Emergency Detention in the Inpatient Setting and a Persons ...



Canberra Hospital and Health Services

Operational Procedure

Emergency Detention in the Inpatient Setting and a Person’s Rights under the Mental Health Act 2015

|Contents |

Contents 1

Purpose 2

Alerts 2

Scope 2

Section 1 – Authorisation, Notification and Treatment in relation to Detention 2

Section 2 – Rights of People with a Mental Illness or Mental Disorder 6

Section 3 – Information and Communication 6

Search Terms 7

Related Policies, Procedures, Guidelines and Legislation 7

Definition of Terms 8

|Purpose |

The purpose of this procedure is to provide information on emergency detention provisions, including patient rights under the Mental Health Act 2015 (the Act) for all people involuntarily detained and admitted to the Canberra Hospital.

|Alerts |

If a decision is made to detain a person, an Emergency Detention -3 days (ED3) form must be completed by a doctor, co-signed by another doctor, and faxed within 12 hours to the ACT Civil and Administrative Tribunal (ACAT) 6205 4855 and the Public Advocate of the ACT (PAACT) 6207 0688.

Within 24 hours of detention, the person in charge of the facility must ensure that a thorough physical and psychiatric examination on the person is undertaken.

Full details of Emergency Detention provisions and legislative requirements can be found in Chapter 6 of the Mental Health Act 2015.

|Scope |

This procedure pertains to all Canberra Hospital clinical staff providing treatment and care for people in the inpatient setting who may be subject to Emergency Detention as determined by the Mental Health Act 2015.

For the purpose of this document, “doctor” refers to a medical officer employed at the relevant health facility as a Consultant Psychiatrist, a Psychiatry Registrar in consultation with a Consultant Psychiatrist, or another doctor (e.g. Emergency Department Registrar) in consultation with a Consultant Psychiatrist.

|Section 1 – Authorisation, Notification and Treatment in relation to Detention |

1. Authorisation of Detention

1. A doctor may authorise involuntary detention and care of a person at an approved mental health facility for a period not exceeding three (3) days.

2. The doctor must be satisfied that the person has a mental illness or mental disorder and as a consequence requires immediate treatment and care or, in the doctors opinion, the person’s condition will deteriorate within three (3) days to such an extent that the person would require immediate treatment or care. The doctor must also be satisfied that the person has refused treatment or care and detention is necessary for the person’s own health or safety, for the protection of others and adequate treatment or care cannot be provided in a less restrictive environment.

3. If the decision is made to detain a person, the doctor must complete an ‘Authorisation/Notification Involuntary Detention’. It is a blue form and is known as an ED3 (Emergency Detention three (3) days) and can be found in the relevant health facility. The doctor must complete the form in full, including the basis for the decision, the time and place that the involuntary detention commenced, and they must sign the document and print their name. A second doctor should have also examined the person and be satisfied the criteria as above (1.2) apply and co-sign the ED 3 form. The doctor must discuss the person with the relevant mental health facility Consultant Psychiatrist or on-call Consultant Psychiatrist (afterhours).

4. The form must be faxed within 12 hours to the ACT Civil and Administrative Tribunal (ACAT) 6205 4855 and the Public Advocate of the ACT (PAACT) 6207 0688.

5. The original form must remain on the person’s medical record file (paper file), whilst the duplicate is to be forwarded to the Tribunal Liaison Officer (TLO). The TLO is physically located at the Adult Mental Health Unit (Building 25, CH) and can be contacted on 61745410 or 62445411 or FAX 6244 4558.

6. Within the first 24 hours of detention, the person in charge of the facility must ensure that a thorough physical and psychiatric examination is undertaken. The psychiatric examination must be undertaken by a Consultant Psychiatrist, a Psychiatry Registrar in consultation with a Consultant Psychiatrist or another doctor in consultation with a Consultant Psychiatrist. Following the psychiatric examination, a doctor can either uphold the detention or release the person from detention. The physical examination may be completed by any of the doctors.

7. A Psychiatry consultation in the general wards can be facilitated though the Mental Health Consultation Liaison Team on 6244 3204 or by contacting the Psychiatry Registrar or the on call Consultant Psychiatrist after hours through Canberra Hospital switch (dial 9).

8. If released from detention, the person can be discharged or become a voluntary patient. If the decision is made to release the person from the ED3, the Psychiatrist should complete the “Release from Involuntary Detention” form available on the Clinical Forms Register and the person’s Mental Health Electronic Clinical Record (ECR, currently MHAGIC). Once completed, this form must be forwarded to the TLO who will then fax it to the ACAT and PAACT, and will also update the legal status in the person’s mental health ECR to ensure the person is identified as voluntary.

9. If the detention is upheld, the mental health treating team should continue to assess the person regularly throughout the detention period, to ensure they still meet the criteria for detention. Otherwise, the person should be released as soon as is practicable.

10. If there is a need for involuntary detention beyond the initial three (3) days, the Chief Psychiatrist or delegate must complete an application for a further period of detention (not exceeding 11 days- ED 11). The ED11 form can be found on the Clinical Forms Register or in the person’s mental health EMR and must be signed by a Consultant Psychiatrist. The form is then faxed to ACAT and PAACT within normal office hours by the completing Psychiatrist and a copy forwarded to the TLO. Any ED3 which is due to expire over a weekend or extended shut down period must also have an ED11 application submitted during office hours on the Friday prior to the weekend or last working day prior to a shut down period.

11. If in the opinion of the mental health treating team there is a need for ongoing involuntary treatment, an application by the Consultant Psychiatrist (or delegate) for a Mental Health Order should be made to ACAT prior to the ED11 order expiring. If the diagnosis is that of mental disorder as defined in the Act, then an application should be made for a Community Care Order (CCO). If the diagnosis is mental illness, a Psychiatric Treatment Order (PTO) should be applied for. Please note: a CCO can only be made if a PTO cannot.

12. Applications should be lodged to the TLO for forwarding to ACAT by 12.30pm on Monday for hearing on Thursday morning and 12.30pm on Thursday for hearing on Monday afternoon. ACAT attends the inpatient unit to hear these applications. As well as members of ACAT, the person themselves and their support/s (including carers, family, friends, Nominated Persons), the public advocate and member/s of the treating team will also attend.

13. A hearing notice and application shall be served on the person by the TLO in writing at least three (3) days prior to the hearing.

14. The Tribunal may on hearing evidence from all relevant parties, make an order for a PTO or CCO, adjourn the matter for further hearing or may dismiss the application and make no order.

15. When the subject of a proceeding is a child, regard shall be had for the age of the person at the commencement of the proceeding.

16. If a Mental Health Order is made, this over-rides an existing ED11 order and authorises the Chief Psychiatrist (or delegate), or the Care Co-ordinator (or delegate) to have responsibility for the treatment and care of the person subject to the order.

2. Notification of Detention

ACAT must be notified (as outlined above in 1.1 ‘Authorisation of Detention’)

A doctor or mental health officer must also, as soon as practicable after authorising the involuntary detention of a person under an Emergency Apprehension, ED3 or ED11 (section 81, section 85), take all reasonable steps to give the required information about the detention to the following:

0. if the person is a child each person with parental responsibility for the child under the Children and Young People Act 2008, division 1.3.2 (Parental responsibility),

0. if the person has a guardian under the Guardianship and Management of Property Act 1991 – the Guardian,

0. if the person has an attorney under the Powers of Attorney Act 2006 – the attorney,

0. if the person has a nominated person – the nominated person, and

0. if a health attorney is involved in the treatment, care or support of the person – the health attorney.

The ACAT must as soon as practicable after each ordering under section 85 (3) that a period of detention be extended, take all reasonable steps to give the required information about the detention to the people mentioned in subsection (2) (a) to (e).

Please refer to section 89 of the Act if the above notifications have not occurred.

3. Treatment during Detention

1. The person in charge of the facility at which a person is detained

a) may keep the person in the custody that the person in charge considers appropriate, and

b) may subject the person to the minimum confinement or restraint that is necessary and reasonable to –

i) prevent the person from causing harm to themself or someone else, or

ii) ensure that the person remains in custody, and

c) must ensure that any treatment, care or support administered to the person is the minimum necessary to prevent any immediate and substantial risk of the person detained causing harm to themself or someone else.

1.3.2 In determining whether to administer long acting medication, the Consultant Psychiatrist shall take into account the likely deterioration in the person’s condition within three (3) days of his or her examination of the person. The Consultant Psychiatrist should document their reasons for administering long acting medication in the person’s clinical record.

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|Section 2 – Rights of People with a Mental Illness or Mental Disorder |

Statement of Rights

On admission to, or before receiving treatment at a mental health or community care facility, a person must be informed verbally of his or her Rights under the Mental Health Act 2015; and must be provided a copy of an information statement containing –

(a) a statement setting out the rights and entitlements of a person under the Act, including the right to obtain legal advice and the right to seek a second opinion from an appropriate mental health professional, and

(b) any other relevant information relating to the treatment and care of the person including information about the right to appeal.

Wherever possible, the information statement should be provided in a language most familiar to the person. People should also be advised of their right to access interpreter services to ensure accurate transmission of information (Refer to Interpreter Services Procedure on the ACT Health Policy Register).

When a person appears to be having difficulty reading and/or understanding an information statement, as far as is practicable, arrangements should be made to convey the information contained in the statement to the person in the language or mode of communication or terms that the person is most likely to understand.

If the person appears to continue to have difficulty understanding the information contained in the information statement, the treating team must inform the PAACT.

Maintenance of freedom, dignity and self-respect

A person exercising a function under the Act, or under an ACAT order in relation to a person with a mental illness or disorder must endeavour to ensure that any restrictions on that person’s personal freedom and any derogation of that person’s dignity and self-respect are kept to the minimum necessary for the proper care and protection of the person and the protection of the public.

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|Section 3 – Information and Communication |

Information to be provided to the person

The responsible person shall ensure that the following items are kept at the facility and are readily accessible to all persons admitted to, or receiving treatment at the facility:

• Copies of the Mental Health Act 2015 and the Guardianship and Management of Property Act 1991 and any other relevant legislation.

• Copies of any publications explaining the legislation.

• Copies of information statements printed in different languages.

• Names and relevant functions of the entities prescribed by regulation e.g. the public advocate, the chief Psychiatrist, the legal aid commission etc and their contact details such as address and telephone numbers

Communication

All persons admitted to, or receiving treatment at a facility must be given reasonable opportunities to communicate with persons of their choice by:

• means other than written communication

• being provided with facilities for preparing written communications and for enclosing those communications in sealed envelopes.

• ensuring their communication is forwarded without being opened and without delay to the person to whom it is addressed (with the exception of an offender with a mental impairment who is subject to security conditions).

Contact with others

If a person is brought to a mental health facility as the result of an assessment order, the person must have adequate opportunity to contact each of the following:

i) a relative or friend

ii) the public advocate

iii) a legal practitioner

iv) their nominated person (if they have one).

The public advocate and the person’s lawyer are entitled to have access to the person at any time.

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|Search Terms |

ED3, ED11, Detention, Emergency Detention, Mental Health Act 2015, Tribunal Liaison Officer, Involuntary

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|Related Policies, Procedures, Guidelines and Legislation |

Policies and Procedures

Restraint of a Person Adult Only Policy

Advance Agreements, Advance Consent Directions and Nominated Persons Procedure

Assessment of Decision-making Capacity and Supported Decision-making Procedure

Unauthorised leave of Admitted People from MHJHADS Inpatient Units

Mental Health Act 2015- Notification and Consultation responsibilities in relation to the Public Advocate of the ACT Procedure

ACAT Ordered Mental Health Assessments Procedure

Care of Persons subject to Forensic Mental Health Orders Procedure

Standards

National Standards for Mental Health Service 2010

National Safety and Quality Health Service Standards

Legislation

Carers Recognition Act 2010

Children and Young People Act 2008

Crimes Act 1900

Human Rights Act 2004

Guardianship and Management of Property Act 1991

Mental Health Act 2015

Powers of Attorney Act 2006

Health Records (Privacy & Access) Act1997

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|Definition of Terms |

ACT Civil and Administrative Tribunal (ACAT) – is the agency tasked with making a range of decisions under the Act in regards to a person’s mental health treatment, care or support. This includes responsibility for making decisions about whether or not to grant Mental Health Orders, based on their judgement around a submitted application.

Approved mental health facility – is a health facility approved by the Minister under section 261 of the Mental Health Act 2015. This is a facility to which persons may be taken under a Psychiatric Treatment Order, Emergency Action, and Contravention of a PTO etc. In the ACT this includes the Canberra Hospital, Brian Hennessy Rehabilitation Centre and Calvary Hospital (with the exception of the Emergency Department).

Care Coordinator – is responsible for coordinating the provision of treatment, care or support for a person living with a mental disorder who is subject to a Community Care Order (see relevant section below). The Care Coordinator is also an employee of ACT Government. The Care Coordinator may delegate many of their functions under this Act to a suitable public servant if the Care Coordinator is satisfied they have the training experience and personal qualities required to exercise the functions.

Community Care Order (CCO) –is a type of Mental Health Order for people who experience a mental disorder. CCOs are applied for by a person with authority to give the treatment, care or support to the person.

Emergency Detention A doctor may authorise involuntary detention at a mental health facility for a period of no more than three days (Emergency Detention- 3days; ED3) if, after conducting an initial examination, the doctor believes that:

0. the person requires immediate treatment, care or support; and

0. the person has refused treatment, care or support; and

0. detention is necessary for the person’s well-being or for the protection of someone else or the public; and

0. adequate treatment, care or support cannot be provided in a less restrictive environment.

0. In addition, another doctor should also examine the person and agree with the above points.

During the three-day period of detention (ED3) , the Chief Psychiatrist (or their delegate) may apply to ACAT for an extension of the period of detention for a maximum of a further 11 days (Emergency Detention- 11 days; ED11), if the person continues to meet the criteria for having a mental disorder or mental illness.

Involuntary person – Is a person who is subject to an Emergency Action (EA), or an Emergency Detention Order (ED3 or ED 11) or a Psychiatric Treatment Order (PTO), a Community Care Order (CCO) or Restriction Order under the Mental Health Act 2015 or who may be subject to a Custodial Order.

Mental disorder – is defined as a disturbance or defect, to a substantially disabling degree, of perceptual interpretation, comprehension, reasoning, learning, judgment, memory, motivation or emotion, but does not include a condition that is a mental illness.

Mental Health Officer – a person appointed by the Minister as a mental health officer under s. 201 of the Mental Health Act 2015.

Mental health order – a psychiatric treatment order, a community care order or a restriction order.

Mental illness – is defined as a condition that seriously impairs (either temporarily or permanently) the mental functioning of a person in 1 or more areas of thought, mood, volition, perception, orientation or memory and is characterised by at least 1 or more of the following symptoms

i) Delusions;

ii) Hallucinations;

iii) serious disorders of streams of thought;

iv) serious disorders of thought form;

v) serious disturbance of mood.

Nominated person - a person with a mental disorder or mental illness, who has decision-making capacity, may, in writing nominate someone else to be the person’s nominated person. Examples are a close relative or close friend; a carer;; the person’s neighbour

Person in charge of the facility is typically a Unit Manager, and in practice the responsibilities under the Act are delegated to the clinician/s who are primarily involved in the person’s care.

Psychiatric Treatment Order (PTO) – is a type of Mental Health Order for people who experience a mental illness. PTOs are applied for by a person with authority to give the treatment, care or support to the person.

Public Advocate of the ACT (PAACT) – The role of the PAACT is to protect and promote the rights and interests of vulnerable people in the ACT. The Act says the PA ACT must receive certain information and be consulted about decisions that are being made on the treatment, care or support of people living with mental illnesses or disorders. This is done for those people who have impaired decision-making capacity and for whom there is no-one else suitable or available to make decisions on their behalf. Public guardians are empowered to make the same decisions as other guardians.

The Care Coordinator – The Care Coordinator is responsible for coordinating the provision of treatment, care or support for a person living with a mental disorder who is subject to a Community Care Order. The Care Coordinator is also an employee of ACT Government. The Care Coordinator may delegate many of their functions under this Act to a suitable public servant if the Care Coordinator is satisfied they have the training experience and personal qualities required to exercise the functions.

The Chief Psychiatrist – The Chief Psychiatrist is employed by ACT Health and has a range of important roles and functions under the Act. This includes responsibility for the treatment, care or support of any person who is subject to a Psychiatric Treatment Order (see relevant section below). The Chief Psychiatrist is able to delegate some functions to Psychiatrists employed by ACT Health.

Voluntary person: Is a person who has been admitted to a bed based program and is not under any Emergency Detention or Treatment orders under the Mental Health Act 2015.

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Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

|Date Amended |Section Amended |Approved By |

|Eg: 17 August 2014 |Section 1 |ED/CHHSPC Chair |

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