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Mental-Health-Acts-Comparative-Tables-all.pdf

1 Involuntary commitment and treatment (ICT) criteria in Australian and New Zealand Mental Health Acts

A C T: N T: Q L D : S A : TA S : V I C : WA : N Z :N S W:

Mental Health Act Mental Health Act Mental Health and Mental Health Act Mental Health Act Mental Health Act Mental Health Act Mental Health Act Mental Health 2015 s58, 66, 101 2007 ss12, 14, 68 Related Services Act 2016 ss3, 12 2009 s21 2013 ss6, 40 2014 s5 2014 s25 Act (Compulsory

1998 s14 Assessment and Treatment) Act 1992 s2; Guidelines to the MHA 2012

Mental The person has a mental The person is suffering The person has a mental The person has a mental The person has a mental The person has, or appears The person has a mental The person has a mental Mental disorder, in relation Illness illness or mental disorder, and from mental illness and, illness and as a result of the illness; because of the illness and because of the to have, a mental illness illness and because the illness for which the person to any person, means an

owing to that illness, there mental illness, without the person’s illness, the absence mental illness, the person and without treatment, the person has mental illness is in need of treatment and abnormal state of mind are reasonable grounds for treatment the person is of involuntary treatment, or requires treatment for mental illness will, or is likely the person needs immediate because of the mental illness, (whether of a continuous believing that care, treatment likely to: the absence of continued to, seriously harm: treatment to prevent: there is: or an intermittent nature), and control of the person is involuntary treatment, is likely characterised by delusions, necessary: to result in: or by disorders of mood or

perception or volition or cognition, of such a degree that it:

Harm is doing, or is likely to do, for the person’s own cause serious harm to himself imminent serious harm to the the person’s own protection the safety of the person or serious harm to the person or a signifcant risk to the safety poses a serious danger to the serious harm to themself or protection from serious harm or herself or to someone person or others or from harm (whether physical others or to another person or of the person or another, or safety of that person or of someone else or or the protection of others else or or mental and including harm a signifcant risk of serious others or

from serious harm and involved in the continuation/ harm to the person or to deterioration of the person’s another or condition) or to protect others from harm and

Need is suffering, or is likely to N/A suffer serious mental or the person suffering the person has impaired the person’s health and serious deterioration in the a signifcant risk to the health seriously diminishes the for care suffer, serious mental or physical deterioration and serious mental or physical decision making capacity person’s mental or physical of the person and capacity of that person to

physical deterioration and deterioration. relating to appropriate health and take care of himself or herself treatment of the person’s or poses a serious danger to mental illness; their health.

Psychiatric treatment/care/support is N/A the person requires treatment N/A N/A the treatment will be the immediate treatment will treatment in the community N/A treatment likely to reduce the harm or that is available at an appropriate and effective be provided to the person cannot reasonably be

deterioration (or its likelihood) approved treatment facility in terms of the outcomes if the person is subject to a provided to the person and or result in an improvement and referred to in section 6(1) temporary treatment order or in the person’s condition and [see additional criteria] and a treatment order and

No less the treatment, care or no other care of a less there is no less restrictive The main objects of the Act there is no less restrictive the treatment cannot be there is no less restrictive the person cannot be Ensure that assessment and restrictive support cannot be adequately restrictive kind, that is means of ensuring that the are to be achieved in a way means than an inpatient adequately given except means reasonably available to adequately provided with treatment occur in the least alternative provided in another way that consistent with safe and person receives the treatment that is the least restrictive treatment order (ITO) under a treatment order. enable the person to receive treatment in a way that restrictive manner consistent

would involve less restriction effective care, is appropriate and of the rights and liberties of of ensuring appropriate the immediate treatment. would involve less restriction. with safety of the freedom of choice and and reasonably available to a person who has a mental treatment of the person’s movement. the person. illness. illness.

Additional The above criteria must be In considering whether a the person is not capable The person does not have In considering whether there (i) The person does not have N/A (i) The person does not N/A criteria satisfed before a mental person is a mentally ill person, of giving informed consent capacity to consent to be is no less restrictive means DMC (ii) the treatment will: demonstrate the capacity to

health order can be made the continuing condition to the treatment or has treated for the illness. than an ITO of ensuring prevent/remedy mental make a treatment decision for a person with decision- of the person, including unreasonably refused to appropriate treatment, illness; or manage/alleviate about the provision of the making capacity (DMC) any likely deterioration in consent to the treatment. consideration must be given, it where possible; or reduce treatment (ii) Decisions who refuses treatment, the person’s condition, and amongst other things, to the risks that persons with regarding ICT must be made care or support; the harm the likely effect of any such the prospects of the person mental illness may pose to with reference to guidelines or deterioration must be so deterioration, are to be taken receiving all necessary themselves or others; or published by the Chief serious that it outweighs the into account. treatment on a voluntary monitor and evaluate the Psychiatrist. right to refuse. If a person basis or in compliance with a person’s mental state. lacks DMC and refuses community treatment order. treatment, care or support, the only criteria that applies is the existence of a mental disorder or illness. Separate criteria apply to forensic psychiatric treatment orders.

Disclaimer: These tables have been developed by the RANZCP as at 30 June 2017 in order to allow key provisions in the Mental Health Acts to be compared. They are intended for reference purposes only and are not intended to be a substitute for legal or clinical advice.

Comment: This table displays the criteria that must be apparent before involuntary commitment and treatment can be authorised. This table does not display the processes that must be followed in making and reviewing that authorisation. These processes vary considerably between jurisdictions; the New Zealand MHA, for example, utilises judicial hearings to make compulsory treatment orders (unlike the Australian MHAs). In some Acts, the criteria are listed separately; in others, they are combined (in several cases, they are merged with the defnition of mental illness). Recent changes to the MHAs have added additional criteria and process elements to ensure that less restrictive alternatives are utilised. All decisions to order involuntary commitment and treatment under the Australian Acts now require, at a minimum: the person to be suffering from mental illness (or a condition with similar manifestations), a nexus between that illness and serious risks to health and/or personal or public safety, the provision of treatment for that illness, and for there to be no less restrictive means of providing that treatment available. The NZ criteria are slightly broader, as they include ‘seriously diminished capacity to take care of oneself’. Increasingly, the MHAs also require an assessment of whether the patient has the capacity to make treatment decisions. This requirement is often included as a Principle or Object of the MHA. Sometimes this requirement is part of the criteria for involuntary commitment and treatment – the new Queensland MHA, for example, prohibits compulsory treatment for a person with decision-making capacity who unreasonably refuses treatment.

RANZCP Mental health legislation – comparison tables as at 30 June 2017 www.ranzcp.org/legislation

www.ranzcp.org/legislation

2 Capacity of adults to give informed consent to psychiatric treatment in Australian and New Zealand Mental Health Acts

A C T: N T: Q L D : S A : TA S : V I C : WA : N Z :N S W:

Mental Health Act Mental Health Act Mental Health and Mental Health Act Mental Health Act Mental Health Act Mental Health Act Mental Health Act Mental Health 2015 ss7-8 2007 Related Services Act 2016 ss14, 18 2009 s5A 2013 s7 2014 ss68, 70 2014 ss13, 15, 18 Act (Compulsory

1998 Assessment and Treatment) Act 1992, ss2, 59, 67, 130; Health and Disability Services Consumers’ Rights Regulation 1996 Right 7; Guidelines to the MH Act 2012 10.2.1, 11.4

Does a Yes; the presumption is Yes; the presumption is Yes; the presumption is Yes; the presumption is Yes; the presumption is Yes; the presumption is Yes; the presumption is Yes; the presumption is Yes; the presumption is presumption rebutted if one of the rebutted if one of the rebutted if one of the rebutted if one of the rebutted if one of the rebutted if he or she is rebutted if one of the rebutted if one of the rebutted if one of the of capacity following elements is lacking: following elements is lacking: following elements is lacking: following elements is lacking: following elements is lacking: unable to make the decision following elements is lacking: following elements is lacking: following elements is lacking: exist? because of an impairment

of, or disturbance in, the functioning of the mind or brain, and one of the following elements is lacking:

Understanding ability to understand when ability to understand the ability to understand the ability to understand, in ability to understand the ability to understand ability to understand ability to understand any ability to understand the a decision about treatment, information material to information material to general terms – that they information material to information relevant to information given that is information or advice about information relevant to care or support for the person the decision the decision have an illness, or symptoms the decision the decision relevant to the decision the decision that is required the decision, including an needs to be made; the facts of an illness, that affects their under this Act to be provided; explanation of the expected that relate to the decision; mental health and wellbeing; and understand the matters effects of any treatment the main choices available and the nature and purpose involved in the decision; and including the expected to the person in relation of the treatment; and the the effect. The information benefts and the likely side to the decision; and how benefts and risks of the includes a clear explanation effects. This should include: the consequences affect treatment, and alternatives; containing suffcient details of any drug, dose and the person and the consequences of not information to enable the method of administration

receiving the treatment person to make a balanced proposed; the likely course judgment; identifying and of the treatment; intended explaining any alternative effects of the treatment treatment about which there on the mental state of the is insuffcient knowledge to patient, possible side effects; justify it being recommended and any other relevant or to enable its effect to information be predicted reliably; and warning about any risks

Retaining N/A ability to retain the ability to retain the N/A ability to retain the ability to retain information ability to remember the N/A ability to retain that information material to the information material to the information material to relevant to the decision information that is relevant information decision decision the decision to the decision

Using and ability to weigh up the ability to use and weigh ability to use and weigh N/A ability to use and weigh ability to weigh information ability to weigh information ability to weigh the above ability to use and weigh Weighing consequences of the the information as part of the information as part of the information as part relevant to the decision that is relevant to the decision factors for the purpose of the information as part of

main choices the process of making the the process of making the of the process of making making the decision the process of making the decision decision the decision decision

Communicating ability to communicate the ability to communicate ability to communicate ability to communicate ability to communicate the ability to communicate the ability to communicate the ability to communicate the ability to communicate that decision in whatever way the decision. the decision. the decision in some way decision in any manner. decision (whether by speech, decision by speech, gestures decision in some way. decision by any means. the person can gesture or other means). or any other means.

Additional on the basis of what N/A N/A ability to make a decision N/A N/A N/A N/A N/A criteria is understood and the about the treatment.

consequences that are weighed, make the decision.

Disclaimer: These tables have been developed by the RANZCP as at 30 June 2017 in order to allow key provisions in the mental health Acts to be compared. They are intended for reference purposes only and are not intended to be a substitute for legal or clinical advice.

Comment: The NSW, NT and SA Acts contain no capacity test, so the common law test in Hunter and New England Area Health Service v A [2009] NSWSC 761 applies. The four-part test set out in that case (understanding/retaining/using and weighing/communicating) is generally applied across the Acts. The Queensland Acts and Tasmanian Acts are the main exceptions. The Queensland Act focuses less on using and weighing information, and more on other aspects of decision-making. The Tasmanian Act adds the qualifer that the decision-making capacity is impaired by ‘an impairment of, or disturbance in, the functioning of the mind or brain’.

RANZCP Mental health legislation – comparison tables as at 30 June 2017 www.ranzcp.org/legislation

www.ranzcp.org/legislation

3 Regulation of electroconvulsive treatment (ECT) in Australian and New Zealand Mental Health Acts

A C T: N T: Q L D : S A : TA S : V I C : WA : N Z :N S W:

Mental Health Act 2015 Mental Health Act Mental Health and Mental Health Act Mental Health Act Mental Health Mental Health Act Mental Health Act Mental Health ss145, 149, 153-4, 156-7, 160-2 2007 ss88-96, Health Policy Related Services Act 2016 ss234-6, 507-9; Guideline 2009 ss42, 90; ECT Chief Act 2013 2014 ss91-99; ECT: Chief 2014 ss192-199; 409-15; Chief Act (Compulsory

Directive PD2011_003 1998 s66 for the administration of ECT Psychiatrist Standard 2013; ECT Psychiatrist’s Update 2015 Psychiatrist’s Guidelines for the Assessment and 2012 Policy Guideline 2013 use of ECT 2006 Treatment) Act 1992,

ss59-60, Guidelines to MH Act 2012 10.4

Defnition A procedure for the induction of None listed. Ordinarily, None listed. Application of electric current None listed in the Act. A No reference to ECT in Application of electric Treatment involving the None listed. A course of ECT of ECT an epileptiform convulsion in a ECT can be administered to specifc areas of the head patient may consent to a the Act or regulations. current to specifc areas of application of electric current is roughly 12 episodes.

person. ECT can be administered a maximum of 12 times in to produce a generalised maximum of 12 episodes a person’s head to produce to specifc areas of a person’s a maximum of 9 times per a 6 month period. seizure that is modifed by over three months; this total a generalised seizure. A head to produce a generalised authorisation (3 in emergencies). general anaesthesia and includes an episode used to course of ECT cannot exceed seizure that is modifed by

the administration of a determine correct doses in 12 treatments and must be general anaesthesia and muscle relaxing agent for the the future. performed within 6 months. the administration of a treatment of a mental illness. muscle relaxing agent. 12 is

the maximum that may be prescribed at a single time.

If informed Chief psychiatrist (CP) or a doctor. Two medical practitioners Two authorised psychiatric Psychiatrist (preferably with a Medical practitioner or mental N/A Authorised psychiatrist. Medical practitioner. Responsible clinician. consent is not (unless the medical practitioners. second opinion from another health clinician. If uncertain, or given, who superintendent of the facility consultant psychiatrist). none of the 7 main indications may apply to refuses to allow it). apply, seek a second opinion perform ECT? from a psychiatrist.

Criteria the If reasonable grounds exist to Clinical condition, history Clinical condition, history The most clinically appropriate Mental illness must exist. N/A Whether there is no less Reasons for recommending None listed in the Act. applicant believe that ACAT could make an of treatment, and any of treatment and other treatment alternative for Indications must be clearly restrictive way to treat, ECT, and a treatment The guidelines refer to must consider electroconvulsive therapy order, and appropriate alternatives. Is appropriate alternatives. Is the person having regard documented in the patient’s having regard to: views and plan including number of RANZCP 2007 Clinical

the person lacks decision-making ECT a reasonable and proper it a reasonable and proper to clinical condition and record. A comprehensive preferences (and the reasons treatments. Memorandum #12: ECT. capacity (DMC) to consent to ECT. treatment and necessary or treatment to be administered treatment history? Also: risk/beneft assessment they’re held) of patient This contains pre-ECT Also: a psychiatric treatment order desirable for the safety or and are they likely to suffer patient/family preferences, must be carried out. Clinical about ECT and any benefcial evaluation considerations, (PTO) or a forensic psychiatric welfare of the patient? serious mental or physical degree of suffering, need assessment of cognitive and alternatives available; views of such as the necessity of a full treatment order (FPTO) must also be deterioration without it? for rapid response, and risk/ memory function must be carer/parent etc; likely results medical history and physical in force. beneft compared to other carried out before/during/after. if ECT is not performed; any examination (including a

treatments. second psychiatrist opinion. fundoscopy).

Who ACT Civil and Administrative Mental Health Review Mental Health Review Mental Health Review Psychiatrist, then the N/A Mental Health Tribunal (MHT). Mental Health Tribunal (MHT). Second psychiatrist hears the Appeal Tribunal (ACAT). Tribunal (MHRT). Tribunal (MHRT). Tribunal (MHRT). South Australian Civil and (independent of requesting application? Administrative Tribunal. clinical team) appointed by

Review Tribunal.

Criteria that Whether the person consents, or Above criteria, and other Whether the person is Whether: ECT is in the None listed. N/A Above criteria, and capacity Above criteria; CP guidelines Is the treatment in the best must be has the DMC to consent; their views info including: whether unable to give informed patient’s best interests; to give informed consent. and approved premises; interests of the patient? considered and wishes (including any advance the patient understands consent, and whether all evidence supports the patient’s wishes; views of Also: the second psychiatrist when statement); the views of carers, the inquiry, what effect reasonable efforts have effectiveness of ECT for the family/carer’s wishes; nature/ must consider the provisions hearing the people at the hearing, any attorney, if any medication has on been made to consult the particular mental illness; degree of signifcant risks of on informed consent in application guardian or nominated person; the patient’s ability to primary carer. effectiveness of any prior ECT; ECT and alternatives; whether the RANZCP 2010 Code of

any alternative treatment, care or communicate, and views of if a minor – effectiveness of ECT is likely to promote Ethics: Principle 5. support reasonably available; any the patient and carer/parent. ECT for persons that age. health. relevant medical history.

Who can CP and doctor must jointly apply No emergency ECT regime. Two authorised psychiatric Jointly: Psychiatrist and senior Psychiatrist. N/A Psychiatrist must apply Medical practitioner, with CP No emergency ECT regime. authorise to ACAT. practitioners. medical administrator. to MHT. approval (CP guidelines apply). emergency ECT?

Criteria for emergency

Similar to ACAT criteria above (but no PTO or FPTO is in force). The

N/A Immediately necessary to save life, prevent

Need to save the patient’s life or prevent the patient from

Urgently needed for the patient’s wellbeing, and in

N/A Needed to save the life of the patient or prevent

Needed to save life or because there is an imminent risk of

N/A

ECT person has a mental illness and ECT serious mental or physical suffering irreparable harm. the circumstances it is not serious damage to health or the patient behaving in a way is necessary to save the person’s deterioration, or to relieve A second opinion should practicable to obtain that prevent the patient suffering that is likely to result in serious life, or to prevent the likely onset of severe distress. Report be sought from another consent. Notify the CP within or continuing to suffer physical injury to the patient a risk to the person’s life within 3 ECT to MHRT as soon as consultant psychiatrist. one business day afterwards. signifcant pain or distress. or another person. Approved days and the treatment is the most practicable afterwards. premises required. appropriate reasonably available or all other treatments reasonably available have failed.

Comment: The regulation of ECT varies widely in most respects across the different Acts. Common features generally include the number of treatments in a course (9–12), the role of tribunals in hearing applications for involuntary ECT, and a separate framework for authorising ECT in emergencies. The main exception is Tasmania, where ECT is not subject to any special regulation. Most Acts have special provisions addressing capacity to consent to ECT, or the matters which the patient must be informed about, or both (see accompanying table ‘Special provisions governing informed consent to electroconvulsive treatment (ECT) in Australian and New Zealand Mental Health Acts’).

RANZCP Mental health legislation – comparison tables as at 30 June 2017 www.ranzcp.org/legislation

www.ranzcp.org/legislation

4 Special provisions governing informed consent to electroconvulsive treatment (ECT) in Australian and New Zealand Mental Health Acts

A C T: N T: Q L D : S A : TA S : V I C : WA : N Z :N S W:

Mental Health Act Mental Health Act 2007 Mental Health and Mental Health Mental Health Act Mental Health Act Mental Health Act Mental Health Act 2014 Mental Health Act (Compulsory 2015 ss8, 27, 30-31, 146, ss 88, 91-2, 96; Health Policy Related Services Act 2016 ss232-5, 2009 ss232-3; ECT Chief 2013 2014 ss90, 93-4, ECT: ss192-199; 409-15; CP’s Guidelines Assessment and Treatment) Act 148, 152 Directive PD2011_003 Act 1998 s66 507-9; Guideline for the Psychiatrist Standard 2013; ECT Chief Psychiatrist’s Update for the use of ECT 2006 1992, ss59-60, Guidelines to MH Act 2012

administration of ECT 2012 Policy Guideline 2013 2015 10.4

Special N/A A person is presumed to be N/A Explicit requirement: Consent must be informed No reference to ECT in All patients must be No ECT on under-14s. Psychiatrist Capacity to provide consent may factors to be incapable of giving informed the patient must have and effective. the Act or regulations. presumed to have must decide if the person has fuctuate. A return of capacity to consent considered consent to ECT if, when consent capacity to give informed capacity to give informed the capacity to give informed to ECT, or a withdrawal of consent to when is sought, the person is affected consent; this exists if consent unless it can be consent. Unless given as ECT at any stage, should lead to a determining by medication that impairs the they can understand demonstrated that the emergency treatment, ECT must re-evaluation of the legal basis of any capacity to person’s ability to give that the nature and effect person lacks capacity not be performed on a person further treatment. The responsible consent consent. of a decision relating when the decision needs who refused to give, or was clinician shall, wherever practicable, seek to ECT to the treatment and to be made. Capacity incapable of giving, informed to obtain the consent of the patient even

make and communicate may develop before or consent. If a patient passively though that treatment may be authorised the decision. Consent after treatment. acquiesces to treatment the by or under the Act without the patient’s must be given freely, not treating psychiatrist cannot view consent. If a patient passively acquiesces obtained by force, threat, that lack of protest as consent. to treatment the treating psychiatrist intimidation, inducement, Consultation between patient, cannot view that lack of protest as deception or exercise of family and doctor is essential consent. Psychiatrists must consider the authority. before and during a course provisions on informed consent in the

of ECT. RANZCP 2010 Code of Ethics: Principle 5.

Explanations N/A Fair explanation of the N/A Full explanation in a form N/A N/A N/A Explain the condition and N/A that must be procedures; full description and language likely to be rationale for ECT with enough given and of any possible risks or understood about: the information to allow balanced understood discomforts, and alternative treatment; possible pain, judgement, including risks, when treatments; full disclosure of discomforts, risks and benefts, alternatives, recovery establishing any fnancial interests involving side effects; alternative period, out of pocket expenses consent the practitioners and the facility; methods of treatment and follow up care. Advise that to ECT notice of right to obtain legal/ available and results of results cannot be guaranteed.

medical advice, withdraw not getting ECT. Patient consent at any time, and have must understand nature any inquiries answered (and and effect of treatment the answers must appear to be and right to withdraw understood). consent.

Who can Guardian or attorney with N/A Adult guardian or N/A Medical agent or guardian of N/A A person who has the An adult’s enduring guardian N/A provide authority to give consent decision-maker for the the patient or by the Tribunal legal authority to consent or guardian or the person consent to for medical treatment. person, or the Local (or parent, if under 16 and on behalf of a minor responsible for the adult; parent ECT on behalf Court. lacking capacity). (under 18). or guardian if a minor. of the patient?

Can the Yes (two witnesses – N/A N/A Yes. Yes. N/A No; the psychiatrist must Yes. N/A patient refuse instead of one – must consider the views and or consent to witness the signatures preferences of the patient ECT through when advance consent expressed in any advance an advance to ECT is given). statement, but other health factors must be regarded directive or when deciding if there is enduring no less restrictive way to power of provide treatment. attorney?

Penalties for performing

Maximum penalty: 50 penalty units,

Maximum penalty: 50 penalty units.

Maximum penalty: 40 penalty units.

Maximum penalty: 200 penalty units or

Maximum penalty: $50,000 or 4 years

N/A N/A Penalty: $15,000 and imprisonment for 2 years.

N/A

ECT without imprisonment for 2 years imprisonment. imprisonment. obtaining 6 months or both. informed consent

Comment: Most Acts subject ECT to special, additional regulations (when compared to other forms of psychiatric treatment). Most of these regulations contain special provisions governing informed consent. The provisions are designed to ensure that consent is genuinely informed, effective and freely given. Several Acts set out the matters that must be explained (and understood) in considerable detail. Penalties for administering ECT without obtaining informed consent vary widely – from jurisdictions with no penalties listed at one end of the spectrum, to South Australia where the maximum penalty is a $50,000 fne or 4 years imprisonment.

RANZCP Mental health legislation – comparison tables as at 30 June 2017 www.ranzcp.org/legislation

www.ranzcp.org/legislation

5 Seclusion in Australian and New Zealand Mental Health Acts

A C T: N T: Q L D : S A : TA S : V I C : WA : N Z :N S W:

Mental Health Act Mental Health Act Mental Health and Mental Health Act Mental Health Act Mental Health Act Mental Health Act Mental Health Act Mental Health 2015 ss65, 73, 80-83, 107, 2007 ss3, 68, 190; Health Related Services Act 2016 ss5, 253-261, 263 2009 ss7, 34A 2013 ss12, 56 2014 ss10, 105-112 2014 ss5, 211-225 (Compulsory 144A, 263-4, 266 Policy Directive 2012/35 1998 ss3, 61 Treatment and

Assessment) Act 1992 s71, Regulation NZS 8134.3

Defnition of N/A Confnement of the Confnement of the patient at Confnement of the patient at Confnement of a person, Deliberate confnement of an Sole confnement of a person Confnement of a person Where a consumer is placed ‘seclusion’ consumer at any time of the any time of the day or night any time of the day or night alone in a room or area from involuntary patient or forensic to a room or any other being provided with alone in a room or area,

day or night alone in a room alone in a room or area from alone in a room or area from which cannot leave of own patient, alone, in a room or enclosed space from which treatment/care at an at any time and for any or area from which free exit which free exit is prevented. which free exit is prevented. volition area that the patient cannot it is not within the control of authorised hospital by leaving duration, from which they is prevented. freely exit. the person confned to leave. the person at any time of the cannot freely exit.

day or night alone in a room/ area from which it is not within the person’s control to leave.

When may If it is the only way in the To manage the risk of serious If no other less restrictive If there is no other reasonably Only as a last resort for safety To facilitate the patient’s If necessary to prevent If necessary to prevent the If necessary for the care or seclusion circumstances to prevent the imminent harm only when method of control is suitable practical way to protect reasons, but seclusion is treatment, or to ensure their imminent and serious person physically injuring treatment of the patient, be used? person from causing harm to appropriate, safe alternative and it is necessary to provide the patient or others from available to ensure treatment safety or that of others, or to harm to the person or to him/herself or another, or or the protection of other

themselves or someone else. options have been considered medical treatment, or to physical harm. Seclusion and compliance with the Act, provide for the management, another person, and after all persistently causing damage patients. In emergencies, seclusion and trialled. Use the prevent harm to the patient/ must also comply with any and to prevent nuisance or good order or security of an reasonable and less restrictive to property, and there is no may be necessary to safely minimum necessary force for others, persistent destruction reduction and elimination harm to others. approved hospital. options have been tried or less restrictive means available apprehend a person and the briefest period required in of property, or absconding. plan. considered and have been to prevent this. remove them to an approved the circumstances. found to be unsuitable. mental health facility (AHMF).

No general restrictions listed. Where can Approved community care Mental health facility. Approved treatment facility. Authorised mental health If subject to an Inpatient Approved hospital. Designated Mental Health Authorised hospital. Premises designated for seclusion facility, an AMHF, or while service. Treatment Order – Service. the purpose by or with the be used? apprehending a person and a treatment centre. approval of the Director of

taking them to an AMHF. Area Mental Health Services.

Who may Chief Psychiatrist (CP) or a Medical superintendent or a Authorised psychiatric Authorised doctor, or a Treatment centre staff. Chief Civil Psychiatrist (CCP), Authorised psychiatrist, Medical practitioner or, in an Responsible clinician or, in an authorise community care coordinator. medical offcer authorised by practitioner; or (in an health practitioner authorised medical practitioner or registered medical emergency, a mental health emergency, a nurse or other seclusion? In emergencies, a police one (often the senior nurse emergency) by the senior by one.* approved nurse; if a child, practitioner or the senior practitioner. health professional.

offcer, authorised ambulance who leads the response registered nurse on duty. only the CCP. registered nurse on duty. paramedic, doctor or mental team). health offcer apprehending the person and taking them to an AMHF.

Who else N/A Medical superintendent, Authorised psychiatric Chief psychiatrist or N/A CCP, medical practitioner or Authorised psychiatrist or Medical practitioner or Responsible clinician. may vary/ operational nurse manager, practitioner. authorised doctor. The approved nurse. (if one is not reasonably mental health practitioner revoke the senior nurse, or medical authorisation may also allow available) a registered medical or the person in charge of authorisation? offcer – preferably a a health practitioner to end practitioner. a ward at an authorised

psychiatrist. the seclusion. hospital.

Who must Public Advocate. Primary carer. If none exists, Authorised psychiatric Chief Psychiatrist (if patient N/A N/A Authorised psychiatrist and Medical practitioner and – Responsible clinician. be notifed? a family member must practitioner and an adult has been or will be secluded the Chief Psychiatrist. Also, if there is one, and they did

be contacted (taking the guardian or decision maker if for over 9 hours in a 24 hour a parent, nominated person, not authorise the seclusion patient’s wishes into account the patient has one. period). or guardian. themselves – the treating in this matter). psychiatrist.

How long Minimum period necessary. No express limit. In prolonged Minimum period necessary. Three hours, and no more Minimum period necessary. Seven hours. Extensions Until it is no longer necessary Two hours. Extensions may be Minimum period necessary; can seclusion The CP must ensure an cases, comprehensive than nine hours in a 24 hour may be authorised by the to prevent imminent and made if a medical practitioner note that the patient has last? examination by a consultant assessment must be carried period unless a reduction CCP if the patient has been serious harm to the person or examines the patient in that a right to the company of

psychiatrist (or a doctor in out every 24–48 hours, and elimination plan has examined by a medical to another person. period. others. consultation with one) at preferably with the carer been made. A single 12 hour practitioner. least every four hours. attending. extension is lawful.

Comment: The NSW Act has the narrowest grounds for authorising seclusion: ‘to manage the risk of serious imminent harm only when appropriate, safe alternative options have been considered and trialled.’ Other Acts also authorise seclusion on other grounds such as absconding, persistently destroying property and facilitating treatment. The SA Act has the widest grounds, although it is accompanied by a non-mandatory guideline that narrows them considerably. The Acts also vary substantially in respect to who may authorise seclusion, who must be notifed, and the length of time seclusion can be applied. *The Qld Act also refers to ‘emergency seclusion’, which may be authorised for one hour by a health practitioner if there is no other reasonably practicable way to protect the patient or others from physical harm. An authorised doctor must be notifed as soon as practicable.

RANZCP Mental health legislation – comparison tables as at 30 June 2017 www.ranzcp.org/legislation

www.ranzcp.org/legislation

6 Restraint in Australian and New Zealand Mental Health Acts

A C T: N T: Q L D : S A : TA S : V I C : WA : N Z :N S W:

Mental Health Act Mental Health Act Mental Health and Mental Health Act Mental Health Act Mental Health Act Mental Health Act Mental Health Act Mental Health Act 2015 ss65, 73, 80-83, 107, 2007 ss3, 68, 190; Health Related Services Act 2016 ss5, 242-253, 268-270 2009 ss7, 34A; Chief 2013 ss12, 57 2014 ss10, 105-109, 113-116 2014 ss10, 226-240 1992 s71, Regulation NZS 144A, 263-4, 266; ACT Policy Policy Directive 2012/35 1998 ss3, 61 Psychiatrist Guideline D0382 8134.2 – Restraint of a Person – Adults Only CHHS16/025 2016

Defnition of Restraint is the interference Mechanical restraint includes Mechanical restraint is the Mechanical restraint is the Restraint is the restriction Mechanical restraint is a Bodily restraint is a form Physical restraint is restraint Restraint limits the freedom ‘restraint’ with, or restriction of, an items used to restrict a application of a device on restraint of a person by the of an individual’s freedom device that controls a person’s of physical or mechanical through the application of of movement of the patient.

individual’s freedom of consumer’s movement, but a patient’s body to restrict application of a device to of movement by physical freedom of movement. restraint that prevents a bodily force to the person’s Chemical restraint is the movement. Physical restraint handcuffs are unacceptable. the patient’s movement, but the person’s body to restrict or mechanical means. Physical restraint is bodily person having free movement body to restrict their use of various medicines to involves physically holding a Chemical restraint is a does not include the use of the person’s movement. It Physical restraint is defned force that controls a person’s of his or her limbs, but movement. Mechanical ensure compliance and to person to do this. Mechanical pharmacological method furniture that restricts the does not include appropriate as the application by health freedom of movement. does not include the use restraint is the restraint render the person incapable restraint refers to the use of used solely to restrict the patient’s capacity to get off use of a medical or surgical care staff of hands-on Chemical restraint is of furniture (including beds through the application of a of resistance. mechanical restraint device movement of a patient; the furniture. appliance in the treatment immobilisation or the physical medication given primarily to with cot sides and chairs with device to a person’s body to for this purpose. Restraint by emergency sedation or rapid of physical illness or injury. restriction of a person. control a person’s behaviour, tables ftted on their arms) restrict their movement; this threat is the direct or implied tranquillisation or medication Physical restraint is the use not as treatment. that restricts the person’s does not include the use of threat to use restraint. used as part of a treatment by a person of his or her ability to get off the furniture. medical devices or furniture. Forcible giving of medication plan does not count. body to restrict the patient’s is medication given to a movement. restrained person against their will.

When may If necessary and reasonable To manage the risk of If no less restrictive method Mechanical restraint may Only as a last resort for safety If it is necessary to facilitate If necessary to prevent If necessary to provide To ensure, maintain, or restraint be to safely apprehend the serious imminent harm only is suitable and it is necessary be used if there is no other reasons, but it is available treatment or transfer, or imminent and serious harm treatment or prevent the enhance the safety of the used? person, convey them to when appropriate, safe to provide medical treatment, reasonably practical way to ensure treatment and ensure health or safety. to the person or others, or patient physically injuring self/ patient, or others. Restraint

a mental health facility, alternative options have been or to prevent harm to the to protect the patient or compliance with the Act, and Emergency short-term administer treatment, and others, or persistently causing must be a last resort, with the ensure they remain in considered and trialled. Any patient or others, absconding others from physical harm, to prevent absconding and physical restraint of a patient after all reasonable and less damage to property, and least amount of force, with custody, or to prevent the restriction is to be kept to the or persistent destruction of the patient is continuously nuisance. is lawful to ensure attendance restrictive options have been there are no less restrictive appropriate planning, after person from causing harm minimum necessary in the property. observed, and the restraint or prevent disputes, damage, tried or considered and found means and no signifcant risk other interventions have to themselves or someone circumstances. complies with any reduction or disorder. unsuitable. to physical health. been considered. else. Also: to administer and elimination plan.* medication authorised by the Chief Psychiatrist (CP) or a Community Care Order.

Is chemical Yes. No. Unclear. Yes. Yes. Yes. Unclear. Unclear. No. restraint allowed?

Where can Determined by the Chief Mental health facility. Approved treatment facility. High-security authorised Treatment centre. Approved hospital or Designated mental health Authorised hospital. Area Designated by Director restraint be Psychiatrist. mental health service. assessment centre. service. of Area MH Services. used?

Who may Unless during apprehension, Medical superintendent of a Authorised psychiatric An authorised doctor may Treatment centre staff. For chemical or mechanical Psychiatrist, registered Medical practitioner or Responsible clinician In an authorise only the Chief Psychiatrist, facility, or a medical offcer practitioner; or (in an apply to the chief psychiatrist restraint, (or physical medical practitioner or the mental health practitioner at emergency, a nurse or other the form and Care Coordinator, person in authorised by one. emergency) by the senior to approve the use of restraint of a child): only the senior registered nurse on an authorised hospital or the health professional having duration of charge of the mental health registered nurse on duty. mechanical restraint on a CCP. Otherwise: a medical duty. A registered nurse may person in charge of a ward. immediate responsibility for the restraint? facility, or the Emergency patient. practitioner or an approved approve urgent physical a patient.

Medicine Specialist. nurse also. restraint.

Who else may N/A Medical superintendent, If the senior registered nurse Chief psychiatrist, authorised N/A Authorised psychiatrist or Psychiatrist or (if one is Medical practitioner or Responsible clinician. vary/revoke operational nurse manager, has authorised restraint, doctor or health practitioner (if one is not reasonably not reasonably available) mental health practitioner authorisation? senior nurse, or medical an authorised psychiatric in charge of the unit. available) a registered medical a registered medical or the person in charge of

offcer (preferably a practitioner may revoke or practitioner. practitioner. a ward. psychiatrist). redetermine.

Who must be notifed?

Public Advocate. Primary carer or family member.

Person-in-charge, psychiatrist, guardian.

N/A N/A N/A Chief Psychiatrist, nominated person, guardian, carer.

Medical practitioner and treating psychiatrist.

Inform/consult patient, family/whanau, as practical.

How long can restraint last?

Minimum period necessary. If restraint has a direct negative

Minimum period necessary. In prolonged cases, a

Minimum period necessary. If the patient is admitted as a

Three hours, and no more than nine hours in a 24 hour

Minimum period necessary. Seven hours, but extensions may be authorised by the

Minimum period necessary. Thirty minutes per order or extension of an order; there

Minimum time necessary, with monitoring and review

effect on the person, cease immediately.

comprehensive assessment must be carried out every

voluntary patient: 6 hours. period unless allowed for in a reduction and elimination

CCP if the patient has been examined by a medical

is no limit to the number of extensions that may be made.

that depends on the risks and restraint involved.

24–48 hours. plan. practitioner.

Comment: Several different forms of restraint are defned in the Acts and accompanying regulations. The ACT regulations contain the only reference to ‘restraint by threat’. Defnitions of ‘chemical restraint’ are highly inconsistent, making comparison diffcult. Depending on the jurisdiction, the use of medication to reduce arousal and agitation may be seen as an acceptable alternative to seclusion and restraint, rather than a form of restraint in itself. The NSW Act has the narrowest grounds for authorising restraint: ‘to manage the risk of serious imminent harm only when appropriate, safe alternative options have been considered and trialled.’ Other Acts also authorise restraint on other grounds such as absconding, persistently destroying property and facilitating treatment. The SA Act has the widest grounds, although it is accompanied by a non-mandatory guideline that narrows them considerably. The Acts also vary substantially in respect to who may authorise restraint, who must be notifed, and the length of time restraint can be applied. *The Qld Act regulates physical and mechanical restraint in different ways. Physical restraint may be authorised if it is the only practicable way to prevent harm (to patient or others), serious damage to property or absconding, or to provide treatment and care.

RANZCP Mental health legislation – comparison tables as at 30 June 2017 www.ranzcp.org/legislation

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7 References to Aboriginal and Torres Strait Islanders and Maori in Australian and New Zealand Mental Health Acts

A C T: N T: Q L D : S A : TA S : V I C : WA : N Z :N S W:

Mental Health Mental Health Act Mental Health and Mental Health Act Mental Health Act Mental Health Act Mental Health Act Mental Health Act 2014 Mental Health Act Act 2015* 2007 ss68, 71, Schedule 1 Related Services Act 2016 ss5, Schedule 3 2009 ss3, 7 2013 s3 2014 ss3, 11 ss4, 50, 80-81, 189, 281, Schedule 1 (Compulsory Assessment

1998 ss4, 7A, 8, 11, 35, 110, and Treatment) Act 1992 118 ss5-6, 7A

Community, N/A The cultural and spiritual As far as possible, the The unique cultural, Take into account the Personal reasons for Aboriginal persons Provide treatment appropriate to, Any court, tribunal, or person culture and beliefs and practices of person’s treatment and care communication and other patients’ traditional granting any patient a leave receiving mental health and consistent with, their cultural exercising a power under this Act spiritual people with a mental illness is to be appropriate to and needs of Aboriginal and beliefs and practices. of absence under this Act services should have and spiritual beliefs and practices and in respect of a person must exercise beliefs or mental disorder who consistent with the person’s Torres Strait Islanders must include – if the patient is an their distinct culture and having regard to the views of their the power with proper recognition

are Aboriginal or Torres cultural beliefs, practices be recognised and taken Aborigine – attending an identity recognised and families and, to the extent that it is of the importance and signifcance Strait Islanders should be and mores. into account; they should be event of cultural or spiritual responded to. practicable and appropriate to do to the person of the person’s ties recognised. provided with treatment, care signifcance to Aborigines. so, the views of signifcant members with his or her family, whanau,

and support in a way that of their communities, including hapu, iwi, and family group; and recognises and is consistent elders and traditional healers, and with proper recognition of the with Aboriginal tradition or Aboriginal and Torres Strait Islander contribution those ties make to the Island custom, mental health mental health workers. person’s wellbeing; and with proper and social and emotional respect for the person’s cultural wellbeing, and isculturally and ethnic identity, language, and appropriate and respectful. religious or ethical beliefs.

Extended N/A For the purposes of For the purposes of Parent of an Aboriginal and If the person is of N/A For this Act – if the person is of [See above] family designating carers, a relative designating primary carers, a Torres Strait Islander minor Aboriginal and Torres N/A Aboriginal and Torres Strait Islander

of a patient who is Aboriginal relative of the person includes includes a person who, under Strait Islander descent, descent – a close family member of a and Torres Strait Islander anyone related to the person Aboriginal and Torres Strait that person may be person includes any person regarded includes a person who is part through a relationship that Islander tradition, is regarded a relative of another as such under the customary law, of the extended family/kin arises through Aboriginal as a parent of the minor. through Aboriginal and tradition or kinship of that person’s according to the indigenous customary law or tradition. Torres Strait Islander community. kinship system of the kinship rules, as the case patient’s culture. may require.

Indigenous N/A N/A Aboriginal and Torres Strait N/A When practicable and N/A N/A Health professional includes an N/A mental Islanders health practitioner appropriate, involve Aboriginal and Torres Strait Islander health means a person registered collaboration with health mental health worker. Traditional practitioners under the Health Practitioner workers and traditional healer, in relation to an Aboriginal and Regulation National Law to healers from their and Torres Strait Islander community, traditional practise in the Aboriginal and communities. means a person of Aboriginal and healers Torres Strait Islander health Torres Strait Islander descent who

practice profession (other uses traditional (including spiritual) than as a student). methods of healing; and is recognised

by the community as a traditional healer.

Duty to N/A N/A N/A To the extent practicable N/A N/A N/A N/A Any court, tribunal, or person provide and appropriate in the exercising a power under this Act Indigenous circumstances. in relation to a person must ensure interpreters a Māori interpreter if it that is the

person’s frst/preferred language.

Other N/A N/A A community visitors panel N/A N/A An Aboriginal person is a Aboriginal person To the extent that it is practicable A practitioner must apply any references to is, so far as is practicable, person who satisfes all of means a person who and appropriate to do so, assessment relevant guidelines and standards indigenous to include persons of both the following requirements: is: descended from and treatment provided to a patient of care and treatment issued by persons or sexes and of diverse ethnic Aboriginal ancestry; Aboriginal and Torres who is of Aboriginal or Torres Strait the Director-General of Health culture backgrounds (including self-identifcation as an Strait Islanders, self- Islander descent must be provided when deciding: when and how to

Aboriginal and Torres Strait Aboriginal person; communal identifes as an Aboriginal in collaboration with Aboriginal or consult the family or whanau, or Islander backgrounds). The recognition by members of person, and is accepted Torres Strait Islander mental health the proposed patient or patient; same applies to Mental the Aboriginal community. as an Aboriginal and workers and signifcant members of whether the consultation is Health Review Tribunals. Torres Strait Islander by the patient’s community, including reasonably practicable; and whether

an Aboriginal and Torres elders and traditional healers. it is in the patient’s best interests. Strait Islander community.

Comment: References to Aboriginal and Torres Strait Islander peoples and Māori are a feature of the newer Acts. The exception is the New Zealand Act, which acknowledged Māori culture, ethnic identity, language and religious or ethical beliefs and extended family and social groups when it was enacted in 1992. The requirement to consult with the family or whānau of the patient or proposed patient was added in 2000. Most of the Acts now acknowledge Aboriginal and Torres Strait Islander and Māori kinship systems and culture. Several Acts go further (such as NZ and WA), requiring the involvement of interpreting services, traditional healers, and Aboriginal and Torres Strait Islander health professionals. *Although the ACT Act does not directly refer to Aboriginal and Torres Strait Islander peoples and Māori, the Principles respect the right to access treatment, care and support that is sensitive and responsive to the patient’s individual needs, including in relation to culture: s6 (f)(i).

RANZCP Mental health legislation – comparison tables as at 30 June 2017 www.ranzcp.org/legislation

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8 Defnitions of forensic patient and similar terms from Australian and New Zealand legislation

At what stage in the criminal justice process does the term apply?

Where is the term defned? Bail

Remand at a hospital or secure mental health facility

Custody after a determination that the accused will be ft to plead within 12 months

Custody or supervised release after being found not guilty by reason of mental illness or unft to stand trial within 12 months Other stages

Mental Health Act 2015 (ACT) (MHA) s127 defnes a forensic patient as a person in relation to whom a forensic mental health order may be made or is in force. A forensic mental health order means a forensic psychiatric treatment order or a forensic community care order (Dictionary); the persons to whom these apply or might apply are listed in ss101 and 108. The list includes people who are required by a court to submit to the jurisdiction of the ACAT under the Crimes Act 1900 (ACT) (CA) Part 13, and people who are ‘detainees’ – a term defned by the Corrections Management Act 2007 (ACT) s6.

CA s315D (2); MHA s94 (1) (g)

CA s315D (2) CA s315D (2) CA ss318 (2), 319 (2) (b), 323, 324, 328 (3), 329 (b), 334 (1), 335 (2)

Parolees, young detainees and offenders, persons released on licence, detainees (which include all adults held in custody or detention) and persons serving community-based sentences may be subject to a forensic mental health order: MHA ss94, 101 and 108.A

C T

N S

Mental Health Act 2007 (NSW) (MHA) s4: incorporates the defnition of forensic patient MHFPA s14 (b) (ii) MHFPA s14 (b) (iii) MHFPA s17 (3) MHFPA s24, 25, 27, 39; CAA 7 (4) N/A found in the Mental Health (Forensic Provisions) Act 1990 (MHFPA) s42. This may include persons belonging to a class prescribed by the Regulations or persons subject to the Criminal Appeal Act 1912 s7(4) (CAA).

Criminal Code Act Schedule One 43A (NT) (CCA) defnes a supervised person as ‘a person who is the subject of a supervision order’. These may be custodial (at a secure care facility or a custodial correctional facility) or non-custodial with conditions: s43ZA (1).

N/A N/A N/A CCA ss43I (2) (a), 43X (2) (a) or (3), 412A (3)

N/A

N T

Q L

The Mental Health Act 2016 (Qld) (MHA) Schedule 3 defnes a forensic patient as ‘a person subject to a forensic order’ and lists three types of forensic order: ‘mental health’, ‘disability’

N/A Forensic Order (Criminal Code): CC ss 613 (3),

N/A Forensic Order (mental health): MHA s134 (3) (a)

A Forensic Order (disability) applies when unftness for trial or unsoundness of mind is considered to be the result of

and ‘criminal code’. A Forensic Order (criminal code) is defned according to the Criminal 645 (1), 647 (1) an intellectual disability, and the person needs care for that Code 1899 (Qld) (CC). The remaining orders are made by the Mental Health Court under the MHA if considered necessary – because of the person’s mental condition – to protect the safety of the community, including from the risk of serious harm to other persons or property.

Forensic Order (Criminal Code): CC s647 (2)

disability but not for any mental illness: MHA s134 (3) (b). The Mental Health Court must do one of the following: order no limited community treatment/approve a doctor or senior practitioner to authorise limited community treatment/ order limited community treatment: MHA ss139-140.

Mental Health Act 2013 (Tas) (MHA) s68 defnes a forensic patient as ‘a person who is admitted to a Secure Mental Health Unit’. This may be ordered under the Criminal Justice (Mental Impairment) Act 1999 (CJMIA), the Sentencing Act 1997 (SA), the Justices Act 1959 (JA), the Criminal Code (CC), the Youth Justice Act 1997 (YJA) or the Corrections Act 1997 (CA).

CJMIA s39 (1)(a) CJMIA s39 (1) (b); JA s47; CC s348; YJA s105

N/A CJMIA ss18 (2), 31; SA s73 A prisoner or detainee who has a disability or appears to have a mental illness may be removed to a secure mental health unit: CCA s36A (2) or (3). If a youth, YJA 134A (2) or (3) applies.T

A S

V IC

Mental Health Act 2014 (Vic) (MHA) s305: incorporates the defnitions of forensic patient found in the Crimes (Mental Impairment and Unftness to be tried) Act 1997 (CYMIUA) and

N/A CYMIUA (Other than Part 5A – Children’s Court

N/A CYMIUA [Other than Part 5A – Children’s Court and Appeals from

N/A

the Crimes Act 1914 (Cth) (CA). and Appeals from those those proceedings], including proceedings) international forensic patients: s73O;

CA s20BJ (1), 20BM

The Criminal Law (Mentally Impaired Accused) Act 1996 (WA) (CLA) s23 defnes a mentally impaired accused person as an accused person in respect of whom an undischarged custody order has been made. Custody orders may only apply to persons found not guilty (due to unsoundness of mind or mental unftness) of offences listed in Schedule One of the CLA.

N/A N/A N/A CLA ss 19 (4) & 22 (1) N/A

W A

N Z

N/A CPMIA ss 23, 35, 44 (1) N/A Mental Health (Compulsory Assessment and Treatment) Act 1992 (NZ) (MHA) s2 defnes a special patient as a person who is liable to be detained in a hospital under an order made under the Criminal Procedure (Mentally Impaired Persons) Act 2003 (CPMIA); the Criminal Procedure Act 2011 (CPA); the Armed Forces Discipline Act 1971 (AFDA); and the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 (IDCCR).

CPMIA ss24 (2) (a), 34 (1) (a) (i). If not in custody, an order to detain at a hospital or secure An order may be made following facility may be made: CPA s169. If in custody (before/ a court martial: AFDA s191 (2) (a). during the hearing or trial), or awaiting sentence or the A special care recipient may become determination of an appeal, a court may order assessment in a special patient if they appear to a hospital or secure facility: CPMIA s39 (2) (c). If imprisoned have developed a mental disorder: and in need of psychiatric care, an order seeking transfer to IDCCR s136 (5) (a). a hospital or secure facility may be made: MHA ss45 (2), 46.

Comment: No defnition of ‘forensic patient’ (or an equivalent term) is found in legislation from the Commonwealth of Australia or South Australia. The main Commonwealth provisions governing persons who are not guilty by reason of mental illness or unft to stand trial are set out in the Crimes Act 1914 (Cth) Part IB. The main South Australian provisions governing persons who are not guilty by reason of mental illness or unft to stand trial are set out in the Criminal Law Consolidation Act 1935 (SA) Part 8A. All the jurisdictions create a framework for detaining persons found to belong to one or both categories or for imposing supervised release. Detention does not necessarily occur in separate forensic facilities (see RANZCP Position Statement 90: Principles for the treatment of persons found not criminally responsible or not ft for trial due to mental illness or cognitive disability). Other categories of forensic patient exist in some jurisdictions, such as bailed defendants and convicted prisoners who have been diagnosed with mental illness.

RANZCP Mental health legislation – comparison tables as at 30 June 2017 www.ranzcp.org/legislation

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