CHHS16/011

Canberra Hospital and Health ServicesClinical ProcedureCare of Persons subject to Psychiatric Treatment Orders (PTOs)Contents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Scope........................................................................................................................................ 2

Alerts.........................................................................................................................................2

Section 1 – PTO Application, ACAT Hearing, and Review Processes:........................................2

Section 2 – Breaches of Psychiatric Treatment Orders:............................................................5

Section 3 – Revocation of Psychiatric Treatment Orders..........................................................5

Related Policies, Procedures, Guidelines and Legislation.........................................................5

Search Terms............................................................................................................................ 6

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CHHS16/011

Purpose

To provide guidelines to ensure mental health clinicians practice according to their legislated obligations and provide effective clinical care for persons who are subject to Psychiatric Treatment Orders (PTOs).

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Scope

This Procedure applies to all staff working within Canberra Hospital and Health Services and relates only to people receiving involuntary treatment, care or support under a PTO. This Procedure does not necessarily cover other elements of the Mental Health Act 2015 or the Act more broadly. Please note that for those persons who also have an intellectual disability, staff should also refer to the procedure: Management of Dual Disability Consumers on Involuntary Psychiatric Treatment Orders (PTO’s).

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Alerts

A Guardianship Order may be considered by the mental health service as a means to provide treatment for a person rather who does not have decision-making capacity but is accepting of treatment. In such cases the Guardianship Order must be established prior to the mental health service initiating a revocation of any existing PTO, to ensure care is effectively maintained during the transition from PTO to Guardianship Order.

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Section 1 – PTO Application, ACAT Hearing, and Review Processes:

1 Only a Consultant Psychiatrist can apply for a Psychiatric Treatment Order (PTO) or a Community Care Order (CCO). The Treatment Plan, Location Determination Form can be prepared and attached to the application for PTO ready for signature by the Consultant Psychiatrist. Both the PTO and application must be submitted at the same time.

2 Anyone, including the person themselves, can apply for an assessment order.3 In exceptional circumstances where a Treatment Plan is not submitted with the

application, it must be completed within 5 working days of the making of a PTO and a copy forwarded to the Tribunal Liaison Officer (TLO) who will forward it to:o the persono if the person is a child (under 18 years), the people holding parental responsibility for

the child o the guardian, if applicable o the attorney, if applicableo the carer, if applicable

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o the nominated person, if applicableo the health attorney, if they are involved in treatment, care or support of the persono ACT Civil and Administrative Tribunal (ACAT) o The Public Advocate of the ACT(PA ACT)

4 A clinical staff member of the relevant mental health team must be present at every ACAT Hearing of an application for a PTO. Prior arrangement for a teleconference can be made to the ACAT in the event that attending is not possible.

5 Where a clinical manager is involved with a person, they are expected to attend any relevant ACAT Hearings. Any inability to attend must be reported to their Team Leader and alternative representation must be organised. One of the treating doctors (Consultant Psychiatrist or Psychiatry Registrar) is also strongly encouraged to attend. Attendance by medical staff is mandatory for all inpatients appearing before ACAT.

6 Carers should be notified and strongly encouraged to apply to attend any ACAT Hearing and be notified of the outcome of same, where consent has been obtained from the person.

7 When there is no clinical manager allocated to a person who currently resides in the community and the person is seen only by a doctor (Consultant Psychiatrist or Psychiatry Registrar), the doctor must attend the ACAT Hearing wherever possible. If it is not possible for the doctor to attend the Tribunal, please contact the Chief Psychiatrist to discuss suitable alternative representation. The ACAT may be satisfied with phone contact but this must be discussed prior to the Hearing.

8 The Mental Health Act 2015 mandates that the ACAT and the Public Advocate of the ACT (PA ACT) are advised of any change of treatment plan and /or location, and of any change of address for persons on a PTO. This means they must be advised of any hospital admission and/or discharge of a person on a PTO. The Tribunal Liaison Officer (TLO) is advised of admissions and discharges of any person on a PTO via the daily ACTPAS bedstate and will notify the treating team who will prepare a Treatment Plan and Location Determination form for faxing to the PA ACT & ACAT.

Before making a determination in relation to a person, the Chief Psychiatrist must take reasonable steps to consult with those listed at point 3. This is a requirement under Section 62 of the Mental Health Act 2015.

The Chief Psychiatrist delegates their authority to the TLO in communicating to the treating teams when a PTO is made by ACAT.

In the event that a person subject to a PTO is not already assigned to a team, the TLO will allocate that person to an appropriate team via a MHAGIC or E-Health and Clinical Records message. The MHAGIC message will indicate that the person, now subject to a PTO is to be picked up by the assigned team. The team who picks up the message will acknowledge receipt of the message on MHAGIC. An email message from the TLO to the Team Leader will also be actioned.

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A treatment plan must be in place within 5 working days after the day the PTO is made. The Chief Psychiatrist must determine, in writing - (a) Whether the person requires admission to an approved mental health facility; (b) for a person living in the community-the times when and the place where the person

is required to attend to receive treatment, care or support, or undertake a counselling, training, therapeutic or rehabilitation program, in accordance with the order; and

(c) the nature of the psychiatric treatment to be given to the person.

Where applicable the guardian (usually the carer or Public Advocate) should be stated in the document in accordance with their rights as a guardian.

9 For any person who has had a period of inpatient treatment, good clinical practice dictates that, prior to discharge, the treatment plan must be reviewed and updated to document the ongoing management arrangements. A copy of this treatment plan must be given to the people listed in 3. A copy of the updated treatment plan should also be forwarded to the TLO who will forward this to ACAT and the PA ACT.

10 For people on a PTO residing in the community, it is the responsibility of the clinical manager, or the treating doctor if there is no case manager, to directly advise the ACAT and PA ACT of any change of address of the person. An entry must be made in MHAGIC confirming the notification has been completed. This should be done via Treatment Plan Location Determination signed by the Consultant Psychiatrist.

11 All persons on PTOs must be contacted by the treating team at a minimum of every 2 weeks. If contact is made by telephone, a summary of the phone call and any identified issues are to be clearly documented in the medical record. Exceptions to this rule will need to be discussed with the psychiatrist and the reasons and the alternate plan clearly documented on MHAGIC. eg there may be sound clinical reasons to have longer intervals between contacts.

12 It is mandatory for all persons on a PTO to be seen and reviewed at least every 4 weeks on a face to face basis. Ideal clinical practice would dictate more regular contact, particularly if the person is in the stages of relapse or recovery.

13 In circumstances where a concern for the deterioration in health of a person is identified; an appointment will be made as per the Clinical Management of a Deteriorating Community-Based Mental Health Consumer Procedure.

14 The ACAT has the capacity under the legislation to schedule reviews of persons on PTOs and has signalled its intention to schedule such reviews routinely. Given that a PTO amounts to the removal of a person’s civil liberties and is experienced as a negative event by many individuals, it is imperative that treating teams regularly review and document the need (or otherwise) for ongoing involuntary treatment, and update the treatment plan accordingly. This must occur at a minimum of every 3 months to coincide with the minimum review period established by the National Standards for Mental Health Services (2010). However, in practice, it should also be a consideration on each occasion the person is seen.

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Section 2 – Breaches of Psychiatric Treatment Orders:

The Mental Health Act 2015 allows for breach proceedings to be commenced at the point of non-adherence by the person to the treatment plan, as lodged with the ACAT. However, the decision to commence breach proceedings must also based on an assessment of risk and likelihood of deterioration. Once the decision has been made by the treating team that a Breach process is appropriate and necessary, the following process must be followed: A verbal notification must be given to the person at the point of the initial non-

adherence. Written notification should then be provided to the person as soon as possible using the

relevant proforma letter in MHAGIC. The Chief Psychiatrist is to be informed of the written notification of the breach being

provided. The Notification of Breach & Authorisation to Require a Person to be Detained Form can

be found in MHAGIC and should be completed by the clinician and emailed or faxed to the Chief Psychiatrist for signature and then emailed or faxed back to the clinician.

The clinical manager or initiator of the breach is to complete and fax or email the Notification Breach & Authorisation to Require a Person to be Detained Form to the PA ACT and ACAT within 24 hours and ACAT must review the order within 72 hours.

The original to be sent by the clinician to the TLO for filing. A file note is to be entered into the clinical record indicating this has occurred.

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Section 3 – Revocation of Psychiatric Treatment Orders

Where involuntary treatment is no longer considered appropriate, the consultant psychiatrist must take all reasonable steps to give notice to the carer and the nominated person of their intention to apply to revoke the order. A Notice of Revocation Form (which can be found in MHAGIC) should be completed and sent to ACAT (there is no need to wait until the expiry of the order before it is reviewed). The ACAT has previously indicated that timely notices of revocation will mean the ACAT can cancel the scheduled reviews.

Revocation of PTOs can only be applied for and signed off by a Consultant Psychiatrist and must state the reasons that a PTO is no longer necessary including (where applicable) the views of the carer and nominated person. The carer and nominated person should be informed that they are entitled to make submissions to ACAT, or to attend the hearing. Once revocation has been approved the clinician must inform the person and treating team as soon as possible.

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Related Policies, Procedures, Guidelines and Legislation

Legislation

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Mental Health Act 2015 Health Records (Privacy and Access) Act 1997 Human Rights Act 2004 Carers Recognition Act 2010

Procedures MHJHADS Procedure: Tribunal Ordered Assessment MHJHADS Procedure: Mental Health Officer MHJHADS Procedure: Clinical Management in Mental Health Services MHJHADS Procedure: Adult Consumers on Custodial Orders (s.309 of the Crimes Act

1900) MHJHADS Procedure: Management of Dual Disability Consumers on Involuntary

Psychiatric Treatment Orders (PTO’s) MHJHADS Procedure: Clinical Management of a Deteriorating Community-Based Mental

Health Consumer

Standards National Standards for Mental Health Services 2010

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Search Terms

Mental Health, Psychiatric Treatment Orders (PTO), Tribunal Liaison Officer (TLO), Public Advocate, ACT (PA ACT), ACT Civil & Administrative Tribunal (ACAT)

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Disclaimer: This document has been developed by ACT Health, <Name of Division/ Branch/Unit> specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved By11/09/2017 Alert Section Added Chief Psychiatrist

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register