Mental health act

Question 1

What is an emergency examination order?

Answer 1

• Made under Public Health Act (2005), therefore patient is not involuntary under Mental Health Act (2016) but can be detained involuntarily in an authorised mental health facility for up to 6 hours while assessment is carried out
• Often made by police or ambulance officer under the conditions that:
  
  • Person’s behaviour indicates immediate risk of serious harm (eg. Commiting suicide)
  • Risk is result of major disturbance, either mental illness, disability, intoxication or other
  • Person seems to require urgent examination and treatment

▪ This leads into a Involuntary examination (6-12 hours)

Question 2

What is a request and recommendation?

Answer 2

Recommendation for assessment (R&R):

• These 2 forms MUST be completed before someone can be assessed involuntarily, although someone can be held for up to 1 hour while they are being completed
• Who completes them?
  
  • Request for assessment can be made by any adult who has seen patient in last 3 days and believes they have a mental illness requiring involuntary assessment
  • Recommendation for assessment can be made by an authorised mental health practitioner (Dr, RN, OT, SW or psychologist) who has examined the patient in the last 3 days. This is valid for up to 7 days
• Once completed, these authorise assessment only, not treatment
• After the assessment period of 24 hours or up to a maximum of 72 hours (if authorised doctor makes application for this which is approved), 1 of 2 things occurs:
  
  • Patient gets placed under ITO (TA) for management
  • Patient’s involuntary assessment status is removed and they can either leave or stay as a voluntary patient
• If these forms cannot be completed, 2 options are available:
  
  • EEO/EEA
  • JEO/EA

Question 3

What is an involuntary treatment order?

Answer 3

• Now called treatment authority
• Treatment authority may be made if:
  
  • Treatment criteria for the person is met:
    
    • Person has a mental illness
    • Person does not have capacity to consent to treatment
    • Absence of TA would likely result in harm to patient and/or other people or significant deterioration in patients mental or physical health
  • There is no less restrictive way for the person to receive treatment
• Overall, TAs authorise involuntary care of a patient and if necessary, detention in an authorised mental health facility

Question 4

What is a justice examination order?

Answer 4

• Now called Examination Authority (EA)
• Made by mental health review tribunal (MHRT), magistrate or JP (in response to a member of the community making an application)
• Authorises doctor or mental health practitioner to enter premises without permission to involuntarily examine a person to decide if recommendation for assessment should be made, valid for up to 7 days

Question 5

Describe the criteria for the mental health act?

Answer 5

INCLUSION CRITERIA
▪ A condition characterised by clinically significant disturbances of thought, mood, perception or memory
▪ The decision that a person has a mental illness must be made in accordance
with internationally accepted medical standards

THE PATIENT FULFILS ALL OF THE FOLLOWING:
▪ Person has a mental illness
▪ Person does not have capacity to consent to be treated
▪ Because of the person’s illness, the absence of involuntary treatment, or absence
of continued involuntary treatment, is likely to result in:

• Imminent serious harm to the person or others, or
• The person suffering serious mental or physical deterioration

THERE ARE NO LESS RESTRICTIVE WAYS (OTHER THAN MHA) TO TREAT THE PERSON:
▪ Patient agreeing to treatment
▪ Minor (parents’ consent)
▪ Advance Health Directive
▪ Guardianship (guardian to consent)
▪ Appointed attorney
▪ Statutory health attorney (spouse, partner, NOK)

EXCLUSION CRITERIA
▪ Sexual preferences / orientation
▪ Drugs + alcohol
▪ Intellectual disability
▪ Antisocial behaviour or illegal behaviour
▪ Immoral / indecent conduct
▪ Family conflict
▪ Any particular religious, cultural, philosophical or political belief

Question 6

What is a judicial order (court order)?

Answer 6

Judicial Order:

• Court examination order: made by mental health court, requires a person to be involuntarily examined to prepare a report for the court
• Examination order: made by magistrate, requires person to be involuntarily examined to decide persons treatment

Question 7

What is the mental health tribunal? How often are reviews initiated? What decisions are made on review?

Answer 7

What is it?

• Independent statutory body established under the Mental Health Act
• Purpose is to review involuntary status of patients with mental illnesses
• Consists of president and other members including lawyers, psychiatrists and other people with relevant qualifications

Initiation of reviews:

• Within 28 days after authority is made
• Within 6 months after the initial review and then within 6 months after the second review
• Within periods of no more than 12 months thereafter

Decisions made on review:

• Review of treatment authority. Must be revoked if:
  
  • Treatment criteria are deemed to no longer apply
  • Less restrictive way of treatment is possible
• Review of forensic orders
• General:
  
  • Support systems in place
  • Current treatment

Question 8

What is the difference between a forensic order and treatment support order?

Answer 8

Forensic Order:

• Mental health: made by mental health court to allow involuntary treatment of a person with mental health condition
• Disability: made by mental health court to allow involuntary treatment of a person with intellectual disability
• Criminal code: made by district or supreme court to allow involuntary treatment of a person who has breached the criminal code

Treatment Support Order:

• Made by mental health court to protect community where forensic order is not warranted
• Different to forensic order in 2 ways:
  
  • Way in which community treatment is authorised
  • Nature of clinical oversight