials, the `guardians of public decency’ and I include the nurses and other doctors. I once saw a case where a young woman was treated almost to death by a very aggressive, cold doctor who believed his ideas were more important than her life. She survived because the nursing staff refused to continue. They, too, have an ethics code of practice and they exercised it. They did not lose their jobs, the girl survived and the doctor? Well, he got promoted. Away from direct patient care admittedly but nothing that could impact on his CV. Do they really think we don’t notice? This should be and will be forwarded to every politician in the land. Here in Australia we are heading up to an election. Start writing, people.

  7. “Just as I was finishing this installment (on February 29th), GD’s father rung me to tell me that GD had just been tied to his bed yet again and that the psychiatrists have re-applied to the MHT for permission to restart the ECTs. Words fail me sometimes.”

    I do feel your utter frustration. I went through a variety of grievance processes as I traversed the system on my own, self-advocating while getting back on my feet from disability, and it was nothing short of maddening. I had to consider on a daily basis standing up for my rights vs. healing, because it so often seemed felt defending my rights as a citizen within the overly controlling system would drive me back over the edge–all power struggle and no reasonability or even the slightest hint of humanity. It was like the movie, Brazil, total bureaucratic nuttiness.

    In the end, however, staring down the abuse with my own truth, regardless of the constant enabling cover-ups and stigma/insults that came flying at me–systemic oppression and discrimination, of course–is what did lead to good healing, because I took back my power. That freed up and cleared my mind considerably.

    Great luck on getting through.

  8. I threatened to kill them if they went near my loved one with ECT- stating that if they did it- they might kill them- and that the only way to fight that- fairly- was with the same threat- mind you i would never do that- just felt so despaired- that was my only chance-so- they just doubled- then tripled the poison- 117 days of full on poison abuse- and trauma- when an average stay is 40 days at the most- couldn’t and would never ever go to a kangaroo court tribunal again-unless you just want to get extremely upset- cause that’s all they ever do to anyone- reallly- really- depress them- its like going to be assaulted- for being assaulted- i would advise no one to ever go to a tribunal- their a real health hazard- similar to asking a government run bin for a second opinion- people just don’t realise- they all work together- for the same boss- who gives them permission to abuse people free will- as if they’re going to go against their bosses- and their work buddies- themselves basically- anyway there ya go- they killed me and my loved one off- and now were too scared to do anything- complain- nothing.- just to live oppressed and drugged- and try to handle it. I have to shut up or they get them- they have to shut up -or they get them.