Public Health Emergency – COVID-19
On 29 January 2020, the Minister for Health and Minister for Ambulance Services, the Honourable Dr Steven Miles, declared a public health emergency in Queensland in response to the COVID-19 virus outbreak.
The Office of the Chief Psychiatrist has been putting plans in place to manage impacts on the provision of treatment and care to patients under the Mental Health Act 2016 (the Act) caused by the pandemic and associated state of emergency.
In response to the public health emergency declaration, the Chief Psychiatrist has released a suite of temporary Chief Psychiatrist Policies.
The first in the suite, Chief Psychiatrist Policy - Temporary amendments to Chief Psychiatrist Policies, aims to reduce and contain the spread of COVID-19. Temporary provisions within this policy amend requirements under existing Chief Psychiatrist policies, to enable administrators and clinicians in authorised mental health services to continue to meet their obligations and requirements under the Act, while ensuring patients receive appropriate treatment and care for their mental illness in the context of the COVID-19 pandemic.
Temporary Policy: Temporary amendments to Chief Psychiatrist Policies
In addition, as part of Government’s response to the COVID-19 pandemic, the Act has been amended to ensure that the legislation can be applied safely and effectively whilst supporting measures aimed at reducing the spread of COVID-19 within the community. These amendments are temporary and will only apply while the public health emergency declaration made under the Public Health Act 2005 remains in place and will expire on 31 December 2020.
Broadly, the amendments allow the Chief Psychiatrist to approve an absence from an authorised mental health service for a patient detained under the Act, if satisfied that the absence is necessary to comply with a detention order or public health direction given under the Public Health Act 2005.
In addition, the Chief Psychiatrist has been granted temporary powers to declare an authorised mental health service or to appoint an administrator of an authorised mental health service via publication on the Queensland Health website, instead of via the Queensland Government Gazette. This amendment will expedite the current process of declaration or appointment should facilities need to be promptly used in response to the COVID-19 pandemic.
The amendments to the Act are intended to operate only as a last resort, when application of the standard provisions result in a conflict with a direction or order given under the Public Health Act 2005.
To guide services in the application of these new provisions the Chief Psychiatrist has released a Chief Psychiatrist Policy - Temporary modifications to the Mental Health Act 2016.
Temporary Policy: Temporary modifications to the Mental Health Act 2016
Temporary amendments to Chief Psychiatrist Policies
1. Examination and assessment
The following temporary amendments are made to accommodate potential staff shortages as a result of the COVID-19 pandemic and to facilitate examination and assessment of a person in isolation due to a positive or potential COVID-19 diagnosis.
Examinations and assessment conducted under the Act may be undertaken via audio-visual technology if it is considered clinically appropriate in the circumstances, including:
- Examination for Recommendation for Assessment, and
- Assessment under a Recommendation for Assessment
Clinicians seeking to conduct an examination or assessment via audio-visual means, must clearly document the rationale for this decision. This should include details of how and why an examination or assessment by audio-visual means is clinically appropriate.
However, as required under the Act, an assessment under a recommendation for assessment still cannot occur in a custodial setting.
2. Assessment and Risk Management Committee
AMHS administrators are required to establish an Assessment and Risk Management Committee (ARMC) in accordance with the ARMC Terms of Reference. The ARMC’s role is of a clinical nature and functions as a peer review of the treatment and care of patients subject to a Forensic Order, Treatment Support Order or other high risk patients.
The clinical director is responsible for facilitating the operation and function of the ARMC. The ARMC:
- reviews the treatment and care of required patients under the Chief Psychiatrist Policy – Treatment and Care of FO, TSO and high-risk Patients
- makes recommendations or decisions about a patient’s treatment and care
- identifies systematic issues relating to the management of forensic and high-risk patients, and
- determines the frequency of monitoring and assessment of forensic and high-risk patients by the case manager (or equivalent), forensic liaison officer and an authorised psychiatrist.
Community Forensic Outreach Service (CFOS) is available to discuss any concerns regarding high risk patients and development of appropriate response, including when a Tier 2 Violence Risk Assessment and Management assessment has not yet been completed.
The following temporary amendments are made in relation to the Terms of Reference for ARMC.
The ARMC must include at least:
- The clinical director (must be a psychiatrist nominated by the administrator)
- The treating psychiatrist and other members of the persons treating team
- The forensic liaison officer (FLO), and
- A representative from CFOS
- If the patient is not an adult, then a representative from the Child and Youth Forensic Outreach Service (CYFOS) should be present instead.
Meetings will proceed on the basis that the clinical director, treating psychiatrist, forensic liaison officer and a representative from CFOS (or CYFOS where relevant) are represented.
Membership and quorum
At a minimum the following members must be present at any ARMC meeting:
- clinical director
- treating psychiatrist (or a member of the treating team where the treating psychiatrist is unavailable)
- CFOS/CYFOS representative (unless advised of unavailability by CFOS/CYFOS psychiatrist or team leader)
Should the FLO not be available to attend as required (i.e. for reasons related to COVID-19), the ARMC may proceed without that member present.
In the absence of being able to hold an ARMC with full membership, AMHS services should establish additional processes to ensure the objects and functions of the ARMC are fulfilled, including:
- Members unavailable to attend (excluding minimum quorum) should request a proxy to attend; and
- The circulation of minutes to all absent members of an ARMC for review.
All timeframes for review and referrals to CFOS established in the Chief Psychiatrist Policy – Treatment and Care of Forensic Order, Treatment Support Order and High Risk Patients, must be complied with.
If there are concerns about a service’s ability to meet timeframe requirements ongoing due to the impacts of COVID-19, the Administrator should escalate to the Chief Psychiatrist via email to MHA2016_COVIDemail@example.com
- ARMC reviews
- Referrals to CFOS/CYFOS
- Implementation of CFOS/CYFOS recommendations
3. Notification of legislative non-compliance
Notifications of legislative non-compliance are monitored by the Office of the Chief Psychiatrist to identify statewide trends, address through policy reform and/or develop statewide improvement initiatives.
During the COVID-19 emergency, notifications will be used to inform appropriate responses from the OCP to address live or arising issues causing challenges with provision of appropriate treatment and care for persons under the Act.
The OCP acknowledges that all non-compliance events may be COVID-related to some degree during this public health emergency; however, the existing requirements for notification to the Chief Psychiatrist via the approved form should continue to be fulfilled. Only notifications for the temporary non-compliance categories are to be made via the temporary email provided below.
Any failure to comply with requirements of the Act must be recorded on the patient’s clinical record, including on CIMHA where possible.
The breach should be discussed with the patient, or if not practicable, the patient’s nominated support person or other support persons.
Notification to the Chief Psychiatrist of non-compliance with the Act are to be made by the AMHS Administrator as soon as practicable after becoming aware of the breach.
Notification to the Chief Psychiatrist of significant or suspected significant non-compliance with the Act, including:
- the detention of a person other than in accordance with the Act
- the provision of a regulated treatment (e.g. electroconvulsive therapy) other than in accordance with the Act
- the use of seclusion, mechanical restraint, physical restraint or administration of medications other than in accordance with the Act, or
- a breach of any other offence provision of the Act (e.g. ill-treatment of patients, contravention of the confidentiality obligations, assisting a patient to unlawfully absent themselves, giving false or misleading information to an official, and obstructing of an official
CIMHA Form: Notification to the Chief Psychiatrist of Significant Non-Compliance with the Act
The amendments below are in addition to current notification requirements and must be emailed as soon as the Administrator becomes aware of the breach.
Additional notifications are required for non-compliance as a result of COVID-19 impact on usual service provision.
- Breach of authorised Limited Community Treatment and/or Conditions of an Order/Authority
(e.g., involuntary patient with no approved LCT required to self-isolate at home due to positive or potential COVID-19 result)
- Breach of statutory timeframes for assessment of persons requiring mental health treatment and care
(e.g., Treatment Authority made by an authorised doctor is not able to be confirmed or revoked by an authorised psychiatrist within 72 hours due to staffing shortages resulting from the COVID-19 pandemic).
- Another possible breach of the Act determined by the AMHS Administrator as requiring escalation to the Chief Psychiatrist (e.g., a significant breach of a person’s rights or repeated breaches of a particular provision).
- Complete the Form: Notification of Non-Compliance due to COVID-19.
- Upload the form to CIMHA as a scanned PDF version under the category of ‘General’ and form type of ‘Notification of Non-Compliance due to Covid-19’.
- CIMHA will automatically send a notification to MHA2016_COVIDfirstname.lastname@example.org.
4. Social distancing and hygiene practices in Mental Health Review Tribunal hearings
To limit the spread of COVID-19, the Chief Health Officer issued public health directions restricting access to hospitals. Hospital and Health Services can further implement local restrictions to hospitals and regions based on clinical risk.
The Mental Health Review Tribunal (MHRT) will gradually return to face-to-face hearings in services and consumers are encouraged to attend their hearing in person if it is clinically appropriate. However, these hearings may be impacted by the restrictions imposed by the public health directions and may be further restricted and differ across the services.
This policy ensures that venues used in hospitals for tribunal hearings continue to provide an environment that is safe and secure for face-to-face hearings.
Where a requirement in this policy cannot be satisfied due to a public health direction or further local restrictions to limit the spread of COVID-19, the AMHS will follow the directions or restrictions instead.
As the MHRT gradually returns to face-to-face hearings in services, it will require information relating to social distancing and hygiene practices in venues. AMHSs will liaise with the MHRT to coordinate the gradual return to face-to-face hearings and measures implemented to limit the spread of COVID-19.
Clinicians and services should also seek guidance from their local Work Health and Safety teams as necessary.