Mental Health Act 2014

Mental Health Act 2014

Overview Objectives of the Act (Section 10) Principles of the Act (Section 11) Statement of rights (Section 12) Capacity (Section 68) Informed consent (Section 69) Supportive decision making mechanisms (Sections 19, 23 & 78) Compulsory patients journey

Overview Assessment Order (Section 28) Temporary Treatment Order (Section 45) Treatment Order (Section 52) Second psychiatric opinions (Sections 78-89) Restrictive interventions (Section 105 116) Information sharing Summary

Objectives of the Act (Section 10) To assess & treat persons with Mental Illness To ensure least restrictive measures are considered To ensure least possible restrictions on rights and dignity To enable & support the patient to make and participate in decisions about their Assessment, Treatment and Recovery To provide oversight and safeguards To recognise the role of parents/carers

Principles of the Act (Section 11) To promote holistic care (mental & physical) that is responsive to the person s needs Person to make decisions about Ax, Tx and recovery that involves a degree of risk Person to have an opportunity to exercise some autonomy Person to have medical and other health needs recognised and responded to Carers and family should be involved in decisions about Ax, Tx and recovery whenever possible Carers and family should be recognised, respected and supported

Statement of rights (Section 12) Is a form which sets out the person's rights under the Act while being assessed or receiving treatment in relation to his or her mental illness It contains information as to the process by which the person will be assessed or receive treatment.

Capacity (Section 68) Outlines that a person has the capacity to provide informed consent if : He or she understands the information given Is able to remember the information Is able to use or weigh the information Is able to communicate the decision he or she makes

Informed consent (Section 69) Is the person capable to give informed consent to his/her treatment? Has the person been given adequate information to make an informed decision? Has the person received reasonable opportunity to make an informed decision? Has the person given consent freely without undue pressure or coercion? Has the person withdrawn consent or indicated their intention to withdraw consent?

Supportive decision making mechanisms (Sections 19, 23 & 78) s. 19 Advance Statements: gives the person greater control over treatment decisions and informs everyone on treatment preferences s. 23 Nominated Person: receives information and supports the person. s. 78 Second Psychiatric Opinion: Promotes the person's self-determination and the dialogue between clinicians and the person about treatment.

The Compulsory Patient s Journey ADMISSION & ENTRY ASSESSMENT CARE PLANNING & IMPLEMENTATION CARE EVALUATION SEPARATION/EXIT s. 68 Presumption of Capacity s. 69 Informed Consent s. 71(1)(a)(ii) NO consent to treatment? s. 19, 23, 78 Supported Decision Making Mechanisms s. 10 Objectives of the Act s. 11 Principles of the Act s. 12 Statement of Rights

Assessment Order (Section 28) Assessment Order Criteria (s.29) The person appears to have a mental illness. The person appears to need immediate treatment to prevent: MADE BY AUTHORISED BY ASSESSMENT ORDER 24hrs serious deterioration of the persons mental or physical health; or serious harm to the person or to another person. If the person is subject to an Assessment Order, the person can be assessed There is no less restrictive means reasonably available SETTING DURATION

MHA Old & New: Assessment MHA 1986 Assessment Request s.9 Recommendation 3days Made by registered medical practitioner S A M E NEW Order expires after 24hrs (max 72hrs) Setting can be either community or inpatient NEW Mental Health Practitioner Employed or engaged by the designated mental health service: Registered Psychologist Registered Nurse MHA 2014 Assessment It does not represent an admission Social Worker Registered OT s.28 Assessment Order 24hrs max 72hrs Made by registered medical practitioner or mental health practitioner

Group Activity Use the case scenario and answer the following questions: 1. Does this young person meet the criteria for an Assessment Order under section 29? 2. This young persons GP has made a Community Based Assessment Order under section 31. Is this an appropriate setting for this young person s assessment? Discuss. 3. If this young person does meet the criteria for the Assessment Order who must receive notification and copies of this order? Who is responsible for making these notifications?

Temporary Treatment Order (Section 45) Treatment Criteria (s.5) The person has a mental illness TEMPORARY TREATMENT ORDER (28 days) The person needs immediate treatment to prevent: serious deterioration of the persons mental or physical health; or serious harm to the person or to another person. Immediate treatment will be provided to the person if the person is subject to a temporary treatment order; and There is no less restrictive means reasonably available MADE BY SETTING & DURATION

MHA Old & New: TTO MHA 1986 Assessment s.14 CTO or s.9 Involuntary Admission Made by AP NEW Assessment Order expires after 24hrs (max 72hrs) NEW Setting can be either community or inpatient NEW The AP who made an Assessment Order in relation to a person MHA 2014 AP can place a person on a TTO for 28days if person meets criteria under s.5 AP must ensure that the views and preferences of the person as stated on the Advance Statement and their Nominated Person, carer or parent are considered. MUST NOT make the person subject to a Temporary Treatment Order. s.29 Assessment Order Temporary Treatment Order TTO (Community/Inpatient) 28days Made by AP

Group Activity Use the scenario and answer the following questions: 1. Based on the ECATT doctor s assessment it is believed that this young person would benefit from having his community based Temporary Treatment order varied to an inpatient based Temporary Treatment Order. Who can authorise this? 2. If the setting of the order is to be changed would this effect the duration of the order? Would the 28 day timeframe reset with the variation? 3. What role does the Mental Health Tribunal play in relation to this order? 4. At what point should Sarah be contacted? At what other stages during this young person s treatment should you contact Sarah? 5. CMI records show details of this young person s parents as carers? Can the team contact this young person s family?

Treatment Orders (Section 53) Treatment Order Criteria (s.5) The person has a mental illness COMMUNITY/INPATIENT TREATMENT ORDER The person needs immediate treatment to prevent: serious deterioration of the persons mental or physical health; or MADE BY serious harm to the person or to another person. Immediate treatment will be provided to the person if the person is subject to a temporary treatment order; and There is no less restrictive means reasonably available SETTING & DURATION Under 18years Valid for 3 mths Under 18years Valid for 3 mths

MHA Old & New: TO MHA 1986 s.14 CTO or s.9 Involuntary Admission Made by AP NEW NEW MHA 2014 TTO will expiry after 28days AP must make an application to the MHT if he or she is satisfied that the person continues to need treatment under s.5 and has ensured that the views and preferences of the person as stated on the Advance Statement and their Nominated Person, carer or parent have been considered. A MHT hearing must be conducted prior the 28 th day of the expiry date to determined whether the person continues to meet the treatment criteria under s.5. s.45 TTO (community or inpatient) 28days s.55 Treatment Order TO (Community/Inpatient) 12months or 6months Made by MHT

Treatment Options under the Act ASSESSMENT ORDER TEMPORARY TREATMENT ORDER COMMUNITY/INPATIENT TREATMENT ORDER Under 18years Valid for 3 mths Under 18years Valid for 3 mths

Restrictive interventions Sections 105-106 Sec 105: When may a restrictive intervention be used? May only be used on a person receiving MH services after all reasonable and less restrictive options have been tried or considered and have found to be unsuitable Sec 106: Facilities and supplies to be provided to a person All mental health services must ensure that the person s needs are met and person s dignity is protected by the provision of appropriate facilities and supplies

Restrictive interventions Sections 107-109 Sec 107: Notification of use of restrictive intervention Authorised psychiatrist must take reasonable steps to ensure that, as soon as practicable after the commencement of the use of a restrictive intervention to inform the nature of the intervention and the reason to the following a) Nominated person b) A guardian c) A carer/family d) Parent, if person is under the age of 16 years e) Secretary of DHS for person under custody order Sec 108: Use of restrictive intervention to be reported to the chief psychiatrist Sec 109: Release from restrictive intervention

Restrictive interventions Sec 110-111 Sec 110 When may seclusion be used? Person in a designated mental health service may be kept in seclusion to prevent imminent and serious harm to the person or to another person. Sec 111 Use of seclusion to be authorised The use of seclusion must be authorised by: a) Authorised psychiatrist b) If an authorised psychiatrist is not immediately available a registered medical practitioner or the senior nurse on duty

Restrictive interventions Sec 111 Sec 111 Use of seclusion to be authorised (continued) If a registered medical practitioner or senior registered nurse authorise seclusion they must notify an authorised psychiatrist as soon as practicable As soon as practicable, after notification, the authorised psychiatrist must examine the person and determine if the continued use of seclusion is necessary If the authorised psychiatrist is not reasonably available they must ensure that a registered medical practitioner examines the person and determines whether the continued use of seclusion is necessary The authorised psychiatrist or registered medical practitioner may continue seclusion if satisfied the continued seclusion is necessary

Restrictive interventions Sec 112 Sec 112 Monitoring of person in seclusion Registered nurse or registered medical practitioner must clinically observe person in seclusion as often as appropriate, but not less frequently than every 15 minutes Authorised psychiatrist must examine a person kept in seclusion as frequently as is appropriate in the circumstances to do so, but not less frequently than every 4 hours If not practicable for the authorised psychiatrist to conduct an examination at the frequency that is appropriate, the person must be examined by a registered medical practitioner when so directed by the authorised psychiatrist

Restrictive interventions Sec 113-114 Sec 113 When may a bodily restraint be used? May be used on a person receiving mental health services in a designated mental health service if the bodily restraint is necessary: a) To prevent imminent and serious harm to the person or to another person b) To administer treatment or medical treatment to the person Sec 114 Use of bodily restraint to be authorised. Must be authorised: a) By an authorised psychiatrist b) If an authorised psychiatrist is not immediately available, by a registered medical practitioner or the senior registered nurse on duty If the registered medical practitioner or senior nurse authorises bodily restraint the authorised psychiatrist must be notified as soon as practicable

Restrictive interventions Sec 114 Sec 114 Use of bodily restraint to be authorised (continued) Authorised psychiatrist must examine the person as soon as practicable to determine if the continued use of bodily restraint is necessary If the authorised psychiatrist is not available they must ensure that a registered medical practitioner examines the person and determines if bodily restraint continues to be necessary Authorised psychiatrist or registered medical practitioner may authorise that the continued use of the bodily restraint is necessary

Restrictive interventions Sec 115 Sec 115 Urgent use of bodily restraint without authorisation 1. A registered nurse may approve the use of bodily restraint (physical restraint only) on a person if: a) It is necessary as a matter of urgency to prevent imminent and serious harm to the person or another person b) If the authorised psychiatrist, registered medical practitioner or senior registered nurse is not immediately available 2. The registered nurse who approved bodily restraint must seek the authorisation from the authorised psychiatrist, a registered medical practitioner or the senior registered nurse on duty 3. A registered nurse must immediately stop the use of bodily restraint on the person if the continued use of the bodily restraint is no longer necessary Note: Only applies to physical hands on restraint it excludes mechanical restraint

Restrictive interventions Sec 116 Sec 116 Monitoring of person on whom a bodily restraint is used Person on whom bodily restraint is used must be under continuous observation by a registered nurse or registered medical practitioner Registered nurse or registered medical practitioner must clinically review the use of the bodily restraint in regards to the persons condition, but not less frequently than every 15 mins Authorised psychiatrist must examine a person whom bodily restraint is used as frequently as they see appropriate, but not less frequently than every 4 hours If it is not practicable for an authorised psychiatrist to examine, they must direct the registered medical practitioner to conduct an examination and frequency in which it should be done (as so directed)

Who must receive notification and copies of the all orders and treatment decisions as per the Mental Health Act 2014? The person subject to the order (with a verbal explanation of the purpose and effect of the order) Nominated person Guardian Carer Parent - If the person is under the age of 16 years The Department of Human Services, if the person is the subject of a custody or guardianship Secretary order

Advance Statement (Sections 19 22) Content: Advance statements may include a range of views and preferences, it is only treatment preferences pertaining to mental illness whilst the person is a compulsory patient that the mental health professional is obliged under the MHA, to comply with unless there is good reason not to comply Witness: Must be witnessed by an authorised witness, which includes a registered medical practitioner, a mental health practitioner or a person who may witness the signing of statutory declaration under s107a of the Evidence Act 1958. A consumer must remember to sign the statement when the witness is observing

Use of an advance statement The Authorised Psychiatrist must have regard to a person s advance statement whenever they make treatment decisions for a patient The Authorised Psychiatrist may make a treatment decision (excluding electroconvulsive treatment and neurosurgery for mental illness) where a patient does not have capacity to give informed consent or has capacity and does not consent to treatment Assist the Authorised Psychiatrist to make decisions that better align with the patient s treatment preferences Advance Statements cannot be amended, if the patients wants to make any changes to their treatment preferences, a new Advance Statement must be done.

Circumstances in which patient s preferences may be overridden (Section 73) An AP may override a patient s advance statement if they are: Satisfied that the preferred treatment is not clinically appropriate; or The treatment is not ordinarily provided by the designated mental health service If the AP overrides a patient s advance statement, they must tell the person, explain their reasons and advise the patient that they can request written reasons for the decision The AP must provide written reasons within 10 business days after being requested The AP must take reasonable steps to make compulsory notifications to necessary people

Nominated Persons (Sections 23-27) The Mental Health Act 2014 enables a consumer to nominate a person to receive information and to represent their views in the event that the consumer becomes unwell and requires assessment and/or treatment under a compulsory order The Act requires that the authorised psychiatrist consults with and informs the nominated person at critical points in the patients care such as when a temporary treatment order is made The same requirements to consult and inform apply to carers although in this circumstance the AP first needs to be satisfied that the treatment decisions directly affect the carer or care relationship. It should also be noted that obligations to consult and inform also apply to parents if the patient is under the age of 16 and to guardians

What is the role of the nominated person? 1. Provide the patient with support and to help represent the interests of the patient 2. Receive information about the patient in accordance with the Act 3. Be one of the persons who must be consulted in accordance with the Act about the patient's treatment 4. Assist the patient to exercise any right that the patient has under the Act Who can be a nominated person? It is the choice of the consumer as to who they nominate When is a nomination made? A person can make a nomination at any time provided they can understand what a nomination is and the consequences of making the nomination. There is no requirement for a person to appoint a nominated person

How is a nomination made? A nomination must be in writing and include: 1. Name and contact details of the nominated person 2. A statement signed by the nominated person agreeing to be the nominated person 3. A statement signed by the consumer identifying the nominated person as the person they want to take on this role 4. A statement signed by an authorised witness stating that: (i) In the opinion of the witness, the person making the nomination understands what a nomination is and the consequences of making a nomination; and (ii) The witness observed the person sign the nomination; and (iii) The witness is an authorised witness (see under terms and definitions)

Ensure that identification of significant people and NP are reviewed at relevant intervals Establishing phase: Clinician Pathway Explore what significant people the consumer has. Does the consumer have a NP? Explore consumer understanding of NP. Explain NP role if needed. Discuss implications of having or not having a NP. Does the consumer want to appoint a NP? Explain they can change their mind at any time. Identify other supports. No Yes No Yes Follow Practice Tips for Enabling Phase Ask who they would like to be their NP. Explore expectations of NP. Explain need for NP to be willing and have capacity. Explore implications of choice. Does the consumer want help to appoint the NP? - Facilitate the conversation with the desired NP, revisit NP role and responsibilities. - Facilitate drafting, signing and witness authorisation of NP form. (*Practitioner may witness) - Explore ongoing implications of NP - Explain option of revoking a nomination Yes Yes No No Does the person agree to be the NP? - Explain they can change their mind at any time. If the NP wants to decline the nomination - Explore with consumer and NP the implications of not having this person as NP in future - Explain option of making a new nomination If the consumer wants to revoke the nomination - Explore the implications of revoking the nomination - Facilitate drafting, signing and witness authorisation of revocation form - Explain that consumer must take reasonable steps to inform NP of revocation and if a patient, must inform authorised psychiatrist

Nominated Persons Video 1 Discussion between clinician and consumer about the NP

Nominated Persons Video 2 - Discussion between clinician and NP

Second psychiatric opinions (Sections 78-89) Exist to promote dialogue between clinicians and compulsory patients about treatment Can be requested at any time Written report from the second opinion psychiatrist will be provided to the patient, Authorised Psychiatrist, Nominated Person and others

Summary Establishes a comprehensive, individual focused legal scheme for the compulsory assessment, treatment, support and recovery of persons with mental illness Commenced Tuesday July 1, 2014 At the heart of legislative reform Recovery framework Presumption of capacity Supported decision making model

Resources http://www.rch.org.au/mhs/health-act www.health.vic.gov.au/mentalhealth/mhactreform/resources.htm

Mandatory Training 1. MHPOD Recovery Recovery Based Practice 2. RCH Learning Hero (E-Learning) MH Act Quiz MH Act Restrictive Interventions 3. Nominated Person Bouverie Centre on line module & quiz 4. Advance Statement Austin Health & MIND on line module & quiz