Mental Health Act 2016 Flashcards
Treatment criteria
- Person has a mental illness
- Does not have capacity to consent
- Harm to self/others - mental/physical deterioration if treatment not provided
Capacity to consent
Understands in general terms
- Have /symptoms of mental illness and the impact of mental illness on health/wellbeing
- Nature/purpose of treatment
- Benefits/risks of treatment and alternatives
- Consequences of not receiving treatment
Can a treatment authority/recommendation for assessment be made if doctor/aithorised beleives person has capacity
No
What is supported decision making
If a person is able to understand matters related to illness with assistance of another person->then has caoacity to make decisions regarding own treatment and care
Less restrictive ways (5)
- Minor-Parents
- AHD
- Personal guardian
4, Attorney appotinted/EPOA
- Person’s statutory health attorney
Main reasons when not a less restrictive way
- AHD does nor cover matters clinically relevant/appropriate
- AHD does not authorise administration of medications clinically necessary
- Attorney does not consent to administration of medications clinically necessary
Can an attorney consent to ECT
No
If attorney + AHD directions, which decision comes first
AHD
Types of attorneys
Appointed under AHD or EPOA
Statutory health Attorney
Statutory health attorney in order
- Spouse
- An adult carer (not paid)
- Adult who is close friend, not a paid carer
Overview for process from examination to recommendation to treatment
Doctor/authorised may examine person at any clinically appropriate location->make recomendation for assessent if:
treatment criteria may apply
appears to be no less restrictive way
What is examination authority
Doctor/authorised enter someone’s home and detain for examination, may be accompanied by police
Who can apply for EA
Administrator of AMHS, personal with authority from admnistrator, concerned person (after advice on clinical matters about behaviour that have raised concerns)
application made to the MHRT and an EA is is issued
Criteria for an EA
- Person has/may have mental illness
- Does not have capacity
- Reasonable attempts have been made to encourage voluntary examination or not practicable to do so
- there is/may be imminent risk to person/others due to mental illness, physical or mental deterioration
What are the clinical matters when considering a ‘concerned person’ applying to the MHRT
- general information about the treatment criteria, their application to the person, and whether there is a less restrictive way for the person to receive treatment and care for the person’s mental illness
- whether the behaviour of the person, or other relevant factors, could reasonably be considered to satisfy the requirements for making an examination authority for the person
- options for the treatment and care of the person, and
- how the person might be encouraged to seek voluntary treatment and care.
Powers of the EA
- Dpctor/authorised enter place eg home without consent
- Force to enter may be used but opportunit to alow entry without force
- May be detained for period of time
- May transport to AMHS, public health sector health facility to be detaines
- May ask police officer to assist
If in AMHS/public health facility->6 hours, may extend to 12
If in home/other place->1 hour
What is EEA
Ambulance/police may detain/transport to facility for examination->under public health act
Doctor/authorised must examine person if appears they may have mental illness
Outcome may be recommendation for assessment
Detained for up to 6 hours, may extend further 6 hours
What is examination order
Magistrate makes order->person before the court requires person to be involuntarily examined by authorised doctor to determine treatment/care needs
-may direct authorised person to transport immediately to authorised mental health facility or direct person to attend AMHS/public sector within an alloted time not more than 28 days
What does an examination order allow an authorised doctor to do
Make a treatment authority
Make a recoendation for person’s voluntary treatment and care
Person already subject to authority/order, change the nature of treatment and care provided to person under the authority/order
Examination order report
details of examination
recommendations/decision made
if recommendation for voluntary treatment, details of explanation given to the person of benefits of being treated voluntarily
Recommendation for assessment purpose, detained for, how long in force, when revoked
To decide if treatment authority to be made->done by authorised doctor
Detained for 1 hour while RA made
In force for 7 days
Revoked if person who made RA not longer satisfied treatment criteria exists or there is a less restrictive way
What is a treatment authority
Possible outcome of assessment undertaken after RA made
Authorises treatment and care if person for mental illness without consent
When can a TA be made
Only after an assessment has been done post RA or examination done under EO
Done by authorised doctor->cannot be the same person who made the recommendation for assessment
When must an assessment be made in relation to time of RA, assessment period
Within 7 days, at a clinically appropriate location, assessment period 24 hours, may be extended to 72 hours
when might an authorised doctor may a TA
Treatment criteria apply, and no less restrictive wat to receive treatment
Treatment authority categories
- Community->treatment within community, must be placed on this unless treatment/care cannot be met
- Inpatient->must decide whether to authrosie Limited Community Treatment
- purpose to support patient’ recovery by transitioning to living in the community, not more than 7 days, may include leave in grounds, escorted leace, overnight leave - Treatment in community
Authorised doctor eeds to decide treatment and care in community ->community and LCT, persons obligations
What needs to happen if TA not authorised by psychiatrist
This review occurs within 3 days->decision made to confirm the treatment authority, amend or revoke
If remote/rural- have 7 days
When can an authorised doctor reduce level of treatment in community contrary to MHRT decision that it cannot be reduced
- Patient is on community category
- Authrorised doctor beleives there has been a material change in person’s mental state and patinet requires urgent treatment and care as inpatient->this decision is then reviewed by the tribunal
When does the first assessment need to be made for person on treatment authority
First regular assessment within 3 months of TA, subsequently 3 months after
Outcomes of regular assessment while on TA
- Amend- change category, change/revoke/authorise LCT, improse/change condition of authority
- Revoke- if treatment criteria no longerapply or less restrictive way, however not required if persons capacity not stable->must consult with authorised psychiatrist
Types of forensic orders
Forensic order
- mental health->by MH court, to provide involuntary treatment and care and if necessary detendtion in AMHS
- disability->court, involuntary treatment with an intellectual disability
- criminal code->supreme or district court, admitted in MHS, involuntary carem review by MHRT to determine if other category of FO more appropriate
Two categories of FO
- Inpatient
- must decide also community LCT and community
- to have/not LCT
- court may decide future community category/extent of treatment and conditions - Community
- may order that authorised doctor not change category to inpatient
- authorised may change nature/extent subject to conditions decided by the court
This is reviewed by MHRT
Roles and responsibilities of MHRT for FO
- General may be
- may not contact victim
- tracking - Recommendations
- intervention
- anger management
- counselling etc - Non-revocation period
- up to 10 years
- for prescribed offence->murder/attempted, manslaughter, GBH, rape/attemtped
Roles/responsibilities for AD for TO
- Level of community
- mental state/psych history
- intellectual disability
- social
- response to treatment/willingess
- response to any treatment in community
- nature of crime/act, time passes and purpose of LCT
Who are classified patients
persons in custody who need to be transferred to an AMHS for treatment and care
When can a person become a classified patient
transported to AMHS + subject to RA and both administrator and custodian consent, or on TA/FO (mental health) or TSO a transfer recommendation has been made and both admin/custodian agree, or person consent s+ 2 agree + transfer recommendations (classified patient voluntary)
What is a transfer recommendatin
Doctor/authrodies MH provides for person to be transported to AMHS to receive treatment for mental illness
continue to be a classified patient
On order or authority, or consents to treatment in AMHS and
clinically appropriate for person to receive treatment and care in AMHS, and person would be in lawful custody under another law id not a classified patient
when returning to custody, when must the authorised doctor notify the psychiarist
- withdraws consent
- assessment period ends, TA not made and not classified (voluntary)
- person no longer subject to authority/order and person does not become a classified patient (voluntary)
Patient rights to information
recommendation for assessment, TA made, regular assessment, TO/TA amended, when someone on TA/TO goes into the comunity for treatment
when explaining information- must ensure understanding, disucss in appropriate way, explain in a way most likely to understand
Patient rights as an inpatient
- be visited by support persons at any reasonable time of day or night (except where an administrator excludes a person from visiting because it would adversely affect the patient’s treatment and care)
- be visited and examined by a health practitioner at any reasonable time of the day or night under arrangements with the administrator
- be visited by legal or other advisers at any reasonable time of the day or night under arrangements with the administrator
- communicate with other persons by post, telephone or electronic communication device, unless the other person asks the communication not take place or if it is prohibited under the Act, for example, under a non-contact condition of a forensic order.
If a person appoints support person, and then has not capacity, what are the roles of support person
·1. must receive the notices under the Act that the person is entitled to receive
- may discuss confidential information relating to the person with the treating team
- may request a psychiatrist report for the person, and
- may act as a support person or represent the person at Tribunal hearings.
Exceptions to information being provided to support person
- the patient requests, when the patient has capacity, that the communication not take place
- the person is not readily available or willing for the communication to take place (for example, the person is not willing to visit the patient or cannot be contacted by phone), or
- the communication with the person is likely to be detrimental to the patient’s health and wellbeing (for example, the person has previously disrupted the patient’s treatment and care, resulting in the patient’s condition deteriorating)
What does the MHRT review
TA, FO, TSO
Fitness for trial of particular persons
Detention of minors in high security units
Tribunal hears applications for
Examination authorities
To perform regulated treatments 9ECTm non ablative neurosurg procedues)
Approval to transfer FO patient into/out of QLD
Approve transfer TSO out of QLD
Appeals heard by MHRT
against decision of chief psychiatrist in relation to info not8ices for vicims, and decision by admin to refuse to allow peron to visit patient
Review of TA by tribunal
at set times, as set out in the Act (periodic reviews) • on application – the application may be made by the relevant person, someone on the person’s behalf or the Chief Psychiatrist • on the initiation of the Tribunal • when the Tribunal receives written notice that the community category has been amended to an inpatient category contrary to a Tribunal decision (a review is not required if the Tribunal receives notice prior to the review that the category has been changed back).
When does a periodic review of TA occur
within 28 days after the authority is made • within 6 months after the initial review and 6 months thereafter, and • at subsequent intervals of not more than 12 months
When are FO, TSO reviewed by tribunal
periodically every 6 months
WHen is an application made to tribunal for ect and when can EcT be performed in AMHS
when adult and unable to provide consent
when a minor
performed when:
patient consenting adults
patient unable to consent and approval by tribunal given
patient a minor and tribunal approved treatment
when may emergency ECT be done
Electroconvulsive therapy may be performed on the following patients in emergency circumstances:
- an involuntary patient subject to a treatment authority, forensic order or treatment support order, or
- a person who is absent without permission from another State and is detained in an AMHS
A doctor may perform electroconvulsive therapy on one of these patients in an AMHS if:
- the doctor and the senior medical administrator of the service have certified in writing that the performance of the therapy is necessary to save the patient’s life or prevent the patient from suffering irreparable harm, and
- an application has been made to the Tribunal to perform electroconvulsive therapy on the person. The application to the Tribunal may have been made prior to the certificate being made or when the certificate is made
