- Preface; The following post is an illustration of the Mental Health Act Queensland 2000 and it’s current application in the hospital services. On the 5th March 2017 the implementation of the 2016 Mental Health Act will address some additional procedures pertaining to assessment requests, and additional provisions for punitive action to be taken against health professionals that don’t adequately fill out request forms (among other things)… In anycase – read-on.
- Qld MHAct 2000 Focuses on aspects that cannot be dealt by any other mainstream legislation – i.e. involuntary assessment and treatment (amounting to detainment) in a hospital setting…
- Principles of the legislation amount to largely protecting the patient’s basic human rights in the provision of a involuntary order – this extends to encouraging the patient to engage and participate in decisions affecting their life and treatment.
- Tx can only be provided if appropriate
- Person has a right to confidentiality
- Seek no-less restrictive way to protect the persons health and safety or to protect others…
- Involuntary assessment; to determine if the person requires treatment for mental illness… assessment MUST be made by an authorised mental health doctor.
- Main conditions
- If a patient lacks capacity or has unreasonably refused to be assessed
- The person appears to have a mental illness
- The person requires immediate assessment
- Assessment is made at a health service
- No less restrictive way of ensuring the pt is assessed
- Request and Recommendation Forms
- Two separate clinicians are involved in submitting either form.
- Any doctor can fill a request form, however an autherised Mental Health doctor can only fill the recommendation form – they can also be the doctor involved in the mental heath assessment (MHA) and subsequent treatment.
- Within 24 hrs of lodging R&R forms a mental health assessment must be completed … extensions can be made up to the 48th
- Reasons for Recommendation…
Regarding appearing to have a mental illness…
– At a minimum the dr or authorised mental health practitioner should be satisfied that there is sufficient indication of mental illness to warrant referral for furter expert assessment…
– Record the facts, which your opinion relies on… (e.g. evidence of mental illness at the time of examination, clinical hx, evidence of mental illness reported by family and others…)
– personal observation must be distinguished from facts communicated by others…
Regarding requirement for immediate assessment…
– Dr should be satisfied that, having regard to all of the circumstances, the person’s assessment should not be delayed.
– Record the reasons and the likely consequences of not undertaking an assessment…
Regarding the assessment being made at an authorised mental health service
– involuntary assessment should only occur if the person has a condition or appears to have a condition that can be properly assessed at a mental health service
– Record information about assessment required and how this can be provided for at the service.
- Main conditions
Regarding Capacity to consent;
- The issue of consent relates to the person’s own capacity to consent. If a guardian has been appointed under the guardianship act 2000 for a person, the guardian’s consent to the person’s assessment is not effective.
- For the purposes of assessment, capacity (defined in the Act’s dictionary) means the person is capable of;
- Understanding the nature and effect of decisions about the person’s assessment and
- Freely and voluntarily making decisions about the person’s assessment and
- Communicating the decision in some way…
- In addressing the criterion on the recommendations for the assessment, the doctor or practitioner should document the elements of capacity that are not met and the basis for this option.
Regarding Unreasonable Refusal;
- Unreasonable refusal is not specifically defined in the legislation… example of when a person’s refusal could be considered unreasonable include…
- When the refusal would put the pt’s safety or the safety of others at risk…
- When the basis of the person’s decision to refuse assessment is not rational.
- Other requests;
- Justice Examination order (JEO);
- made by JP(qual)/Magistrate
- Valid for 7 days
- Emergency examination order (EEO);
- made by the Ambulance or Police officer OR psychiatrist
- Valid for 6 hrs
- Strict criteria apply
- Must be examined by dr or authorised mental health practitioner to determine a recommendation for assessment should be made.
- If a recommendation for assessment is not made, arrangements must be made for the person to be returned to place the person reasonably asks to be taken.
- Inherent safeguards for patients;
- R&R are made by 2 separate people
- The JEO cannot be a relative or employee of the person making the recommendation…
- Penalties for provision of false and misleading information
- Once a mental health assessment is made a decision MUST be made to determine whether the patient requires another assessment (within 24 hrs) OR cancellation of their involuntary assessment orders OR to proceed with treatment (voluntary/involuntary).
- Justice Examination order (JEO);
- Mental Health Review Tribunal;
- Independent body of at least 3 people; lawyer, psychiatrist and community member …
- Review within 6/52 of the ITO in place
- The mental health team appeals to the tribunal for reasons to keep the ITO in place…
- Able to cancel the ITO at their discretion
A word about the 2016 act…
- It’s ultimately going to be harder for dr’s to assess capacity
- Legally trained patients rights advisors (AO7 job) will be appointed to scruitine everything in documents and patient charts.
- The act represents another step forward for patient rights…
- Strengthens the role of family and support persons
- Better aligns the legislation with good clinical practice
- Consumers, clinicians and the legal fraternity will benefit from the improved and simplified practices and increase the focus on pt rights and recover.y..