7. Statutory Roles

The following sections provide information about the activity reported to the Chief Civil and Chief Forensic Psychiatrist as required under the Mental Health Act 2013.


Chief Civil Psychiatrist

The data provided to the Chief Civil Psychiatrist regarding the detention and treatment of patients who are mentally ill and lacking decision making capacity, reflects the Act’s operation for the past twelve month period and indicates compliance with the fundamental provisions of the Act.

i) Assessment Orders

Applications for Assessment Orders are made pursuant to section 22 of the Mental Health Act 2013 and may be made to a medical practitioner by:

  1. Another medical practitioner
  2. A nurse
  3. A Mental Health Officer (MHO)
  4. A police officer
  5. A guardian, parent or support person of the prospective patient
  6. An ambulance officer
  7. A person prescribed by the regulations

The applicant must be satisfied from personal knowledge of the prospective patient that they have or might have a mental illness and that a reasonable attempt to have the patient assessed with informed consent has failed or that it would be futile or inappropriate to make such an attempt.

Assessment Orders may be made by a medical practitioner (other than the medical practitioner who applied for the Order). The medical practitioner must have examined the person in the 72 hour period immediately before or after receiving the application and be satisfied from the examination that the person needs to be assessed against the assessment criteria.  The medical practitioner must also be satisfied that a reasonable attempt to have the patient assessed with informed consent has failed or that it would be futile or inappropriate to make such an attempt.

An Assessment Order may require the patient’s detention in an approved hospital. It does not authorise treatment which may only be given under the authority of the Mental Health Tribunal or if authorised as Urgent Circumstances Treatment under section 55 of the Act.

Table 1: Assessment Orders Made – 1 July 2014 to 30 June 2015

Area

Female Child

Female Adult

Male Child

Male Adult

Total Child

Total Adult

Total Persons

Interstate*

0

11

0

5

0

16

16

North

3

218

7

190

10

408

418

North West

1

56

2

105

3

161

164

Overseas

0

1

0

0

0

1

1

South

1

173

3

247

4

420

424

Total

5

459

12

547

17

1006

1023

Assessment Orders tend to reflect the gender distribution across the State. The Act defines a child as anyone under the age of 18, and the relatively small number of children subjected to Assessment Orders is reflective of the fact that treatment of children is most often undertaken with the consent of the parent or guardian.

*There are small numbers of orders made labelled ‘interstate’. These apply to people with an interstate home address who become unwell while in Tasmania.

ii) Treatment Plans

A treatment plan sets out an outline of the treatment the patient is to receive, and is  made under sections 50-54 of the Mental Health Act 2013.  Treatment Plans may be prepared by any medical practitioner involved in the patient’s treatment or care and are required for each involuntary patient. They must be made in consultation with the patient and anyone else the medical practitioner thinks fit in the circumstances. This would frequently be a guardian, parent, carer or support person of the patient. Medical practitioners preparing Treatment Plans are encouraged to consult with all persons involved with the care of the patient wherever possible within the limits imposed by privacy and confidentiality.

Table 2: Treatment Plans Made – 1 July 2014 to 30 June 2015

Area

Female Child

Female Adult

Male Child

Male Adult

Total Child

Total Adult

Total Persons

Interstate*

0

6

0

4

0

10

10

North

0

127

2

118

2

245

247

North West

0

48

1

94

1

142

143

South

1

157

2

236

3

393

396

Total

1

338

5

452

6

790

796

Patients who have a brief admission (less than 96 hours) are generally treated with urgent circumstances treatment and do not require a formal Treatment Plan to be submitted. The Act defines a child as anyone under the age of 18.

*There are small numbers of Orders made labelled ‘interstate’. These apply to people with an interstate home address who become unwell while in Tasmania.

iii) Urgent Circumstances Treatment

Urgent circumstances treatment is treatment given under section 55 of the Act and is authorised by the Chief Civil Psychiatrist or a delegate as being urgently needed in the patient’s best interests. The Urgent Circumstances Treatment provisions enable treatment that is urgently needed in the patient’s best interests to be given to the patient, without informed consent or the need for Mental Health Tribunal authorisation, in circumstances where it is not feasible to wait for the Tribunal’s determination. Authorisation may be given on the application of any medical practitioner involved in the patient’s treatment and care. Authorisation should only be sought after reasonable attempts have been made to give the patient urgent circumstances treatment with informed consent, and these have either failed, or circumstances exist where it would be futile or inappropriate to seek to obtain the patient’s informed consent to the treatment.

Urgent Circumstances treatment may be given for up to 96 hours. In most cases, it will be superseded by either a Treatment Order or an Interim Treatment Order made by the Mental Health Tribunal.

Table 3: Number of completed Urgent Circumstances Treatment notifications received by the Chief Civil Psychiatrist under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

Area

Female Child

Female Adult

Male Child

Male Adult

Total Child

Total Adult

Total Persons

Interstate*

0

7

0

3

0

10

10

North

2

163

5

170

7

333

340

North West

1

51

1

109

2

160

162

South

1

132

2

207

3

339

342

Total

4

353

8

489

12

842

854

The Act defines a child as anyone under the age of 18.

*There are small numbers of applications received and Orders made labelled ‘interstate’. These apply to people with an interstate home address who become unwell while in Tasmania.

iv) Seclusion and Restraint

Seclusion is dealt with under section 56 of the Act while restraint is dealt with under section 57 of the Act. Seclusion or restraint may only be used to facilitate a patient’s treatment or to ensure the patient’s health or safety or the safety of others. Seclusion may be understood as the deliberate isolation of an involuntary patient from others, without the patient’s consent, in an environment that they cannot leave without the agreement or assistance of others.

Seclusion may also be used to maintain order in, and the security of, the relevant approved hospital. Restraint, whether mechanical, physical or chemical, may also be used to effect the transport of a patient from one facility to another.

Under the Act, “mechanical restraint” is defined as use of a device that controls a person’s freedom of movement. The Act allows an involuntary patient to be mechanically restrained only if the means of restraint employed in the specific case has been approved in advance by the Chief Civil Psychiatrist.

Seclusion and restraint are extremely restrictive interventions, the application of which may cause distress for patients, support people and staff members. They are essentially interventions of last resort and may only be applied when less restrictive interventions have been tried without success or have been excluded as inappropriate or unsuitable in the circumstances. The need to ensure that seclusion or restraint are emergency interventions has been recognised by the United Nations through the Principles for Protection of Persons with Mental Illness and the Improvement of Mental Health Care which provide that:

Physical restraint or involuntary seclusion of a patient shall not be employed except in accordance with the officially approved procedures of the mental health facility and only when it is the only means available to prevent immediate or imminent harm to the patient or others.

Table 4: Number of completed Seclusion Authorisation notifications received by the Chief Civil Psychiatrist under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

Area

Female Child

Female Adult

Male Child

Male Adult

Total Child

Total Adult

Total Persons

North

0

19

0

86

0

105

105

North West

0

26

0

31

0

57

57

South

0

118

0

157

0

275

275

Total

0

163

0

274

0

437

437

NOTE: The figures presented here for seclusion differ from the National Collection of Seclusion data due to different scope of collection.

The Act requires seclusion of a child to be authorised by the Chief Civil Psychiatrist or delegate. The Act defines a child as anyone under the age of 18.

Analysis of seclusion data shows that males accounted for the most episodes of seclusion across all regions. The median time spent in seclusion was 161minutes, with 23.46 per cent of seclusions occurring within the first 24 hours of admission.

Table 5: Number of completed Restraint Authorisation notifications received by the Chief Civil Psychiatrist under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

Area

Female Child

Female Adult

Male Child

Male Adult

Total Child

Total Adult

Total Persons

North Total

2

30

1

25

3

55

58

Mechanical - North

0

3

0

1

0

4

4

Physical- North

1

26

1

22

2

48

50

Chemical- North

1

1

0

2

1

3

4

North West Total

0

24

0

33

0

57

57

Mechanical - North West

0

0

0

2

0

2

2

Physical - North West

0

24

0

31

0

55

55

Chemical - North West

0

0

0

0

0

0

0

South Total

0

93

0

50

0

143

143

Mechanical - South

0

1

0

1

0

2

2

Physical - South

0

91

0

48

0

139

139

Chemical - South

0

1

0

1

0

2

2

State Total

2

147

1

108

3

255

258

Mechanical - State

0

4

0

4

0

8

8

Physical - State

1

141

1

101

2

242

244

Chemical - State

1

2

0

3

1

5

6

The Act requires mechanical restraint, chemical restraint and physical restraint of a child to be authorised by the Chief Civil Psychiatrist or delegate. The Act defines a child as anyone under the age of 18.

The median time for a patient to be physically restrained was nine minutes, with the most common reason being to facilitate the patient’s treatment and ensure the patient’s health or safety and the safety of others.
v)         Involuntary Patient Transfer Between Hospitals

Transfers of involuntary patients between hospitals are made pursuant to section 59 of the
Mental Health Act 2013. Such transfers are directed by the Chief Civil Psychiatrist if satisfied that the transfer is necessary for the health or safety of the patient or the safety of others. No children were transferred. The majority of the transfers from both the Launceston General Hospital (LGH) and the North West Regional Hospital (NWRH) to the Royal Hobart Hospital (RHH) were to the Psychiatric Intensive Care Unit (PICU), a statewide unit located at the RHH. The PICU functions to provide intensive expert care for patients whose presentation is both complex and most often complicated by severe behavioural difficulties.

Table 6: Number of completed Involuntary Patient Transfers Between Hospitals applications received by the Chief Civil Psychiatrist under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

Area

Originating Unit

Destination Unit

Female

Male

Total

North

LGH

NWRH

3

5

8

North

LGH

RHH

2

11

13

North

LGH

Roy Fagan Centre

4

1

5

North West

NWRH

LGH

4

6

10

North West

NWRH

RHH

0

5

5

North West

NWRH

Roy Fagan Centre

1

0

1

South

RHH

LGH

0

3

3

South

RHH

Millbrook Rise Centre

5

2

7

South

RHH

NWRH

0

1

1

South

RHH

Roy Fagan Centre

3

4

7

South

Millbrook Rise Centre

RHH

4

1

5

South

Roy Fagan Centre

RHH

0

1

1

TOTAL

26

40

66

vi)        Failure to comply with Treatment Order

Section 47 of the Act applies if a treating medical practitioner is satisfied on reasonable grounds that a patient subject to a Treatment Order has failed to comply with the Treatment Order (despite reasonable steps being taken to ensure compliance) and such failure has seriously harmed or is likely to seriously harm the patient’s health or safety or the safety of others and the harm or likely harm cannot be adequately addressed except by way of an alternative treatment or treatment setting. The medical practitioner may apply to the Tribunal to vary the Treatment Order, seek to have the patient taken under escort and involuntarily admitted to an approved facility or apply to the Chief Civil Psychiatrist to give the patient urgent circumstances treatment.

Table 7: Number of completed Failure to Comply with Treatment Order – Admission to Hospital notifications received by the Chief Civil Psychiatrist under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

Area

Female Child

Female Adult

Male Child

Male Adult

Total Child

Total Adult

Total Persons

North

0

4

0

5

0

9

9

North West

0

0

0

10

0

10

10

South

0

6

0

13

0

19

19

Total

0

10

0

28

0

38

38

Back to top


Chief Forensic Psychiatrist

The data provided to the Chief Forensic Psychiatrist regarding the detention and treatment of forensic patients who are mentally ill and lacking decision making capacity reflects the operation of the Act over a short period of time and demonstrates compliance with the fundamental provisions of the Act.

i) Urgent Circumstances Treatment

Urgent circumstances treatment is treatment given under section 87 of the Act and which is authorised by the Chief Forensic Psychiatrist or a delegate as being urgently needed in the patient’s best interests. The Urgent Circumstances Treatment provisions enable treatment that is urgently needed in the patient’s best interests to be given to the patient, without informed consent or the need for Mental Health Tribunal authorisation, in circumstances where it is not feasible to wait for the Tribunal’s determination. Authorisation may be given on the application of any medical practitioner involved in the patient’s treatment and care. Authorisation should only be sought after reasonable attempts have been made to give the patient urgent circumstances treatment with informed consent, and these have either failed, or circumstances exist where it would be futile or inappropriate to seek to obtain the patient’s informed consent to the treatment. Wherever possible, alternative, less restrictive ways of managing a patient’s treatment needs should be pursued and the use of Urgent Circumstances Treatment minimised.

Urgent circumstances treatment may be given for up to 96 hours. In most cases, it will be superseded by treatment that is authorised by the Mental Health Tribunal under sections 88 or 91 of the Act.

Table 8: Number of completed Urgent Circumstances Treatment notifications received by the Chief Forensic Psychiatrist under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

 

Female Child

Female Adult

Male Child

Male Adult

Total Child

Total Adult

Total Persons

 

0

1

0

1

0

2

2

Total

0

1

0

1

0

2

2

ii) Seclusion and Restraint

Seclusion for forensic patients is dealt with under section 94 of the Mental Health Act 2013, with restraint for forensic patients dealt with under section 95 of the Act. Seclusion may be understood as the deliberate isolation of an involuntary patient from others, without the patient’s consent, in an environment that they cannot leave without the agreement or assistance of others.

Seclusion may only be used to facilitate a patient’s treatment or general health care, to ensure the patient’s health or safety or the safety of others, to prevent the patient from destroying or damaging property, to prevent the patient’s escape from lawful custody, to provide for the management, good order or security of the Secure Mental Health Unit (SMHU) or to facilitate the patient’s lawful transfer to or from another facility.

Restraint, whether mechanical or physical, may only be used to facilitate a patient’s treatment or general health care, to ensure the patient’s health or safety or the safety of others, to prevent the patient from destroying or damaging property, to prevent the patient’s escape from lawful custody, to provide for the good order or security of the SMHU or to facilitate the patient’s lawful transfer to or from another facility.

Chemical restraint may only be used to facilitate a patient’s treatment, to ensure the patient’s health or safety or the safety of others, or to facilitate the patient’s lawful transfer to or from another facility.

Under the Act, “mechanical restraint” is defined as use of a device that controls a person’s freedom of movement. The Act allows a forensic patient to be mechanically restrained only if the means of restraint employed in the specific case has been approved in advance by the Chief Forensic Psychiatrist

Table 9: Number of completed Seclusion Authorisation notifications received by the Chief Forensic Psychiatrist under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

 

Female Child

Female Adult

Male Child

Male Adult

Total Child

Total Adult

Total Persons

 

0

5

0

46

0

51

51

Total

0

5

0

46

0

51

51

Table 10: Number of completed Restraint Authorisation Notifications Received by the Chief Forensic Psychiatrist under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

 

Female Child

Female Adult

Male Child

Male Adult

Total Child

Total Adult

Total Persons

Mechanical

0

0

0

0

0

0

0

Physical

0

1

0

29

0

30

30

Chemical

0

0

0

0

0

0

0

Total

0

1

0

29

0

30

30

iii) Leave of Absence

Under sections 81 – 84 of the Act, the Chief Forensic Psychiatrist or a delegate may grant a forensic patient who is not subject to a restriction order leave of absence in Tasmania. Such leave may be granted for a particular purpose, or for a particular period, or both. Leave is granted subject to such conditions as the Chief Forensic Psychiatrist considers necessary and desirable for the patient’s health or safety or for the safety of others. There may be a requirement that the patient be under escort for any portion of the leave or for the whole period of leave.

Table 11: Number of completed Leave of Absence notifications received by the Chief Forensic Psychiatrist under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

 

Female Child

Female Adult

Male Child

Male Adult

Total Child

Total Adult

Total Persons

 

0

0

0

57

0

57

57

Total

0

0

0

57

0

57

57

iv) Forensic Patient Transfer to Hospital

Transfer of forensic patients to a secure institution, an approved hospital or a health service may be made pursuant to section 73 of the Mental Health Act 2013. Transfer is directed by the Chief Forensic Psychiatrist or delegate and would generally be for the purposes of receiving specialised care in that facility.

Table 12: Number of completed Forensic Patient Transfer to Hospital notifications received by the Chief Forensic Psychiatrist under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

NIL notifications received.

v) Cancellation or Suspension of Visit

Under section 98 (4) of the Mental Health Act 2013, the Chief Forensic Psychiatrist may cancel or suspend for a time any individual’s privileged visitor, privileged caller, or privileged correspondent status if satisfied on reasonable grounds that the individual has engaged in behaviour that is incompatible with the management, good order or security of a SMHU.

Table 13: Number of completed Cancellation or Suspension of Visits by the Chief Forensic Psychiatrist under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

NIL cancellations or suspensions.

vi) Involuntary Patient Transfer to Secure Mental Health Unit

Under section 63 of the Mental Health Act 2013, an involuntary patient may be admitted to a SMHU if the admission is authorised by the Chief Forensic Psychiatrist or delegate upon request by the Chief Civil Psychiatrist or delegate.

Authorisation is given only if, amongst other criteria, the patient is being detained in an approved hospital, is not a prisoner or youth detainee, is a danger to self or others and the SMHU is the only appropriate place where the patient can be safely detained.

A child (defined in the Act as a person under 18 years) may only be admitted to a SMHU if the Chief Forensic Psychiatrist is also satisfied that the patient can be detained separately from adults and that the probable benefits of accommodating the patient in a SMHU outweigh the probable risks.

Table 14: Number of completed Involuntary Patient Transfers to Secure Mental Health Unit authorised by the Chief Forensic Psychiatrist or delegate under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

 

Female Child

Female Adult

Male Child

Male Adult

Total Child

Total Adult

Total Persons

 

0

2

0

18

0

20

20

Total

0

2

0

18

0

20

20

In accordance with section 63 of the Act, involuntary patients are only transferred to a secure mental health unit in situations where the danger that the patient poses to self or others is or has become so serious as to make the patient’s continued detention in an approved hospital untenable.

vii) Request To Return To Prison

Under section 70 of the Mental Health Act 2013, a forensic patient who is a prisoner or youth detainee and whose removal to the SMHU was directed at the patient’s own request may request the Chief Forensic Psychiatrist to return him/her to the custody of the relevant authority at any time.

The Chief Forensic Psychiatrist is to have the patient examined by an approved medical practitioner before either agreeing to the request or refusing the request having regard to the results of the examination and whether the reasons for the patient’s admission are still valid, as well as such other matters considered to be relevant.

Table 15: Number of completed Requests to Return to Prison received by the Chief Forensic Psychiatrist under the Mental Health Act 2013 from 1 July 2014 to 30 June 2015

 

Female Child

Female Adult

Male Child

Male Adult

Total Child

Total Adult

Total Persons

 

0

0

0

1

0

1

1

Total

0

0

0

1

0

1

1

Back to top