2. Assessment & treatment Least restrictions on rights and dignity Support persons to make/participate in decisions Provide oversight & safeguard Role of carers & support persons

4. Presumption of capacity to make treatment decisions regardless of age or legal status Understand the information given, able to remember, use or weigh information & communicate the decision Person gives informed consent if they: have the capacity, given adequate information, given the opportunity to make decision, consent freely & has not withdrawn consent

5. What if a patient does not have capacity or does not give informed consent to a course of treatment? Authorised Psychiatrist can make a treatment decision (except ECT/neurosurgery) Must be no less restrictive way for patient to be treated In determining the treatment, authorised Psychiatrist must consider: - Patients views and preferences including in an advance statement - Views of nominated person, guardian, carer, parent of patient < 16 years - Likely consequences for the patient if treatment is not performed - Any second Psychiatric opinion given to authorised Psychiatrist

6. Supported decision making: Second Psychiatric Opinion- Intended to promote self- determination and possible alternative treatments. Treating authorised Psychiatrist to consider the second opinion Advance statements- Gives person greater control over preferences. Clinicians aswell as carers, guardians &/or nominated person understand treatment preferences. Advance statement is effective from the time it is made until it is revoked. Regardless of legal status anyone can make an advance statement so long as they understand what it is & the consequences of making one.

7. Nominated person- Supports the patient, receives information about the care & is consulted about the patient’s treatment at all stages. Exercise rights. Is NOT able to make treatment decisions on behalf of the patient. Regardless of legal status anyone can nominate a nominated person so long as they understand what it is & the consequences of making one. Advocates- Government will fund advocacy support services for people receiving public mental health services. Assist people to understand & exercise their rights, may also make representations on behalf of people receiving mental health services

8. Seeks to minimise the use and duration of compulsory treatment provided in the least restrictive manner possible Establishes compulsory treatment orders comprising: Assessment Orders (s. 28) Temporary Treatment orders (s. 45) Treatment orders (s. 52)

9. Criteria for Assessment order (registered medical practitioner or mental health practitioner) : a) The person appears to have a mental illness; and b) Because the person appears to have a mental illness, they appear to need immediate treatment to prevent- (i) serious deterioration in the person’s mental or physical health; or (ii) serious harm to the person or to another person; & requires immediate treatment to prevent deterioration or serious harm to self or others; and c) If the person is made subject to an Assessment Order they can be assessed; and d) There is no less restrictive means reasonably available to enable the person to be assessed. Community (Max 24 hours) Inpatient (Max 72 hrs for transport, max 24 hrs when person received at hospital, AP can extend < 72 hours)

10. Temporary Treatment Order (Authorised Psychiatrist has determined person has a mental illness): Community or Inpatient- duration of 28 days unless revoked earlier. Must take into the persons views/preferences, advance statements, views of nominated person, guardian/carer, parent (< 16). Notify nominated person/carer/parent MHT must occur if order not revoked before 28 days

11. Treatment Order (made by the Mental Health Tribunal): After the hearing, MHT must: a) Make a Treatment Order in respect of a person if the treatment criteria apply to the person; - The duration of the order; and - Whether order is Community or Inpatient b) Revoke the Order if the Tribunal is not satisfied that the treatment criteria apply

12. Treatment Order duration: Community (Max 12 months; Max 3 months person <18 years) Inpatient (Max 6 months; Max 3 months person < 18 years) Setting (inpatient or community) may be varied by authorised Psychiatrist. End of the Treatment Order, Psychiatrist may make an application to the MHT for further Treatment Order.

13. The Mental Health Tribunal will make treatment orders Will consider factors including patient’s recovery goals and treatment preferences, views of nominated person, carer, guardian or parent of young person & any second Psychiatric opinion ECT Patient has given informed consent; or with the approval of the MHT. If under 18, irrespective of capacity to give informed consent must be approved by the MHT (voluntary or compulsory) A course of ECT will not exceed 12 within 6 month period

14. Restrictive Interventions will be subject to improved safety and accountability: Includes bodily restraint (mechanical & physical) and seclusion Notification to patients nominated person, guardian, carer, parent if under 18. Statement of rights to be provided to patients, nominated person, carer & parent if patient is < 16 years old. Includes; - To make or participate in decisions about their treatment - Right to have an advanced statement & nominated person - To be legally represented and supported by a support person - To apply to the MHT - To discuss their treatment and care with the community visitors

15. Mental Health Complaints Commissioner (Lynn Barr) Will accept, assess, manage, investigate & endeavour to resolve complaints Assist mental health services to develop/improve policies & procedures to resolve complaints Chief Psychiatrist will provide clinical leadership, support & advice to public mental health service providers informed by: Clinical audits & reviews Reportable deaths Develop guidelines, policies and practice directions

16. Community visitors Will continue visiting, providing support & monitor services Assist in the resolution of issues, seek support from other bodies & make complaints to the Commissioner Disclosure of health information (privacy/carers rights & needs) Consent or treatment purposes Information disclosed to carers where a decision will directly affect the carer Information must be disclosed to nominated persons, guardians & parents if patient < 16 years

17. Mental Health Act Reform webpage: www.health.vic.gov.au/mentalhealth/mhactreform Enquiry phone line: 1300 656 692 and/or Email: mhactreform@health.vic.gov.aumhactreform@health.vic.gov.au