Chief Psychiatrist Annual Report 2015-16

On 6 February 1995, the Mental Health (Treatment and Care) Act 1994 was implemented in the Australian Capital Territory (ACT). This was repealed by the Mental Health Act 2015.

The Mental Health Act 2015 commenced on 1 March 2016. It gives those people in the ACT living with a mental illness, or their carers and family members, greater opportunity to contribute on decisions on their treatment, care and support. The Act was developed over several years with extensive stakeholder engagement. The objectives and principals of the Act uphold the human rights of those people with a mental illness and an acknowledgement of the place of carers is a feature throughout the Act. The Act is about empowering people in the ACT community with mental illnesses and mental disorders to make critical decisions about their treatment, care and support to the best of their ability, and with the involvement of carers, and close family and friends.

Emergency apprehension

Table 59 shows the number of emergency apprehensions in 2015–16, by initiator.

Table 59: Emergency apprehension
  Mental Health (Treatment and Care) Act 1994
1 July 2015 to 29 February 2016
Mental Health Act 2015
1 March to 30 June 2016
Total
Police officer 490 204 694
Mental health officer 111 51 162
Medical practitioner 90 39 129
Authorised ambulance paramedic * 0 43 43
Emergency apprehensions (total) 691 337 1028
*NB the Mental Health Act 2015 allows Authorised Ambulance Paramedics to undertake emergency apprehensions.

Emergency detention

Table 60 shows the number of emergency detention notifications issued in 2015–16 in comparison to previous years. One of the major elements of the Mental Health Act 2015 is that applications for an extension of emergency detention now allow the total period to be up to 11 days.

Applications for extension of emergency detention, mental health orders and variations of mental health orders are made to the ACT Civil and Administrative Tribunal (ACAT).

Outcome of those detained

Table 60: Emergency detentions
Year Number of emergency detentions
July 2012–June 2013 689
July 2013–June 2014 596
July 2014–June 2015 698
1 July 2015–29 February 2016 526
1 March–30 June 2016
Mental Health Act 2015
237

 

Table 61 shows the outcomes for those detained in 2015–16 in comparison to previous years.

Table 61: Outcome of those detailed
Year Revocation of 72-hour detention and/or 72-hour detention being allowed to lapse Applications for extension of involuntary detention
July 2012–June 2013 363 326
July 2013–June 2014 295 299
July 2014–June 2015 387 311
1 July 2015–29 February 2016 293 233
1 March–30 June 2016
Mental Health Act 2015
136 101

Psychiatric treatment orders

Under both the Mental Health (Treatment and Care) Act 1994 and the Mental Health Act 2015, the Chief Psychiatrist is responsible for the treatment and care of a person to whom a psychiatric treatment order (PTO) applies. The maximum duration of a PTO is six months.

Table 62 shows the PTO and Community Care Order (CCO) restriction order statistics for 2015–16 in comparison to previous years.

Table 62: Psychiatric treatment orders
Year PTOs granted by the Tribunal PTOs revoked Contravention of PTO Restriction orders made by Tribunal were all in relation to CCOs
July 2012–June 2013 924 127 82 16
July 2013–June 2014 890 167 80 15
July 2014–June 2015 921 156 90 14
1 July 2015–29 February 2016 668 126 67 44
1 March – 30 June 2016
Mental Health Act 2015
244 128 34 3

Other matters

Both the Mental Health (Treatment and Care) Act 1994 and the Mental Health Act 2015 provide for the authorisation of involuntary electro-convulsive therapy (ECT), including emergency ECT. They also have provisions for the interstate application of mental health laws, including for the transfer of people to and from the ACT.

The Crimes Act 1900 provides for the court to order an individual to Canberra Hospital for the purposes of an emergency assessment to determine whether immediate treatment and care are required.

Table 63 provides statistics for other matters in 2015–16 in comparison to previous years.

Table 63: Other matters
Year Application for ECT authorised Application for emergency ECT authorised Transfers to/from NSW Court ordered removal for assessment—s309 of the Crimes Act 1900
July 2012–June 2013 13 1 8 40
July 2013–June 2014 7 0 9 44
July 2014–June 2015 10 1 12 63
July 2015–June 2016 8 0 8 6
1 March–30 June 2016
Mental Health Act 2015
6 0 2 17

Key points arising

The following trends in key areas of activity related to the Office of the Chief Psychiatrist are noteworthy.

In 2015–16, 1,028 people were apprehended and brought to Canberra Hospital for assessment. This is a marginal increase of 0.8 per cent from the previous year, when it was 1,020. Emergency detention revocations have increased from 387 to 421, an 8 per cent increase from the previous year. This reflects the continuing efforts to provide the least restrictive care at an early opportunity, if at all possible.

Applications to extend involuntary detention increased by 7 per cent, indicating the treating team’s efforts to continue to appropriately stabilise an acute episode of illness. Increasing the stability of a person’s mental health during an inpatient admission provides a greater chance of successful ongoing management for that person in the community.

ACAT held 1,246 hearings during 2015–16 and granted 912 PTOs. This is a marginal increase of 1.8 per cent from 2014–15.

There are two sets of figures for PTOs revoked by the Tribunal taking into account the new Mental Health Act 2015. For 2015–16, 254 revocations were made, as follows:

  • 126 from 1 July 2015 to 29 February 2016 under the Mental Health (Treatment and Care) Act 1994
  • 128 from 1 March to 30 June 2016 under the Mental Health Act 2015.

This anomaly is due to the changes in the Guardianship and Management of Property Act 1991 as a consequence of the Mental Health Act 2015, which now allows for Guardians or Health Attorneys to give consent for people with a mental illness or mental disorder who do not have decision-making capacity but show a willingness to accept treatment.

Fourteen ECT orders were authorised by the Tribunal, an increase from ten from the previous year. No applications were made to the Tribunal for emergency ECT.

Ten cross-border agreements were made between the ACT and NSW. The ACT accepted four transfers from NSW, and six transfers were made to NSW facilities.

Contraventions of PTOs increased from 90 to 101 in 2015–16. This is an increase of 12 per cent from 2014–15. Twenty-nine people were brought to Canberra Hospital for medication or assessment purposes, and 16 were admitted to hospital as a result. Community teams make every effort to anticipate and manage crises early. Often, if this is successful, a contravention is not required.

The ACT Magistrates Court made 78 referrals for assessment pursuant to section 309 of the Crimes Act 1900, an increase of 23 per cent from the previous year. Of these, 40 people required admission to the Adult Mental Health Unit for assessment purposes, with 38 being returned to court on the same day. The Court Assessment Liaison Service continues to provide assessment and advice to the courts at the time of the hearing, which in many circumstances means that a section 309 referral is not required.

 

Dr Peter Norrie

Chief Psychiatrist