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Role of the Psychosurgery Review Board
The Psychosurgery Review Board (the Board) was established by s56 of the Mental Health Act 1986 (the Act). The role of the Board is to determine applications by psychiatrists for a neurosurgeon to perform psychosurgery on a person. To protect confidentiality, Board hearings are closed to the public.
Schedule 3 to the Act sets out the procedure for appointments to the Board, the membership of the Board and the qualifications for membership. The Board consists of five members appointed by the Governor-in-Council on the recommendation of the Minister for Mental Health. Alternate members are also appointed to act during the absence or illness of a member. The Board must be made up of both males and females and consist of:
(a) a person who has been admitted to legal practice, in Victoria or elsewhere in Australia, for not less than five years; and
(b) a person who is a neurosurgeon nominated by the Royal Australasian College of Surgeons; and
(c) a person who is a psychiatrist nominated by the Minister for Mental Health; and
(d) a person who is a psychiatrist nominated by the Royal Australian and New Zealand College of Psychiatrists; and
(e) a person who is a member of the public nominated by the Victorian Council for Civil Liberties Inc.
The Board has no full-time staff. It operates from the offices of the Mental Health Review Board, and the Mental Health Review Board’s Executive Officer and Legal Officer provide operational and administrative support to the Board as required.
Psychosurgery is defined by s54 of the Act to include:
(a) any surgical technique or procedure by which one or more lesions are created in a person's brain on the same or on separate occasions primarily for the purpose of altering the thoughts, emotions or behaviour of that person; or
(b) the use of intracerebral electrodes to create one or more lesions in a person's brain on the same or on separate occasions primarily for the purpose of altering the thoughts, emotions or behaviour of that person; or
(c) the use of intracerebral electrodes to cause stimulation through the electrodes on the same or on separate occasions without creating a lesion in the person's brain for the purpose of influencing or altering the thoughts, emotions or behaviour of that person.
Over the period covered by this report, all applications to perform psychosurgery related to a procedure known as deep brain stimulation, which falls within the third limb of the above definition.
In order to grant consent for the performance of psychosurgery the Board must be satisfied in relation to the following matters:
- that the person for whom psychosurgery is being proposed is capable of giving, and has given, informed consent;
- that the proposed psychosurgery has clinical merit and is appropriate;
- that the doctors involved are properly qualified and experienced in the field;
- that the hospital where the procedure will be performed (if approved) is an appropriate place for the procedure to be performed; and
- that all other reasonable treatments have already been adequately and skilfully administered without sufficient and lasting benefit.
The Board has detailed guidelines to assist applicant psychiatrists provide all relevant information to the Board prior to a hearing being convened. These guidelines were designed to ensure that the Board is furnished with all the information it needs to decide whether to consent to psychosurgery, and to facilitate the expeditious determination of applications. These guidelines set out the minimum requirements for information regarding clinical practice and treatment history, in order to minimise the risk of applications having to be adjourned to enable additional information to be gathered and presented to the Board to enable it to make a decision.
Applications received from 1988 to 2011 are tabled below:
Under the Act, the neurosurgeon who performs psychosurgery on a person must make a written report to the Board as to the performance of the operation within three months after the completion of surgery. Likewise, the psychiatrist who has arranged for the neurosurgeon to perform the psychosurgery on a person must also make a written report within three months, and again within 12 months after the completion of the psychosurgery.
The Board is also required to ensure that at regular intervals there is a review of the case of any person on whom psychosurgery has been preformed. For this purpose, the Board may observe the person or make arrangements for the gathering and recording of information that it considers appropriate. However, the Board cannot review the case of a person who has objected to being reviewed.
Previously, the Board has not had a systematic approach governing when and how it would undertake reviews of psychosurgery. In 2010 the Board decided that, subject to the right of the person to object, it would only undertake bi-annual reviews in relation to cases where approval for psychosurgery had been granted in 2007 or later. Furthermore, such reviews would be ‘paper based’, essentially comprising a report from the original applicant psychiatrist.