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Overview of Queensland Mental Health Involuntary Treatment Law

The process of involuntary assessment and treatment of a patient in Queensland, Australia

Daniel Lu

on 18 October 2013

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Transcript of Overview of Queensland Mental Health Involuntary Treatment Law

Are you Mentally Ill?
Involuntary Assessment
Mental Illness as defined in the act
"Mental illness is a condition characterised by a clinically significant disturbance of thought, mood, perception or memory"
- s12(1) Mental Health Act (MHA) 2000 Queensland (QLD)
Does this man have a mental illness?
A poor Asian Buddhist who engages in sexual activities with many men and women while married with three children and drinks alcohol
Not mental illness simply because the person:
s12(2) MHA2000 (QLD)
holds or refuses to hold particular religious, cultural, philosophical or political belief
is part of a particular racial group
has a particular economic or social status
has a particular sexual preference or sexual orientation
sexually promiscuous
immoral or indecent conduct
takes drugs or alcohol
has an intellectual disability
engages in antisocial or illegal behaviour
is or has been involved in family conduct
previously been treated for mental illness or been subject to involuntary assessment or treatment

Request & Recommendation (R&R)
Justice Examination Order (JEO)
Emergency Examination Order (EEO)
...does not prevent a person mentioned in the subsection having a mental illness

Example: person may have mental illness caused by taking drugs.
- s12(3) MHA2000
REQUEST for assessment: Is done by an
who reasonably believes the person has a mental illness, or to an extent, that involuntary assessment is necessary and has observed the person within 3 days before making the request - s17 MHA
RECOMMENDATION for assessment: is
done by a doctor

or authorised mental health practitioner
who has examined the person in the last three days. The person is not a related to the doctor or practitioner. The examination over audiovisual link is permitted (s19 MHA). This recommendation is not done by the same person who made the REQUEST s23 MHA.
The recommendation must be in approved form, state facts, distinguish personal observation and facts communicated by others (s20 MHA)
recommendation in force for 7 days (s21 MHA)

A person may apply to a
or a
Justice of Peace (JP)
who then would need to complete application in the approved form. The JP or magistrate needs to reasonably believe that the person has a mental illness and that an examination is required (s27 MHA)
The JEO authorises a doctor or authorised mental health practitioner
to examine the person to see if a RECOMMENDATION for Assessment should be made
(s30(1) MHA). The order lasts for 7 days (s31 MHA). The doctor or practitioner
may enter a place
stated in the order or another place the doctor or practitioner reasonably believes the person may be found. (s30(2) MHA)
Police assistance - The doctor or practitioner may exercise a power under this section with the help that is reasonable in the circumstances (s30(3) MHA).... The doctor is a public official for the Police Powers and Responsibilities Act 2000
Involuntary Treatment Process
An EEO is Made by a
police officer
ambulance officer
who reasonably believes that the person has a mental illness that is at risk of significant physical harm to anyone and that a JEO would take too long and they think it is is better to send them to authorised mental health service for examination to decide if an R&R is needed. (s33 MHA)
On the making of the order, the person may be
detained for not longer than 6 hours
for examination (s36(1) MHA)
Involuntary Treatment
Making the order
Identifying Illness
The person may be detained in an authorised mental health service for assessment for the assessment period (S44 MHA)
Detainment is initially 24 hours
s47 allows
extention to 72 hours by an authorised doctor
at the health service
no one
has assessed this person and initiated an Involuntary Treatment Order (ITO) then they are free to go and arrangements need to be made for transport to where the person came from or another reasonable location. (s49MHA2000QLD)
Where reasonable and practical, the doctor must explain to the person what this JEO is about and show it to the person (s30 (7) MHA)
How other states are defining it
NSW - Similar safeguard to QLD's s12(2)MHA and further goes on to specifically include: delusions, hallucinations, thought disorder, mood disturbance, sustained or repeated irrational behaviour related to the already stated.
SA - "any illness or disorder of the mind", that's it! It doesn't have safeguard (i.e. excluding opinions, beliefs and sexual preferences similar to s12(2) MHA2000(QLD))
Tasmania - condition resulting in: distortion of thought, disturbance of rational thought, serious mood disorder, impairment of capacity to control behaviour. Has similar safeguard but not as extensive
WA - disturbance of thought, mood, volition, perception, orientation of memory that impairs judgement or behaviour to a significant extent.
Safeguards similar to s12(2) MHA2000(QLD)
... significant disturbance of thought, mood, perception, or memory... effects of drug or alcohol taking can be regarded as indication that a person is mentally ill...

similar safeguards as QLD
ACT - defines Mental Dysfunction and Mental Illness separately
Similar to NSW
Who should be told?
s45 - Administrator for the mental health service must tell:
the patient
the patient's allied person
the parent (if the patient is minor)
the attorney (if administrator thinks they have one)
the guardian (if administrator thinks they have one)
Making the Involuntary Treatment Order (ITO)
(3) The order must—
(a) be in the approved form; and
(b) state the following—
(i) the time when it is made;
(ii) the basis on which the doctor is satisfied the treatment criteria apply to the patient, including the facts indicating mental illness observed by the doctor;
(iii) the authorised mental health service responsible for ensuring the person receives treatment.
s109 requires you to specify if the patient is to be tx as inpatient or in the community
Treatment plan
s110, s111 - A
Treatment plan
needs to be prepared for the patient, also the doctor
needs to tell the patient
that treatment order has been made, whether it is inpatient or outpatient, the reasoning for treatment and to have a discussion with the patient about it
s113 Notice of making of ITO
(1) Within 7 days after an involuntary treatment order for a
patient is made, the administrator of the patient’s treating
health service must give
written notice of the order
(a) the patient; and
(b) the tribunal; and
(c) the patient’s allied person.
Statement of rights
(written material) to be given to involuntary patient and patient’s allied person along with an o
ral explanation
Duration of ITO
(1) ...
continues until it is revoked
(a) by an authorised doctor for the patient's treating health service or the director; or
(b) on a review or appeal against a review decision
(2)... order ends if the patient
does not receive treatment under the order for 6 months
[if this is the case, then written notice to patient, their allied person, tribunal and (before ended) to the director]
Special Treatments
s139 Performance of
electroconvulsive (ECT)
therapy with consent or tribunal approval
s140 - doctor may perform
Emergency ECT
on an invountary patient after getting a certificate from a psychiatrist and the medical superintendent that certifies that ECT is necessary to
(a) Save the patients life; or
(b) prevent the patient from suffering irreparable harm
s161 Psychosurgery allowed only if there has been informed consent and tribunal approval
s162 Prohibited treatment
A person must not administer to another person
insulin induced coma therapy
; or
deep sleep therapy
Restraint and seclusion
Mechanical restraint
... preventing movement of the persons body or a limb ... s162D use only if the doctor is satisfied it is most clinically appropriate way of preventing injury to patient or someone else.
s162j ...
is the confinement of the patient ... alone in a room or area from which free exit is prevented... however overnight confinement for security purposes ... is not seclusion
162L ... a doctor or by senior registered nurse on duty can authorise seclusion... when they think it is necessary to protect patient from harming self or others and there is no less restrictive way
Patient's consent not required

Allied Person
s340: An allied person represents the patient's views, wishes and interests relating to the patient's assessment, detention and treatment. s341 involuntary patient may choose who this may be:
(a) if the patient is a minor—a parent of the minor or the minor’s guardian;
(b) if the patient has a personal guardian—the guardian;
(c) if the patient has a personal attorney—the attorney;
(d) an adult relative or adult close friend of the patient;
(e) an adult carer of the patient;
(f) another adult.
or one stated in their Advance Health Directive (AHD) or the administrator chooses from the list for the patient.
Treatment criteria Checklist
s14 Involuntary Treatment order allowed only if:
(a) the person
has a mental illness
(b) the person’s illness
requires immediate treatment
(c) the proposed
treatment is available
at an authorised mental health service;
(d) because of the person’s illness—
(i) there is an
imminent risk that the person may cause harm
to himself or herself or someone else; or
(ii) the person is likely to
suffer serious
mental or physical deterioration;
(e) there is
no less restrictive way
of ensuring the person receives appropriate treatment for the illness;
(f) the person—
lacks the capacity to consent
to be treated for the illness; or
(ii) has
unreasonably refused proposed treatment
for the illness.
Review Tribunals
s187 a tribunal needs to review the application of the treatment criteria to a patient under and ITO within 6 weeks of an ITO being made and again at every 6 months

s191 the tribunal decides on
confirm or revoke ITO
change the ITO category (inpatient or community) (unless classified patient)
order a transfer to another service (unless classified patient)
change monitoring conditions (unless classified patient)
Classified patient
A Classified patient is a person admitted to an authorised mental health service from court or custody.

Case study
PF is a 47YO male with 28yr hx of depression, who was admitted to hospital following a suicide attempt involving an overdose of alprazolam. Life stressors: divorce, prostate cancer dx.
He was also due for a bone scan to confirm metastasis. He feels he doesn't need to confirm it despite advice from psych team.
[case from Delpachitra, S. (2011)]
Some questions
Can we impose an ITO on this man?
Should we ignore PF's refusal and order the bone scan anyway? is there a way we can convince PF to have the scans?

Yes we can because PF fits treatment criteria, especially s14(1)(d)(i): ... imminent risk that the person may cause harm to himself or herself or someone else...

He is a high risk of suicide

Manage his Prostate cancer?
In short - there is no clear jurisdiction for enforcement of medical care under an ITO in Queensland, unless the medical condition is directly associated with the development of the mental illness (Delpachitra, 2011)

General principles for administration of Act
(1) The following principles apply to the administration of this Act
in relation to a person who has a mental illness

(a) ...
(b) Matters to be considered in making decisions
• to the greatest extent practicable, a person is to be
encouraged to take part in making decisions affecting the person’s life, especially decisions about treatment
• to the greatest extent practicable, in making a decision about a person, the
person’s views and the effect on his or her family or carers are to be taken into account
• a person is
presumed to have capacity
to make decisions about the person’s assessment, treatment and choosing of an allied person....
(h) Provision of treatment
• treatment provided under this Act must be administered to a person who has a mental illness
only if it is appropriate to promote and maintain the person’s mental health and wellbeing
How to help convince?
Involve family and friends with explanation of treatment as well as providing support and assurance
delay medical intervention until mental state has improved - thus the urgency of treatment also plays a role
Did you know?
DSM-1 saw homosexuality as a Sociopathic Personality Disturbance (Kerridge, 2009) and remained until the 7th printing of DSM-II in 1974 because of gay rights activism and even then it was changed to be called Sexual Orientation Disturbance

So can you see how these exclusions are important?
Mental Health Act 2000 (QLD) available http://www.legislation.qld.gov.au/LEGISLTN/CURRENT/M/MentalHealthA00.pdf
Kerridge, I., Lowe, M., & Stewart, C. (2009). Ethics and law for the health professions (3rd ed.)
Delpachitra, S. (2011). Enforcing medical treatment under the Involuntary Treatment Order: An ethical dilemma? Australian Medical Student Journal, 2(1), 56-57.
Wikipedia http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders [Accessed 12/10/2013]
Spitzer, R. L. (1981). The diagnostic status of homosexuality in DSM-III: a reformulation of the issues. Am J Psychiatry, 138(2), 210-215.
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