11Act History of Victorian Mental Health Legislation The 1986 Mental Health Actenshrined the principleof ‘normalization’ and the moveto shorter stays, if any, inbed-based psychiatric services.
12Mental Health Act 2014The Current Mental Health Act was Introduced in 1986oldest Act within AustraliaNot reflective of current mental health policy or best practiceunlikely to be compatible with the Charter of Human Rights, Convention on rights of Persons with a Disability, Convention on the rights of a Child.
17Presumption of capacity Capacity is the ability of a person to make a particular treatment decision at a particular point in time. Capacity of people with mental illness can fluctuate and the capacity of children and young people may still be evolving (Gillick case –maturing capacity).
18Capacity: What will change under the new legislation MHA 1986 patients presumed to lack capacity.Capacity forms part of the criteria for placing someone on an ITO.This creates a presumption that the person does not have capacity to make any decision about their treatment, care and recovery.What will be differentCriteria for compulsory treatment order will not include capacity.New legislation will establish a presumption of capacity to make an informed decision about treatment for all people with a mental illness regardless of age.New legislation will include a capacity test
19The presumption of capacity A person is presumed to have capacity to make decisions about their treatment care and recovery regardless of age or legal status this includes patients and children and young people who are under compulsory treatment orders.
20Displacing the presumption of capacity. The presumption of capacity may be displaced where it is demonstrated that the person cannot make a decision about a particular treatment or course of treatment at that point in time.HoweverA person is not to be treated as being unable to make a decision unless all practicable steps have been taken to help him or her without success.Person not to be treated as unable to make decision merely because he or she makes an unwise decision.Lack of capacity cannot be established merely by reference to a persons age or appearance or because the person is a compulsory patient.
21How do you know if a person has capacity The new legislation will establish a capacity test.The TestA person has capacity to make decision if the person:-Understands the information he or she is given that is relevant to the decision.Is able to remember the information relevant to the decision.Is able to use or weigh information relevant to the decision.Is able to communicate the decision.
22UnderstandsThe person must be able to understand the information relevant to a decision and the effects of that decision.The person maybe supported to understand informationThe person is not to be regarded as unable to understand the information. Information is to be provided that is appropriate to the persons circumstances e.g. using simple language, visual aids or other means.Where a person cannot make a decision at a particular time, it may be appropriate to delay the making of the decision if it is likely the person may be able to make the decision at a time in the near future.
23RememberThe fact that a person is able to retain the information relevant to a decision for only a short period should not preclude her or him from being regarded as being able to make a decision.A person requires the ability to remember only to the extent it is necessary to make a decision.It will not be necessary for the person to have memorised exactly the advice or information being provided. If it is generally recalled that is sufficient.
24Use or weighThe person must be able to understand the information relevant to a decision and the effects of that decision.Person must be able to simply assess the information and consider the impact of making a particular decision or another decision or of failing to make a decision at all.
25CommunicateA inability to communicate a decision does not mean a person lacks the cognitive ability to make a decision.All reasonable efforts should be made to assist people in these circumstances to communicate their decisions to othersA person should be able to communicate even on simple terms their understanding of the factors they considered relevant to their decision.
26AdvocatesThe government will fund advocacy and support services/telephone advice to assist in decisions:assessmenttreatmentrecovery
27Advance statementsEnable a person to record their treatment preferences if they become unwell and require compulsory treatment. DoH will be developing advance statement protocols and processes. A statewide proforma will be established to utilised by all AMHS.
28Nominated personA patient will be able to nominate a person to receive information and to support the patient for the duration of the compulsory treatment order.No work will be complete on this until the bill has been drafted.
29Carers and familiesThe support of carers and families is significant to patient recoveryinvolve carers and families in supporting patients to make decisions about their assessment, treatment and recovery wherever possible.
30Compulsory treatment orders The new legislation will establish compulsory treatment orders comprising:An Assessment OrderA 28-day Treatment OrderA Treatment Order.
31An Assessment OrderA registered medical practitioner or a mental health practitioner.that the person appears to have a mental illnessneeds treatment to prevent serious harm to the person
32An Assessment Order3. need treatment to prevent serious deterioration in their mental or physical health or 4. need treatment to prevent serious harm to another person 5. no less restrictive means reasonably available, including a voluntary basis.
33An Assessment OrderEnable an authorised psychiatrist to assess the person to determine whether they ‘have a mental illness’will last for a maximum of 24 hoursextended up to a maximum of 72 hours in exceptional circumstances.
3428-day Treatment OrderAfter an Assessment Order the authorised psychiatrist may:make a 28-day Treatment Order
3528 day Treatment OrderThe criteria for a 28-day Treatment Order will require that the authorised psychiatrist determine:that the person has a mental illness.needs treatment to prevent serious harm to the person.need treatment to prevent serious deterioration in their mental or physical health orneed treatment to prevent serious harm to another person.no less restrictive means reasonably available, including a voluntary basis.
3628-day Treatment OrderA person is not to be placed on a compulsory treatmenthistory of mental illnessand as a result there may be a harm that manifests in the future.
3728-day Treatment OrderThe authorised psychiatrist must also specify the category of the order:‘inpatient’‘community’The authorised psychiatrist must regularly review the Order and discharge the person:if the criteria no longer apply.
38Treatment OrderIf a patient remains on a 28-day Treatment Order at the end of the period of the order:The Mental Health Tribunal must conduct a hearing. To ensure the criteria for compulsory treatment applies to the personIf the matter is not heard within 28-day the order will expire
39Treatment OrderIf a patient remains on a 28-day Treatment Order at the end of the period of the order:The Mental Health Tribunal can make a Treatment Order:Inpatient (up to six months)Community (up to 12 months)
40Treatment OrderThe authorised psychiatrist will be responsible for providing treatment:The authorised psychiatrist will be able to vary the category of the Treatment Order if required.
41Treatment OrderThe authorised psychiatrist may make an application to the further Treatment Order to the Mental Health Tribunalif the criteria for compulsory treatment still apply to the patientthe matter is not heard by the Mental Health Tribunal within the period of the order the Treatment Order will expire
42Treatment Order for young persons under 18 years of age The criteria for a YP 28-day Treatment Order will require that the authorised psychiatrist must determine if.The young person has a mental illness ?Needs treatment to prevent serious harm to the person?need treatment to prevent serious deterioration in their mental or physical health orneed treatment to prevent serious harm to another person.no less restrictive means reasonably available, including a voluntary basis.
43Treatment Order for young persons under 18 years of age The authorised psychiatrist will be responsible for providing treatment:InpatientCommunityThe authorised psychiatrist will be able to vary the category of the Treatment Order if required.
44Treatment Order for young persons under 18 years of age The Mental Health Tribunal can make Treatment Order Treatment Order (either inpatient or community category):3 months, although the tribunal will be able to make further orders if the criteria still apply
45Safeguards – increase safeguards to protect rights and dignity The legislation will establish a Mental Health Tribunal(MHT) to replace the Mental Health Review Board and the Psychosurgery Review BoardMHT-will make Treatment Orders for patientsthree members: a lawyer, a registered medical practitioner and a member of the community
46Safeguards – increase safeguards to protect rights and dignity Registered medical practitioner members will be qualified psychiatrists wherever practicablethe registered medical practitioner must be a psychiatrist when the MHT:considering an application for electroconvulsive therapyor psychosurgery for mental illness
47Mental Health Tribunal MHT will be a primary decision maker rather than a review bodyMHT will perform its functions in a manner that promotes the principles and objectives of the MHA
48Mental Health Tribunal MHT will make order for /approveCompulsory treatment beyond an initial 28 day period, including duration and the setting the order will take place.All orders will be time limitedApplications can be made for further treatment orders by Authorised Psychiatrist – must be done before current order expires.Consumers will still be able to appeal to the MHT – this will be called a application for revocation.
49Mental Health Tribunal More frequent hearings scheduled at venues,supplemented by a capacity to conduct videoconferencehearings as needed.Adjournments will be limited to matters involvingexceptional circumstances.Must be assumed that hearings have to proceed on the day theyare scheduled.Reports and oral evidence from the treating team must address each of the applicable criteria and provide sufficient detail in relation to treatment.Insufficient /inadequate evidence will mean the MHT will not be able to make an order.
50Electroconvulsive therapy ECT may only be performed with the approval of the Mental Health Tribunal.on a compulsory patientor a person under 18 years of age with
51Electroconvulsive therapy ECT may only be performed with the approval of the Mental Health Tribunal.on a compulsory patientor a person under 18 years of age with
52Electroconvulsive therapy-Informed Consent If the MHT determines that a compulsory patient or young person has capacity to consentthe tribunal will still be required to give approval for ECT if the patient or young person gives informed consent
53Electroconvulsive therapy-Not able to provide Informed Consent A compulsory patient or young person does not have capacity to consent to ECT:The MHT must decide:whether the ECT will be for the ‘benefit of the person’whether the ECT is likely to remedy the mental illness or lessen the ill effects
54Restrictive interventions (bodily restraint and seclusion) improve the safety of restraint and seclusionoversight of and accountability for these restrictive practices.Current Reducing Restrictive Intervention Project is being undertaken.Project Officers have been appointed across the state.Each AMHS is required to develop a plan on how to reduce restrictive practices within their organisations.
55Second psychiatric opinion A right for compulsory patients to seek a second psychiatric opinion provided by a psychiatrist:public mental health serviceor in the private sectorSome additional state funds for second opinions provided by private psychiatrists.Feedback is currently being sought from the Sector.
56Second psychiatric opinion A right for compulsory patients to seek a second psychiatric opinion:second psychiatric opinion promote a dialogue between:the authorised psychiatrist,the treating teamthe patientfamily and carers
57Second psychiatric opinion Intended to promote self –determination for Pts by providingInformation about their treatmentWhether treatment is least restrictiveBetter understand their illnessEmpower them to contribute to decision the making.
58Second psychiatric opinion Authorised Psychiatrist will be required toConsider the second psychiatric opinionWill not be required to change course of treatment if they disagree with 2nd opinion.Required to discuss the 2nd opinion with the patient.Explain to the reasons why they believe the 2nd opinion treatment option in all or in part should be adopted.
59Second psychiatric opinion: Review By Chief Psychiatrist A patient will be entitled to apply to the Chief Psychiatrist for a review:If the authorised psychiatrist does not adopt any or all of the recommendations contained in the second opinion reportThe Chief Psychiatrist may direct the authorised psychiatrist to make changes to the patient’s treatment.2nd opinions will not delay or prevent an authorised psychiatrist from providing treatment.
60Second psychiatric opinion Eligibility for a 2nd opinionPatient under the nMHA, compulsory, forensic or security patientDisclosed if they have obtained a 2nd opinion (from any source) within the last 12 months
61Second psychiatric opinion Who will provide the 2nd opinionA Psychiatrist registered with AHPRAA Psychiatrist registered with AHPRA with a minimum of 3 years experience practicing in public mental health.Required to be registered on a panel of psychiatrist able to provide 2nd opinions.
62Oversight and service improvement Mental Health Complaints CommissionerThe commissioner:Will be accessible, supportive and timely.Adopt best practice principles, including transparent complaints handling processes.receive,conciliate,investigate and resolve complaints about public sector mental health service providerswill have broad powers to investigate services, make recommendations and issue compliance notices
63Oversight and service improvement Chief Psychiatrist:will focus on supporting public sector to deliver quality mental health servicesalso analyse dataundertake research
64Oversight and service improvement Chief Psychiatrist:publish reports about the provision of public mental health servicesmonitor services and conduct investigationsissue directions to public mental health services to improve patient safety and wellbeing.
65Oversight and service improvement Community visitors This program will remain in place under the nMHA They will continue to monitor and provide feedback on the provision of mental health service.
66Oversight and service improvement Codes of practice The Office of the Chief Psychiatrist will be establishing codes of practice for Mental Health Clinicians that will comply with the underpinning principles of the nMHA.
67Oversight and service improvement Disclosure of health information. The nMHA will clarify when a person mental health information may be disclosed so that people with mental illness, clinicians, families and carers can better understand their rights and responsibilities.
68NMHA Steering Committee Members of the CommitteeProject Officer: Jim Reid (Chair)Director of Nursing: Vic TrippSenior Psychiatric Nurse Consultant: Tim LentenConsultant Psychiatrist: Dr Holly AndersonBendigo CMH Team: Jan TrippSouthern sector CMH Team: Sue AitkenNorthern Sector CMH Team: Brendan WatsonInpatient Services: Rachel FinchETP Team: Belinda CrossleyYouth Mental Health: Steve PotterCAMHS Team: Melinda ForbesAPMHS Team: Kevin Gerber
69NMHA Steering Committee Members of the CommitteeSt Lukes Service: Chris McInnesMedicare Local: Jag DhaliwalDepartment of Health: Annette TooheyConsumer Consultant: Brendan LandyCarer Consultant: Cathy SpencerAdministrative Services Representative: Vance LindreaBendigo Health Emergency Department: Carol-Anne LeverAustralian Nursing Federation: Loretta Marchesi/Donna HansenHACSU: Ginny AdamsMinute Secretary: Lyn Wilson