Treatment and care
The Act promotes voluntary treatment wherever possible and seeks to minimise the use and duration of involuntary treatment to ensure that the treatment is provided in the least restrictive manner possible.
Clinicians must have regard to a person’s safety and welfare, and the safety of others.
Wherever possible treatment and care should be provided to a person in the community, preferably at home.
Treatment and care of people under the Act must be achieved in a way which:
- safeguards a person’s rights
- is least restrictive of the person’s rights and liberties, and
- promotes the recovery of the person.
Individuals and their family, carers and support persons should be actively engaged in the development and planning of the person’s treatment and care and are entitled to be provided with information. See Patient Rights and Support for information about your involvement in your own or someone else’s mental health care.
Policy: Treatment and care of patients
Fact Sheet: Treatment in the community
Fact Sheet: Written Notices and Documents for Patients
Fact Sheet: Rural and remote services
Clinical Note: Involuntary Patient and Voluntary High Risk Patient Summary
Considerations for Minors
For the purpose of the Act, a minor means an individual who is under the age of 18 years.
A minor may consent to treatment if they are deemed to have the maturity and capacity to do so. Alternatively, a less restrictive way of providing treatment includes parental consent.
In most instances the same provisions apply for minors as for adults in relation to involuntary assessment, treatment and protection of persons.
However, there are a number of provisions which relate specifically to minors to promote the best interests of the minor receiving treatment, including:
- receiving treatment and care separately from adults
- strict legislative requirements regarding
- approval, application, notification, monitoring and reporting of the use of regulated practices for minors, and
- the treatment of minors within a high security unit of an authorised mental health service.
Additional protections also exist for minors outside of the Act, such as the Office of the Public Guardian Community Visitors Program.
Policy: Treatment and care of minors
Fact Sheet: Treatment and care of minors
For parents or carers wanting more information about their rights, or the rights of patients under the Act please see Patient Rights and Support.
Capacity to consent to be treated
Capacity is the ability of a person to give informed consent to a particular treatment at a particular time.
Capacity can fluctuate over time or a person might have the capacity to consent to some aspects of their treatment and care but not to others.
Under the Act, the person receiving a mental health assessment is presumed to have capacity to consent to their mental health treatment.
The Act promotes supported decision-making, so if a person is able to understand information with the assistance of another person, then the person is deemed to have capacity to make decisions about their own treatment.
If after an assessment, a doctor or authorised mental health practitioner determines that the person does not have capacity to consent to be treated, a Treatment Authority may be required to ensure the person receives the necessary treatment and care for their mental illness.
‘Less restrictive way’
The ‘less restrictive way’ is one of the main intentions of the Act which requires that mental health treatment and care is to be provided in a way that is the least restrictive of the person's rights and liabilities.
This means that service providers must consider alternatives to involuntary treatment and care, particularly through the use of advance health directives and substituted decision making, if a person’s mental health treatment and care needs can be met using these options.
In deciding whether there is a less restrictive way to treat a person, the Act requires an authorised doctor to check the patient's health records to see if an advance health directive is in place, or if an attorney or guardian has been appointed for the person. When requested to do so, the service must keep a record of advance health directives and attorneys on the patient’s health records.
Guidelines: Less restrictive way
Advance Health Directives (AHD)
In line with recovery-oriented practice, advance health directives allow individuals to provide consent for future mental health care, and to document their views, wishes and preferences about future mental health treatment should they become unwell and lack the capacity to make decisions.
Guide and Form: Advance Health Directives (Online)
Guide and Form: Advance Health Directives (Print)
Checklist: Advance Health Directives
Brochure: Advance Health Directives
Substitute Decision Makers
A substitute decision maker is a person appointed by the person (at a time when they have capacity) to provide substitute decision making and consent in times when the person lacks capacity.
A substitute decision maker includes:
- Enduring Power Of Attorney
- Statutory Health Attorney
Types of decisions may include, consent to treatment, community and housing support decisions or financial decisions, depending on the type of appointment made for the substitute decision maker.
Checklist: Enduring Power Of Attorney
Checklist Guide: Decision Maker Information Checklist - Child and Youth
Clinical need for medication
It is an offence under the Act for a person to administer medication to a patient unless the medication is clinically necessary for the patient’s treatment and care for a medical condition.
Authorised mental health services are responsible for compliance with the National Strategy for quality use of medicines, involving:
- the choice between medicine and non-medicine treatment options and no treatment
- appropriate choice of medicine when medicine is required, and
- safe and effective use of medicines.
In addition, authorised mental health services must comply with the National Safety and Quality Health Service Standards. This includes medication safety, with the intention of ensuring that competent clinicians safely prescribe and administer appropriate medicines to informed patients and carers.
Policy: Clinical need for medication
Regulated treatment (Electroconvulsive therapy - ECT)
The Act regulates two types of treatment for patients of authorised mental health services – electroconvulsive therapy and non-ablative neurosurgical procedures, such as deep brain stimulation.
Deep brain stimulation is performed by neurosurgeons and is used as a treatment of last resort, for patients who are unable to control their symptoms with medications alone.
Fact Sheet: Regulated treatments
The primary purpose of electroconvulsive therapy (ECT) is to quickly and significantly alleviate psychiatric symptoms.
ECT is a highly effective treatment with a strong evidence base and may be recommended for treatment of a person's mental illness in some acute situations when other treatments have been ineffective or when ECT has worked well previously.
In some circumstances, emergency ECT may be necessary to save the person’s life or to prevent the person from suffering irreparable harm.
ECT is a regulated treatment under the Act and may only be given:
- with informed consent – if the person is an adult, or
- with the approval of the Mental Health Review Tribunal – if the person is a minor or if the person is an adult who is unable to give informed consent.
An application for ECT must include any views, wishes and preferences the person has expressed about the therapy in an Advance Health Directive or at other times or in other documents.
Policy: Electroconvulsive therapy
Form: Treatment application for ECT - available from MHRT website