IN THE MATTER OF ADAM (Mental Health)
[2020] ACAT 91
•12 November 2020
ACT CIVIL & ADMINISTRATIVE TRIBUNAL
IN THE MATTER OF ADAM (Mental Health) [2020] ACAT 91
MH 291/2020
Catchwords: MENTAL HEALTH – requirements for a psychiatric treatment order – requirement that the person refuses to receive treatment care and support – requirement that the treatment cannot be adequately provided in another way
Legislation cited: ACT Civil and Administrative Tribunal Act 2008 ss 39, 40
Guardianship and Management of Property Act 1991 Pt 2A, s 70A
Human Rights Act 2004 ss 10, 13, 28, 30, 40B
Legislation Act 2001 s 179
Mental Health Act 2015 ss 5, 6, 56, 58, 85, 190, 194
Mental Health Act 2007 (NSW) ss 12, 14, 38
Mental Health Act 2014 (Vic) ss 5, 55
Cases cited:Chief Psychiatrist and A [2011] ACAT 21
In the matter of BC [2018] ACAT 67
In the matter of ED [2017] ACAT 84
In the matter of FG [2018] ACAT 134
In the Matter of Michael [2020] ACAT 8
In the Matter of Renée [2019] ACAT 116
Other sources: Principles for the protection of persons with
mental illness and the improvement of mental health care, GA Res 46/119, UN GAOR, 46th session, 75th plen mtg, Agenda Item 98, Supp No 46, UN Doc A/RES/46/119 (17 December 1991)
Tribunal:Acting Presidential Member R Orr QC
Senior Member Dr K Lubbe
Date of Order: 23 July 2020
Date of Reasons for Decision: 12 November 2020
AUSTRALIAN CAPITAL TERRITORY
CIVIL & ADMINISTRATIVE TRIBUNAL MH 291/2020
IN THE MATTER OF ADAM
TRIBUNAL: Acting Presidential Member R Orr QC
Senior Member Dr K Lubbe
DATE:23 July 2020
ORDER
No order made
…………Signed……………..
Acting Presidential Member R Orr QC
For and on behalf of the Tribunal
REASONS FOR DECISION
A delegate of the Chief Psychiatrist sought a psychiatric treatment order (PTO) in relation to Adam.[1] This application was made on the basis of a report from a delegate of the Chief Psychiatrist, (Psychiatrist) dated 20 July 2020 (Report). The Tribunal heard the application at the Adult Mental Health Unit, Canberra Hospital (AMHU) on 23 July 2020. The Tribunal made an order refusing the application for a PTO and provided brief reasons. These reasons now set out in more detail the basis for that order.
Summary of Tribunal decision
[1] Given that this matter concerns a mental health hearing, in these reasons the Tribunal has chosen a name for the patient that bears no resemblance to his real name, and has not disclosed facts which would enable him to be identified.
There are six material requirements that must be met in order for a PTO to be made. They are set out in section 58(2) of the Mental Health Act 2015 (Mental Health Act), which is in the appendix to these reasons. On the basis of the Report and the evidence before it, the Tribunal found that four of the requirements for a PTO were met, namely that Adam had a mental illness; that he did not have decision-making capacity; that because of the mental illness he was suffering serious mental deterioration; and that psychiatric treatment, care and support (called treatment in these reasons) was likely to reduce that deterioration.
However, the Tribunal was not satisfied that Adam met the requirement that he refuses to receive the treatment he needs for his mental illness (section 58(2)(b)(i)) and the requirement that the treatment to be provided under a PTO cannot be adequately provided in another way that would involve less restriction of Adam’s freedom of choice and movement (section 58(2)(g)).
Regarding refusal, Adam did do and say some things when he was admitted to hospital which suggested he was refusing to receive treatment. But at the hearing he said that he now consented to the treatment. This is not usually sufficient, and the Tribunal also looked at a range of other factors in considering whether it was likely that he would continue to consent to the treatment if a PTO was not made. These factors included that he had maintained a treatment regime for his attention deficit hyperactivity disorder (ADHD) over many years, though he had recently not had his prescription filled. He had no other history of refusing treatment for this condition.
His acts which suggested he refused treatment took place when he was very sick and under great stress and where he said that the new regime had not been fully explained to him. He accepted at the hearing that he had been very sick and had a mental illness, and he had been recently accepting treatment. He had a supportive family and a home, and a past history of voluntarily accessing community mental health services. This was his first admission to hospital for a psychotic mental illness. He had improved under the treatment. These factors lead us to decide that it was not likely that he would refuse to receive the treatment if a PTO was not made.
Also, for similar reasons we were not satisfied that the treatment to be provided under the proposed order could not be adequately provided in way other than under a PTO. In our view it could be provided to Adam as a voluntary patient.
On this basis the Tribunal decided not to make a PTO. Of course, if the situation changes, and in particular if Adam refuses to receive treatment, the treating team can make another application.
The application
In July 2020, Adam was brought to the hospital by police officers. Some aspects of the circumstances which led to this are discussed below. A treating doctor made an emergency detention order in relation to him under section 85(1) of the Mental Health Act[2] (ED 3 order). The Tribunal extended the operation of that order for a further 11 days under section 85(2) and (3) of the Mental Health Act (ED 11 order). During the period when the emergency detention order was in force, the Psychiatrist and the treating team prepared their Report which formed the basis of the application for a PTO.
[2] For an analysis of emergency detention orders, see In the Matter of ED [2017] ACAT 84
On 23 July 2020, the Tribunal held a hearing to determine whether a PTO should be made. The Psychiatrist and other members of the treating team attended the hearing. Adam also attended, along with his parents, with whom Adam lives. Adam provided a written statement dated 21 July 2020, which was supported by his parents, who also signed it (Adam’s statement). His parents provided an additional statement dated 21 July 2020 (parents’ statement). Adam and his parents all participated in the hearing.
Under section 194 of the Mental Health Act, such a hearing must be held in private, but may be held in public if an order to that effect is made. No such order was made. However, an order was made under section 190(2) of the Mental Health Act allowing those who were present at the hearing to appear and give evidence.[3]
[3] Transcript of proceedings 23 July 2020 page 3
If the Tribunal makes an order and a party asks for a statement of reasons for the making of the order, the Tribunal must give the party a written statement of reasons or a transcript of an oral statement of reasons for the making of the order.[4] The statement of reasons must set out any principles of law relied on by the Tribunal and the way in which the Tribunal applied the principles of law to the facts. Further details of what must be included in a statement of reasons is set out in section 179 of the Legislation Act 2001. Such a request was made in this case, and this statement seeks to comply with these requirements. As noted, we have taken steps to prevent Adam being identified from these reasons.
[4] Section 60 of the ACT Civil and Administrative Tribunal Act 2008
As stated in section 58(2) of the Mental Health Act (set out in the appendix), there are in substance six requirements for a PTO. We considered each of these.
1. The person has a mental illness (section 58(2)(a))
The Report stated that Adam had had a “first episode psychosis” with “paranoid persecutory delusions, with labile mood and thought disorder.” It noted that Adam has a background history of ADHD, but that this was his first psychiatric admission to hospital. It said that he was brought in “expressing suicidal ideation”, was “sending messages to friends that he was involved in a family violence situation”, “had guns at home”, “tried to abscond”, “required sedation with IM (sic) medication” and that “he had decided to leave his current accommodation and go elsewhere”.[5] The Psychiatrist stated that Adam had said that he did not have a mental illness and did not want to take medication, and would contact the community mental health team if he wanted to.[6]
[5] Report, page 3
[6] Transcript of proceedings 23 July 2020 pages 6, 15
At the hearing, the Psychiatrist stated that Adam was more settled though he still remained suspicious and paranoid and was difficult to fully engage for mental health treatment. The Psychiatrist thought that until they could establish a treatment plan Adam needed to remain in hospital, possibly for another week.[7]
[7] Transcript of proceedings 23 July 2020 page 4
Adam said that he had ADHD and had been treated with dexamphetamine for a number of years. With the prescription running out and the COVID-19 pandemic situation making it difficult to get the medication, he had seen this as an opportunity to give his body a break and be chemical free. However, in the month before his admission he had trouble focussing and remembering, became agitated and in the week before was unable to sleep. On the night of his detention he said he was extremely agitated and anxious, and agreed he was delusional.[8]
[8] Adam’s statement 21 July 2020 pages 1-2
He admitted that he thought he was being poisoned by his sister and said this was when she was mixing with the wrong people. He admitted that he was planning to leave his family’s house, but only to visit family and friends or go camping. He admitted he owned guns, but said that he had the relevant licences, stored the guns safely and generally complied with the relevant legal regime. He stated that when the police arrived, he informed them that he had guns. He said that at no time did he intend to use the guns to harm himself or others.[9]
[9] Adam’s statement 21 July 2020 pages 4, 12
Adam said that after being held at the hospital for over six hours he was extremely anxious and agitated and felt that a nurse was taunting him, to which he responded “do you want me to go crazy and strangle myself”. He admitted that at this stage he wanted to leave the hospital, and when the nurse turned his back he saw that as an opportunity to run, but the attempt was unsuccessful.[10] His lawyer indicated at the hearing that he “agrees he was experiencing symptoms of a mental illness”.[11]
[10] Adam’s statement 21 July 2020 pages 1-2
[11] Transcript of proceedings 23 July 2020 page 29
Adam’s parents indicated that while on dexamphetamine medication Adam was a normal functioning adult and had his ADHD under control. However, with the COVID-19 restrictions and his prescription running out he thought this was an opportunity to give his body a rest from all the medications. They indicated that in the months and weeks leading up to the detention his ADHD symptoms returned and he became increasingly anxious, unable to control his racing thoughts, suffered sleeplessness, and experienced delusions. They said that on the evening that Adam was taken to the hospital he was not quite right and was worse than he had been in the past.[12]
[12] Parents’ statement; transcript of proceedings 23 July 2020 pages 21-22
The Tribunal accepts the statements in the Report that Adam was having a psychotic episode, and had a mental illness as defined in section 10 of the Mental Health Act, that is, an illness that is a condition that seriously impairs his mental functioning in the area of thought, and can be characterised by delusions. As noted, Adam agreed he was delusional when admitted, and took the position in the hearing that “he was experiencing symptoms of a mental illness”.[13] Therefore, the requirement that he had a mental illness was made out.
2. The person does not have decision-making capacity (section 58(2)(b)(i))
[13] Transcript of proceedings 23 July 2020 page 29
The Report stated that Adam did not have decision-making capacity in relation to most of the elements of making a decision about his treatment care and support.[14] It was said that he did not believe he had an illness and that when thought disordered he had difficulty taking in and processing information so he could not come to a decision.
[14] Section 7 of the Mental Health Act states seven aspects of cognitive understanding, each of which a person must have (with assistance if needed) in order to have capacity to make a decision in relation to their treatment, care or support for a mental disorder or mental illness
Adam said he had capacity,[15] although he seemed to admit that he had a mental illness. He also admitted that he had been extremely agitated, anxious, and delusional when he was brought to the hospital.
[15] Transcript of proceedings 23 July 2020 page 29
There was therefore significant evidence that Adam had been significantly thought disordered, and remained so to some extent at the hearing, even though he had improved. The Tribunal accepted the assessment in the Report that Adam did not yet have decision-making capacity to consent to the treatment. We consider the requirement of refusal below, but note here that section 8(1)(f) of the Mental Health Act states that a person must not be treated as having decision-making capacity to consent to treatment only because the person complies with the provision of treatment.
3.The person refuses to receive the treatment (section 58(2)(b)(i))
The Report stated that Adam tried to abscond from the emergency department after he had been brought in, that he initially declined medications but agreed to take them after discussion, and that he was fearful of side effects. It was stated that Adam does not believe he is unwell or requires treatment.[16] At the hearing, the Psychiatrist stated that Adam was now agreeing to take the relevant medication.[17]
[16] Report page 6
[17] Transcript of proceedings 23 July 2020 page 23
Adam said in his statement that he intends to go back to his GP and personal psychiatrist.[18] He stated that he would accept the treatment even if there was not a PTO, but that he would prefer not to have a PTO.[19] His mother stated that from her understanding he was not refusing to take medication, but he was more worried about a negative record on his file.[20] The submissions made on behalf of Adam were that he was not currently refusing treatment, and that his initial refusal was due to the lack of a proper explanation for the treatment.[21]
Refusal of treatment is a necessary requirement
[18] Adam’s statement 21 July 2020 page 5
[19] Transcript of proceedings 23 July 2020 page 26
[20] Transcript of proceedings 23 July 2020 page 28
[21] Transcript of proceedings 23 July 2020 page 29
We begin with a few observations about refusal, as a precondition to making a PTO.
First, it is clear from the terms of section 58(2)(b)(i) that for a person with a mental illness and without capacity, ‘refusal of treatment’ is an additional necessary requirement before a PTO can be made.[22] This requirement was apparently first added into ACT law by the Mental Health (Treatment and Care) Amendment Act 2014 (2014 Act).[23] [24] The relevant explanatory statement for the Bill that became that Act (explanatory statement) at pages 130-131 said that what is now section 58(2) differed from the previous criteria in three ways:
First, as well as having a mental illness, the person must also either:
·have no decision-making capacity for giving consent to the treatment, care or support and refuse to receive the treatment, care or support; or
·have decision-making capacity, but refuse to consent to the treatment, care or support. [Emphasis added]
[22]In the matter of FG [2018] ACAT 134 at [27]-[104]; In the matter of BC [2018] ACAT 67 at [18]-[25]
[23] The earlier requirements are set out and discussed in Chief Psychiatrist and A [2011] ACAT 21
[24] The requirement of refusal is unusual. It is not a general requirement for the equivalent of a PTO in the NSW Mental Health Act 2007, see sections 12, 14 and 38 (but see section 53(3)(c) and (5)), or in the Victorian Mental Health Act 2014, see sections 5 and 55
Second, the policy behind this requirement seems to be that a person with a mental illness has the same rights as others,[25] and that those providing services to a person with a mental illness should support and allow them to make their own decisions and respect their decisions to accept treatment whenever practicable and appropriate.[26] That is, even though a person may have a mental illness and not have capacity, if they accept treatment, this acceptance should be respected rather than rendered irrelevant by a compulsory treatment order. Further, the policy is clearly that a person with a mental illness should receive treatment in a way that is least restrictive of them and that respects their rights, inherent dignity, and needs.[27] Allowing a person to accept treatment, rather than requiring them to undergo treatment by a compulsory order, is less restrictive to them.
[25] Mental Health Act section 6(a)
[26] Mental Health Act sections 5(b), 6(b), (d) and (j) and 56(1)(b)
[27] Mental Health Act sections 5(c) and (d) and 56(1)(g), picked up specifically in section 58(2)(g) discussed below
Third, this approach is supported by human rights considerations in ACT law. Section 10(2) of the Human Rights Act 2004 (Human Rights Act) provides that “no-one may be subject to medical… treatment without his or her free consent”, though this right may be subject to reasonable limits set by laws that can be demonstrably justified in a free and democratic society (section 28). Section 58 of the Mental Health Act and PTOs limit the right in section 10(2) of the Human Rights Act, but the requirement of refusal restricts the circumstances where such a limitation of the human right can take place. That is the human right can only be so limited where the person refuses the treatment. The Mental Health Act is required to be interpreted in light of this right “so far as it is possible to do so consistently with its purpose.”[28] The existence of the right reinforces that proper regard must be had to the requirement for refusal. The Human Rights Act similarly provides for freedom of movement,[29] which section 58 and PTOs also restrict.
[28] Section 30 of the Human Rights Act
[29] Human Rights Act section 13
Fourth, the requirement of refusal, separate from the requirement of lack of capacity, raises a range of issues. The explanatory statement for the 2014 Act noted at pages 217-218 that amendments were also made to address the situation where a person lacks decision-making capacity to consent to treatment, but expresses a willingness to receive treatment or simply acquiesces to treatment. In such situations the person will often not meet the requirement of refusing treatment, in which case they cannot be the subject of a PTO. If this is the position, a guardian with power to give consent to medical treatment can give consent to treatment of the person’s mental illness.[30] If a guardian has not been appointed at the time that consent for treatment is required and, as is often the case, there is not a relevant advance consent direction in place under Part 3.3 of the Mental Health Act, the 2014 Act provided for health attorneys. Such a health attorney, who can be a partner, carer, relative or friend may give consent for medical treatment including treatment for a person’s mental illness, which may or may not include treatment under the Mental Health Act.[31] However, the period for which a health professional can rely on the consent of a health attorney is limited.[32] It was said in the explanatory statement that these arrangements for a health attorney allow for the person’s mental illness to be treated in the short to medium term.
[30] See In the Matter of Renée [2019] ACAT 116 at [11]–[14]; In the Matter of Michael [2020] ACAT 8 at [84].
[31] See Part 2A, especially sections 32A, 32B and 32D of the Guardianship and Management of Property Act 1991 (Guardianship Act)
[32] To 21 days under section 32JA(3) of the Guardianship Act, though this can be extended by the Tribunal under section 32JA(5)
For completeness, it is also noted that section 70A(1) of the Guardianship Act provides that a guardian who has power to give consent for medical treatment for a person under the Mental Health Act may consent to that treatment only (among other things) if the person “expresses willingness to receive the treatment”. Without that willingness, an order under the Mental Health Act, or authority under some other provision, is required for the person to receive treatment. This section reinforces the policy that refusal is an important requirement for a PTO under section 58 of the Mental Health Act.
What constitutes refusal
The Tribunal has generally taken the view that it is not enough that a patient simply says that they will not refuse, that is, says they will accept the treatment, for section 58(2)(b)(i) to prevent the making of a PTO. The Tribunal has generally looked at broader factors including (where applicable) the person’s past acceptance or refusal of treatment to determine whether it is likely that they will consent to the treatment in the period within which it would otherwise be ordered.[33] This reflects the reality of the effect of a mental illness, and the resulting lack of capacity, on people. It is an approach supported by the possible significant detrimental effect on a person if an order is not made on this basis. That is, that a person with a mental illness, without capacity, who is likely to do serious harm to themselves or someone else or suffer serious mental or physical deterioration, will not be required to have treatment.
Application of the requirement of refusal in this case
[33] Section 56(1)(i) of the Mental Health Act; In the matter of FG [2018] ACAT 134 especially at [70]-[74] and [99]-[104]; In the matter of BC [2018] ACAT 67 at [18]-[25]
In this case, there were some features which suggested that Adam may refuse the treatment. When he was first brought to the hospital he tried to abscond and refused treatment. The Psychiatrist said that at some point he had indicated that he did not believe he had a mental illness and would not take the prescribed medication.
But there were a number of features which suggested that Adam was likely to continue the treatment if an order was not made. Adam admitted he had ADHD, and had actively pursued and then maintained treatment for it. Indeed, he said that when he was seeking this treatment his psychiatrist did not believe he had ADHD and so he had to bring in his report cards from school to prove that he did.[34] It seems that he had been voluntarily on medication for ADHD for many years, and regularly visiting his local mental health service in relation to this condition.
[34] Transcript of proceedings 23 July 2020 page 10
It is true that he had recently stopped taking the medication, even though he had initiated this treatment and was a voluntary patient for many years. This step was linked, at least to some extent, to problems associated with the COVID-19 pandemic and the difficulty that caused in him obtaining the medication. He also said he thought this an opportunity to give his body a break and be chemical free, which does not seem an unreasonable position. He now indicated that he would take the medication for ADHD. The treating team was not providing this because of the need to treat Adam’s psychosis.
The events of the day on which Adam was taken to the hospital were clearly very dramatic. Adam and his parents contested some of the elements of the version of these events relied on in the Report, but on any version Adam was very distressed. It was directly after these events and having been in the hospital for a number of hours that Adam tried to ‘leave’ and ‘refused’ medication. He argued that at this stage there had not been a proper explanation to him of what the medication was for.[35]
[35] Transcript of proceedings 23 July 2020 page 29
At the time of the hearing Adam was clearly in a different state. He admitted that on the night of his detention he was extremely agitated, anxious, and delusional. But he denied threatening to harm himself or others, which the Tribunal accepts (see paragraph [44] below). Importantly at the hearing he agreed he was experiencing symptoms of a mental illness and said he would accept the medication from the treating team, with or without a PTO. He expressed the view that he would however prefer not to be on a PTO.
This is the first psychotic event for Adam. There is no evidence of past events, or evidence of past failure to comply with relevant treatment regimes, which can be strong evidence that there is likely to be future refusal.
It is also relevant that Adam lives with his parents, who were very supportive of him and the treatment regime he needs. They can be his health attorney under the Guardianship Act for the purpose of consenting to the treatment for his mental illness without the need for a PTO. As noted below, we do not think that he is likely to be a danger to them, himself or others.
On the basis of Adam’s statement that he consents to the treatment, his significant past history of complying with the treatment regime for his ADHD, his explanation that he was very distressed and delusional when he was brought to the hospital and that the treatment regime was not fully explained to him at that time, his improved condition, and his acceptance that he has a mental illness and his current compliance with the treatment regime, we did not think that Adam refused to receive the treatment. It follows that we did not have power to make a PTO.
The absence of refusal was enough to dismiss the application. However, for completeness, we considered the other criteria.
4. The person is likely to do serious harm to themselves or someone else (section 58(2)(c)(i)) or is likely to suffer serious mental or physical deterioration (section 58(2)(c)(ii))
The Report said Adam was at risk of harming himself and had expressed suicidal ideation before admission. It also said that he was at risk of harming others if he acts out on his delusional beliefs.
Adam indicated that at no time did he intend to use his guns to harm himself or others. Rather, during the episode, he thought he was in danger of being held against his will. He said that at no time did he threaten his parents or anyone else. His version of the self-strangulation comment is noted above at paragraph [17]. He said that he never intended to harm or kill himself.[36] Through his lawyer he indicated that he had had suicidal ideation in the past, but by implication not recently.[37]
[36] Adam’s statement 21 July 2020 page 5
[37] Transcript of proceedings 23 July 2020 page 23
Adam’s parents said in their statement that at no time did he threaten to harm himself or them, though conversations were at times heated. They did not hear him say he was going to harm himself.[38]
[38] Transcript of proceedings 23 July 2020 page 17
On the basis of Adam’s evidence and that of his parents, the Tribunal has significant doubt that he was likely to do harm to himself or someone else, and therefore we do not think that the requirement in section 58(2)(c)(i) was made out.
However, there is an alternative requirement in section 58(2)(c)(ii), namely that because of the illness he was suffering or likely to suffer serious mental or physical deterioration. The Report said that when psychotic and thought disordered, it was likely he would not be able to attend to his needs, and that there was a risk of further mental deterioration if he should remain untreated.
The Tribunal accepts this expert opinion. Adam was clearly very unwell when he was brought to the hospital. While he had improved with treatment, it clearly remained the case that because of his mental illness he was suffering serious mental deterioration. The fact that with treatment this was improving, and was likely to improve more, and that Adam agreed to the treatment, did not change this position. This requirement was therefore met.
5. The psychiatric treatment is likely to reduce the deterioration (section 58(2)(e)(i))
The Report stated that Adam has been commenced on oral antipsychotic medication which he will need to continue until he has shown improvement in symptoms and hopefully insight; that he will be referred for case management and to see his community team after discharge; and that during his admission he will attend the activities and groups and receive support from psychologists and social workers. The Report stated that it was hoped that with treatment Adam’s symptoms will resolve and he will gain insight.[39] At the hearing it was clear that he had some insight into his illness, and it seemed that it was likely this would continue to improve. It was not disputed by Adam that treatment was likely to reduce deterioration. Therefore, this requirement was met.
6. The treatment cannot be adequately provided in another way (section 58(2)(g))
[39] Report pages 6-7
There is a requirement in section 58(2)(g) that the treatment to be provided under the PTO cannot be adequately provided in another way that would involve less restriction of the freedom of choice and movement of the person. The Report stated that there was no safe less restrictive way than a PTO that treatment could be provided. It stated that Adam has been moved from the high dependency unit (HDU) to the low dependency unit (LDU) at the AMHU but currently he was not fit for treatment in the community.[40]
[40] Report page 7
As noted above, this requirement reflects a key policy under the Act.[41] The explanatory statement provided that the relevant provisions of the Mental Health Act were “explicitly directed towards ensuring that the person’s liberty is interfered with by detention and treatment to the least extent commensurate with them receiving the treatment, care or support they need to prevent their health and safety, or others’, from being seriously compromised.”[42] This policy is reflected in what is now section 58(2)(g) of the Mental Health Act. The explanatory statement went on to say that these provisions reflect Principle 9(1) of the United Nations, Principles for the protection of persons with mental illness and the improvement of mental health care (1991)[43] which states:
Every patient shall have the right to be treated in the least restrictive environment and with the least restrictive or intrusive treatment appropriate to the patient's health needs and the need to protect the physical safety of others.
[41] See also Mental Health Act 2007 (NSW) sections 12(1)(b), 38(1); and Mental Health Act 2014 (Vic) section 5(d)
[42] Pages 63-64
[43] Adopted by General Assembly resolution 46/119 of 17 December 1991
In our view it is likely that treatment can be provided to Adam in a way other than under a PTO, that is as a voluntary patient. The matters which we have considered in relation to the issue of refusal support this conclusion.
In particular, Adam’s parents indicated that they would be supporting him in his recovery.[44] He lives with his parents. As noted above, we did not think that he is likely to be a danger to himself or others.
[44] Transcript of proceedings 23 July 2020 page 24
Therefore, we concluded that this requirement was not met.
Conclusion
All six substantive requirements need to be met for a PTO to be made. We did not think that the requirements for refusal and that the treatment cannot be provided in another less restrictive way had been met. Therefore, we did not make the PTO.
This was not an easy decision, in particular because the issue of whether there had been refusal involved assessing a range of evidence. Whilst we declined to make the order, the application was properly made. The Psychiatrist and the treating team made the application based on the information available to them at the time, but more information became available by the time the Tribunal heard the application, including that Adam had improved thanks to their care.
If the situation changes, and in particular if Adam refuses to receive treatment, the treating team can make another application.
………………………………..
Senior Member R Orr QC
For and on behalf of the Tribunal
APPENDIX
Section 58(2) of the Mental Health Act 2015
(2)The ACAT may make a psychiatric treatment order in relation to the person if—
(a) the person has a mental illness; and
(b) either—
(i)the person does not have decision-making capacity to consent to the treatment, care or support and refuses to receive the treatment, care or support; or
(ii)the person has decision-making capacity to consent to the treatment, care or support, but refuses to consent; and
(c) the ACAT believes on reasonable grounds that, because of the mental illness, the person—
(i)is doing, or is likely to do, serious harm to themself or someone else; or
(ii)is suffering, or is likely to suffer, serious mental or physical deterioration; and
(d) in relation to a person mentioned in paragraph (b) (ii)—the ACAT is satisfied that the harm or deterioration, or likely harm or deterioration, mentioned in paragraph (c) is of such a serious nature that it outweighs the person’s right to refuse to consent; and
(e) the ACAT is satisfied that psychiatric treatment, care or support is likely to—
(i)reduce the harm or deterioration, or the likelihood of the harm or deterioration, mentioned in paragraph (c); or
(ii)result in an improvement in the person’s psychiatric condition; and
(f) if an application has been made for a forensic mental health order—the ACAT is satisfied that a psychiatric treatment order should be made instead; and
(g) the ACAT is satisfied that the treatment, care or support to be provided under the psychiatric treatment order cannot be adequately provided in another way that would involve less restriction of the freedom of choice and movement of the person.
HEARING DETAILS
FILE NUMBER: | MH 291/2020 |
PARTIES, APPLICANT: | Chief Psychiatrist |
PARTIES, RESPONDENT: | Adam |
COUNSEL APPEARING, APPLICANT | N/A |
COUNSEL APPEARING, RESPONDENT | N/A |
SOLICITORS FOR APPLICANT | N/A |
SOLICITORS FOR RESPONDENT | ACT Legal Aid |
TRIBUNAL MEMBERS: | Acting Presidential Member R Orr QC Senior Member Dr K Lubbe |
DATES OF HEARING: | 23 July 2020 |
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