The Medico-Legal Society of Victoria

Air Chief Marshal Sir Angus Houston AK, AFC (Ret'd) was awarded the Knight of the Order of Australia in January 2015 for extraordinary and pre-eminent achievement and merit in service to Australia, through distinguished service in the Australian Defence Force, continued commitment to serve the nation in leadership roles, particularly the national responses to the MH370 and MH17 disasters, and in a variety of roles in the community.

25 years ago Victoria led Australia, and arguably the world, as the 19th century asylums were swept away in the final phase of deinstitutionalisation. The land was sold and realised huge sums of money for government. We drastically reduced inpatient beds with were relocated to general hospitals, though typically squeezed into poorly designed and confined spaces. Victorians were promised this would work, provided we built strong community mental health services to allow us to cope with the loss of beds. There was initially great energy and innovation, with early intervention, dynamic and intensive home-based care and case management teams springing up. 20 years ago Victoria had the highest per capita spend of all States on mental health care, and was seen as the “jewel in the crown” of Australian and even global mental health care. Tragically over the past two decades, Victorians have seen this brave new world crumble and descend into an appalling crisis. I have characterised this decline as “Victoria’s Mental Breakdown”. The causes are clear. Firstly, the design of the new system was flawed with the governance and financing of the new system sitting unprotected within the major acute hospital networks, and the community mental health system, in which 95% of patients sit at any given moment, progressively neglected. Secondly, as stigma faded and the population surged dramatically, investment collapsed, and Victoria sank to the lowest level among the States. 3% of Victorians experience serious mental illness, which is the responsibility of State governments, yet only 1.1% are covered by current levels of expenditure. Hence, every day 2 out of 3 seriously ill Victorians are turned away from public mental health services. There is a rising tide, especially of young people, desperately seeking help in our emergency departments, widely acknowledged to be highly unsuitable venues for the care of distressed and suicidal people. Over 600 Victorians die annually from suicide. They don’t have terminal illnesses and their deaths are all therefore preventable. This collapse of public mental health care represents a “death of a thousand cuts”, and has happened in every jurisdiction where this careless and complacent approach to deinstitutionalisation has occurred. However, Victoria’s decline, her mental breakdown, is among the most spectacular and disappointing given such early promise. We cannot just blame governments, it is a collective failure of leadership and of our society that despite the dramatic rise of awareness and the decline of stigma, we have failed the severely mentally ill, and especially our young people in whom mental illnesses generally appear for the first time.

Dr Rebecca Kogios, will discuss the use of DNA in criminal investigations including identifying persons of interest through DNA profiles uploaded to internet genealogy websites and databases as occurred recently in California with the identification of the Golden State Killer. Australian Forensic DNA capabilities have evolved significantly over the past 2 decades; since the introduction of the National Criminal Investigation DNA Database (NCIDD system) in 2001 we’ve seen an exponential growth in the ability and swiftness of law enforcement to identify offenders. This has been accompanied by extensive ethical dialogue about how these capabilities can be applied to the benefit of community safety whilst also maintaining appropriate checks and balances on privacy. Those debates continue to occur today, as we further expand forensic DNA capabilities through exciting developments such as kinship matching, familial searching and massive parallel sequencing. This speech will provide an overview of current state and next generation developments in the world of forensic DNA and explore the complex debates that surround how we apply new capabilities.

Personal genomic testing or online DNA testing has challenged the traditional model of clinical genetic testing. This type of testing is advertised directly to the consumer and is marketed globally for a range of health and recreational (predominantly ancestry) purposes, posing a number of ethical concerns. While research has focused on its use by early adopters, mostly in the USA, little is known about Australians’ expectations and use of this type of testing. The Genioz study (Genomics: National Insights of Australians) was funded through the Australian Research Council, and collected Australians’ perspectives on personal genomic testing. This presentation will give an overview of the findings. Outcomes from this study are informing educational strategies and policies in Australia to support potential consumers, and healthcare professionals, to understand and make meaningful and well-considered decisions about the benefits, harms, and implications of personal genomic tests.

Ann Thomas is the Managing Partner at International Family Lawyers Group LLP). Ann is a Lawyer who specialises in International Child Relocation. She is recognised as a leading International Children’s Lawyer and is head of the International Family Law Group’s international children’s team. Ann has been involved in a number of International high profile and reported Cases and is often asked by the Media to comment on topical issues in Family Law. Ann (with her fellow partner and co-founder of the firm David Hodson) have also written on recent developments in family law and have presented seminars on the international aspects in the United Kingdom, Europe, Australia and elsewhere. This particular topic will cover lessons which can be learnt for all us in the Legal and/or Medical profession when dealing with very high-profile cases unexpectedly. She will also cover the developments of global co-operation. By way of background, Ann is also a classical trained singer (Royal College of Music) and had a career in Teaching before qualifying as a solicitor. Outside work she teaches CPR and undertakes voluntary work at The Phylis Tuckwell Hospice and at St Luke’s Cancer Centre (Royal Surrey Hospital). We welcome Ann and David to Melbourne from London. Chatham House rules will apply to this meeting