CRISIS CONTACTS

Who should I call first?

In a crisis you should seek help, especially if you feel concerned about your safety or the safety of your client, staff member or family member. The service you call first will depend on the type of crisis or emergency situation and when it occurs.

• If there is an immediate threat to you or someone else: contact the Police directly (it is appropriate to use the emergency number "000"). The Mental Health Service can attend in these situations, but if there is a high risk of violence they are required to work with the Police.
• If there is an immediate risk to the physical health of your family member or another person: If emergency medical attention is required contact the ambulance service. This may include situations where the person has caused severe physical harm to themselves (e.g. overdose). It is appropriate to use the emergency number "000".
• During regular business hours: Call 1800 011 511 for a direct link to your local Community Mental Health Centre and ask for the acute care or crisis team. If the person has a case manager or care coordinator they would be the most appropriate person to speak to, if available.
• After hours and weekends - Community Acute Care Teams: The After Hours Triage Service and Community Acute Care Teams 1800 011 511 are available to respond to mental health crisis and emergency situations. If you are unsure about whether it is a crisis situation you can call the service to discuss over the phone and they will assist you. This may include talking to the mentally person over the phone, visiting them at home or asking them to come to a Hospital Emergency Department or to a mental health facility for a more thorough assessment of their current situation.

Reporting criminal or violent behaviours

What to do when a mentally ill client threatens violence - ethical considerations (Summary of seminar by Steve Mark, Commissioner, and Tahlia Gordon, Research and Projects Manager, Legal Services Commission October 2012)

Ethical behaviour

Ethics are not rules. Rules do not have values and cannot be ethical or unethical. The way you apply rules is based on your values. It is something you can feel and have a gut instinct about. For example you might have a feeling that a matter involves a conflict of interest. If you have that feeling you may well have an ethical dilemma.

Ethical behaviour does not flow from the rules of professional conduct but from the values held by the practitioner. The rules of professional conduct are not ethical rules or principles, they are only a baseline of conduct and should not prevent lawyers from acting as they would ordinarily. conduct rules, by their very nature are only a framework of codified statements that describe appropriate "ethical behaviour ". As The Hon Sir Gerard Brennan AC KBE has stated:

"The first, and perhaps the most important thing to be said about ethics is that they cannot be reduced to rules. Ethics are not what the barrister knows what he or she should do; ethics are what the barrister does. They are not so much learnt as lived. Ethics are the hallmark of a profession, imposing obligations more exacting than any imposed by law and incapable of adequate enforcement by legal process. If ethics were reduced merely to rules a spiritless compliance would soon be replaced by skilful evasion. There is no really effective forum for their enforcement save individual acceptance and peer expectation. However, among those who see themselves as members of a profession, peer expectation is sufficient to maintain the profession's ethical code. Ethics give practical expression to the purpose for which a profession exists, so a member who repudiates the ethical code in effect repudiates membership of the profession.^"1

Good ethical practice involves a legal practitioner considering the impact of their actions on justice, the integrity of the legal system and the impact of their decision on the preservation of relationships. For Professor Gerald Postema, Professor of Law and Professor of Philosophy at the University of North Carolina, this means treating clients not as objects but as humans and applying our wisdom based on our world experience and knowledge.² According to Professor Postema, we are not only authorised to raise moral issues with our clients but we have a professional responsibility to do so. Postema states:

"The good lawyer is one who is capable of drawing a tight circle around himself and his client, allowing no other considerations to interfere with his zealous and scrupulously loyal pursuit of the client's objectives. The good lawyer leaves behind his own family, religious, political and moral concerns, and devotes himself entirely to the client...

Cut off from sound moral judgment, the lawyer's ability to do his job well - to determine the applicable law and effectively advise his clients is likely to be seriously affected. The lawyer who must detach professional judgment from his own moral judgment is deprived of the resources from which arguments regarding his legal rights and duties can be fashioned. In effect, the ideal of neutrality and detachment wars against its companion ideal of zealous pursuit of the client's interests.^"3

Legal practitioners should therefore engage in far more moral counselling with their clients and be responsible for the consequences of their actions. According to Professor David Luban, Professor of Law and Philosophy at Georgetown University this means:

"..discussing with the client the rightness or wrongness of her projects, and the possible impact of those projects 'on the people', in the same matter-of-fact and (one hopes) un-moralistic manner that one discusses the financial aspects of a representation. It may involve considerable negotiation about what will and won't be done in the course of a representation; it may eventuate in a lawyer's accepting a case only on condition that it takes a certain shape, or threatening to withdraw from a case if a client insists on pursuing a project that the lawyer finds unworthy. Crucially, moral activism envisages the possibility that it is the lawyer rather than the client who will eventually modify her moral stance..."

Good ethical practice does not just involve lawyers being aware of and deferring to the practice rules. Good ethical practice comes from morally reflective decision-making, that is, a consideration of both professional and ordinary morals.

An ethical dilemma is not something that requires you to choose between right and wrong. Rather it is a choice between two positions both of which may be right. You find the answer in your values. The decision involves an interface between three concepts.

1. Your morality
2. Your role morality, as a lawyer
3. Your values

Your ethical dilemma may be a clash between your role morality and your values. You may choose to activate or suppress your values to fit the situation to your role as lawyer.

Ethical Questions
1. What can I do?
2. What should I do?
3. What would I do?

What can I do? Rules and Procedures
Your organisation will have many rules and procedures governing many aspects of your work. However the action you take when presented with a challenging situation will still depend on three things.

1. The culture of the organisation
2. Your relationship with other staff
3. Your values

By law you are not required to report a threat by a client to others. Section 316 Crimes Act 1900 requires that you must report, after the fact, unless there is a lawful excuse. There will almost always be a lawful excuse if you are the person's lawyer. There may be an exception to this in new legislation (not yet active) that requires you to know your client and to report suspicious transaction over $10,000.

Generally the decision on whether to report or not is an ethical decision rather than a legal requirement.

What should I do?
The most important thing to do is to share the problem. Run it past someone. Raise the issue. For your own mental health and wellbeing do not let it fester. Generally what you will be talking about are ethics rather than the legal requirements or the Legal Aid Guidelines.

Practical tips for dealing with clients who may be psychotic or delusional:
If you believe there is a chance a client will hurt themselves or someone else, you can call the police or the Mental Health Team (see Crisis Contacts). You can also call the police if the client is 'perfectly sane' and exhibiting unacceptable behaviour, e.g. if they drop their pants in the reception area.

Remember arguing with a mentally ill person about their beliefs will not change their belief or delusion. You should however let them know the limits of what you can do. You could say that you need more evidence. That the court will require material or concrete evidence; their word alone will not be enough. Without the evidence you can't take the case. You could suggest, if they are anxious, that they might need a doctor for the anxiety rather than a lawyer.

Taking into account other staff members concerns
Part of your decision about what to do in the circumstances will take into account other staff members concerns. Staff need to be able to raise safety issues but how you deal with them may differ.

There is no right answer
You need to deal with the matter directly and with kindness and humanity.

If in doubt contact the following organisations for advice:

• Legal Services Commissioner
• Law Society of NSW
• NSW Bar Association

 

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¹ "Ethics and the Advocate", Bar Association of Queensland, Continuing Legal Education Lectures, 3 May 1992, available at
http://www.nswbar.asn.au/docs/professional/pcd/brenan.pdf

²Gerald Postema, Moral Responsibility in Professional Ethics, 55 N.Y.U.L.Rev.63 (1980), 68.
³ at 78-79
⁴ D.Luban, LAWYERS AND JUSTICE: AN ETHICAL STUDY, Princeton University Press, Princeton, 1988 at 173-4.

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Emergency Contacts by Health Area 24 hours - 7 days	Crisis Mental Health Teams You should contact a mental health crisis team when a client presents as severely mentally ill. Your client may not realise they are in crisis and may be hallucinating, appear delusional, be contemplating suicide, be a risk to themselves. In these circumstances they may need to be placed in care (hospital) for their own protection under the Mental Health Act. You can consult with a mental health professional by calling the emergency contact in your area.
Phone: 13 11 14 24 hours - 7 days	Crisis Telephone Counselling Lifeline - www.lifeline.org.au Lifeline provides telephone counselling 24 hours a day for the cost of a local phone call. You should give this phone number to your client if they present as depressed, distressed or indicate to you they have little or no social support network.
Sydney Metro Phone: (02) 8736 3292 Regional NSW and ACT- Phone: 1300 36 36 22 24 hours - 7 days	Salvo Care Line - www.salvos.org.au The Salvo Care Line provides a 24 hours telephone counselling service staffed by trained volunteer counsellors. If your client is in crisis, experiencing feelings of depression, isolation or loneliness they can contact the Salvo Care Line for support.
Phone: 1800 55 1800 24 hours - 7 days	Kids Helpline - www.kidshelp.com.au Kids Helpline is a free telephone counselling service for children and teenagers. You should give this number to a child or teenager if they appear troubled or indicate to you they would like someone outside the family to talk to. This number could also be given to parents to pass on to their children.
Phone: 1300 78 99 78 24 hours - 7 days	Mensline - www.menslineaus.org.au The Mensline is a free 24 hour telephone counselling service staffed by professional counsellors. You should give this number to men who are experiencing family and relationships concerns and need support.
Phone: 1800 633 635 24 hours - 7 days	G-Line NSW - http://www.olgr.nsw.gov.au/gaming_rgf_g-line.asp The G-line provides a 24 hour telephone counselling service staffed by professional counsellors for problem gamblers. You should give this number to anyone who wants to talk about their own or someone else’s problem gambling.
Phone: 1800 234 566 7 days - 9am to 10pm (closed 1pm to 2pm)	Homeless Persons Information Service - www.cityofsydney.nsw.gov.au The Homeless Persons Information Centre is a telephone information and referral service for people who are homeless or at risk of homelessness. It provides referrals to accommodation and support services in NSW.
Phone: 1800 65 64 63 24 hours - 7 days	Domestic Violence Line - www.community.nsw.gov.au The Domestic Violence line is a 24 hours referral and information service for people who are experiencing domestic violence. You should give this number to anyone who is experiencing domestic violence and wanting to arrange crisis accommodation or referrals to services that support people experiencing domestic violence.
Phone: 9361 8000 or 1800 422 599 24 hours - 7 days	Alcohol and Drug Information Service - http://exwwwsvh.stvincents.com.au A confidential telephone information, advice and counselling service for people with problems related to drugs and alcohol. Keeps a complete database of treatment agencies in NSW. Located at St Vincent’s Hospital, Victoria Street, Darlinghurst.
Phone: 131 450 24 hours - 7 days	Translating & Interpreting Service (TIS) - www.immi.gov.au Call 131 450 to be connected with TIS Contact Centre staff who can arrange a telephone interpreter in over 120 languages. This service is free to NGO health and welfare organisations, GPs and government agencies.