Patient Information
The functions of the Mental Health Review Board are
concerned with involuntary and security patients. It plays no role in
relation to patients who voluntarily receive psychiatric treatment.
The process of involuntary detention usually includes
the steps of request, recommendation, admission and examination by a
psychiatrist. The Board is not involved in the admission process. Similarly
the Board is not involved with making a person a security patient. This
status can arise after transfer from a prison or by order of a court.
Involuntary or security patients
can appeal to the Board at any time. This may be done by lodging an
appeal
form  31kb or sending a letter or using this site to lodge
the appeal electronically.
Once the Board decides to
conduct a hearing then a number of rights for the patient are activated.
The Board has an obligation to provide natural justice: parties are given a right to be heard; an opportunity
to prepare properly; an opportunity to know and to comment on any information
that is given to the Board. To maximise the extent to which patients
can participate in hearings the Board seeks to provide information
in plain English, has published ‘fact
sheets’, provides interpreters when required, and conducts
hearings in an informal way so that everyone concerned has the best
possible chance to understand what is happening and to join in.
Follow the link to lodge an
appeal electronically
or print an appeal
form 31kb.
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Admission Process
- Involuntary Patient
How is a person admitted as an involuntary patient
in Victoria?
There are three documents that require completion during
the process of admitting and detaining a person as an involuntary patient.
1. Request
The first document is a Request for Admission of a Person
as an Involuntary Patient. The form to be used is set out in Schedule
1 of the Regulations to the Mental Health Act. The Request can be signed
by any person. It can be signed before or after the recommendation.
The only details required are the name and address of the patient and
of the person signing the Request.
2. Recommendation
The second document is called the Recommendation for
Admission of a Person as an Involuntary Patient. The form is set out
in Schedule 2 of the Regulations. A Recommendation must be signed by
a registered medical practitioner. Usually it is signed following that
doctor's personal examination made within the last three days. However,
the doctor can sign it without making personal observations if he or
she has reasonable grounds for relying upon facts observed by someone
else and has personally observed some facts which support the Recommendation
or has relied upon facts personally observed by another doctor within
the last 28 days and which are communicated directly to the doctor who
is signing the Recommendation. If the signing doctor does rely upon
another doctor's observations then the name and address of that other
doctor must be given.
A Recommendation cannot be signed by a relative or guardian
of the proposed patient. Nor can it be signed by the person who signs
the Request. The critical part of the form is that the doctor must express
the opinion that the person meets all five criteria for admission and
detention as an involuntary patient.
Can admission occur without a Recommendation?
Yes, a person can be taken to an approved mental health
service without a Recommendation in certain circumstances. First, the
situation must be that steps have been taken to obtain a doctor but
none is available within a reasonable period. If this occurs a "mental
health practitioner" may decide that in their opinion the criteria
for admission and detention are satisfied and that the admission is
needed to make an examination for the purpose of a Recommendation being
signed. In these circumstances a "mental health practitioner"
includes persons employed by an approved mental health service who are
engaged in the provision of acute psychiatric assessment and treatment
functions in the community. Such persons must also be a registered nurse
or a registered psychologist or a social worker or an occupational therapist.
What is the effect of a Request and Recommendation?
Once the two forms are signed they constitute sufficient
authority for the proposed involuntary patient to be taken to an approved
mental health service. To do this a police officer, an ambulance officer,
or a doctor, nurse, psychologist, social worker or occupational therapist
employed by a psychiatric service may use such assistance as is required;
may use such force as may be reasonably necessary; may enter premises
if they have reasonable grounds to believe that the proposed patient
is there; and may use such restraint as is reasonably necessary.
What happens next?
Once the Request and Recommendation have been made the
person can be admitted to an approved mental health service by a doctor
employed in or by that service. The doctor who admits the patient must
notify the authorised psychiatrist as soon as possible if he or she
does not consider the person should be admitted. If necessary, the admitting
doctor can administer treatment if it is required immediately without
waiting for an examination by a psychiatrist.
3. Examination
The third document is the record of the examination
of the person by a psychiatrist. If the patient is not being treated
this examination must occur as soon as practicable. In any event, the
examination must occur within 24 hours after admission. The examination
results in the authorised psychiatrist or their delegate either discharging
the patient or confirming their admission as an involuntary patient.
The following flow chart outlines the overall process
of admission of an involuntary patient and the Mental Health Review
Board’s jurisdiction.
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Admission
Process - Security Patients
Security Patients include persons who appear to be mentally
ill and who are transferred from a prison or other place of confinement
to an approved mental health service. They also include persons found
guilty of a criminal offence who are ordered by a court to be admitted
and detained as a Security Patient. For more information
see our brochure Information About Your Hearing - Security Patient Brouchure
In both cases there must be a certificate by a psychiatrist.
It must state that the patient satisfies criteria that are similar to,
but slightly different from, those that apply to involuntary patients.
The criteria for security patients are that:
The
following flow chart outlines the overall process of admission of a
security patient and the Mental Health Review Board’s jurisdiction.
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How to Appeal
An involuntary patient or
a security patient may appeal to the Board at any time. This is usually
done by filling in an appeal
form (31KB .pdf), copies of which are readily available at all mental
health services. The form should then be given to a member of the staff
of the mental health service who must forward it to the Board immediately.
This is normally done by fax or by post. The form is very simple and
only requires a person to say what decision they are appealing about
and to briefly say why they are appealing.
Alternatively
an appeal may be made simply by writing to the Board without using the
form.
Finally
an appeal may be made electronically
by using the form that is contained in this web site.
Once the
Board receives an appeal, a hearing will be organised. This usually
occurs between 2 and 16 days.
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Patient Rights
What are
the rights of patients in relation to the Board?
Apart from
having the right to appeal to the Board at any time about decisions
regarding their status as an involuntary or security patient, the Board
also looks after the rights of patients by automatically conducting
reviews.
Once the
Board arranges for a hearing to be conducted there are a number of further
rights that patients have.
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Notice
of the Hearing
Patients
have a right to be notified of the hearing. Normally notice of more
than seven days is given in order to allow time for someone to prepare
for the hearing. However, this period may be shorter if everyone agrees.
This shorter time is mainly used when hearing an appeal as a patient
may wish to have the matter heard more quickly. The notice of the hearing
will include a letter setting out the details of the matters to be heard
and the time and place of the hearing. It will also include a comprehensive
brochure providing information to assist the patient in preparing for
the hearing.
Inpatients
are given the Notice of Hearing by a member of the staff of the mental
health service who must then sign a form so that the Board can be satisfied
when the service took place. Patients living in the community are sent
their Notice of Hearing directly by the Board through the mail.
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Representation
Patients
have the right to arrange for someone to represent them or assist them
at a hearing. The representative may either be a lawyer or a non-lawyer.
If the patient cannot afford the cost of legal representation they may
be able, in some cases, to arrange for representation from Victoria
Legal Aid or the Mental Health Legal Centre.
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Hearings
by Videoconferencing
The use of
videoconferencing enables the Board to provide a timely service to persons
in those parts of the State located furthest from Melbourne. Hearings
for Mildura Base Hospital, Warrnambool and District Base Hospital and
the Wodonga and District Adult Mental Health Service are regularly conducted
by using videoconferencing equipment.
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Access
to Documents
Patients
have the right to inspect any documents that are to be given to the
Board in connection with the hearing. If the mental health service is
proposing to give the Board the patient's clinical file then the patient
can see this that file. The patient must be given access at least 24
hours before the hearing. It is possible for a doctor to apply to the
Board for an order that certain documents not be inspected by a patient.
The grounds for seeking an order are either that such inspection would
cause serious harm to the patient's health or the health or safety of
another person; or involve the unreasonable disclosure of information
relating to the personal affairs of any person; or breach a confidentiality
provision imposed by the person who supplied the information contained
in the document.
The doctor
appearing at the hearing is required by the Board to produce a written
report (this is in addition to any other written information that may
be provided). The form of the report is specified by the Board. Doctors
are asked by the Board to ensure that the report is always given to
the patient prior to the hearing.
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Appear
in Person
Patients
have the right to appear in person at their hearing unless the Board
decides that their appearance would be detrimental to the patient's
health. The Board may hear a review or appeal without the patient being
present if it is satisfied the patient has made the decision not to
attend of their own free will. A patient who does not want to attend
a hearing can sign a simple
form supplied with the Notice of Hearing which may be mailed to
the Board. Alternatively, they can telephone the Board on 86015270 to
say that they do not wish to attend. Not only does a patient have a
right to be present at the hearing but they will be given an opportunity
to ask questions of the doctor or other witnesses and will be given
the opportunity to make any comments or statements.
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Bringing
Someone
A patient
may bring people to the hearing either to give information to the Board
or just for moral support.
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Statement
of Reasons
A patient
may request the Board in writing within 28 days of the Board's decision
for a written statement of the reasons for its decision.
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Further
Appeals
A patient
who is not satisfied with a decision of the Board has two possible ways
of having the decision reviewed again. They can appeal to the Victorian
Civil and Administrative Tribunal. This must be done within 28 days
of the Board's decision. Alternatively they may lodge a further appeal
with the Board.
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Preparation for
the Hearing
One of
the most important steps is to understand the criteria that will be
considered by the Board in their particular hearing.
In over
97% of cases the issue is whether or not the involuntary status of a
person should continue. For the precise wording of the criteria
for involuntary detention click here. The following questions are
a plain English version of the criteria.
-
Do you have a mental illness? (That is, does it appear from the
evidence that you have a significant disturbance of thought or mood
or perception or memory?)
-
Does your mental illness require immediate treatment? If it does,
can that treatment be obtained in hospital or on a community treatment
order?
-
Is the treatment for your mental illness necessary either:
-
to avoid a risk to your health, or
-
to avoid a risk to your safety, or
-
to protect any other person?
-
a. Have you refused consent to necessary treatment?
b. are you unable to give informed consent to necessary treatment?
That is, do you have a sufficient understanding of your illness
and the effects of your treatment?
-
Is it correct that adequate treatment cannot be received in a manner
that allows you more freedom?
If the
Board finds that the answer to any one or more of these questions is
"No", then the Board is required to discharge the patient.
By way
of preparation a patient should think about each of the questions. They
should think about what they are going to say to the Board. Before the
hearing, the doctor will prepare a report for the Board. This report
will state why the doctor believes that the patient is ill, their diagnosis,
their treatment and other information about the patient. It is important
to obtain a copy of the report and to read it prior to the hearing.
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Other steps to
check
Where and
when will the hearing be held? Nearly all hearings are held either in
hospitals or at community health services. Check the notice of hearing
for details. As there are several hearings on the same day check with
the hospital or clinic staff to find out an approximate time.
Is an interpreter
needed? If the patient requires an interpreter they should inform the
mental health service or telephone the Board direct.
Is representation
to be arranged? A patient should also consider whether they want to
arrange any representation or whether they want to ask any other people
to come to the hearing with them.
Are there
any witnesses? Consider whether there are any people whom the patient
wants to bring to the hearing to give evidence as a witness.
Is the
Report on Involuntary Status and the file available for inspection?
Any documents to be given to the Board should be available for inspection
at least 24 hours ahead of the hearing.
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Patient Information