Chief Psychiatrist policy
This page includes information about the following Chief Psychiatrist policy.
| Policy | Patient records (PDF 169 kB) |
This policy is mandatory for all authorised mental health services (AMHSs). An authorised doctor, authorised mental health practitioner (AMHP), AMHS administrator, or other person performing a function or exercising a power under the Mental Health Act 2016 must comply with this policy.
You can also find additional fact sheets, forms, clinical notes and resources that are available for these policies under the relevant subtopics on this page.
Managing patient health records
An accurate, comprehensive and up to date patient record management system supports mental health clinicians and AMHS administrators in delivering high quality treatment and care and upholding the rights of involuntary patients.
AMHS administrators are required to ensure that data relevant to the assessment, treatment and care of patients under the Mental Health Act 2016 is:
- accurate and up-to-date, and
- that all Mental Health Act 2016 related documents are electronically entered or uploaded to the patient record.
Consumer Integrated Mental Health and Addiction (CIMHA) application
The CIMHA application is a statewide consumer-centric clinical information system which is the designated patient record for the purposes of the Mental Health Act 2016.
Read the policy for more information or find out more about CIMHA
What you must discuss with patients
The Mental Health Act 2016 requires persons, such as authorised doctors and AMHPs, to tell, explain or discuss particular matters with patients.
The matters that must be explained or discussed with patients include:
- patient rights
- examinations
- assessments
- treatment and care of patients including in relation to treatment in the community
- certain matters affecting persons in custody
- psychiatrist reports
- regulated treatment such as electroconvulsive therapy (ECT)
- transport and security at AMHSs.
The person who is required to discuss or explain a matter with a patient must:
- take reasonable steps to ensure the patient understands the information
- tell or explain the matter to, or discuss the matter with, the patient in an appropriate way having regard to the patient’s age, culture, mental illness, ability to communicate and any disability
- tell or explain the matter to, or discuss the matter with, the patient in a way the patient is most likely to understand, for example, in the patient’s language.
Read the What you need to discuss with patients fact sheet (PDF 636 kB) for more information.
Written notices and documents must also be provided to patients in some situations. Learn more about notifying patients, written notices and treatment and care.
Guidance for sharing patient information
The Information sharing in mental health alcohol and other drugs care page provides information for Queensland Health staff about the management of information related to consumers receiving treatment and care in Queensland Health mental health alcohol and other drug services, including:
- information sharing requirements and practices
- common legislative frameworks that apply to information sharing
- when and how consumer information can and should be shared.
Queensland Health has also established information sharing agreements and Memorandum of Understanding with other government departments for people who are accessing, or who may access, Queensland Health mental health, alcohol and other drugs services.
Learn more about information sharing in mental health alcohol and other drugs care.