Contemporary perspectives-

Least restrictive treatment à community focused care  Influences in practice:

  • Increased effectiveness/availability of psychotropic medications
  • Classification of mental illness
  • Beacon Project (National Mental Health Seclusions & restraint)

 

established procedures:

  • Independent review by the Mental Health Tribunal (MHT)- compulsory treatments/rlectroconvulsive Therapy (rCT)

 

 

Definitions-

Patient- Person being treated under VMHA (2014)

Designated Mental Health Service- Approved MH service

Authorised person- Ambulance paramedic, police officer, medical practitioner & mental health practitioner  Mental health practitioner- registered nurse, registered psychologist, register occupational therapist or social worker

Authorised witness- Registered medical practitioner, mental health practitioner, anyone who can sign a stat declaration

 

 

Supported decision making-

  • Central to the promotion of recovery-oriented practice
  • rnables and supports compulsory patients to make decisions about their treatment and to determine their recovery

 

  • Advance Statement– a formal statement of treatment that must be regarded in Tx decision making

− Allows consumers have the opportunity to have their Tx wishes respected  − Can be made at any time

− Must be in writing (signed & dated)

− Witnessed by an authorised witness

 

Nominated person (s. 23-27)- 

A person who is nominated by the consumer to:

  • Receive information and support the treatment preferences of the consumer
  • Helps the person to exercise their rights and views
  • Must be willing to be available to support the individual

 

Second opinion (s.78)-

  • Provides another opinion to assess treatment and review of treatment
  • Provides recommended changes if required
  • Supports and provides written information for the individual & nominated person
  • Free service à rligibility only for consumers on a treatment order or temporary treatment order (inpatient mental health service)

 

Capacity- 

  • Individuals are presumed to have capacity
  • The person has been given adequate information to make an informed decision
  • Capacity: (s.68) is the ability of a person to make a particular treatment decision at a particular time

 

The person has capacity to make a decision if he or she:

− Understands the information given

− Is able to remember the information

− Is able to use or weigh up the information

− Is able to communicate the decision

 

Consent to treatment- 

  • Some consumers may not have capacity to given consent to treatment/refuse consent
  • In these circumstances:

− Authorised Psychiatrist may make treatment decision

− Some decisions will require Mental Heath tribunal (MHT) eg. rCT

 

 

 

Assessment Orders (s. 28)- AO

− The person appears to have a mental illness

− Requirement for the consideration of compulsory mental health treatment

− Made by a registered medical practitioner or mental health practitioner

  • Person must have been assessed within the last 24 hours
  • Community or Inpatient Assessment Order

− Valid for 24 hours; can be extended by up to 72 hours

− Inpatient AO allows 72 hours for transport; 24 hour clock starts when received at DMHS

 

Temporary Treatment Orders (s.45) (TTO)

− TTO is an order for the provision of compulsory treatment  − The person has a mental illness

− Because the person has mental illness the person needs immediate treatment  − Duration of 28 days (max)

 

Treatment Orders (s.52) (TO)

− The tribunal must be satisfied that all of the treatment criteria apply

− Within 28 days, the tribunal will form and decide whether treatment criteria apply and if the patient needs to stay on an order/treatment

 

− If TTO is made >18yrs

  • Community TO (max 12 months)
  • Inpatient TO (max 6 months)

− If TTO is made <18yrs

  • Community TO & inpatient TO (max 3 months)

Role of the Mental Health Tribunal-  − Independent of the treating team

− Support process for consumers involvement in making and reviewing: tx orders and temp tx orders  − Solution focused

− Determine transfer of compulsory patients to other facilities

− Review applications for rCT where consent is unable to be obtained

− Are the only decision body for all rCT for people <18

− Review applications for neurosurgery and court secure treatment

 

 

Electro-Convulsive Therapy (s.90-99) 

− Is a safe & effective treatment for some mental illness, particularly severe depression/mood disorders

− The application of electrical current to specific areas of the brain to produce generalised seizure

 

Neurosurgery (s.100) 

− A surgical technique/procedure performed on the person’s brain

− Used to treat severe/incapacitating mental illness where other treatments were ineffective

− Requires informed consent and MHT has to approve the application

 

Reducing restrictive practices (Part 6 MHA)

− Can ONLY be used within a designated mental health service

− All reasonable and less restrictive options must have been tried before using restrictive practices  − The persons dignity is protected

− Restrictive practices include: seclusion & restraint

 

Seclusion-

  • A room where doors and windows are locked from the outside, no sharp edges, adequate windows to look into, no furniture
  • Considered as LAST RrSORT
  • Aims to prevent serious harm to self or others
  • Requires clinical observation by RN/MO at 15 min intervals

− Monitor breathing  

− Levels of aggression/agitation  

  • Review by AP must be checked every 4 hours
  • Report back to chief psychiatrist

 

Bodily restraint (s.113)

  • Considered as LAST RrSORT
  • Includes physical or mechanical restraint that prevents a person having free moment or their limbs
  • Aim to prevent serious harm to self or others
  • Must be under continuous observation- every 15 mins with documentation

 

Chemical restraint-

  • Medication provided to reduce symptoms and treat illness   Used to treat high levels of agitation and aggression  Consider risks: prone restraint 

Positional Asphyxia- occurs when breathing is compromised/lack of O2

rxacerbated by:

− Obesity

− Pre-existing medical conditions

− Pressure on abdomen

 Signs:

−

−

−

 Person telling you they cant breathe

Gurgling/gasping sounds

Sudden tranquillity

Police involvement (s.351)

  • Police may apprehend a person if they person appears to have a MH illness
  • Aim to transport to a designated MH service for assessment
  • Police don’t provide any clinical judgement

 

Compulsory Notification Persons (CNP)

An authorised psychiatrist must ensure that reasonable steps are taken to inform the following persons

  • The nominated person
  • A guardian
  • A carer
  • A patient if the patient is under 16 years
  • The secretary to DHS

 

When:

  • As soon as possible!
  • Deciding whether to make a TTO or TO including setting and duration
  • The right to communicate is restricted
  • Deciding whether to grant a leave of absence from inpatient unit

 

 

Principles

  • Autonomy

− Right to make own decisions, provided it doesn’t violate another’s autonomy

 

  • Beneficence

− Care provided is for the benefit of the individual; positive action or intervention

 

  • Non-maleficence

− To do no harm; avoid actual harm, risk of potential

 

  • Justice

− Society’s expectation of what is fair & right