1. The Mental Health Act 2014

2. The Mental Health Act 2014
QUIZ TIME!

3. The Mental Health Act 2014
What year was Crocodile Dundee released? 1986 What year was John Farnham’s ‘You’re the Voice’ a number 1 in the charts? What year was Lady Gaga born?

4. The Mental Health Act 2014
1986 was a good year for film and TV….

5. The Mental Health Act 2014
Bad year for fashion

6. The Mental Health Act 2014
1986
2013
Tom Sellicks moustashe

7. The Mental Health Act 2014
1986
2013
………..with the exception of some slight amendments MHA has remained largely unchanged for the last 27 yrs

8. The Mental Health Act 2014
1986
2013
The need to reform the Act to reflect current trends in mental health policy and working practices.

9. Victorian Mental Health Legislation History

10. Victorian Mental Health Legislation History

11. Act History of Victorian Mental Health Legislation
The 1986 Mental Health Act
enshrined the principle
of ‘normalization’ and the move
to shorter stays, if any, in
bed-based psychiatric services.

12. Mental Health Act 2014
The Current Mental Health Act was Introduced in 1986
oldest Act within Australia
Not reflective of current mental health policy or best practice
unlikely to be compatible with the Charter of Human Rights, Convention on rights of Persons with a Disability, Convention on the rights of a Child.

13. MH ACT 2014

17. Presumption 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).

18. Capacity: 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 different
Criteria 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

19. The 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.

20. Displacing 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.
However
A 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.

21. How do you know if a person has capacity
The new legislation will establish a capacity test.
The Test
A 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.

22. Understands
The person must be able to understand the information relevant to a decision and the effects of that decision.
The person maybe supported to understand information
The 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.

23. Remember
The 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.

24. Use or weigh
The 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.

25. Communicate
A 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 others
A person should be able to communicate even on simple terms their understanding of the factors they considered relevant to their decision.

26. Advocates
The government will fund advocacy and support services/telephone advice to assist in decisions:
assessment
treatment
recovery

27. Advance statements
Enable 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.

28. Nominated person
A 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.

29. Carers and families
The support of carers and families is significant to patient recovery
involve carers and families in supporting patients to make decisions about their assessment, treatment and recovery wherever possible.

30. Compulsory treatment orders
The new legislation will establish compulsory treatment orders comprising:
An Assessment Order
A 28-day Treatment Order
A Treatment Order.

31. An Assessment Order
A registered medical practitioner or a mental health practitioner.
that the person appears to have a mental illness
needs treatment to prevent serious harm to the person

32. An Assessment Order
3. 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.

33. An Assessment Order
Enable an authorised psychiatrist to assess the person to determine whether they ‘have a mental illness’
will last for a maximum of 24 hours
extended up to a maximum of 72 hours in exceptional circumstances.

34. 28-day Treatment Order
After an Assessment Order the authorised psychiatrist may:
make a 28-day Treatment Order

35. 28 day Treatment Order
The 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 or
need treatment to prevent serious harm to another person.
no less restrictive means reasonably available, including a voluntary basis.

36. 28-day Treatment Order
A person is not to be placed on a compulsory treatment
history of mental illness
and as a result there may be a harm that manifests in the future.

37. 28-day Treatment Order
The 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.

38. Treatment Order
If 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 person
If the matter is not heard within 28-day the order will expire

39. Treatment Order
If 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)

40. Treatment Order
The authorised psychiatrist will be responsible for providing treatment:
The authorised psychiatrist will be able to vary the category of the Treatment Order if required.

41. Treatment Order
The authorised psychiatrist may make an application to the further Treatment Order to the Mental Health Tribunal
if the criteria for compulsory treatment still apply to the patient
the matter is not heard by the Mental Health Tribunal within the period of the order the Treatment Order will expire

42. Treatment 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 or
need treatment to prevent serious harm to another person.
no less restrictive means reasonably available, including a voluntary basis.

43. Treatment Order for young persons under 18 years of age
The authorised psychiatrist will be responsible for providing treatment:
Inpatient
Community
The authorised psychiatrist will be able to vary the category of the Treatment Order if required.

44. Treatment 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

45. Safeguards – 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 Board
MHT-will make Treatment Orders for patients
three members: a lawyer, a registered medical practitioner and a member of the community

46. Safeguards – increase safeguards to protect rights and dignity
Registered medical practitioner members will be qualified psychiatrists wherever practicable
the registered medical practitioner must be a psychiatrist when the MHT:
considering an application for electroconvulsive therapy
or psychosurgery for mental illness

47. Mental Health Tribunal
MHT will be a primary decision maker rather than a review body
MHT will perform its functions in a manner that promotes the principles and objectives of the MHA

48. Mental Health Tribunal
MHT will make order for /approve
Compulsory treatment beyond an initial 28 day period, including duration and the setting the order will take place.
All orders will be time limited
Applications 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.

49. Mental Health Tribunal
More frequent hearings scheduled at venues,
supplemented by a capacity to conduct videoconference
hearings as needed.
Adjournments will be limited to matters involving
exceptional circumstances.
Must be assumed that hearings have to proceed on the day they
are 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.

50. Electroconvulsive therapy
ECT may only be performed with the approval of the Mental Health Tribunal.
on a compulsory patient
or a person under 18 years of age with

51. Electroconvulsive therapy
ECT may only be performed with the approval of the Mental Health Tribunal.
on a compulsory patient
or a person under 18 years of age with

52. Electroconvulsive therapy-Informed Consent
If the MHT determines that a compulsory patient or young person has capacity to consent
the tribunal will still be required to give approval for ECT if the patient or young person gives informed consent

53. Electroconvulsive 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

54. Restrictive interventions (bodily restraint and seclusion)
improve the safety of restraint and seclusion
oversight 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.

55. Second psychiatric opinion
A right for compulsory patients to seek a second psychiatric opinion provided by a psychiatrist:
public mental health service
or in the private sector
Some additional state funds for second opinions provided by private psychiatrists.
Feedback is currently being sought from the Sector.

56. Second 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 team
the patient
family and carers

57. Second psychiatric opinion
Intended to promote self –determination for Pts by providing
Information about their treatment
Whether treatment is least restrictive
Better understand their illness
Empower them to contribute to decision the making.

58. Second psychiatric opinion
Authorised Psychiatrist will be required to
Consider the second psychiatric opinion
Will 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.

59. Second 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 report
The 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.

60. Second psychiatric opinion
Eligibility for a 2nd opinion
Patient under the nMHA, compulsory, forensic or security patient
Disclosed if they have obtained a 2nd opinion (from any source) within the last 12 months

61. Second psychiatric opinion
Who will provide the 2nd opinion
A Psychiatrist registered with AHPRA
A 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.

62. Oversight and service improvement
Mental Health Complaints Commissioner
The 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 providers
will have broad powers to investigate services, make recommendations and issue compliance notices

63. Oversight and service improvement
Chief Psychiatrist:
will focus on supporting public sector to deliver quality mental health services
also analyse data
undertake research

64. Oversight and service improvement
Chief Psychiatrist:
publish reports about the provision of public mental health services
monitor services and conduct investigations
issue directions to public mental health services to improve patient safety and wellbeing.

65. Oversight 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.

66. Oversight 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.

67. Oversight 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.

68. NMHA Steering Committee
Members of the Committee
Project Officer: Jim Reid (Chair)
Director of Nursing: Vic Tripp
Senior Psychiatric Nurse Consultant: Tim Lenten
Consultant Psychiatrist: Dr Holly Anderson
Bendigo CMH Team: Jan Tripp
Southern sector CMH Team: Sue Aitken
Northern Sector CMH Team: Brendan Watson
Inpatient Services: Rachel Finch
ETP Team: Belinda Crossley
Youth Mental Health: Steve Potter
CAMHS Team: Melinda Forbes
APMHS Team: Kevin Gerber

69. NMHA Steering Committee
Members of the Committee
St Lukes Service: Chris McInnes
Medicare Local: Jag Dhaliwal
Department of Health: Annette Toohey
Consumer Consultant: Brendan Landy
Carer Consultant: Cathy Spencer
Administrative Services Representative: Vance Lindrea
Bendigo Health Emergency Department: Carol-Anne Lever
Australian Nursing Federation: Loretta Marchesi/Donna Hansen
HACSU: Ginny Adams
Minute Secretary: Lyn Wilson