Treatment and care

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.

The following resources have been developed specifically in relation to treatment and care of minors. These should be read in conjunction with the corresponding Chief Psychiatrist Policy.

Treatment and care

Policy:  Treatment and care of minors

Fact Sheet: Treatment and care of minors

Capacity to consent to treatment

Form: Capacity Assessment for Child and Youth

Form Guide: Capacity Assessment for Mental Health Treatment - Child and Youth

Flow Chart: Decision Making for Child and Youth - Mental Health Treatment and Care

Checklist: Decision Maker Information Checklist - Child and Youth

Checklist Guide: Decision Maker Information Checklist - Child and Youth

Clinical need for medication

FAQ: Acute Sedation - Using medicine to calm - Child and Youth

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 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.

Policy: Treatment criteria, assessment of capacity, less restrictive way and advance health directives

Form: Capacity Assessment for Adults

Form Guide: Capacity Assessment for Mental Health Treatment - Adults

Form: Capacity Assessment for Child and Youth

Form Guide: Capacity Assessment for Mental Health Treatment - Child and Youth

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.

Policy: Treatment criteria, assessment of capacity, less restrictive way and advance health directives

Guide: Advance Health Directives, Enduring Power of Attorney, Guardians and Administrators

Guidelines: Less restrictive way

Advance Health Directives

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.

You can use the Advance health directive for mental health guide and form below, issued by the Office of the Chief Psychiatrist. It includes information to help you make directions for mental health.

Alternatively, you can use the Advance health directive form issued by the Department of Justice and Attorney-General. We recommend this form if you’re also including directions for other matters, such as your physical health.

Fact sheet: Making directions for mental health

Policy: Treatment criteria, assessment of capacity, less restrictive way and advance health directives

Fact sheet: Advance health directives and less restrictive way of treatment

Guide and Form: Advance health directives for mental health

Form: Revocation of advance health directive

Checklist: Advance health directives and enduring powers of attorney

Brochure: Advance health directives

Video: Advance health directive for mental health

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:

• Guardian
• 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: Advance health directives and enduring powers of attorney

Flow Chart: Decision Making for Adults - Mental Health Treatment and Care

Flow Chart: Decision Making for Child and Youth - Mental Health Treatment and Care

Checklist: Decision Maker Information Checklist - Child and Youth

Checklist Guide: Decision Maker Information Checklist - Child and Youth

If a person is not able to consent to treatment of their mental illness, and there is no less restrictive way available, it may be necessary for an authorised doctor to make a Treatment Authority to authorise involuntary treatment for the person.

When a Treatment Authority is made, the authorised doctor must determine whether the patient is to receive treatment as an inpatient of a mental health unit or in the community (e.g. a community based mental health unit or preferably in their own home). The community category is the default category unless the person’s treatment and care needs cannot be met in the community. If required, an authorised doctor may change the category of the Treatment Authority at any time during the person’s treatment.

As a key safeguard patients subject to a Treatment Authority are regularly reviewed by the Mental Health Review Tribunal. The Tribunal’s role is to review the appropriateness of the order and decide whether to confirm (continue) or revoke (end) the Treatment Authority. The Tribunal may also decide to change the category of the Authority (inpatient or community) or change community treatment arrangements or other conditions of the Authority.

Policy: Treatment authorities

Fact Sheet: Treatment authorities

Clinical Note: Involuntary Patient and Voluntary High Risk Patient Summary

Form: Order / Authority Amendment

Form: Limited Community Treatment Access and Return

Other Treatment Orders - Forensic and Treatment Support Orders

The majority of persons receiving involuntary treatment and care under the Act are subject to a Treatment Authority. However, where a person with a mental illness, or an intellectual or cognitive disability, is charged with committing an offence, the Act enables them to be diverted from the criminal justice system if they are found to have been of unsound mind at the time of the offence, or unfit for trial.

In this instance, individuals with a mental illness may be receiving involuntary treatment and care under a Treatment Support Order or Forensic Order.

See Courts, forensic patients and people in custody for more information about persons charged with offences.

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

FAQ: Acute Sedation - Using medicine to calm - Adults

FAQ: Acute Sedation - Using medicine to calm - Child and Youth

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

Electroconvulsive Therapy

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 and may only be given in accordance with the Act.

Policy: Electroconvulsive therapy

Guideline: The Administration of Electroconvulsive Therapy - Clinical Guideline

Guide: A Guide to Electroconvulsive Therapy (ECT) for Consumers and Carers

Fact Sheet: Information about Electroconvulsive Therapy (ECT) – A fact sheet for you and your family

Form: Treatment application for ECT - available from MHRT website

Online Decision Tree: Regulatory requirements for the approval and performance of ECT