Re D (No 2)

[2025] NSWSC 251

Supreme Court

New South Wales

Medium Neutral Citation:	Re D (No 2) [2025] NSWSC 251
Hearing dates:	14 and 20 March 2025
Date of orders:	25 March 2025
Decision date:	25 March 2025
Jurisdiction:	Equity
Before:	Hammerschlag CJ in Eq
Decision:	Summons dismissed. The injunction made by Lindsay J on 7 February 2025 is dissolved. The Notice of Motion dated 28 February 2025 is dismissed.
Catchwords:	MENTAL HEALTH – Community treatment order – Proceedings by plaintiff seeking to appeal community treatment order authorising compulsory treatment of her in the community – Where the plaintiff has a diagnosis of bipolar affective disorder and displays grandiose delusions, examples of which were demonstrated throughout the hearing – Where plaintiff has a demonstrated history of resisting or not complying with previous treatment plans, which leads to worsening of her condition, and has history evidencing she is a risk of harm to herself and others – HELD: the community treatment order should be continued
Legislation Cited:	Mental Health Act 2007 (NSW) ss 14(1), 51(1), 53, 54, 56(1), 56(2), 163, 164
Cases Cited:	SMF v South Western Sydney Local Health District [2018] NSWSC 303
Category:	Principal judgment
Parties:	D (Plaintiff) Sydney Local Health District (First Defendant) Mental Health Review Tribunal (Second Defendant)
Representation:	Counsel: J Wilcox (First Defendant) Solicitors: Plaintiff (self-represented) Crown Solicitor’s Office (First and Second Defendants)
File Number(s):	2025/00050117
Publication restriction:	The name of the plaintiff has been anonymised pursuant to an order of Lindsay J dated 7 February 2025.

JUDGMENT

1. By Summons issued on 7 February 2025, the plaintiff, a woman in her early 50s, who for the purposes of these proceedings will be known as D, appeals against a determination on 30 January 2025 by the second defendant, the Mental Health Review Tribunal (the Tribunal) to make a community treatment order (CTO) under the Mental Health Act 2007 (NSW) (the Act), authorising her compulsory treatment in the community (the 2025 CTO). The 2025 CTO will expire no later than 29 July 2025.

2. The first defendant is Sydney Local Health District (SLHD), which is the only active defendant. The Tribunal has filed a submitting appearance.

3. The Summons sought an interim injunction restraining the implementation by force of the 2025 CTO. An injunction was granted by Lindsay J on 7 February 2025, initially for a period of a few days and was then continued by my order, until further order or delivery of this judgment, whichever occurs earlier. No further order was made.

4. For the reasons which follow, the appeal must be dismissed. The 2025 CTO will stand and the injunction will be dissolved.

5. Additionally, by motion dated 28 February 2025, D sought an order reinstating proceedings brought by her with respect to an earlier CTO, which proceedings she abandoned. The motion must be dismissed.

The Statutory Landscape

6. The Act is to make provision with respect to the care, treatment and control of mentally ill and mentally disordered persons and other matters relating to mental health.

7. References below to sections are, unless otherwise stated or the context indicates differently, to sections of the Act.

8. Part 3 of Chapter 3 is headed “Involuntary treatment in the community”; Division 1 (ss 50-56) is headed “Applications for and making of community treatment orders”; Division 2 (ss 57-64) “Operation of community orders”; and Division 3 (ss 65-67) “Revocation, variation and review of community treatment orders”.

9. Under s 50, an “affected person” is a person for whom a CTO has been applied for or made.

10. Section 51(1) provides:

51   Community treatment orders

(1)  A community treatment order authorising the compulsory treatment in the community of a person may be made by the Tribunal.

11. Section 51(2)(a) provides that the authorised medical officer of a mental health facility in which the affected person is a patient under the Act may apply for a CTO for the person.

12. Although it will contribute to the prolixity of this judgment, I consider it appropriate to set out s 53 in full.

13. Section 53 provides:

53   Determination of applications for community treatment orders

(1)  The Tribunal is, on an application for a community treatment order, to determine whether the affected person is a person who should be subject to the order.

(2)  For that purpose, the Tribunal is to consider the following—

(a)  a treatment plan for the affected person proposed by the declared mental health facility that is to implement the proposed order,

(b)  if the affected person is subject to an existing community treatment order, a report by the psychiatric case manager of the person as to the efficacy of that order,

(c)  a report as to the efficacy of any previous community treatment order for the affected person,

(d)  any other information placed before the Tribunal.

(3)  The Tribunal may make a community treatment order for an affected person if the Tribunal determines that—

(a)  no other care of a less restrictive kind, that is consistent with safe and effective care, is appropriate and reasonably available to the person and that the affected person would benefit from the order as the least restrictive alternative consistent with safe and effective care, and

(b)  a declared mental health facility has an appropriate treatment plan for the affected person and is capable of implementing it, and

(c)  if the affected person has been previously diagnosed as suffering from a mental illness, the affected person has a previous history of refusing to accept appropriate treatment.

(3A)  If the affected person has within the last 12 months been a forensic patient or the subject of a community treatment order, the Tribunal is not required to make a determination under subsection (3) (c) but must be satisfied that the person is likely to continue in or to relapse into an active phase of mental illness if the order is not granted.

(4)  The Tribunal may not make a community treatment order at a mental health inquiry unless the Tribunal is of the opinion that the person is a mentally ill person.

(5)  For the purposes of this section, a person has a previous history of refusing to accept appropriate treatment if the following are satisfied—

(a)  the affected person has previously refused to accept appropriate treatment,

(b)  when appropriate treatment has been refused, there has been a relapse into an active phase of mental illness,

(c)  the relapse has been followed by mental or physical deterioration justifying involuntary admission to a mental health facility (whether or not there has been such an admission),

(d)  care and treatment following involuntary admission resulted, or could have resulted, in an amelioration of, or recovery from, the debilitating symptoms of a mental illness or the short-term prevention of deterioration in the mental or physical condition of the affected person.

(6)  The Tribunal must not specify a period longer than 12 months as the period for which a community treatment order is in force.

(7)  In determining the duration of a community treatment order, the Tribunal must take into account the estimated time required—

(a)  to stabilise the condition of the affected person, and

(b)  to establish, or re-establish, a therapeutic relationship between the person and the person’s psychiatric case manager.

(8)  The Tribunal may order that the discharge of an involuntary patient for whom a community treatment order is made be deferred for a period of up to 14 days, if the Tribunal thinks it is in the best interests of the patient to do so.

14. Section 14 provides:

14   Mentally ill persons

(1)  A person is a mentally ill person if the person is suffering from mental illness and, owing to that illness, there are reasonable grounds for believing that care, treatment or control of the person is necessary—

(a)  for the person’s own protection from serious harm, or

(b)  for the protection of others from serious harm.

(2)  In considering whether a person is a mentally ill person, the continuing condition of the person, including any likely deterioration in the person’s condition and the likely effects of any such deterioration, are to be taken into account.

15. Section 4 provides the following as a definition for “mental illness”:

mental illness means a condition that seriously impairs, either temporarily or permanently, the mental functioning of a person and is characterised by the presence in the person of any one or more of the following symptoms—

(a)  delusions,

(b)  hallucinations,

(c)  serious disorder of thought form,

(d)  a severe disturbance of mood,

(e)  sustained or repeated irrational behaviour indicating the presence of any one or more of the symptoms referred to in paragraphs (a)–(d).

16. Section 56(1) provides:

56   Form and duration of community treatment orders

(1)  A community treatment order is to—

(a)  nominate the declared mental health facility that is to implement the treatment plan for the affected person, and

(b)  require the affected person to be present, at the reasonable times and places specified in the order to receive the medication and therapy, counselling, management, rehabilitation and other services provided in accordance with the treatment plan.

17. Section 54 provides the requirements for a “treatment plan” for someone affected by a CTO:

54   Requirements for treatment plans under community treatment orders

A treatment plan for an affected person is to consist of the following—

(a)  in general terms, an outline of the proposed treatment, counselling, management, rehabilitation or other services to be provided to implement the community treatment order,

(b)  in specific terms, the method by which, the frequency with which, and the place at which, the services would be provided for that purpose.

18. By the combined effect of ss 56(2) and 53(6), a CTO cannot have effect for longer than 12 months, though a shorter period may be specified.

19. Section 163(1)(a) provides that a person may appeal to this Court against a determination of the Tribunal made with respect to a person.

20. Section 151(1)-(2) provides:

151   Procedure at meetings of Tribunal to be informal

(1)  Meetings of the Tribunal are to be conducted with as little formality and technicality, and with as much expedition, as the requirements of this Act, the Mental Health and Cognitive Impairment Forensic Provisions Act 2020, the regulations and as the proper consideration of the matters before the Tribunal permit.

(2)  In determining any matter relating to a forensic patient, correctional patient or other patient or a person detained in a mental health facility, or any matter relating to a community treatment order, the Tribunal is not bound by the rules of evidence but may inform itself of any matter in such manner as it thinks appropriate and as the proper consideration of the matter before the Tribunal permits.

21. Sections 164(1)-(4) provide:

164   Power of the Court on appeals

(1)  The Court has, for the purposes of hearing and disposing of an appeal, all the functions and discretions of the Tribunal in respect of the subject- matter of the appeal, in addition to any other functions and discretions it has.

(2)  An appeal is to be by way of a new hearing and new evidence or evidence in addition to, or in substitution for, the evidence given in relation to the determination of the Tribunal, or the failure or refusal of the Tribunal to make a determination, in respect of which the appeal is made may be given on the appeal.

(3)  The Court is to have regard to the provisions of this Act and any other matters it considers to be relevant in determining an appeal.

(4)  The decision of the Court on an appeal is, for the purposes of this or any other Act or instrument, taken to be, where appropriate, the final determination of the Tribunal and is to be given effect to accordingly.

The History of D

22. The appeal can be disposed of, on one approach, very briefly.

23. D suffers from and has been diagnosed with bipolar affective disorder (the disorder). She does not accept, but rather denies that she suffers from the illness. One of the symptoms of the illness displayed by her include, according to hospital records in evidence, having “grandiose delusions”.

24. The following are excerpts of the transcript of the final day of the appeal.

1. Tcpt, 20 March 2025, p 26(8)-(17):

HIS HONOUR: When you talk about your ability to carry out your professions, what exactly are you talking about there?

PLAINTIFF: Well, I have previously worked as a psychiatrist and a neurosurgeon and I want to go back to at least psychiatry.

HIS HONOUR: Are you a qualified medical psychiatrist and a neurosurgeon?

PLAINTIFF: I have a medical degree from Oxford University and I have also held the position of Chief Psychiatrist of Western Australia and also Chief Psychiatrist in Denmark and so I wish to go back and I’m presently studying several textbooks to offer to sit exams to demonstrate my ongoing competency.

2. Tcpt, 20 March 2025, p 26(32)-(40):

PLAINTIFF: I don’t have any records at the moment because my house was subject to an arson attack and all my records were destroyed but I am on the register of the New South Wales, Western Australian and Victorian Register for Psychiatrists and Neurosurgeons. I also held the position of Chief Psychiatrist here in New South Wales for about approximately six months. So that should be in the records.

HIS HONOUR: Chief Psychiatrist of New South Wales‑‑…

3. Tcpt, 20 March 2025, p 30(47)-(50):

HIS HONOUR: What year did you graduate in medicine at Oxford?

PLAINTIFF: It was the mid‑70s, I think it was ‘75/’76. I was Dux of medical school at Oxford.

4. Tcpt, 20 March 2025, p 31(1) to (17):

HIS HONOUR: What year were you born in?

PLAINTIFF: ‘71. I was an advanced learner.

HIS HONOUR: If you were born in 1971 and you graduated at Oxford between ‘75 and ‘76 you would have been four years old?

PLAINTIFF: I think I was five years old. It may have been ‘77. Yes, so I was very young. And they’re not able to discriminate on age in Europe because of the European Convention of Human Rights; there have been decisions in that respect and they are‑‑

HIS HONOUR: Okay. So you say you graduated in medicine at Oxford at the age of six years old?

PLAINTIFF: That is correct and I was Dux of Oxford. That is correct.

25. D’s delusions that she graduated medicine at age 6 years old and was the dux at Oxford, and is a specialist psychiatrist and neurosurgeon are grandiose and a stark symptom of her serious illness.

26. Her belief that she is a doctor involves obvious and serious risk of serious harm to others (let alone herself). This constitutes reasonable grounds for believing that treatment is necessary for the protection of others from serious harm.

27. She also believes she is a legal practitioner in this State and the State of Victoria. I gave her an opportunity of establishing this by affidavit. She did not prove it. If she believes that she is on the Roll of Legal Practitioners, this too involves the prospect of serious harm to others. As mentioned earlier, there is evidence that she was struck off the Roll of Practitioners in Western Australia.

28. A fuller approach is, however, also appropriate.

29. The history recounted below is established by affidavit evidence and primary documentation before the Court. The affidavit evidence is from Dr Andrew McDonald, specialist psychiatrist and Clinical Director of Mental Health for SLHD, Ms Blaise Lyons, Director of Legal Services for SLHD, and Ms Anna Johnson, the solicitor with carriage of the matter for the Crown Solicitor. I observe that D objected to the admission of all affidavit evidence and documentation. Apart from the expressions of expert opinion by Dr McDonald, the facts recounted are supported by clinical and other records and evidence of matters within the knowledge of affidavit deponents. Dr McDonald’s affidavit evidence, so far as it merely recounted facts disclosed by contemporaneous clinical or other records, was disallowed by me. The medical records themselves establish the facts.

30. The hearing took place over two days because D, who was self-represented, complained that material exhibited to affidavits had been given to her in electronic form only. She said she could not access it. She was given physical copies on the first day and wanted more time to deal with it and to put on further affidavit evidence. I gave her that time and she did put on a further affidavit (she had filed an earlier one). Her second affidavit takes issue with, amongst other matters, the accuracy of things said in the medical records. She denies that she has a serious and enduring mental illness and she says that she has never suffered from delusions (itself an obvious delusion). At the end of the hearing, I gave the parties an opportunity to provide affidavit material by 10am on 24 March 2025 as to her asserted qualifications and appointments.

31. D provided no further material. SLHD provided two affidavits which were an hour out of time and I have disregarded them.

32. At 10:42am on 24 March 2025, D sent an email to my Associate seeking leave to issue subpoenas to obtain information as to her appointments, with a return date of 2pm today (the time I had specified for judgment). I declined the application. It is yet another example of delusionary behaviour. She has on a number of occasions sought to delay the outcome of these proceedings and has been moderately successful in that endeavour. Since 7 February 2025, there has been on foot an injunction preventing the administration of treatment for her.

33. Sitting as I am, in the place of the Tribunal, I can say that I observed a progressive change in D’s demeanour from the date of her first appearance before me to the date of her last one. My observation is that over that time she has become more agitated. This change is consistent with the medical evidence that the longer she goes without her medication, the worse things will get. The grandiose delusions revealed in the transcripts excerpted earlier are consistent with her health having deteriorated. The necessity for her to be treated for her illness has assumed a greater degree of urgency.

34. The 2025 CTO includes the following Reasons of the Members of the Tribunal:

[D] did not attend and didn’t answer her phone. She suffers from Bipolar Affective Disorder. Her mental health history indicates she does not always fully follow her treatment, and is difficult to engage in her treatment, including her January 2025 admission which was in the context of non-adherence to medication. The Tribunal is satisfied she is likely to relapse without the order. She would benefit from the order and it’s the least restrictive care consistent with her safe and effective care. The proposed plan is appropriate and [not transcribable] … available.

35. Prior to the 2025 CTO, two CTOs were made for D to which reference is made below.

36. The recent history commences with the admission of D to Royal Prince Alfred Hospital (RPAH) on 3 November 2022.

37. The Professor Marie Bashir Centre (PMBC) is a mental health unit which is part of RPAH.

38. Contemporaneous records show that D was admitted to RPAH on 3 November 2022. The clinical report as to the mental state of a detained person signed by a medical practitioner records that D was “brought in under sec 22 ^[1] after neighbours complained of a very strong chemical smell.” The report says that “… client states that she has had a mental health history”.

    1. Section 22 of the Act provides for detention after apprehension by police of a person who appears to be mentally ill or mentally disturbed.

39. A further such report dated the following date by a psychiatrist contains the following conclusion:

Demonstrated risks to self + others.

Requires treatment under MHA.

40. A letter from a social worker at PMBC dated 14 November 2022, in relation to a court appearance, records that D was an in-patient and was unable to attend court on 14 November 2022.

40. In a report dated 12 January 2023, the psychiatry registrar for a consultant psychiatrist at PMBC gave a written report to the Tribunal which includes the following:

Background:

…

She has a diagnosis of bipolar affective disorder, depression and PTSD with 2 prior admissions in WA for 3-4 weeks each time. She has previously been treated with mood stabilisers and antipsychotics.

…

Progress since admission:

On assessment in ED she was found to be circular in thought form, guarded surrounding details of her mental state. She voiced systematised persecutory delusions of her landlord conspiring with police, she voiced grandiose thought content. She gave illogical explanations with regards to the burns on her hands and cleaning chemicals. She voiced that she was the 13th generation of neurosurgeons and psychiatrists. She required IM medications prior to admission to PMBC due to aggression.

…

She has been started on antipsychotic treatment (paliperidone) and lithium, though she initially refused to take the lithium. She refused assessment or examination of the chemical injury on her hands initially. Collateral from her previous psychiatrist review in NSW reveals a history of bipolar affective disorder with prior admissions in WA.

During admission she has been compliant with lithium and her antipsychotic treatment and her mental state has gradually improved. She was switched over to the antipsychotic depot due to poor insight and concerns about compliance in the long term. She has been started on propanolol during admission due to reports of akathisia secondary to medications.

…

Risks:

Self – psychological distress due to psychotic symptoms, deterioration in function, evicted from housing, harm to own health – chemical burns to hands prior to admission

Further deterioration in mental state

42. The first CTO (the 2023 CTO) was made on 18 January 2023, to expire no later than 17 July 2023. It includes the following Reasons of the Members of the Tribunal:

The Tribunal was satisfied that the affected person was suffering from a mental illness and that her health care had an appropriate and substantial treatment plan which was the least restrictive available. The patient was at risk of non-compliance in the community without the [not transcribable] of a [not transcribable] plan. The duration of the order is appropriate in the circumstances.

43. The SLHD report to the Tribunal used when applying for the 2023 CTO records that D had two prior hospital admissions in Western Australia for three weeks each time and that she had previously been treated with mood stabilisers and antipsychotics.

44. The 2023 CTO prescribed a monthly intramuscular injection of paliperidone (an antipsychotic treatment) and twice-daily oral lithium. D did not challenge it.

45. The second CTO (the 2024 CTO) was made on 31 July 2024, to expire no later than 30 January 2025. It includes the following Reasons of the Members of the Tribunal:

50yo woman. Admitted 3-7-24. Diagnosis of BPAD. When unwell poses risk of serious harm to self. Suffers delusions. History of medication non-adherence. [D] did not attend hearing and did not return from leave. Treating team will advise police of her discharge as she is awaiting return to court. No less restrictive form of care consistent with safe and effective care.

46. The 2024 CTO was, in my opinion, necessary and properly made. I interpolate that by reason of the 2024 CTO, s 53(3A) relieves me of making a determination under sub-s (3)(c), but I must be satisfied that D is likely to continue in or relapse into an active phase of mental illness if the order is not granted. I am so satisfied that D will continue in her active phase of mental illness if the 2025 CTO would not be granted but, in any event, I am satisfied that the requirements of s 53(3)(c) have been met.

47. I observe that the Reasons include that when unwell, D poses risk of serious harm to herself and suffers delusions.

48. The 2024 CTO provided for D to receive treatment at the Redfern Community Mental Health Service (Redfern). Records from Redfern record that:

On discharge on 30 October 2024 she was superficially polite and agreed to take her medications and engage with the community mental health team upon discharge. She was not cross sectionally psychotic or presenting with a major disturbance of mood and she was future focused.

49. On 3 July 2024, D was admitted to the PMBC at RPAH after coming to the attention of police. A psychiatric report by the psychiatry registrar dated 26 July 2024, prepared for the purposes of the application for the 2024 CTO, includes the following:

Diagnosis

Manic relapse of bipolar affective disorder 1.

Current Psychotropic Medications

Lithium SR 450mg BD

Clopixol 100mg q2wkly, next due 1/9/24

Background

[D] is a 50 year old woman living in [XXX] Department of Housing. [D] reports previously working as a barrister and is currently unemployed, in receipt of the DSP. She moved to Sydney from WA, and was known to a psychiatrist Dr Paul Skerritt in WA who diagnosed her with Bipolar Affective Disorder. She has been difficult to treat due to poor cooperation with treatment. She has had multiple admissions to hospitals in Western Australia and NSW, and polysubstance abuse (stimulants). Her admissions have been complicated by poor engagements with treating teams, conflicting information in relation to her name and date of birth, and fabricating information. [D] has a forensic history of common assault, assault occasioning actual bodily harm, shoplifting, and breach of AVO.

Reason for Admission

[D] was brought in by police on a Section 19b due to custody of knife in a public place. She was seen by the Magistrate, court liaison nurse, and Forensic Psychiatrist who formed an impression of “features of untreated affective guarded paranoid psychosis in the context of previously diagnosed bipolar affective disorder manic type with psychotic features.” As per documentation, police approached [D] due to breach of bail, searched her handbag and found a box cutter, scissors and a kitchen knife. [D] reported that police had mistaken her for her sister and the knives were for cutting apples. She also reported that she had a 6 year old child.

50. The clinical report as to her mental health as a detained person under ss 27, 27A or 203 of the Act by a medical practitioner, made on 3 July 2024, records that she was charged with carrying knives and psychotic on review. The medical practitioner noted observations of delusions of grandiosity and of misidentification. D’s name on the report is a different one to that apparently more commonly used by D.

51. D, who was in the PMBC at the time, was granted day leave to attend the Tribunal hearing but “absconded” and was marked absent without leave at the PMBC.

52. On 5 August 2024, she was apprehended by the police and conveyed to the PMBC where she was given medication originally scheduled for 1 August 2024 under the 2024 CTO. She was scheduled for further medication on 19 August 2024, but SLHD was restrained by the Court from enforcing the 2024 CTO.

53. On 10 October 2024, D’s general practitioner, Dr Rajalingam observed “nil thoughts of harm to self or others”.

54. Contemporaneous clinical records establish that D was admitted to RPAH on 13 October 2024 and discharged on 30 October 2024. The RPAH report records:

Issues/Problems Identified at Assessment

…

[D] was transferred from the community under a schedule done by ACS. She is also in breach of her CTO and has not had her depot since 19/08/2024. She is meant to be on zuclopenthixol 200mg IMI every two weeks and Lithium SR 450mg BD for schizooaffective/bipolar [sic] disorder. Despite multiple attempts by the community team to engage with her this has been unsuccessful.

Impression and Plan

Formulation / Clinical Impression: …

Manic relapse on bg of medication non adherence and schizoaffective/bipolar order at risk of accidental harm to self (home smells of chemicals and hx of chemical burns), caring for a pet dog who may be at accidental risk, poor engagement in medical treatment due to grandiosity and irritability and at harm of deterioration of physical and mental health if not treated. Community treatment has been unsuccessful.

55. D challenged the 2024 CTO in this Court. ^[2] She ultimately discontinued the challenge on 20 December 2024. D wishes “to reinstate those proceedings”. On 28 February 2025, she filed (with my leave) a Notice of Motion in which she seeks reinstatement and that that matter be heard jointly with this one. The 2024 CTO has expired. There is no utility in her Notice of Motion and I dismiss it.

    2. These proceedings have file number 2024/00312836.

56. The third CTO, the subject of these proceedings, was made by the MHRT on 30 January 2025, following the expiry of the second CTO on the same day. The third CTO is in substantially the same terms as the second CTO.

Consideration

57. The Court is charged with the task of determining afresh, on the material before it, whether the 2025 CTO was appropriate to have been made.

58. I am persuaded beyond any reasonable doubt that it was.

59. At the hearing and by affidavit, D maintained steadfastly, and contrary to clinical records going back over two years recording the diagnosis and treatment received by her for it, that she has no mental illness at all and has not been diagnosed with the disorder. She argues that she is not a mentally ill person under s 14 because it has not been shown that there is any risk of harm to herself or others if the CTO is not implemented.

60. She is a lawyer (without registration). She was apparently removed from the Roll in Western Australia. She would not say why.

61. She denies, in the face of the report about her admission to RPAH, that she was admitted to that institution. I interpolate that there is also a record of her being discharged from PMBC on 5 August 2024. At the hearing I understood her to take the position that her denial was based on the proposition that PMBC is not RPAH.

62. She maintains that she is a psychiatrist and has held high office and has been the Chief Psychiatrist of this State. She maintains that she is also a neurosurgeon. This reflects her grandiose delusionary behaviour.

63. The contemporaneous clinical records establish and Dr McDonald’s expert opinion confirms that:

1. D has been diagnosed with the disorder and displays significant symptoms but denies being ill;

2. she has delusions (including that she has no illness) and serious disorder of thought form;

3. there have been instances which give rise to serious concern that she is a danger to herself and to others including an occasion where she had chemical burns to her hands (which she denies) and an occasion where she was found in possession of knives and a box-cutter. This leads to the clear conclusion that she will pose a risk to herself and the public if she does not receive the necessary treatment. I note that there is no evidence of any previous criminal conviction;

4. she has been detained and treated involuntarily on occasion and she has on various occasions not cooperated with respect to obtaining treatment and has refused same. She has a history of discontinuing treatment after discharge from inpatient care;

5. when treated, her condition improves and when not, it deteriorates. No other care of a less restrictive kind consistent with her safe and effective care is appropriate and reasonably available to her. I determine that she will benefit from the 2025 CTO as the least restrictive alternative consistent with safe and effective care. I observe that she says she would have a preference for oral medication. Whether this is possible, feasible or appropriate is a matter for the clinicians; and

6. effects of her health deterioration may include obvious increased vulnerability to potential detrimental social consequences of her illness. I think there is a realistic possibility that she will not be able to maintain stable accommodation.

64. I am satisfied that she is a mentally ill person within the meaning of s 14.

65. The 2025 CTO provides a measure of flexibility so that clinicians may tailor the treatment regime. She says she has an allergic reaction to lithium (which is not expressly mentioned in the 2025 CTO).

66. The SLHD has well discharged its onus of establishing that the 2025 CTO should be continued (see SMF v South Western Sydney Local Health District [2018] NSWSC 303 (Lindsay J)). In reaching this conclusion, I am cognisant of the fact that forced medical treatment is an exceptional form of treatment not to be approached lightly.

67. I observe that the reasons given by the Tribunal for the 2025 CTO are consistent with my own findings.

68. At the end of the hearing, D sought that if the 2025 CTO stands, I order a stay (or continuation of the injunction) for a day to allow her to approach the Court of Appeal. I do not propose to order any such stay. The requirement for her treatment has assumed a degree of urgency and her own interests and, perhaps more importantly, the public interest will not be served by any such stay.

69. The Summons is dismissed. The injunction made by Lindsay J on 7 February 2025 is dissolved.

70. The Notice of Motion dated 28 February 2025 is dismissed.

71. The exhibits are to be returned.

**********

Endnotes

Decision last updated: 25 March 2025