Re DKB

[2012] QMHC 6

MENTAL HEALTH COURT

CITATION:	Re DKB  [2012] QMHC 6
PARTIES:	REFERENCE BY THE PATIENT’S LEGAL REPRESENTATIVES IN RESPECT OF DKB
PROCEEDING NO:	0168/10
DELIVERED ON:	Ex tempore reasons given on 3 February 2012 Written reasons given on 16 February 2012
DELIVERED AT:	Brisbane
HEARING DATE:	30 August 2011 3 February 2012
JUDGE:	Ann Lyons J
ASSISTING PSYCHIATRISTS:	30 August 2011: Dr E N McVie and Dr J M Lawrence 3 February 2012: Dr E N McVie and Dr J N Chalk
FINDINGS AND ORDERS:	That there is a reasonable doubt that the defendant committed the alleged offences; That the defendant is not fit for trial and the unfitness if of a permanent nature; That the defendant be detained pursuant to a Forensic Order – Disability in the Logan Beaudesert Authorised Mental Health Service; That limited community treatment is approved to commence immediately at the discretion of the authorised psychiatrist, on the conditions set out in the submission of the Director of Mental Health.
COUNSEL:	J Briggs for the defendant J Tate for the Director of Mental Health D Holliday for the Director of Public Prosecutions S Ryan for the Director of Forensic Disability
SOLICITORS:	Legal Aid Queensland for the defendant Crown Law for the Director of Mental Health Office of the Director of Public Prosecutions (Qld) Director of Forensic Disability (Qld)

NN LYONS J: A

This reference

1. This is a reference by Legal Aid Queensland in relation to DKB. DKB is charged with rape and indecent treatment of a child between 31 March 2009 and 4 April 2009. DKB suffers from a significant intellectual impairment and epilepsy.

1. The Queensland Police Service court briefs indicate that the complainant is a child who also suffers from an intellectual impairment and is stated to function at the level of a six-year-old child. The statements allege that, on return from school camp, the victim complained that his friend DKB had done things to him. It is said that they occurred in a toilet and involved penetration as well as touching of the penis and testicles.

1. DKB turned 18 on 10 October 2012. Prior to that date he had been in the care of the Department of Child Safety.

1. This reference first came before the Court on 30 August 2011 when the process of transition from the Department of Child Safety to the Department of Communities was incomplete. Arrangements in relation to DKB’s future placement were also unclear and there was a pending application before QCAT for the appointment of the Adult Guardian as his guardian.

1. Concern was also raised during that initial hearing that DKB had been placed on the anti-androgen drug Androcur at the age of 16 by his general practitioner. Dr Lawrence was concerned that there had been no adequate assessment of the need for that drug at such a young age and no real indication of an appropriate review of the use of that medication.

1. Given his complex medical problems it was considered that a comprehensive plan needed to be drawn up in relation to his long term treatment and care needs. In the circumstances the matter was adjourned to allow issues in relation to placement and funding to be finalised and for further reports to be prepared.

1. On 5 October 2011 QCAT appointed the Adult Guardian as guardian for all personal matters as well as restrictive practices. The Public Trustee of Queensland was appointed as financial administrator.

1. On 7 November 2011 an accommodation decision was made by the Adult Guardian to accept a community housing offer for DKB as it was considered that this was a long term suitable accommodation arrangement with Maddison Community Care providing 24-hour support.

1. The hearing resumed on 3 February 2012 and, at the conclusion of the hearing, I made orders and gave short reasons in relation to the determination of the reference and indicated I would publish more extensive reason at a later date. These are those reasons.

The Reports

1. A number of reports have been prepared in relation to this reference. The report of Dr Scott Harden dated 6 April 2011 indicates that DKB has intellectual impairment, Attention Deficit Hyperactive Disorder and Asperger Syndrome. He also has a complex medical history of epilepsy. Dr Harden indicates that the patient has a very high level of need for support and has quite disruptive behaviour which requires out-of-home residential placement supported by government departments. Dr Harden notes a history of sexualised behaviour in the school environment over a number of years.

1. Dr Harden also noted that DKB denies the allegations of rape and indecent treatment of a child. Dr Harden considers that, whilst he suffers from a natural mental infirmity, they are not sufficient to deprive him of the capacity to understand what he was doing, the capacity to control his actions, or the capacity to know he ought not do the act or make the admissions.

1. In a report dated 12 June 2010 Dr Beech noted that DKB had previously been diagnosed with an array of neuro-developmental disorders including epilepsy, intellectual impairment, Asperger’s disorder and Attention Deficit Hyperactivity Disorder. He stated that those disorders appeared to have been compounded by difficulties throughout his childhood and development, in particular the dynamics between his domestic circumstances and his behaviour. He stated that inappropriate sexualised behaviours had been evident since early childhood and occurred in the context of childhood sexual abuse, childhood physical abuse, the onset of puberty and his generalised disruptive behaviours.

1. He stated that there is a full scale IQ assessment of 62. Dr Beech concluded that DKB suffered from a natural mental infirmity. He stated however that at interview DKB indicated that it would be wrong to act in the manner of the alleged offences.

1. Dr Beech considered that overall DKB would understand that it is wrong to rape and indecently touch a co-student. Dr Beech considered that, whilst his understanding of the wrongfulness was likely to be impaired by his limited intellectual ability and his interpersonal skills, he did not think that overall he could be seen to be deprived of this capacity. He did not think DKB would have been deprived of the capacity to control his actions.

1. Dr Beech also indicated that DKB denied the allegations to him. He did not consider the denial of the allegations arose from his natural mental infirmity.

1. It is clear therefore that DKB has consistently disputed the charges. Accordingly pursuant to s 268 this court cannot proceed to determine the reference in accordance with s 267. Furthermore I am satisfied that any dispute of fact does not arise as a result of his natural mental infirmity.

1. Section 270 then provides that if the Court does not proceed to make a decision pursuant to s 268 the Court must decide if DKB is fit for trial.

Is DKB fit for trial?

1. In a report dated 31 January 2010 Luke Hatzipetrou indicated that, based on current assessments, DKB presented with significantly impaired reasoning abilities and he demonstrated limited appreciation of his own legal predicament. Mr Hatzipetrou did not consider that he possessed adequate knowledge or understanding of court processes, concepts of legal rights or roles of key personnel. He stated:

“[DKB] did not possess the capacity to sufficiently contest incriminating evidence or provide reliable instructions to his legal counsel. He would be significantly disadvantaged in the courtroom and he was highly susceptible to interrogative suggestibility and acquiescence.”

1. He also considered that the patient would be likely to be vulnerable to leading questions due to a constellation of clinical practice including impaired social skills and ineffective coping mechanisms.

1. Dr Harden similarly concluded that DKB is not fit for trial. He considers that although he would be able to understand the charge and offer a plea, he would have difficulty in following and understanding the nature of the proceedings as well as difficulty in providing ongoing instructions to his counsel.

1. Dr Beech also considered that DKB was not fit for trial. He noted that he was unable to get an account from DKB other than that he denied the allegations. He concluded that DKB would not be able to follow a trial in any meaningful way or instruct counsel. He also considered that the trial process itself would lead to anxiety which cause an exacerbation of his seizures. He noted that DKB has pseudo-seizures which are an expression of his anxiety.

1. There has been no change in that situation. The report of the Adult Guardian dated 31 January 2012 indicates that DKB has had a number of serious seizures in the period since the last hearing and has been hospitalised on a number of occasions. It would seem that he has had at least three emergency admissions since November 2011, with the most recent being an admission on 12 January 2012 for unexplained high fevers. His epilepsy is currently unstable despite increases in his epilepsy medication. The report also indicated that he absconded on the night of 9 January 2012 after he refused medication. DKB clearly continues to be significantly physically and intellectually impaired.

1. The advice of the assisting psychiatrists is that DKB is not fit for trial.

1. Having considered the medical reports as well as the advice of the assisting psychiatrists I am satisfied that DKB is not fit for trial and that such a condition is permanent.

Is a forensic order required?

1. Section 288(2) then provides that if a person is found to be permanently unfit for trial the Court may make a forensic order. Section 288 provides as follows;

288 Mental Health Court may make forensic order

(1)This section applies if, on a reference, the Mental Health Court decides a person charged with an indictable offence—

(a) was of unsound mind when the alleged offence was committed; or

(b) is unfit for trial for the alleged offence and the unfitness for trial is of a permanent nature; or (c) is unfit for trial for the alleged offence and the unfitness for trial is not of a permanent nature.

(2)The court may make an order in accordance with this division (a forensic order (Mental Health Court) or a forensic order (Mental Health Court—Disability)) for a person mentioned in subsection (1)(a) or (b) that the person be detained for involuntary treatment or care.

(3) The court must make an order in accordance with this division (also a forensic order (Mental Health Court) or a forensic order (Mental Health Court—Disability)) for a person mentioned in subsection (1)(c) that the person be detained for involuntary treatment or care.

(4)In deciding whether to make an order under subsection (2), the court must have regard to the following—

(a)       the seriousness of the offence;

(b)      the person’s treatment or care needs;

(c)       the protection of the community.

(5)After deciding to make an order under subsection (2), or for the purpose of making an order as required under subsection (3), the court must consider whether the person’s unsoundness of mind or unfitness for trial is a consequence of an intellectual disability.

(6)         If the court does not consider the person’s unsoundness of

mind or unfitness for trial is a consequence of an intellectual

disability, the order—

(a)       must be a forensic order (Mental Health Court); and

(b) must state that the person is to be detained in a stated authorised mental health service for involuntary treatment or care.

(7)If the court considers the person’s unsoundness of mind or unfitness for trial is a consequence of an intellectual disability, the order—

(a) must be a forensic order (Mental Health Court—Disability); and

(b) subject to subsections (8) and (9), must state which of the following services the person is to be detained in for care—

(i)       the forensic disability service;

(ii)      a stated authorised mental health service.

(8)In deciding whether a forensic order (Mental Health Court—Disability) is to state that the person is to be detained in the forensic disability service for care, the court must have regard to the following—

(a) whether the person has an intellectual or cognitive disability within the meaning of the Forensic Disability Act but does not require involuntary treatment for a mental illness under this Act;

(b) whether the person is likely to benefit from care and support within the meaning of the Forensic Disability Act provided in the forensic disability service.

(9) A forensic order (Mental Health Court—Disability), must not state that the person to whom the order relates be detained in the forensic disability service for care unless a certificate given to the court under section 288AA states that the forensic disability service has the capacity for the person’s detention and care.

(10)To remove any doubt, it is declared that the court is not required to have regard to the matters mentioned in subsection (8)(a) and (b), or a certificate given to the court under section 288AA, in deciding whether to make an order under subsection (2).

(11) A forensic order (Mental Health Court) or a forensic order (Mental Health Court—Disability) must be in the approved form.

(12)      In this section—

benefit means benefit by way of individual development and opportunities for quality of life and participation and inclusion in the community.

1. In determining whether a forensic order is required, s 288(4) requires the court to consider:

   (i)         the seriousness of the offence;

   (ii)       the person’s treatment or care needs; and

   (iii)      the protection of the community.

   Are the requirements of s 288(4) satisfied?

1. In terms of DKB’s treatment and care needs, all the reports, as well as the advice of the assisting psychiatrists, indicate that DKB has complex treatment and care needs. Not only does he have a diagnosis of mental retardation but he also has other diagnoses of autism spectrum disorder, attention deficit hyperactivity disorder as well as epilepsy which is currently unstable.

1. It is also clear that these needs have been long standing. A report from Lenore Bryant, Child Safety Officer, dated 18 August 2011 indicated that DKB was previously subject to a child protection order and had been under the care and protection of the Department of Communities.

1. In his report of 7 July 2011, Professor O’Brien considered that DKB should continue to receive the current degree of supervision for public safety reasons and that attention should be given to arranging appropriate employment and activities for him because his lifestyle at present is one of inactivity. He asked that Mr Luke Hatzipetrou or a similar competent consultant psychologist be approached and requested to give input in the area of sexual development and behaviour and that the ongoing planning for DKB’s future should take account of those matters. Professor O’Brien stated that there was a very clear need for developmental work on his sexuality and that this was a high profile need which needed to be urgently addressed.

1. In terms of medication, Professor O’Brien indicated that he would take on the psychiatric supervision of the cautious attempted withdrawal of the Androcur in accordance with Dr Harden’s recommendations.

1. I also note the contents of the 6 December 2011 report of Carl Patterson from the Department of Disability Care Services that DKB may be depressed. The undated 2010 Initial Assessment Report of Lyndell Hulett also noted he was taking four tablets of the anti-depressant Tolerade at night at that time and Mr Patterson’s report indicates that that medication is still being used. I also note that currently approval has been given to use both Androcur and Risperidone as an approved chemical restraint pursuant to a short term approval under the Disability Services Act 2006 (Qld) until 17 April 2012.

1. The most recent report of DKB’s complex needs is the report of the Adult Guardian, which indicates that the decision to accept an offer of community housing is a co-tenancy arrangement. The report also indicated that, whilst there was a short term approval for restrictive practices, a Positive Behaviour Support Plan was still to be formulated. The report also stated that, whilst the commencement of therapy with Mr Hatzipetrou was discussed with Disability Services staff, negotiations were ongoing and therapy had not in fact commenced. The report also raised concerns about incomplete modifications to his share house and the fact that a protective helmet recommended by his neurologist in December had still not been purchased. I note that the neurologist indicated on 28 December 2011 that DKB was to have “a helmet insitu at all times when outside in order to prevent injury when he has a drop attack. All [DKB’s] carers must abide by this and ensure he is wearing the helmet when outside at all times”. He was certainly not wearing one on 3 February 2012.

1. The Report of the Adult Guardian concluded:

“Due to the extent of [DKB’s] complex health needs and ongoing hospitalization, it has been difficult for the new service provider to undertake full assessments to complete [DKB’s] Case Plan. This case plan is yet to be provided to the delegate Guardian. Whilst [DKB’s] accommodation arrangement has settled, the delegate Guardian is currently working with all stakeholders in order to make a service provision decision, i.e. to determine whether Maddison Community Care has the capacity to adequately meet [DKB’s] needs, and to explore other service providers available to [DKB].”

1. Whilst his care and treatment needs have been identified there is still no clear plan and no overall coordination currently in place. It would seem clear that there may well be a change of service providers and this could necessarily involve a period of instability for DKB. DKB obviously needs 24-hour supported accommodation and supervision. There are however some gaps in his care as identified by the Adult Guardian’s very thorough report.

1. In this regard I take into account Dr McVie’s advice that the historic view of a forensic order was that the order ensured that there was one identified individual, namely the authorised psychiatrist, who was responsible for co-ordinating all aspects of the patient's management, including medication, services, co-ordination of housing, employment and access to disability services. It is significant that traditionally it was that authorised psychiatrist who was responsible for ensuring that all aspects of the management were integrated and suitable for the patient.

1. In terms of his treatment the reduction of Androcur is still ongoing. Both assisting psychiatrists were concerned about the use of Androcur and the lack of documented reasons for its initial introduction and the failure to appropriately review its continued use. 

1. Whilst a thorough medication review was recommended I am not certain that has been done.  I simply note that the report of the Adult Guardian indicates that prior to his discharge from the RBH on 28 December 2011 DKB’s neuropsychologist made six changes to his medication regime. I am not certain however if there was a thorough review of all medication or just his epilepsy medication given the use of Androcur and Risperidone for chemical restraint purposes would appear to be ongoing.

1. Significantly his epilepsy is still unstable. The Adult Guardian also raised concerns identified by Professor O’Brien in December 2011 that DKB was “oversedated, drowsy and lethargic”, which I note was consistent with his presentation at the hearing given he was asleep through most of the hearing.

1. I also note that DKB is still not receiving the urgently needed counselling and therapy identified as urgent by Professor O’Brien over six months ago.

1. The assisting psychiatrist’s advice is that a forensic order would assist with DKB overall management, given that there would not seem to be one person who is in overall charge at the moment. That may well change in the future once plans are in place and an appropriate review regime is in place under QCAT. That would not seem to be the current situation. I note Dr Chalk’s advice that the forensic order “would provide a measure of security in the short term so that the case is reviewed and so that there is appropriate psychiatric oversight”.

1. It would seem to me that based on his treatment and care needs alone there is ample reason to make a forensic order. Significantly, the other criteria in s 288(4) have also been met. The offences DKB was charged with are very serious and concerning offences given they involve allegations of rape and indecent treatment. Much needed therapy has not even commenced. In terms of the protection of the community, DKB refused his medication and absconded from his accommodation less than a month ago.

1. In my view, having regard to the requirements of s 288(4), I am satisfied that all the conditions necessary for the making of a forensic order have been satisfied.

Is DKB’s unfitness for trial a consequence of his intellectual disability?

1. Pursuant to s 288(5) the Court is required to consider whether DKB’s unfitness for trial is a consequence of his intellectual disability. On the basis of the reports of Drs Beech and Harden and Mr Hatzipetrou, as well as the advice of the assisting psychiatrists, I am satisfied pursuant to s 288(5) that his unfitness is due to his intellectual disability. 

1. Section 288(7) then mandates that if the person’s unfitness for trial is a consequence of an intellectual disability the order “must be a forensic order (Mental Health Court – Disability)”.

1. It is clear that the unfitness arises as a result of his natural mental infirmity. Accordingly the order must be a Mental Health Court – Disability forensic order.  

1. That then leaves the question as to whether, pursuant to that Mental Health Court –Disability forensic order, DKB should be detained to the Forensic Disability Service or an Authorised Mental Health Service.

1. Given the current regime there are difficulties in determining what is the appropriate service DKB should be detained to. The current restrictions surrounding a Mental Health Court – Disability forensic order essentially mean that neither service would seem to provide the optimal care for DKB.

1. The relevant scheme is also set out in s 288. 

Should DKB be detained in the Forensic Disability Service or an Authorised Mental Health Service?

1. Section 288(8) sets out the relevant criteria that needs to be considered in order to determine whether DKB should be detained to the Forensic Disability Service or an Authorised Mental Health Service.

1. In order to detain a person in the Forensic Disability Service the court must be satisfied that the person has an intellectual or cognitive disability but does not require involuntary treatment for a mental illness. The court then needs to be satisfied that the person is likely to benefit from care and support as defined in the Forensic Disability Act 2011 (Qld) and provided in the Forensic Disability Service. Benefit is defined to mean “benefit by way of individual development and opportunities for quality of life and participation and inclusion in the community”.

1. Finally s 288(9) provides that the court cannot make an order detaining a person to a Forensic Disability Service unless a certificate is given to the court pursuant to s 288A which states that the Forensic Disability Service has the capacity for the person’s detention and care.

1. In the present case the relevant Certificate has been provided and DKB could be accommodated in the Forensic Disability Service. That is not the preferred option in this case however and I note that the advice of the assisting psychiatrists is that it is in DKB’s best interest to remain in community-based accommodation rather than to go into the Forensic Disability Service. That is also the submission of his Counsel, the Counsel for the Director of Mental Health and the Director of Forensic Disability.

1. It is generally conceded that that placement in the Forensic Disability Service is not actually the most suitable arrangement because a forensic order in those terms would mean DKB would have to be detained at the Forensic Disability Service even though community accommodation is available and appropriate. Significantly, detention to an Authorised Mental Health Service would allow for accommodation in the community by way of the Limited Community Treatment Condition but with oversight from a psychiatrist. Detention in the Forensic Disability Service does not allow for that.

1. If all of the criteria in s 288(9) are in fact met does that mean that DKB must go the Forensic Disability Service? In other words, if all the criteria are satisfied is a Certificate of Capacity determinative?

1. In this case however I am not satisfied that all the criteria in s 288(9) have in fact been satisfied. Whilst I am satisfied that he would benefit from the care and support provided by the Forensic Disability Service and there is clearly the relevant Certificate, I cannot at this stage be satisfied that all the requirements of s 288(8)(a) have been fulfilled because the section requires I be satisfied that DKB “does not require involuntary treatment for a mental illness under this Act”. At this stage I cannot answer that question in the affirmative. 

1. I consider that there is an area of uncertainty which precludes me from being satisfied that DKB does not need involuntary treatment for a mental illness, which is a prerequisite to making a forensic order detaining DKB to the Forensic Disability Service. There is clear evidence that there are concerns about DKB suffering from depression.  He is in fact being treated for depression and takes four tablets of an anti-depressant medication each evening. Whilst all the reporting psychiatrist have agreed that DKB has an intellectual disability, I am not certain that the reports rule out the possibility of a concurrent mental illness which requires treatment. It is also not clear to me why he was actually prescribed Risperidone and whether it was to treat aggression alone.

1. On the current evidence it would also seem clear that he does not have the capacity to consent to health treatment, given the appointment of the Adult Guardian in this regard. The inference would also be, therefore, that he cannot consent to mental health treatment himself. Accordingly, if DKB cannot voluntarily consent to mental health treatment, he is being involuntarily treated for his mental illness.  He is not being involuntarily treated under the Mental Health Act 2000 (Qld) as there is no involuntary treatment order in place.

1. It may be that consent for mental health treatment can be provided under the substitute decision making regime. The question would seem to be whether DKB can be involuntarily treated for a mental illness through the substitute consent regime of the Guardianship and Administration Act 2000 (Qld)? Can the Adult Guardian consent to treatment for a mental illness where a person is incapable of consenting himself, particularly given the clear indication in s 13(2) and s 14(2) of the Mental Health Act that a substitute decision maker cannot give the relevant consent for either assessment or treatment as required for those sections?  I also note that he has recently refused medication.

1. I accordingly pose the following question: if DKB cannot give consent himself to treatment for a mental illness and if the Adult Guardian cannot give consent for that treatment, particularly if he is refusing that medication, will he require involuntary treatment under the Mental Health Act? 

1. I also note that detention to an Authorised Mental Health Service for “care” pursuant to a forensic order Mental Health Court – Disability would not authorise the Authorised Psychiatrist to provide “treatment” for a mental illness.

1. Accordingly I am not certain therefore who is consenting to his current treatment for depression. It is also unclear to me whether his guardian can provide consent for treatment for a mental illness, if, on review, it is considered he has a mental illness.

1. In my view there are too many questions that still need to be answered to allow me to be satisfied in relation that he “does not require involuntary treatment for a mental illness under this Act”.

1. It would seem therefore that, by a process of elimination, DKB must be detained to an Authorised Mental Health Service.

1. DKB’s care needs primarily arise due to his intellectual disability but, given the current legislative scheme, he will necessarily have to be managed by an Authorised Mental Health Service who would not seem to be the most appropriate service.

1. Dr McVie advised that, with a forensic order Mental Health Court – Disability with detention to an Authorised Mental Health Service rather than the Forensic Disability Service, it makes it very difficult for the authorised psychiatrist in a District Mental Health Service “to have any sense of control over a patient when they don't have any authority to prescribe medication, and when there are so many other different agencies reporting to different tribunals and different Departments.”

1. Dr McVie considered that it would be extremely difficult for a District Mental Health Service psychiatrist with limited knowledge and understanding of intellectual disability, epilepsy and sexual offending behaviour to coordinate that type of management required particularly for DKB.

1. Dr McVie commented that a possible option would be a system run by a Community Forensic Disability Service or Disability Services whereby an identified clinician could be responsible for coordinating the management and care for a person with an intellectual disability who was not a resident of the 10-bed Forensic Disability Service and therefore not presently under the forensic disability legislation.

1. I note Dr McVie’s advice that it would seem that Professor O'Brien is going to be the primary psychiatrist involved in this care.  However I share the concern that there is a lack of clarity as to how that oversight and decision making, which is appropriate and commendable, actually fits within the current legislative and administrative arrangements given he is actually employed by the Department of Communities and not by the Director of Mental Health. It would seem clear that if DKB was actually placed as a resident within the Forensic Disability Service Dr O'Brien could be the lead clinician in the service, providing this coordination of care.

1. I also have concerns in relation to DKB’s epilepsy. Epilepsy is a mental disease and if DKB had been given a defence based on his epilepsy then he would have been placed on the normal forensic order and he would have been detained to an Authorised Mental Health Service and the authorised psychiatrist could prescribe medication for his epilepsy. It would seem to me that if he is placed under a Mental Health Court – Disability forensic order then he is only detained for care and not treatment given the provisions of s 288(7). The authorised psychiatrist cannot therefore prescribe treatment for DKB’s epilepsy, depression or other mental illness but it would seem that the Adult Guardian could provide consent to this health care for at least his epilepsy.  This would seem to be an anomaly.

1. Of further concern is how a Mental Health Court – Disability forensic order actually fits within the substituted decision making regime established under the Powers of Attorney Act 1998 (Qld) and the Guardianship and Administration Act 2000 (Qld) and the consents to restrictive practise provided pursuant to the Disability Services Act 2006 (Qld).

Conclusion

1. As can be seen from the above discussion I consider that a forensic order Mental Health Court – Disability should be made. In my view the only order which can currently be made is an order detaining DKB to an Authorised Mental Health Service.

1. In the current circumstances DKB should be detained to the Authorised Mental Health Service as set out in the draft submission from the Director of Mental Health with Limited Community Treatment to commence immediately to an address approved by the Authorised Psychiatrist.