Mental Health (Statements) Regulations 2004

Victorian Legislation and Parliamentary Documents i Mental Health (Statements) Regulations 2004 S.R. No. 157/2004 TABLE OF PROVISIONS Regulation Page 1. Objective 1 2. Authorising provision 1 3. Principal Regulations 1 4. New regulation 7 substituted 2 7. Statements to be provided on admission to approved mental health services 2 5. Statements to be provided with respect to treatment 2 6. Schedules 7 to 9 substituted 3 SCHEDULE 7—Statement of Legal Rights and Entitlements and other Information—Involuntary Patient 3 SCHEDULE 8—Statement of Legal Rights and Entitlements and other Information—Hospital Order Patient 15 SCHEDULE 9—Statement of Legal Rights and Entitlements and other Information—Security Patient 27 7. Statement for continuing involuntary treatment 36 8. Schedules 11 to 14 substituted 37 SCHEDULE 11—Statement of Legal Rights and Entitlements and other Information—Forensic Patient 37 SCHEDULE 14—Statement of Legal Rights and Entitlements and other Information—Electroconvulsive Therapy 50 9. New Schedule 16 substituted 54 SCHEDULE 16—Statement of Legal Rights and Entitlements and other Information—Major Non-Psychiatric Treatment 54 ═══════════════ ENDNOTES 59 -- 1 of 60 -- Victorian Legislation and Parliamentary Documents 1 STATUTORY RULES 2004 S.R. No. 157/2004 Mental Health Act 1986 Mental Health (Statements) Regulations 2004 The Governor in Council makes the following Regulations: Dated: 7 December 2004 Responsible Minister: BRONWYN PIKE Minister for Health DIANE CASEY Clerk of the Executive Council 1. Objective The objective of these Regulations is to amend the Mental Health Regulations 1998 to— (a) prescribe new statements of patient's rights; and (b) make other amendments to those regulations. 2. Authorising provision These Regulations are made under section 142 of the Mental Health Act 1986. 3. Principal Regulations In these Regulations the Mental Health Regulations 19981 are called the Principal Regulations. -- 2 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 2 4. New regulation 7 substituted For regulation 7 of the Principal Regulations substitute— "7. Statements to be provided on admission to approved mental health services For the purposes of section 18(1) of the Act, the prescribed printed statement to be given to every person on becoming a patient must— (a) in the case of a person subject to an involuntary treatment order, be in the form set out in Schedule 7; (b) in the case of a person subject to a hospital order, be in the form set out in Schedule 8; (c) in the case of a security patient, be in the form set out in Schedule 9; (d) in the case of a continuing treatment involuntary patient, be in the form set out in Schedule 10; (e) in the case of— (i) a forensic patient subject to a supervision order; or (ii) a person detained in an approved mental health service under section 20BJ(1) or 20BM of the Crimes Act 1914 of the Commonwealth— be in the form set out in Schedule 11.". 5. Statements to be provided with respect to treatment In regulation 8(c) of the Principal Regulations, omit "or a major medical procedure". r. 4 -- 3 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 3 6. Schedules 7 to 9 substituted For Schedules 7, 8 and 9 to the Principal Regulations substitute— 'SCHEDULE 7 Regulation 7(a) STATEMENT OF LEGAL RIGHTS AND ENTITLEMENTS AND OTHER INFORMATION—INVOLUNTARY PATIENT Mental Health Act 1986 Mental Health Regulations 1998 IN SUMMARY When you are on an Involuntary Treatment Order or a Community Treatment Order (CTO) you— • will have a treatment plan and can be involved in planning your treatment; • have a right to obtain a second opinion from a psychiatrist about your treatment; • have a right to appeal to the Mental Health Review Board against being on the order; • have a right to obtain legal advice and have a lawyer represent you; • can talk to and have a friend or family member represent you; • can complain about your treatment. You can ask a member of the treating team, a friend, a family member, a lawyer, an advocate or a community visitor to help you do these things. ABOUT THIS STATEMENT This statement provides information about being on an involuntary treatment order or a community treatment order (CTO) and your legal rights and entitlements under the Mental Health Act 1986. A member of the treating team will talk to you about this information and answer your questions. r. 6 -- 4 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 4 The information must be explained in a language or manner that you can understand. This statement is also translated into a number of languages. You can ask a member of the treating team if it is available in your preferred language. Copies of the Mental Health Act 1986 are available at the mental health service. If at any time you have questions about this information or your rights, ask someone to explain. You can ask a member of the treating team, a friend, a family member, a lawyer, an advocate or a community visitor. INVOLUNTARY TREATMENT ORDERS Involuntary treatment orders are orders under the Mental Health Act that require people with a mental illness to receive treatment for their illness. A doctor has recommended you be placed on an involuntary treatment order so you can receive treatment for a mental illness. In the doctor's opinion all of the following criteria for involuntary treatment in the Mental Health Act apply to you— • you appear to be mentally ill (mental illness is defined in the Act as a medical condition that is characterised by a significant disturbance of thought, mood, perception or memory); • your mental illness requires immediate treatment and that treatment can be obtained by placing you on an involuntary treatment order; • because of your mental illness, involuntary treatment is necessary for your health or safety (whether to prevent a deterioration in your physical or mental condition or otherwise) or for the protection of members of the public; • you have either refused or are unable to consent to necessary treatment; • there is no less restrictive way for you to receive adequate treatment for your mental illness. Initial review of involuntary treatment orders Within 24 hours of being placed on the order, a psychiatrist from the mental health service will examine you to decide if all of these criteria apply to you. If they do, the psychiatrist will confirm the order and you will remain an involuntary patient under the Mental Health Act. The psychiatrist will then either admit you to the mental health service or make a community treatment order (CTO) for you. Where possible, you will be treated in the community. If you are admitted as an inpatient, you must stay in the mental health service. Read the section on "Inpatient Treatment" in this statement for more information. If the psychiatrist makes a CTO for you, read the section in this statement on "Community Treatment Orders". r. 6 -- 5 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 5 If the psychiatrist does not believe all of the criteria for involuntary treatment apply to you, the involuntary treatment order will be discharged. You can discuss continuing treatment on a voluntary basis with your case manager or psychiatrist. If you have been an inpatient and both you and the psychiatrist think you would benefit from further treatment at the mental health service, you can ask to be allowed to stay on a voluntary basis. If you have any questions about the review, such as when the psychiatrist will come to see you, ask a member of the treating team. Treatment Your psychiatrist will prepare a treatment plan that is designed to meet your specific needs. You can be involved in planning your treatment and the psychiatrist will consider your preferences and concerns. However, if your psychiatrist believes a particular psychiatric treatment is necessary, that treatment can be given to you, even if you refuse. If this happens, your psychiatrist will explain why the treatment is necessary. Your psychiatrist will discuss your treatment plan with you, and give you a copy. Your psychiatrist and other members of the treating team will regularly discuss with you your diagnosis, medication, methods of treatment, alternative treatments and available services. They will review and update your treatment plan on a regular basis. You may have a friend or advocate with you when you are discussing your treatment with your psychiatrist. Family members and other caregivers can provide valuable support and care to you while you are receiving treatment for your illness. Generally, they will only be given information about your treatment and care if you agree. However, if a guardian, family member or your primary carer needs information to care for you, a member of the treating team can give them the information, even if you don't agree. Second Opinions It is your right to get a second opinion about your psychiatric condition and treatment. Your case manager or psychiatrist can arrange this from within the mental health service, or they can help you choose your own psychiatrist. If you choose a private psychiatrist you may have to pay a fee. You can discuss the second opinion with your treating psychiatrist. However, your treating psychiatrist is responsible for making the final decision about the treatment you receive. r. 6 -- 6 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 6 Access to Information It is your right under Freedom of Information (FOI) laws to request access to documents about your personal information that are held by the mental health service. If you wish to access the information, you can ask a member of the treating team or the mental health service's FOI officer to help you make an FOI application. Organisations that may be able to help you with an FOI application are described at the end of this statement. INPATIENT TREATMENT This section of the statement has information about your rights and entitlements if you are admitted to a mental health service on an involuntary treatment order. Leave of Absence You may be allowed to leave the mental health service for a short time (for example, a few hours, overnight or a weekend) to visit family or friends or for some other purpose. If you would like to have leave, you should talk to a member of the treating team. Your psychiatrist will make the final decision about a request for leave. Seclusion and Restraint Seclusion Seclusion is when a person is kept alone in a room where the doors and windows are locked from the outside. This only happens if it is necessary to protect the person or others from an immediate or imminent risk to their health or safety or to prevent the person from absconding. It is only used when other ways of ensuring safety have failed. Mechanical Restraint Mechanical restraint is the use of a device, such as a harness or straps, to restrict a person's freedom to move about. Restraint may be used to enable a person to be medically treated, to prevent the person from injuring themselves or others or to prevent the person from continuing to destroy property. r. 6 -- 7 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 7 Approval and Monitoring of Seclusion and Mechanical Restraint Seclusion and restraint may be approved by your psychiatrist or, in an emergency, authorised by the senior nurse on duty. They can only be used for as long as the above reasons apply. If you are put in a seclusion room or are restrained, staff must give you appropriate bedding, clothing, food and drink when you want them. They must also provide you with adequate toilet arrangements, including the opportunity to wash. A nurse must review your physical and mental condition at least every 15 minutes. A doctor must also examine you at least every 4 hours, unless your psychiatrist thinks less frequent examinations are appropriate. If you are being restrained you must be monitored continuously. Letters and Telephone calls You can contact people by letter or telephone. Your mail will not be opened. Transfer You may be transferred to a different mental health service if your psychiatrist believes that you would benefit from the transfer or if it is necessary for your treatment. If you do not want to be transferred, you should talk to your psychiatrist or you can appeal to the Mental Health Review Board. If you are transferred before the appeal is heard, the Board will decide whether you should be returned to the original service when it hears the appeal. Community Treatment Orders (CTO) If your psychiatrist believes that you can live in the community while you receive the treatment you need, you may be placed on a CTO. To find out more about these orders, read the section in this statement on "Community Treatment Orders" and ask a member of the treating team to explain them. Discharge from involuntary patient status If your psychiatrist believes that any of the criteria for involuntary treatment no longer apply to you, you must be discharged as an involuntary patient and you will be free to leave. However, if both you and your psychiatrist think that you would benefit from further treatment at the mental health service, you can ask to be allowed to stay in the service on a voluntary basis. r. 6 -- 8 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 8 If at any time you want to be discharged from being an involuntary patient, you should talk to your psychiatrist or other members of the treating team, or you can appeal to the Mental Health Review Board. Whether or not you appeal, the Board will automatically review you within 8 weeks of you becoming an involuntary patient and then at least every 12 months if you continue as an involuntary patient. Your psychiatrist will also regularly review you to see if you should be discharged. COMMUNITY TREATMENT ORDERS This section of the statement contains information about your rights and entitlements if you are placed on a community treatment order (CTO). CTOs are orders under the Mental Health Act that enable involuntary patients to live in the community while they receive treatment for their mental illness. If your psychiatrist believes you can obtain the treatment you need while you live in the community, you will be placed on a CTO. You will still be an involuntary patient on an involuntary treatment order, even though you are living in the community on a CTO. Planning for a CTO Your psychiatrist will talk to you about the CTO and prepare a new treatment plan. You can be involved in planning your order and treatment plan. The treatment plan will include an assessment about your needs for continuing treatment and support in the community and the best way these can be met. Your preferences will be taken into consideration. For example, you may have a particular doctor that you wish to supervise the order. Your psychiatrist will discuss your treatment plan with you and give you a copy. The plan will include— • an outline of your treatment; • the name of the psychiatrist who will monitor your treatment; • the name of the doctor who will supervise your treatment; • the name of your case manager; • the place and times at which you are to receive treatment; • how often the supervising doctor must report on your treatment to the monitoring psychiatrist; • anything else the authorised psychiatrist thinks is appropriate. r. 6 -- 9 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 9 Conditions of the CTO You will be given a copy of the CTO. It will say how long the order will last, which can be for up to 12 months. The CTO sometimes states where you must live if this is necessary for the treatment of your illness. Your psychiatrist may vary these conditions from time to time and will discuss the reasons with you. If you are unhappy with any of the conditions, you should talk to a member of the treating team or you can appeal to the Mental Health Review Board. Your psychiatrist can extend the CTO if the criteria for involuntary treatment still apply to you and the treatment you need can continue to be obtained through the order. If your CTO is extended, the Mental Health Review Board will review the extension. If your psychiatrist does not extend your CTO, it will expire and you will no longer be an involuntary patient. Revoking the CTO If you do not comply with your order or your treatment plan, your psychiatrist may revoke the order and you must return to the mental health service for treatment. Members of the treating team will try to help you comply with the order and your treatment plan. However, if there is a significant risk that your health will get worse because of the non- compliance, the CTO will be revoked. Your CTO may also be revoked if your psychiatrist believes that your illness would be better treated in a mental health service. If your CTO is revoked, reasonable efforts will be made to tell you and you must then go to the mental health service as an inpatient. Discharging the CTO If your psychiatrist believes that any of the criteria for involuntary treatment no longer apply to you, you must be discharged from the CTO and from being an involuntary patient. You can discuss continuing treatment on a voluntary basis with your case manager or psychiatrist. If at any time you want to be discharged from the CTO, you should talk to your psychiatrist or other members of the treating team, or you can appeal to the Mental Health Review Board. Whether or not you appeal, the Board will automatically review you at least every 12 months if you continue as an involuntary patient. Your psychiatrist will also regularly review you to see if you should be discharged. r. 6 -- 10 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 10 APPEAL AND REVIEW: THE MENTAL HEALTH REVIEW BOARD This section of the statement contains information about your rights and entitlements to appeal and review by the Mental Health Review Board. The Functions of the Board The Mental Health Review Board is an independent tribunal that— • hears appeals from involuntary patients on involuntary treatment orders or community treatment orders who want to be discharged; • reviews all involuntary patients within 8 weeks of being placed on an involuntary treatment order to decide if they can be discharged from the order; • reviews all involuntary patients at least every 12 months to decide if they can be discharged; • hears appeals from patients who do not want to be transferred to a different mental health service; • reviews the extension of all community treatment orders. At each appeal or review, the Board will also review your treatment plan. Appeals to the Board It is your right to appeal to the Mental Health Review Board at any time. If you want to appeal, ask a member of the treating team for an Appeal Form, fill it in and ask the team member to send it to the Board. If no appeal form is available, you can write a letter or email to the Board that sets out your name, the name of the mental health service and what you want to appeal about. The Board must hear your appeal without delay. If you need help to fill in the form or with anything else, you should ask a member of the treating team, a friend, a family member, a lawyer or a community visitor to help you. The Board's contact details To fax, mail or email an appeal to the Board, or to find out further information, use the contact details below— Executive Officer Mental Health Review Board [insert appropriate contact details] r. 6 -- 11 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 11 Preparing for the Board Hearing The Board will send you a notice advising the date, time and place at which your review or appeal will be heard. Your psychiatrist and case manager will also be notified of the hearing. It is your right to attend the hearing unless the Board decides that this would be bad for your health. You are encouraged to attend and present your case. You can have someone attend to offer support or speak for you, for example, an advocate, a lawyer, a private doctor, a friend or a family member. If you are unable to attend the hearing, you should tell the Board as soon as possible. Before the hearing, read the documents that will be given to the Board for your hearing (see below) and think about what you are going to say to the Board. You may also want to give the Board written information. Your family and friends or someone you respect may wish to write letters or come to the hearing in support of your appeal or review. If you have special needs, such as an interpreter, you should discuss these with a member of the treating team or contact the Board. The Board will arrange an interpreter if necessary. Organisations that may be able to help you with your appeal or review are described at the end of this statement. Access to documents for the hearing You or your representative will be given the opportunity to read any documents to be given to the Board for your hearing, including your clinical file and your psychiatrist's report to the Board, at least 24 hours before the hearing. However, your psychiatrist may apply to the Board to prevent you from seeing a document or part of a document if it is believed that— • seeing the document will cause serious harm to your health or the health or safety of another person; or • the information in a document was given in confidence; or is personal information about another person. If an application is made to prevent you seeing a document or part of a document a member of the treating team will tell you and explain the process. The Board will make the final decision whether you see the whole document or part of the document or none of the document. If the Board decides you should not see a document or part of any document, it may allow your representative to see it instead. r. 6 -- 12 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 12 The Board Hearing Hearings are held either at hospitals or community mental health services. Your hearing will usually be heard by 3 Board members—a lawyer, a psychiatrist and a community member. If the hearing is the annual review of your involuntary treatment order or the review of the extension of your community treatment order, it may be conducted by one person—a lawyer, a psychiatrist or a community member of the Board. The hearing will be informal and private, unless the Board decides that it is in your best interests or the public interest for the hearing to be open. Your doctor and other members of the treating team will give information to the Board. You and your representative will be able to ask questions and explain your side of the case, for example, why you believe you should not be on an involuntary treatment order. If you are an inpatient and too ill to attend the hearing, the Board may visit you in your ward. The Board's Decision on Appeal or Review of Involuntary Status The Board must decide whether all the criteria for involuntary treatment still apply to you. Discharge from involuntary status If any one of the criteria does not apply, you will be discharged from your order and from being an involuntary patient. If you were on a Community Treatment Order (CTO), you will no longer be on the order. You can discuss continuing treatment on a voluntary basis with your case manager or psychiatrist. If you were an inpatient, you will be free to leave the mental health service. However, if both you and your psychiatrist think you would benefit from further treatment at the mental health service, you can ask to be allowed to stay on a voluntary basis. Continuation of involuntary status If the Board decides that all of the criteria for involuntary treatment still apply to you, you will continue to receive treatment as an involuntary patient. If you are an inpatient and the Board considers that the treatment you need can be obtained through a CTO, it may order your psychiatrist to place you on a CTO. If you are on a CTO, the Board can vary the conditions of the CTO. The Board will also review your treatment plan to decide whether the proper procedures have been followed in making the plan, for example, were your wishes taken into account and did the psychiatrist consider alternative treatments? The Board must be satisfied that the plan can be implemented by the mental health service. r. 6 -- 13 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 13 At the end of the hearing, the Board will advise you of its decision and the reasons for it. You will be given a written copy of the order. If you want written reasons for the decision, you must request these in writing from the Board within 28 days and the Board must provide you with a statement of reasons within 14 days of your request. You can appeal again to the Board at any time. Review of the Board's Decision If you disagree with the Board's decision you can apply to the Victorian Civil and Administrative Tribunal (VCAT) for a review of the Board's decision. VCAT is an independent tribunal with the power to confirm or overturn the decision of the Board. Appeals must be made in writing within 28 days to— Victorian Civil and Administrative Tribunal [insert appropriate contact details] COMPLAINTS You should be treated with dignity and respect and be protected from abuse when you receive treatment and care from the mental health service. If you are unhappy about any part of your treatment or care, you can complain. A good place to start is with your case manager, primary nurse or another member of the treating team, the complaints liaison officer or patient representative in the hospital or the Director of Psychiatry at the mental health service. You can also complain directly to the Health Services Commissioner or the Chief Psychiatrist. If you need help with your complaint, you can ask someone you trust to assist you. This might be a member of the treating team, a friend, a family member, a lawyer or a community visitor. IMPORTANT CONTACTS The organisations you can contact for assistance and more information are described below. The service will provide you with their contact details. • The Mental Health Review Board is an independent tribunal that hears appeals from involuntary patients, hospital order patients and security patients who want to be discharged from their involuntary treatment status. It also automatically reviews these patients. • Community Visitors are people who visit mental health services at least once a month to inquire into the adequacy of services and facilities for the treatment and care of patients, investigate complaints and report on their inquiries and investigations. r. 6 -- 14 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 14 • The Mental Health Legal Centre is an independent legal service which specialises in mental health legal issues. It may be able to arrange representation for you at Mental Health Review Board hearings or about other legal matters. • Victoria Legal Aid provides free legal advice about a range of issues, legal assistance if you cannot afford a private solicitor and may be able to assist with legal representation at Mental Health Review Board hearings. • The Public Advocate assists, advises and advocates for people with serious complaints about mental health and disability services and treatment. • The Chief Psychiatrist is a senior departmental official appointed under the Mental Health Act, with special responsibilities in relation to people receiving mental health services. These include the power to investigate complaints and other matters and to take necessary action. • The Health Service Commissioner is an independent commissioner who investigates and helps to resolve complaints by health care consumers about health services, including mental health services. The Commissioner can help patients access their health information. • The Ombudsman investigates complaints about government departments. You can also ask your case manager or any member of staff about other local organisations and support groups which may be able to help you. __________________ r. 6 -- 15 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 15 SCHEDULE 8 Regulation 7(b) STATEMENT OF LEGAL RIGHTS AND ENTITLEMENTS AND OTHER INFORMATION—HOSPITAL ORDER PATIENT Mental Health Act 1986 Mental Health Regulations 1998 IN SUMMARY When you are on a hospital order or Restricted Community Treatment Order (RCTO) you— • will have a treatment plan and can be involved in planning your treatment; • have a right to obtain a second opinion from a psychiatrist about your treatment; • have a right to appeal to the Mental Health Review Board against being on the order; • have a right to obtain legal advice and have a lawyer represent you; • can talk to and have a friend or family member represent you; • can complain about your treatment. You can ask a member of the treating team, a friend, a family member, a lawyer, an advocate or a community visitor to help you do these things. ABOUT THIS STATEMENT This statement provides information about being on a Hospital Order or Restricted Community Treatment Order (RCTO) and your legal rights and entitlements under the Mental Health Act 1986. A member of the treating team will talk to you about this information and answer your questions. The information must be explained in a language or manner that you can understand. This statement is also translated into a number of languages. You can ask a member of the treating team if it is available in your preferred language. Copies of the Mental Health Act 1986 are available at the mental health service. r. 6 -- 16 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 16 If at any time you have questions about this information or your rights, ask someone to explain. You can ask a member of the treating team, a friend, a family member, a lawyer, an advocate or a community visitor. HOSPITAL ORDERS Hospital orders are made by a court under the Sentencing Act 1991. If a person with a mental illness is found guilty of an offence, the court may make a hospital order instead of giving the person a sentence. The person is then admitted to a mental health service and is given treatment for their mental illness. Mental illness is defined in the Mental Health Act as a medical condition that is characterised by a significant disturbance of thought, mood, perception or memory. A court has placed you on a hospital order so you can receive treatment for a mental illness. The court made the order after a psychiatrist found that all of the following criteria for being a hospital order patient apply to you— • you appear to be mentally ill and require treatment for your illness; • the treatment you need can be obtained in a mental health service; • because of your mental illness, you need to be admitted and detained in the mental health service for treatment as an involuntary patient for your health or safety (whether to prevent a deterioration in your physical or mental condition or otherwise) or for the protection of members of the public. Once you are admitted as a hospital order patient, you must remain in the mental health service and receive treatment for mental illness. Treatment Your psychiatrist will prepare a treatment plan that is designed to meet your specific needs. You can be involved in planning your treatment and the psychiatrist will consider your preferences and concerns. However, if your psychiatrist believes a particular psychiatric treatment is necessary, that treatment can be given to you, even if you refuse. If this happens, your psychiatrist will explain why the treatment is necessary. Your psychiatrist will discuss your treatment plan with you and give you a copy. Your psychiatrist and other members of the treating team will regularly discuss with you your diagnosis, medication, methods of treatment, alternative treatments and available services. They will review and update your treatment plan on a regular basis. You may have a friend or advocate with you when you are discussing your treatment with your psychiatrist. r. 6 -- 17 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 17 Family members and other caregivers can provide valuable support and care to you while you are receiving treatment for your illness. Generally, they will only be given information about your treatment and care if you agree. However, if a guardian, family member or your primary carer needs information to care for you, a member of the treating team can give them the information, even if you don't agree. Second Opinions It is your right to get a second opinion about your psychiatric condition and treatment. Your case manager or psychiatrist can arrange this from within the mental health service, or they can help you choose your own psychiatrist. If you choose a private psychiatrist you may have to pay a fee. You can discuss the second opinion with your treating psychiatrist. However, your treating psychiatrist is responsible for making the final decision about the treatment you receive. Access to Information It is your right under Freedom of Information (FOI) laws to request access to documents about your personal information that are held by the mental health service. If you wish to access the information, you can ask a member of the treating team or the mental health service's FOI officer to help you make an FOI application. Organisations that may be able to help you with an FOI application are described at the end of this statement. INPATIENT TREATMENT This section of the statement has information about your rights and entitlements while you are admitted to a mental health service on a hospital order. Leave of Absence You may be allowed to leave the mental health service for a short time (for example, a few hours, overnight or a weekend) to visit family or friends or for some other purpose. If you would like to have leave, you should talk to a member of the treating team. Your psychiatrist will make the final decision about a request for leave. r. 6 -- 18 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 18 Seclusion and Restraint Seclusion Seclusion is when a person is kept alone in a room where the doors and windows are locked from the outside. This only happens if it is necessary to protect the person or others from an immediate or imminent risk to their health or safety or to prevent the person from absconding. It is only used when other ways of ensuring safety have failed. Mechanical Restraint Mechanical restraint is the use of a device, such as a harness or straps, to restrict a person's freedom to move about. Restraint may be used to enable a person to be medically treated, to prevent the person from injuring themselves or others or to prevent the person from continuing to destroy property. Approval and Monitoring of Seclusion and Mechanical Restraint Seclusion and restraint may be approved by your psychiatrist or, in an emergency, authorised by the senior nurse on duty. They can only be used for as long as the above reasons apply. If you are put in a seclusion room or are restrained, staff must give you appropriate bedding, clothing, food and drink when you want them. They must also provide you with adequate toilet arrangements, including the opportunity to wash. A nurse must review your physical and mental condition at least every 15 minutes. A doctor must also examine you at least every 4 hours, unless your psychiatrist thinks less frequent examinations are appropriate. If you are being restrained you must be monitored continuously. Letters and telephone calls You can contact people by letter or telephone. Your mail will not be opened. Transfer You may be transferred to a different mental health service if your psychiatrist believes that you would benefit from the transfer or if it is necessary for your treatment. If you do not want to be transferred, you should talk to your psychiatrist or you can appeal to the Mental Health Review Board. If you are transferred before the appeal is heard, the Board will decide whether you should be returned to the original service when it hears the appeal. r. 6 -- 19 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 19 Restricted Community Treatment Orders (RCTO) If the chief psychiatrist believes that you can live in the community while you receive the treatment you need, you may be placed on a Restricted Community Treatment Order (RCTO). To find out more about these orders, read the section in this statement on "Restricted Community Treatment Orders" and ask a member of the treating team to explain them. Discharge from hospital order patient status If the chief psychiatrist is satisfied that any of the criteria for being a hospital order patient no longer apply to you and your continued detention as a hospital order patient is no longer necessary, you must be discharged as a hospital order patient and you will be free to leave. However, if both you and your psychiatrist think that you would benefit from further treatment at the mental health service, you can ask to be allowed to stay on a voluntary basis. If at any time you want to be discharged from being on a hospital order, you should talk to your psychiatrist or other members of the treating team, or you can appeal to the Mental Health Review Board. Whether or not you appeal, the Board will automatically review you within 8 weeks of you becoming a hospital order patient and then at least every 12 months if you continue as a hospital order patient. Your psychiatrist will also regularly review you to see if you should be discharged. RESTRICTED COMMUNITY TREATMENT ORDERS (RCTO) This section of the statement contains information about your rights and entitlements if you are placed on a Restricted Community Treatment Order (RCTO). RCTOs are orders under the Mental Health Act that enable hospital order patients to live in the community while they receive treatment for their mental illness. You will be placed on a RCTO if the chief psychiatrist believes you can obtain the treatment you need while you live in the community and all the following criteria for a RCTO apply to you— • you appear to be mentally ill and require treatment for your illness; • the treatment you need can be obtained on a RCTO; • because of your mental illness, you need to be on a RCTO for your health or safety (whether to prevent a deterioration of your physical or mental condition or otherwise) or for the protection of members of the public. You will still be a hospital order patient, even though you are living in the community on a RCTO. r. 6 -- 20 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 20 Planning for a RCTO Your psychiatrist will talk to you about the RCTO and prepare a new treatment plan. You can be involved in planning your order and treatment plan. The treatment plan will include an assessment about your needs for continuing treatment and support in the community and the best way these can be met. Your preferences will be taken into consideration. For example, you may have a particular doctor that you wish to supervise the order. Your psychiatrist will discuss your treatment plan with you and give you a copy. The plan will include— • an outline of your treatment; • the name of the psychiatrist who will monitor your treatment; • the name of the doctor who will supervise your treatment; • the name of your case manager; • the place and times at which you are to receive treatment; • how often the monitoring psychiatrist must report on your treatment to the chief psychiatrist; • anything else the authorised psychiatrist thinks is appropriate. Making the RCTO The chief psychiatrist will make the RCTO and send it to the Mental Health Review Board for approval. The RCTO does not come into effect until the Mental Health Review Board approves it. The Board will have a hearing to decide whether or not to approve the RCTO. The Board will send you a notice advising the date, time and place of the hearing. To find out more about the Board, read the section in this statement on "Appeal and Review: the Mental Health Review Board". Conditions of the RCTO You will be given a copy of the RCTO. It will say how long the order will last, which can be for up to 12 months. The RCTO sometimes states where you must live. The order may also specify any conditions that the chief psychiatrist considers appropriate. The chief psychiatrist may vary the conditions from time to time, and will discuss the reasons with you. If you are unhappy with any of the conditions, you should talk to a member of the treating team or contact the chief psychiatrist directly. The chief psychiatrist can extend the RCTO if the criteria for being on a RCTO still apply to you and the treatment you need can continue to be obtained through the order. r. 6 -- 21 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 21 If your RCTO is extended, the Mental Health Review Board will review the extension. Revoking the RCTO If you do not comply with your order or your treatment plan, the chief psychiatrist may revoke the order. Your RCTO may also be revoked if the chief psychiatrist believes that your illness would be better treated in a mental health service. If your RCTO is revoked, reasonable efforts will be made to tell you and you must then go to the mental health service as an inpatient. Discharging the RCTO If the chief psychiatrist believes that any of the criteria for being a hospital order patient no longer apply to you, you must be discharged from the RCTO and from being a hospital order patient. You can discuss continuing treatment on a voluntary basis with your case manager or psychiatrist. If at any time you want to be discharged from the RCTO, you should talk to your psychiatrist or other members of the treating team, or you can appeal to the Mental Health Review Board. Whether or not you appeal, the Board will automatically review you at least every 12 months if you continue as a hospital order patient. Your psychiatrist will also regularly review you to see if you should be discharged. APPEAL AND REVIEW: THE MENTAL HEALTH REVIEW BOARD This section of the statement contains information about your rights and entitlements to appeal and review by the Mental Health Review Board. The functions of the Board The Mental Health Review Board is an independent tribunal that— • hears appeals from hospital order patients who want to be discharged; • reviews all hospital order patients within 8 weeks of their admission to decide if they can be discharged; • reviews all hospital order patients at least every 12 months to decide if they can be discharged; • hears appeals from patients who do not want to be transferred to a different mental health service; and • reviews the making and extension of all Restricted Community Treatment Orders (RCTO). At each appeal or review, the Board will also review your treatment plan. r. 6 -- 22 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 22 Your Right to Appeal to the Board It is your right to appeal to the Mental Health Review Board at any time. If you want to appeal, ask a member of the treating team for an Appeal Form, fill it in and ask the team member to send it to the Board. If no appeal form is available, you can write a letter or email to the Board that sets out your name, the name of the mental health service and what you want to appeal about. The Board must hear your appeal without delay. If you need help to fill in the form or with anything else, you should ask a member of the treating team, a friend, a family member, a lawyer or a community visitor to help you. The Board's contact details To fax, mail or email an appeal to the Board, or to find out further information, use the contact details below— Executive Officer Mental Health Review Board [insert appropriate contact details] Preparing for the Board Hearing The Board will send you a notice advising the date, time and place at which your review or appeal will be heard. Your psychiatrist and case manager will also be notified of the hearing. It is your right to attend the hearing unless the Board decides that this would be bad for your health. You are encouraged to attend and present your case and you can have someone attend to offer support or speak for you, for example, an advocate, a lawyer, a private doctor, a friend or a family member. If you are unable to attend the hearing, you should tell the Board as soon as possible. Before the hearing, read the documents that will be given to the Board for your hearing (see below) and think about what you are going to say to the Board. You may also want to give the Board written information. Your family and friends or someone you respect may wish to write letters or come to the hearing in support of your appeal or review. If you have special needs, such as an interpreter, you should discuss these with a member of the treating team or contact the Board. The Board will arrange an interpreter if necessary. Organisations that may be able to help you with your appeal or review are described at the end of this statement. r. 6 -- 23 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 23 Access to documents for the hearing You or your representative will be given the opportunity to read any documents to be given to the Board for your hearing, including your clinical file and your psychiatrist's report to the Board, at least 24 hours before the hearing. However, your psychiatrist may apply to the Board to prevent you from seeing a document or part of a document if it is believed that— • seeing the document will cause serious harm to your health or the health or safety of another person; or • the information in a document was given in confidence; or is personal information about another person. If an application is made to prevent you seeing a document or part of a document a member of the treating team will tell you and explain the process. The Board will make the final decision whether you see the whole document or part of the document or none of the document. If the Board decides you should not see a document or part of any document, it may allow your representative to see it instead. The Board Hearing Hearings are held either at hospitals or community mental health services. Your hearing will usually be heard by 3 Board members—a lawyer, a psychiatrist and a community member. If the hearing is the annual review of you being a hospital order patient, it may be conducted by one person— a lawyer, a psychiatrist or a community member of the Board. The hearing will be informal and private, unless the Board decides that it is in your best interests or the public interest for the hearing to be open. Your doctor and other members of the treating team will give information to the Board. You and your representative will be able to ask questions and explain your side of the case, for example, why you believe you should not be a hospital order patient. If you are an inpatient and too ill to attend the hearing, the Board may visit you in your ward. The Board's Decision on Appeal or Review The Board must decide whether all the criteria for being a hospital order patient still apply to you and whether your continued detention as a hospital order patient is still necessary. r. 6 -- 24 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 24 Discharge from inpatient treatment If the Board is satisfied that any of the criteria for a hospital order no longer apply to you and your continued detention as a hospital order patient is not necessary, you must be discharged from the order. Discharge from Restricted Community Treatment Orders If you are on a RCTO, and the Board considers that the criteria for a RCTO and the criteria for a hospital order no longer apply to you, you must be discharged from both the RCTO and the hospital order. After Discharge If you are discharged, you can discuss continuing treatment on a voluntary basis with your case manager or psychiatrist. If you were an inpatient, you will be free to leave the mental health service. However, if both you and your psychiatrist think you would benefit from further treatment at the mental health service, you can ask to be allowed to stay on a voluntary basis. Continuation of involuntary status If the Board decides that all the criteria for being a hospital order patient or on a RCTO still apply to you, you will continue to receive treatment, either as an inpatient or on a RCTO. The Board will also review your treatment plan to decide whether the proper procedures have been followed in making the plan, for example, were your wishes taken into account and did the psychiatrist consider alternative treatments? The Board must be satisfied that the plan can be implemented by the mental health service. At the end of the hearing, the Board will advise you of its decision and the reasons for it. You will be given a written copy of the order. If you want written reasons for the decision, you must request these in writing from the Board within 28 days and the Board must provide you with a statement of reasons within 14 days of your request. You can appeal again to the Board at any time. Review of the Board's decision If you disagree with the Board's decision you can apply to the Victorian Civil and Administrative Tribunal (VCAT) for a review of the Board's decision. VCAT is an independent tribunal with the power to confirm or overturn the decision of the Board. Appeals must be made in writing within 28 days to— Victorian Civil and Administrative Tribunal [insert appropriate contact details] r. 6 -- 25 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 25 COMPLAINTS You should be treated with dignity and respect and be protected from abuse when you receive treatment and care from the mental health service. If you are unhappy about any part of your treatment or care, you can complain. A good place to start is with your case manager, primary nurse or another member of the treating team, the complaints liaison officer or patient representative in the hospital or the Director of Psychiatry at the mental health service. You can also complain directly to the Health Services Commissioner or the Chief Psychiatrist. If you need help with your complaint, you can ask someone you trust to assist you. This might be a member of the treating team, a friend, a family member, a lawyer or a community visitor. IMPORTANT CONTACTS The organisations you can contact for assistance and more information are described below. The service will provide you with their contact details. • The Mental Health Review Board is an independent tribunal that hears appeals from involuntary patients, hospital order patients and security patients who want to be discharged from their involuntary treatment status. It also automatically reviews these patients. • Community Visitors are people who visit mental health services at least once a month to inquire into the adequacy of services and facilities for the treatment and care of patients, investigate complaints and report on their inquiries and investigations. • The Mental Health Legal Centre is an independent legal service which specialises in mental health legal issues. It may be able to arrange representation for you at Mental Health Review Board hearings or about other legal matters. • Victoria Legal Aid provides free legal advice about a range of issues, legal assistance if you cannot afford a private solicitor and may be able to assist with legal representation at Mental Health Review Board hearings. • The Public Advocate assists, advises and advocates for people with serious complaints about mental health and disability services and treatment. • The Chief Psychiatrist is a senior departmental official appointed under the Mental Health Act, with special responsibilities in relation to people receiving mental health services. These include the power to investigate complaints and other matters and to take necessary action. r. 6 -- 26 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 26 • The Health Service Commissioner is an independent commissioner who investigates and helps to resolve complaints by health care consumers about health services, including mental health services. The Commissioner can help patients access their health information. • The Ombudsman investigates complaints about government departments. You can also ask your case manager or any member of the treating team about other local organisations and support groups which may be able to help you. __________________ r. 6 -- 27 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 27 SCHEDULE 9 Regulation 7(c) STATEMENT OF LEGAL RIGHTS AND ENTITLEMENTS AND OTHER INFORMATION—SECURITY PATIENT Mental Health Act 1986 Mental Health Regulations 1998 IN SUMMARY When you are a security patient you— • will have a treatment plan and can be involved in planning your treatment; • have a right to obtain a second opinion from a psychiatrist about your treatment; • have a right to appeal to the Mental Health Review Board against being a security patient; • have a right to obtain legal advice and have a lawyer represent you; • can talk to and have a friend or family member represent you; • can complain about your treatment. You can ask a member of the treating team, a friend, a family member, a lawyer, an advocate or a community visitor to help you do these things. ABOUT THIS STATEMENT This statement provides information about being a security patient and your legal rights and entitlements under the Mental Health Act 1986. A member of the treating team will talk to you about this information and answer your questions. The information must be explained in a language or manner that you can understand. This statement is also translated into a number of languages. You can ask a member of the treating team if it is available in your preferred language. Copies of the Mental Health Act 1986 are available at the mental health service. If at any time you have questions about your rights, ask someone to explain. You can ask a member of the treating team, a friend, a family member, a lawyer, an advocate or a community visitor. r. 6 -- 28 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 28 SECURITY PATIENTS You have been admitted to a mental health service as a security patient so you can receive treatment for a mental illness. Mental illness is defined in the Mental Health Act as a medical condition that is characterised by a significant disturbance of thought, mood, perception or memory. There are two ways you may have been admitted as a security patient. A member of the treating team will tell you which of the following orders applies to you and tick the correct box. † 1. Restricted Hospital Transfer Order You have been transferred to a mental health service from prison, police cells, a youth training centre, a remand centre or a youth residential centre. A psychiatrist examined you and found that all of the following criteria for being a security patient apply to you— • you appear to be mentally ill and require immediate treatment for your illness; • the treatment you need can be obtained in a mental health service; • because of your mental illness, you need to be admitted and detained in the mental health service for treatment for your health or safety (whether to prevent a deterioration in your physical or mental condition or otherwise) or for the protection of members of the public. † 2. Hospital Security Order You have been found guilty of an offence and the court has sentenced you to be admitted to and detained in a mental health service for the time specified in the order. A psychiatrist examined you and found that all of the following criteria for being a security patient apply to you— • you appear to be mentally ill and require treatment for your illness; • the treatment you need can be obtained in a mental health service; • because of your mental illness, you need to be admitted and detained in the mental health service for treatment for your health or safety (whether to prevent a deterioration in your physical or mental condition or otherwise) or for the protection of members of the public. Once you are admitted as a security patient, you must remain in the mental health service and receive treatment for mental illness. r. 6 -- 29 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 29 INPATIENT TREATMENT This section of the statement has information about your legal rights and entitlements while you are admitted to a mental health service as a security patient. Treatment Your psychiatrist will prepare a treatment plan that is designed to meet your specific needs. You can be involved in planning your treatment and the psychiatrist will consider your preferences and concerns. However, if your psychiatrist believes a particular psychiatric treatment is necessary, that treatment can be given to you, even if you refuse. If this happens, your psychiatrist will explain why the treatment is necessary. Your psychiatrist will discuss your treatment plan with you and give you a copy. Your psychiatrist and other members of the treating team will regularly discuss with you your diagnosis, medication, methods of treatment, alternative treatments and available services. They will review and update your treatment plan on a regular basis. You may have a friend or advocate with you when you are discussing your treatment with your psychiatrist. Family members and other caregivers can provide valuable support and care to you while you are receiving treatment for your illness. Generally, they will only be given information about your treatment and care if you agree. However, if a guardian, family member or your primary carer needs information to care for you, a member of the treating team can give them the information, even if you don't agree. Second Opinions It is your right to get a second opinion about your psychiatric condition and treatment. Your case coordinator or psychiatrist can arrange this from within the mental health service, or they can help you choose your own psychiatrist. If you choose a private psychiatrist you may have to pay a fee. You can discuss the second opinion with your treating psychiatrist. However, your treating psychiatrist is responsible for making the final decision about the treatment you receive. Access to Information It is your right under Freedom of Information (FOI) laws to request access to documents about your personal information that are held by the mental health service. If you wish to access the information, you can ask a member of the treating team or the mental health service's FOI officer to help you make an FOI application. r. 6 -- 30 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 30 Organisations that may be able to help you with an FOI application are described at the end of this statement. Leave Leave allows security patients to leave the mental health service for a variety of purposes, including medical appointments, court appearances and rehabilitation programs. Leave is always subject to security conditions and time limits. There are two types of leave: special leave and leave of absence. Special leave Special leave is for specific purposes and cannot exceed 24 hours. You or someone on your behalf can apply to the chief psychiatrist stating the special circumstances for which special leave is needed. If the chief psychiatrist is satisfied there are special circumstances and the safety of members of the public will not be seriously endangered, the special leave must be granted. If you are refused special leave by the chief psychiatrist, you can appeal to the Mental Health Review Board. Leave of absence Leave of absence is for longer periods—up to 6 months—and is generally used to help with your rehabilitation and to prepare you for your return to the community at the end of your sentence. Leave of absence is granted by the Secretary to the Department of Justice. If you would like to have leave of absence, you should talk to a member of the treating team about how to make an application. The Secretary to the Department of Justice will make the final decision about a request for leave. Seclusion and Restraint Seclusion Seclusion is when a person is kept alone in a room where the doors and windows are locked from the outside. This only happens if it is necessary to protect the person or others from an immediate or imminent risk to their health or safety or to prevent the person from absconding. It is only used when other ways of ensuring safety have failed. Mechanical Restraint Mechanical restraint is the use of a device, such as a harness or straps, to restrict a person's freedom to move about. Restraint may be used to enable a person to be medically treated, to prevent the person from injuring themselves or others or to prevent the person from continuing to destroy property. r. 6 -- 31 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 31 Approval and Monitoring of Seclusion and Mechanical Restraint Seclusion and restraint may be approved by your psychiatrist or, in an emergency, authorised by the senior nurse on duty. They can only be used for as long as the above reasons apply. If you are put in a seclusion room or are restrained, staff must give you appropriate bedding, clothing, food and drink when you want them. They must also provide you with adequate toilet arrangements, including the opportunity to wash. A nurse must review your physical and mental condition at least every 15 minutes. A doctor must also examine you at least every 4 hours, unless your psychiatrist thinks less frequent examinations are appropriate. If you are being restrained you must be monitored continuously. Security Conditions While you are in the mental health service, you are in the custody of your psychiatrist who may apply any security conditions that are considered necessary, for example limiting your phone calls or opening your mail. Security conditions are applied to ensure your health or safety, or for the protection of members of the public. Letters and Telephone calls You can contact people by letter or telephone, unless your psychiatrist has applied a security condition to you. Transfer You may be transferred to a different mental health service if the chief psychiatrist believes that you would benefit from the transfer or if it is necessary for your treatment. If you do not want to be transferred, you should talk to your psychiatrist or you can appeal to the Mental Health Review Board. If you are transferred before the appeal is heard, the Board will decide whether you should be returned to the original service when it hears the appeal. Discharge from security patient status You can be held in this mental health service as a security patient only as long as you would have been held at your original place of detention. If the term of your sentence ends, you are released from custody by a court, or you are granted bail, you can no longer be treated as a security patient. You can discuss continuing treatment with your case coordinator or psychiatrist. r. 6 -- 32 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 32 If the chief psychiatrist is satisfied that any of the criteria for being a security patient no longer apply to you and your continued detention as a security patient is no longer necessary, you may be discharged and returned to your original place of detention. If you are a hospital security order patient, you will be sent to prison to serve the rest of your sentence. If at any time you want to be discharged from the mental health service, you should talk to your psychiatrist or other members of the treating team, or you can appeal to the Mental Health Review Board. Whether or not you appeal, the Board will automatically review you within 8 weeks of your admission and then at least every 12 months if you continue as a security patient. Your psychiatrist will also regularly review you to see if you should be discharged. APPEAL AND REVIEW: THE MENTAL HEALTH REVIEW BOARD This section of the statement has information about your rights and entitlements to appeal and review by the Mental Health Review Board. The functions of the board The Mental Health Review Board is an independent tribunal that— • hears appeals from security patients who want to be discharged; • reviews all security patients within 8 weeks of their admission to decide if they can be discharged; • reviews all security patients at least every 12 months to decide if they can be discharged; • hears appeals from patients who do not want to be transferred to a different mental health service; • hears appeals from security patients who have been refused special leave by the chief psychiatrist. At each appeal or review, the Board will also review your treatment plan. Your Right to Appeal to the Board It is your right to appeal to the Mental Health Review Board at any time. If you want to appeal, ask a member of the treating team for an Appeal Form, fill it in and ask the team member to send it to the Board. If no appeal form is available, you can write a letter or email to the Board that sets out your name, the name of the mental health service and what you want to appeal about. The Board must hear your appeal without delay. If you need help to fill in the form or with anything else, you should ask a member of the treating team, a friend, a family member, a lawyer or a community visitor to help you. r. 6 -- 33 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 33 The Board's contact details To fax, mail or email an appeal to the Board, or to find out further information, use the contact details below— Executive Officer Mental Health Review Board [insert appropriate contact details] Preparing for the Board Hearing The Board will send you a notice advising the date, time and place at which your review or appeal will be heard. Your psychiatrist and case coordinator will also be notified of the hearing. It is your right to attend the hearing unless the Board decides that this would be bad for your health. You are encouraged to attend and present your case. You can have someone attend to offer support or speak for you, for example, an advocate, a lawyer, a private doctor, a friend or a family member. If you are unable to attend the hearing, you should tell the Board as soon as possible. Before the hearing, read the documents which will be given to the Board for your hearing (see below) and think about what you are going to say to the Board. You may also want to give the Board written information. Your family and friends or someone you respect may wish to write letters or come to the hearing in support of your appeal or review. If you have special needs, such as an interpreter, you should discuss these with a member of the treating team or contact the Board. The Board will arrange an interpreter if necessary. Organisations that may be able to help you with your appeal or review are described at the end of this statement. Access to documents for the hearing You or your representative will be given the opportunity to read any documents to be given to the Board for your hearing, including your clinical file and your psychiatrist's report to the Board, at least 24 hours before the hearing. However, your psychiatrist may apply to the Board to prevent you from seeing a document or part of a document if it is believed that— • seeing the document will cause serious harm to your health or the health or safety of another person; or • the information in a document was given in confidence; or is personal information about another person. r. 6 -- 34 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 34 If an application is made to prevent you seeing a document or part of a document a member of the treating team will tell you and explain the process. The Board will make the final decision whether you see the whole document or part of the document or none of the document. If the Board decides you should not see a document or part of any document, it may allow your representative to see it instead. The Board Hearing Hearings will be held at the mental health service. Your hearing will usually be heard by 3 Board members—a lawyer, a psychiatrist and a community member. If the hearing is the annual review of you being a security patient, it may be conducted by one person—a lawyer, a psychiatrist or a community member of the Board. The hearing will be informal and private, unless the Board decides that it is in your best interests or the public interest for the hearing to be open. Your doctor and other members of the treating team will give information to the Board. You and your representative will be able to ask questions and explain your side of the case, for example, why you believe you should not be a security patient. If you are too ill to attend the hearing, the Board may visit you in your ward. The Board's Decision on Appeal or Review of Security Patient Status The Board must decide whether all the criteria for being a security patient still apply to you and whether your continued detention as a security patient is still necessary. Discharge from security patient status If the Board is satisfied that any of the criteria for being a security patient no longer apply to you and your continued detention as a security patient is not necessary, you will be discharged and returned to your original place of detention. If you are a hospital security order patient, you will be sent to prison to serve the rest of your sentence. If you are discharged, you can discuss continuing treatment on a voluntary basis with your case coordinator or psychiatrist. Continuation of security patient status If the Board doesn't discharge you, you will continue to receive treatment as a security patient. The Board will also review your treatment plan to decide whether the proper procedures have been followed in making the plan, for example, were your wishes taken into account and did the psychiatrist consider alternative treatments? The Board must be satisfied that the plan can be implemented by the mental health service. r. 6 -- 35 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 35 At the end of the hearing, the Board will advise you of its decision and the reasons for it. You will be given a written copy of the order. If you want written reasons for the decision, you must request these in writing from the Board within 28 days and the Board must provide you with a statement of reasons within 14 days of your request. You can appeal again to the Board at any time. Review of the Board's decision If you disagree with the Board's decision you can apply to the Victorian Civil and Administrative Tribunal (VCAT) for a review of the Board's decision. VCAT is an independent tribunal with the power to confirm or overturn the decision of the Board. Appeals must be made in writing within 28 days to— Victorian Civil and Administrative Tribunal [insert appropriate contact details] COMPLAINTS You should be treated with dignity and respect and be protected from abuse when you receive treatment and care from the mental health service. If you are unhappy about any part of your treatment or care, you can complain. A good place to start is with your case coordinator, primary nurse or another member of the treating team, the complaints liaison officer or consumer consultant in the hospital or the Director of Psychiatry at the mental health service. You can also complain directly to the Health Services Commissioner or the Chief Psychiatrist. If you need help with your complaint, you can ask someone you trust to assist you. This might be a member of the treating team, a friend, a family member, a lawyer or a community visitor. IMPORTANT CONTACTS The organisations you can contact for assistance and more information are described below. The service will provide you with their contact details. • The Mental Health Review Board is an independent tribunal that hears appeals from involuntary patients, hospital order patients and security patients who want to be discharged from their involuntary treatment status. It also automatically reviews these patients. • Community Visitors are people who visit mental health services at least once a month to inquire into the adequacy of services and facilities for the treatment and care of patients, investigate complaints and report on their inquiries and investigations. r. 6 -- 36 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 36 • The Mental Health Legal Centre is an independent legal service which specialises in mental health legal issues. It may be able to arrange representation for you at Mental Health Review Board hearings or about other legal matters. • Victoria Legal Aid provides free legal advice about a range of issues, legal assistance if you cannot afford a private solicitor and may be able to assist with legal representation at Mental Health Review Board hearings. • The Public Advocate assists, advises and advocates for people with serious complaints about mental health and disability services and treatment. • The Chief Psychiatrist is a senior departmental official appointed under the Mental Health Act, with special responsibilities in relation to people receiving mental health services. These include the power to investigate complaints and other matters and to take necessary action. • The Health Service Commissioner is an independent commissioner who investigates and helps to resolve complaints by health care consumers about health services, including mental health services. The Commissioner can help patients access their health information. • The Ombudsman investigates complaints about government departments. You can also ask your case coordinator or any member of the treating team about other local organisations and support groups which may be able to help you. __________________'. 7. Statement for continuing involuntary treatment In Schedule 10 to the Principal Regulations, for "Regulation 7(e)" substitute "Regulation 7(d)". r. 7 -- 37 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 37 8. Schedules 11 to 14 substituted For Schedules 11, 12, 13 and 14 to the Principal Regulations substitute— 'SCHEDULE 11 Regulation 7(e) STATEMENT OF LEGAL RIGHTS AND ENTITLEMENTS AND OTHER INFORMATION—FORENSIC PATIENT Mental Health Act 1986 Mental Health Regulations 1998 IN SUMMARY When you are a forensic patient you— • will have a treatment plan and can be involved in planning your treatment; • have a right to obtain a second opinion from a psychiatrist about your treatment; • have a right to obtain legal advice and have a lawyer represent you; • can talk to and have a friend or family member represent you; • can complain about your treatment. You can ask a member of the treating team, a friend, a family member, a lawyer, an advocate or a community visitor to help you do these things. ABOUT THIS STATEMENT This statement provides information about being a forensic patient and your legal rights and entitlements under the Mental Health Act 1986. The statement also provides information about rights and entitlements some forensic patients have under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 and the Commonwealth Crimes Act 1914. A member of the treating team will talk to you about this information and answer your questions. The information must be explained in a language or manner that you can understand. This statement is also translated into a number of languages. You can ask a member of the treating team if it is available in your preferred language. Copies of the Mental Health Act 1986 are available at the mental health service. r. 8 -- 38 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 38 If at any time you have questions about this information or your rights, ask someone to explain. You can ask a member of the treating team, a friend, a family member, a lawyer, an advocate or a community visitor. FORENSIC PATIENTS You have been admitted to a mental health service as a forensic patient so you can receive treatment for a mental disorder. There are several ways you may have been admitted as a forensic patient. A member of the treating team will tell you which of the following applies to you and tick the correct box— Most forensic patients are admitted on— † A custodial supervision order. A court has placed you on a custodial supervision order. The order is not for a fixed period of time, but will end when the court decides. Some forensic patients are admitted on— † A non-custodial supervision order. You have been admitted as a forensic patient because you failed to comply with your non-custodial supervision order and your safety or the safety of the public was at serious risk; or you left Victoria without permission and have been arrested and returned to the mental health service; or † A federal forensic patient order. A court has placed you on an order under the Commonwealth Crimes Act 1914 for the time specified in the order. TREATMENT Your psychiatrist will prepare a treatment plan that is designed to meet your specific needs. You can be involved in planning your treatment and the psychiatrist will consider your preferences and concerns. However, if your psychiatrist believes a particular psychiatric treatment is necessary, that treatment can be given to you, even if you refuse. If this happens, your psychiatrist will explain why the treatment is necessary. Your psychiatrist will discuss your treatment plan with you and give you a copy. Your psychiatrist and other members of the treating team will regularly discuss with you your diagnosis, medication, methods of treatment, alternative treatments and available services. They will review and update your treatment plan on a regular basis. You may have a friend or advocate with you when you are discussing your treatment with your psychiatrist. r. 8 -- 39 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 39 Family members and other caregivers can provide valuable support and care to you while you are receiving treatment for your illness. Generally, they will only be given information about your treatment and care if you agree. However, if a guardian, family member or your primary carer needs information to care for you, a member of the treating team can give them the information, even if you don't agree. Second Opinions It is your right to get a second opinion about your psychiatric condition and treatment. Your case coordinator or psychiatrist can arrange this from within the mental health service, or they can help you choose your own psychiatrist. If you choose a private psychiatrist you may have to pay a fee. You can discuss the second opinion with your treating psychiatrist. However, your treating psychiatrist is responsible for making the final decision about the treatment you receive. Access to Information It is your right under Freedom of Information (FOI) laws to request access to documents about your personal information that are held by the mental health service. If you wish to access the information, you can ask a member of the treating team or the mental health service's FOI officer to help you make an FOI application. Organisations that may be able to help you with an FOI application are described at the end of this statement. Seclusion and Restraint Seclusion Seclusion is when a person is kept alone in a room where the doors and windows are locked from the outside. This only happens if it is necessary to protect the person or others from an immediate or imminent risk to their health or safety or to prevent the person from absconding. It is only used when other ways of ensuring safety have failed. Mechanical Restraint Mechanical restraint is the use of a device, such as a harness or straps, to restrict a person's freedom to move about. Restraint may be used to enable a person to be medically treated, to prevent the person from injuring themselves or others or to prevent the person from continuing to destroy property. r. 8 -- 40 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 40 Approval and Monitoring of Seclusion and Mechanical Restraint Seclusion and restraint may be approved by your psychiatrist or, in an emergency, authorised by the senior nurse on duty. They can only be used for as long as the above reasons apply. If you are put in a seclusion room or are restrained, staff must give you appropriate bedding, clothing, food and drink when you want them. They must also provide you with adequate toilet arrangements, including the opportunity to wash. A nurse must review your physical and mental condition at least every 15 minutes. A doctor must also examine you at least every 4 hours, unless your psychiatrist thinks less frequent examinations are appropriate. If you are being restrained you must be monitored continuously. Security Conditions While you are in the mental health service, your psychiatrist may apply any security conditions that are considered necessary, for example limiting your phone calls or opening your mail. Security conditions are applied to ensure your health or safety, or for the protection of members of the public. Letters and telephone calls You can contact people by letter or telephone, unless your psychiatrist has applied a security condition to you. Transfer You may be transferred to a different mental health service if the chief psychiatrist believes that you would benefit from the transfer or if it is necessary for your treatment. If you do not want to be transferred, you should talk to your psychiatrist or you can appeal to the Forensic Leave Panel. If you are transferred before the appeal is heard, the Panel will decide whether you should be returned to the original service when it hears the appeal. Federal Forensic Patients If you are a federal forensic patient, you can be transferred to another hospital or prison if— • there are urgent medical or security reasons; or • the Commonwealth Attorney-General orders a transfer. Federal forensic patients cannot appeal against a transfer. r. 8 -- 41 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 41 Reports to Court If you are on a custodial supervision order or a non-custodial supervision order, a report about your treatment and progress must be sent to the court that made your supervision order at least every 12 months. Leave Leave allows forensic patients to leave the mental health service for a variety of purposes. Leave is always subject to security conditions and time limits. There are three main types of short-term leave available to forensic patients: special leave of absence, on-ground leave and limited off ground leave. Special leave of absence is for specific purposes, such as medical treatment, court appearances, or special events (like funerals). It cannot exceed 24 hours, or 7 days in the case of medical treatment. You or someone on your behalf can apply to your psychiatrist stating the special circumstances for which special leave is needed. If your psychiatrist is satisfied that there are special circumstances and that the safety of members of the public will not be seriously endangered, the special leave must be granted. If your psychiatrist refuses to grant you special leave, you can appeal to the Forensic Leave Panel. THE FORENSIC LEAVE PANEL The Forensic Leave Panel is an independent tribunal that hears— • applications for on-ground and limited off-ground leave from forensic patients; • appeals from forensic patients who have been refused special leave of absence by their psychiatrist; • appeals from forensic patients who do not want to be transferred to a different mental health service. On-ground leave and limited off-ground leave On-ground leave allows forensic patients to leave the mental health service, but the leave is limited to a defined area around the mental health service known as the surrounds. To obtain on-ground leave or limited off-ground leave, you must apply to the Forensic Leave Panel. Limited off-ground leave allows forensic patients to go beyond the surrounds of the mental health service. Generally, limited off-ground leave is only permitted during the day between the hours of 6.00 a.m. and 9.00 p.m. It can be granted outside these hours, but only for a maximum of 3 days in any 7-day period. Leave may be granted for a period of up to 6 months. At the end of this time, an application can be made to the Panel to have the leave renewed. r. 8 -- 42 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 42 The purpose of on-ground leave and limited off-ground leave is to help with the treatment and rehabilitation of forensic patients. If you would like on-ground leave or limited off-ground leave, you should talk to the treating team. They will be able to give you advice and discuss your choices. If your treating team believes you are ready for leave, they will update your treatment plan and prepare a leave plan. It is important that the treating team is involved because the Forensic Leave Panel will want to know whether they support your application and how it relates to your treatment plan and your leave plan. Applications to the Panel To apply for on-ground leave or limited off-ground leave, or to appeal against the refusal of special leave of absence, ask a member of your treating team for the appropriate form, fill it in and ask the team member to send it to the Panel. If no forms are available, you can write a letter to the Panel setting out your name, the name of the mental health service and the type of leave you want. The application or letter should be mailed or faxed to— Executive Officer Forensic Leave Panel [insert appropriate address and telephone and facsimile numbers] If you need help to fill in the form or with anything else, you should ask a member of the treating team, a friend, a family member, a lawyer or a community visitor to help you. Preparing for the Panel hearing The Panel will arrange for you to be given a notice advising the date, time and place at which your application will be heard. It is your right to attend the hearing and present your case, and you are encouraged to do so. You can have someone attend to offer support or speak for you, for example, an advocate, a lawyer, a friend or a family member. If you are unable to attend the hearing, you should tell the Panel as soon as possible. Before the hearing, read the documents that will be given to the Panel for the hearing (see below) and think about what you are going to say to the Panel. You may also want to give the Panel written information. Your family and friends or someone you respect may wish to write letters or come to the hearing in support of your application. If you have special needs, such as an interpreter, you should discuss these with a member of the treating team or contact the Panel. The Panel will arrange an interpreter if necessary. Organisations that may be able to help you with your application are described at the end of this statement. r. 8 -- 43 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 43 Access to documents for the hearing You or your representative will be given the opportunity to read any documents to be given to the Panel for your hearing at least 24 hours before the hearing. These will include your clinical file, your psychiatrist's report, a profile about you and your leave plan. However, an application can be made to the Panel to prevent you from seeing a document or part of a document if it is believed that— • seeing the document will cause serious harm to your health or the health or safety of another person; or • the information in a document was given in confidence; or is personal information about another person. If an application is made to prevent you seeing a document or part of a document a member of the treating team will tell you and explain the process. The Panel will make the final decision whether you see the whole document or part of the document or none of the document. If the Panel decides you should not see a document or part of any document, it may allow your representative to see it instead. The Panel Hearing Your hearing will be held at the mental health service. The Panel members are a judge, a community member, the chief psychiatrist and a medical practitioner. The hearing will be informal and private, unless the Panel decides that it is in your best interests or the public interest for the hearing to be open. The Panel is not bound by strict rules of practice like a court and can inform itself in any way it thinks fit. Your psychiatrist and other members of the treating team will give information to the Panel. You and your representative will be able to ask questions and explain your side of the case, for example, why you believe you should be given leave of absence. The Panel's Decision Approval of leave If the Panel is satisfied that the proposed leave will help your rehabilitation, and that your safety or the safety of members of the public will not be seriously endangered, it may grant your leave. It will place conditions on the leave, for example, that members of staff escort you at all times. You and your representative will be given a copy of the order, which will list the type of leave granted and the conditions of the leave. r. 8 -- 44 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 44 Leave can be granted for a period of up to 6 months. At the end of this time, you can apply to the Panel to have the leave renewed. You can also apply at any time to have the conditions of the leave varied if your circumstances have significantly changed, for example, if a new rehabilitation program has become available. Refusal of leave If the Panel refuses your application for leave, you should talk to your case coordinator or another member of the treating team and discuss the reasons. They may be able to help you make another application that is more likely be granted. While you remain a forensic patient, you can apply for leave to the Panel at any time. Your psychiatrist and other members of the treating team will also regularly review your progress to see whether to make a new application for leave. Special Leave If you have appealed to the Panel because you have been refused special leave by your psychiatrist, the Panel may grant the special leave if it believes that there are special circumstances and the safety of members of the public will not be seriously endangered. The Panel's decision At the end of the hearing, the Panel will advise you of its decision and the reasons for it. You will be given a written copy of the order. If you want written reasons for the Panel's decision, you must request them in writing from the Panel. The Panel must provide you with a statement of reasons within 14 days of your request. Suspension of Leave If, at any time, the chief psychiatrist believes your safety or the safety of members of the public will be seriously endangered, your leave, or part of your leave may be suspended. You will be told if your leave is suspended. If you are not already in the mental health service, you must return there. You will be given written notification of the suspension from the chief psychiatrist. If you do not return, police or other prescribed people can apprehend you at any time. LEAVING THE SERVICE TO LIVE IN THE COMMUNITY This section of the statement has information about your rights and entitlements under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 in relation to leaving the service to live in the community. The way in which you will be released from the mental health service depends on how you were admitted to the service. r. 8 -- 45 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 45 Non-custodial Supervision Orders If you were admitted because you did not comply with your non-custodial supervision order, you must be released within 48 hours unless an application is made to the court to vary the order. If an application is made, the court must have a hearing as soon as possible. It is your right to attend the court hearing and to have a lawyer represent you. Your psychiatrist and other members of the treating team will give evidence at the court hearing—for example, how you failed to comply with your non-custodial supervision order. You and your representative will also be able to give evidence and explain your side of the case. The court will make its decision and will— • release you from the mental health service back onto your non-custodial supervision order—it might also change the conditions of the order; or • place you on a custodial supervision order. If the court places you on a custodial supervision order, you must remain in the mental health service as a forensic patient. Custodial Supervision Orders Extended leave Extended leave allows forensic patients on custodial supervision orders to leave the mental health service and live in the community for a period of up to 12 months. If you have successfully used on-ground leave and limited off-ground leave over time, you may be ready to apply for extended leave. If you want extended leave, you must make an application to the court that made your custodial supervision order. You will need a lawyer to help you make the application because the procedures are complex and you will need a legal representative at the court. Organisations that may be able to help with your application are described at the end of this statement. You should also talk to your treating team. They will be able to give you advice and discuss your choices. Your psychiatrist will prepare a leave plan for the court. You can be involved in planning the extended leave and your preferences will be taken into consideration. The plan will include an assessment about your need for continuing treatment and support in the community and the best way these can be met. It will also state whether the treating team supports your application or not. r. 8 -- 46 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 46 Your psychiatrist will send a clinical report and the leave plan to the court. Copies will be given to you or your representative. It is your right to attend the court hearing and to have a lawyer represent you. Your psychiatrist and other members of the treating team will give evidence at the court hearing. You and your representative will also be able to give evidence. The court may grant your application if it is satisfied that granting you leave will not seriously endanger your safety or the safety of members of the public. Extended leave may be given for a period of up to 12 months. At the end of this time, you can apply to the court to renew your extended leave. The application for renewal should be made well before your extended leave expires. The court will apply conditions to the leave—for example, the place you will live and where and how often you should receive treatment. If the court refuses your application, it is your right to appeal against the court's decision to the Court of Appeal. If, at any time, the chief psychiatrist believes your safety or the safety of members of the public will be seriously endangered, your extended leave may be suspended. The chief psychiatrist will notify you in writing about the suspension and you must return to the mental health service. If you do not return, police or other prescribed people can apprehend you at any time. If the suspension is not lifted within 48 hours, the chief psychiatrist will make an application to the court to revoke your extended leave. The court must have a hearing as soon as possible. It is your right to attend the court hearing and to have a lawyer represent you. Your psychiatrist and other members of the treating team will give evidence at the court hearing. You and your representative will also be able to give evidence and explain your side of the case. The court will make its decision and will— • lift the suspension. You will then be released to live in the community again on extended leave—the court might also change the conditions of the leave; or • revoke your extended leave. You must then remain in the mental health service as a forensic patient. Variation of supervision order If you have completed at least 12 months of extended leave, you can apply to the court that made your supervision order to have it varied to a non-custodial supervision order. The court may make a non-custodial supervision order if it is satisfied your safety and the safety of members of the public will not be seriously endangered. r. 8 -- 47 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 47 The court will take into account whether you have complied with the conditions of the extended leave. If the court releases you on a non-custodial supervision order, you will be able to live in the community, subject to conditions decided by the court. If the court refuses your application, you cannot apply again for at least 3 years, unless the court sets a shorter period. You have the right to appeal against the court's decision to the Court of Appeal. Your psychiatrist, the Secretary to the Department of Human Services, the Director of Public Prosecutions or the Victorian Attorney-General can also apply to have your order varied. Major Review When the court made your custodial supervision order, it set a time called the nominal term. At least 3 months before the end of the nominal term the court must conduct a major review of your progress. The major review will only occur if you are still subject to a supervision order at the end of the nominal term. If the court has released you from supervision before the end of the nominal term, there is no need for a major review. The purpose of the major review will be to decide whether you can be released from the custodial order on to a non-custodial supervision order. The court must change your order to a non-custodial supervision order unless it is satisfied your safety or the safety of members of the public will be seriously endangered. If the court releases you on a non-custodial supervision order, you will be able to live in the community, subject to conditions decided by the court. If the court does not release you on a non-custodial supervision order, you have the right to appeal to the Court of Appeal. The court will automatically review you at least every 5 years after your major review, while you remain on a supervision order. Federal Forensic Patient Discharge from the order If you are a federal forensic patient, you will be discharged from the court order at the end of the time specified in the order and you will no longer be a forensic patient. You can then discuss continuing treatment with your psychiatrist or case coordinator. Release order While you remain a federal forensic patient, the Commonwealth Attorney- General will review you at least once every six months to see whether you can be released from the mental health service on a "Release Order". r. 8 -- 48 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 48 Release orders allow federal forensic patients to live in the community, subject to any conditions imposed by the Commonwealth Attorney-General. In deciding whether to make a release order, the Attorney-General must be satisfied that you are not a threat or danger to yourself or to the community. The Attorney-General will obtain reports about you from a psychiatrist or psychologist, a doctor and from anyone else the Attorney-General chooses. You, or someone on your behalf, can also send information to the Attorney- General—for example, to explain why you should be allowed to live in the community on a release order. You can ask a member of the treating team, a friend or family member, a lawyer or a community visitor to help you do this. If the Attorney-General makes a release order for you, it will last for the rest of the time specified in your court order, or for five years, whichever is shorter. Your release order will also have conditions such as where you must live and what treatment you must receive. The Attorney-General may revoke your release order if you do not comply with the conditions of the Order. If this happens, you will be arrested and either taken to a hospital or a prison. COMPLAINTS You should be treated with dignity and respect and be protected from abuse when you receive treatment and care from the mental health service. If you are unhappy about any part of your treatment or care, you can complain. A good place to start is with your case coordinator, primary nurse or another member of the treating team, the complaints liaison officer or consumer consultant in the hospital or the Clinical Director of the mental health service. You can also complain directly to the Health Services Commissioner or the Chief Psychiatrist. If you need help with your complaint, you can ask someone you trust to assist you. This might be a member of the treating team, a friend, a family member, a lawyer or a community visitor. IMPORTANT CONTACTS The organisations you can contact for assistance and more information are described below. The service will provide you with their contact details. • Forensic Leave Panel is an independent Panel. Its main function is to hear applications for leave of absence by forensic patients. • Community Visitors are people who visit mental health services at least once a month to inquire into the adequacy of services and facilities for the treatment and care of patients, investigate complaints and report on their inquiries and investigations. r. 8 -- 49 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 49 • The Mental Health Legal Centre is an independent legal service which specialises in mental health legal issues. It may be able to arrange representation for you at Mental Health Review Board hearings or about other legal matters. • Victoria Legal Aid provides free legal advice about a range of issues, legal assistance if you cannot afford a private solicitor and may be able to assist with legal representation at Mental Health Review Board hearings. • The Public Advocate assists, advises and advocates for people with serious complaints about mental health and disability services and treatment. • The Chief Psychiatrist is a senior departmental official appointed under the Mental Health Act, with special responsibilities in relation to people receiving mental health services. These include the power to investigate complaints and other matters and to take necessary action. • The Health Service Commissioner is an independent commissioner who investigates and helps to resolve complaints by health care consumers about health services, including mental health services. The Commissioner can help patients access their health information. • The Ombudsman investigates complaints about government departments. You can also ask your case manager or any member of staff about other local organisations and support groups which may be able to help you. __________________ r. 8 -- 50 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 50 SCHEDULE 14 Regulation 8(a) STATEMENT OF LEGAL RIGHTS AND ENTITLEMENTS AND OTHER INFORMATION—ELECTROCONVULSIVE THERAPY Mental Health Act 1986 Mental Health Regulations 1998 ABOUT THIS STATEMENT This statement has been given to you because your doctor or psychiatrist has recommended that you would benefit from a course of Electroconvulsive Therapy (ECT). It provides information about the treatment and your legal rights and entitlements under the Mental Health Act 1986. Your psychiatrist or a member of the treating team will talk to you about this information and your rights and entitlements and answer your questions. This information must be explained in a language or manner that you can understand. This statement is also translated into a number of languages. You can ask a member of your treating team if it is available in your preferred language. If at any time you have questions about this information or your rights, ask someone to explain. You can ask a member of the treating team, a friend, a family member, a lawyer, an advocate or a community visitor. ECT: YOUR RIGHTS AND ENTITLEMENTS Your psychiatrist will talk to you about ECT and explain how it works and how it can help your illness. The psychiatrist will discuss possible side- effects, alternative treatments, ask your views and answer any questions you might have. When you are discussing ECT with your psychiatrist, you can have a friend, a family member, a lawyer or an advocate with you for support. It is your right for that person to represent you before you consent to ECT. Advice and second opinions It is your right to get legal and medical advice. It is also your right to get a second opinion about whether you need ECT. Your case manager or psychiatrist can arrange this from within the mental health service or they can help you choose your own psychiatrist. If you choose a private psychiatrist you may have to pay a fee. r. 8 -- 51 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 51 Consenting to ECT If you are able to give informed consent, you can only be given ECT if you agree. This means that if you are able to give informed consent, you have the right to refuse ECT. Informed Consent Informed consent is when you agree to have ECT after you have been told— • what ECT involves; • the benefits, discomforts and risks of ECT; • any beneficial alternative treatments; • the answers to any questions you have about ECT and you have understood the answers; • whether the person recommending ECT or the doctor who will perform the ECT has any financial relationship with the service, hospital or clinic where the ECT will be given; • your legal rights and other entitlements. Before you decide whether you want to have ECT, it is important that you are well informed. If you have any questions, you should ask your psychiatrist or seek advice from a friend, family member, lawyer or an advocate, or one of the organisations described at the end of this statement. If you agree to have ECT, you will be asked to sign a form to say you have given informed consent. Your psychiatrist will discuss with you how many treatments are recommended. You may consent to have up to 6 treatments. If your doctor believes you need more than the initial 6 treatments you will be asked to consent to each further course of up to 6 treatments. Withdrawing consent to ECT If you agree to have ECT, but then change your mind, it is your right to withdraw your consent at any time and the treatments will be stopped, unless your psychiatrist believes that you are not able to give informed consent. If you want to withdraw your consent, you should talk to your psychiatrist. Remember that you can have a friend, a family member, a lawyer or an advocate with you for support or to represent you. r. 8 -- 52 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 52 Treatment if you are not able to give informed consent If you are not able to give informed consent to ECT, your psychiatrist can consent for you if the psychiatrist is satisfied that— • the ECT is necessary; and • your physical or mental condition is likely to get worse unless you have ECT; and • the benefits and risks of ECT, and any other beneficial treatments, have been considered. Your psychiatrist will talk to you about the ECT before you receive the treatment. Reasonable efforts will be made to notify your primary carer (a family member or friend who is primarily responsible for providing support or care to you) or your guardian (if you have one) about the proposed ECT. Urgent Treatment If ECT is urgently needed because of the nature of your mental illness, it can be given to you without your consent. If this happens, your psychiatrist will explain to you why the treatment is urgent. COMPLAINTS You should be treated with dignity and respect and be protected from abuse when you are receiving ECT. If you are unhappy about any part of your treatment or care, you can complain. A good place to start is with your case manager, primary nurse or another member of the treating team, the complaints liaison officer or patient representative in the hospital or the Director of Psychiatry at the mental health service. You can also complain directly to the Health Services Commissioner or the Chief Psychiatrist. If you need help with your complaint, you can ask someone you trust to assist you. This might be a member of the treating team, a friend, a family member, a lawyer or a community visitor. IMPORTANT CONTACTS The organisations you can contact for assistance and more information are described below. The service will provide you with their contact details. • Community Visitors are people who visit mental health services at least once a month to inquire into the adequacy of services and facilities for the treatment and care of patients, investigate complaints and report on their inquiries and investigations. r. 8 -- 53 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 53 • The Mental Health Legal Centre is an independent legal service which specialises in mental health legal issues. It may be able to arrange representation for you at Mental Health Review Board hearings or about other legal matters. • Victoria Legal Aid provides free legal advice about a range of issues, legal assistance if you cannot afford a private solicitor and may be able to assist with legal representation at Mental Health Review Board hearings. • The Public Advocate assists, advises and advocates for people with serious complaints about mental health and disability services and treatment. • The Chief Psychiatrist is a senior departmental official appointed under the Mental Health Act, with special responsibilities in relation to people receiving mental health services. These include the power to investigate complaints and other matters and to take necessary action. • The Health Service Commissioner is an independent commissioner who investigates and helps to resolve complaints by health care consumers about health services, including mental health services. The Commissioner can help patients access their health information. • The Ombudsman investigates complaints about government departments. • The Mental Health Review Board is an independent tribunal that hears appeals from involuntary patients, hospital order patients and security patients who want to be discharged from their involuntary treatment status. It also automatically reviews these patients. You can also ask your case manager or any member of staff about other local organisations and support groups which may be able to help you. __________________'. r. 8 -- 54 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 54 9. New Schedule 16 substituted For Schedule 16 to the Principal Regulations substitute— 'SCHEDULE 16 Regulation 8(c) STATEMENT OF LEGAL RIGHTS AND ENTITLEMENTS AND OTHER INFORMATION—MAJOR NON-PSYCHIATRIC TREATMENT Mental Health Act 1986 Mental Health Regulations 1998 ABOUT THIS STATEMENT This statement has been given to you because your doctor or psychiatrist has recommended that you would benefit from a particular major non-psychiatric treatment. It provides information about your legal rights and entitlements under the Mental Health Act 1986. Your psychiatrist or a member of the treating team will talk to you about this information and your rights and answer your questions. This information must be explained in a language or manner that you can understand. This statement is also translated into a number of languages. You can ask a member of your treating team if it is available in your preferred language. If at any time you have questions about major non-psychiatric treatment or your rights, ask someone to explain. You can ask a member of the treating team, a friend, a family member, a lawyer, an advocate or a community visitor. MAJOR NON-PSYCHIATRIC TREATMENT The treatment your doctor has recommended is described as a major non- psychiatric treatment. It is primarily intended to treat a physical condition and not your mental illness. The treatments in the following list are major non-psychiatric treatments— • any surgery performed under a general or regional anaesthetic; • the use of general or regional block anaesthetic for any purpose; • chemotherapy; • radiotherapy. r. 9 -- 55 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 55 However, major non-psychiatric treatment does not include "special procedures". These treatments are— • any procedure that is intended to make a person permanently infertile (sterilisation); • any procedure carried out for the purposes of medical research; • termination of pregnancy (abortion); • removal of tissue for transplantation to another person. If a doctor recommends you have a "special procedure", you should seek advice from the Public Advocate or one of the other organisations described at the end of this statement. Treatment Your psychiatrist or doctor will talk to you about your medical condition, explain the proposed treatment, discuss possible side-effects, alternative treatments, ask your views and answer any questions you might have about the treatment. Advocacy When you are discussing the major non-psychiatric treatment with your psychiatrist or doctor, you can have a friend, relative, lawyer or an advocate with you for support. It is your right for that person to represent you before you consent to the treatment. Advice and Second Opinions It is your right to get legal and medical advice. It is also your right to get a second opinion about whether you need the major non-psychiatric treatment. Your case manager or psychiatrist can arrange this or you can choose your own doctor. If you choose a private doctor you may have to pay a fee. Consenting to Treatment If you are able to give informed consent, you can only be given the major non-psychiatric treatment if you agree. This means that if you are able to give informed consent, you have the right to refuse the treatment. Informed Consent Informed consent is when you agree to have the treatment after you have been told— • what the treatment involves; • the benefits, discomforts and risks of the treatment; • any beneficial alternative treatments; r. 9 -- 56 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 56 • the answers to any questions you have about the treatment and you have understood the answers; • whether the person recommending the treatment or the doctor who will perform the treatment has any financial relationship with the service, hospital or clinic where the treatment will be given or performed; • your legal rights and other entitlements. Before you decide whether you want to have the treatment, it is important that you are well informed. If you have any questions, you should ask your psychiatrist, doctor or other specialist or seek advice from a friend, family member, lawyer or an advocate, or one of the organisations described at the end of this statement. If you agree to have the major non-psychiatric treatment, you will be asked to sign a form to say that you have given informed consent. Withdrawing Consent If you agree to have a major non-psychiatric treatment, but then change your mind, it is your right to withdraw your consent at any time and the treatment will not proceed. If you want to withdraw your consent, you should talk to your treating doctor. Treatment if you are not able to give informed consent If you are not able to give informed consent and a major non-psychiatric treatment is necessary, you may be given the treatment, even if you refuse. If you are 18 years or older, consent may be given by the first person listed below who is available, willing and able to make a decision about the proposed treatment (if there is no one in the first category, go to the second and so on)— • a medical enduring power of attorney (if you have appointed one); • a person appointed by the Victorian Civil and Administrative Tribunal to make decisions about the proposed treatment (if someone has been appointed); • a guardian (if you have one); • an enduring guardian (if you have appointed one); • the authorised psychiatrist. r. 9 -- 57 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 57 If you are under the age of 18 years and you are not able to give informed consent, consent may be given by any of the persons listed below who is available, willing and able to make a decision about the proposed treatment— • a parent; • a guardian; • a child protection manager appointed under section 271 of the Children and Young Persons Act 1989; • the authorised psychiatrist—but only if there is no parent, guardian, custodian or child protection manager who is available, willing and able to make the decision. Urgent Treatment If any major non-psychiatric treatment is needed to save your life, to prevent serious damage to your health or to prevent you from suffering or continuing to suffer significant pain or distress, it can be given to you without your consent. COMPLAINTS You should be treated with dignity and respect and be protected from abuse when you receive treatment and care for your medical condition. If you are unhappy about any part of your treatment or care, you can complain. A good place to start is with your case manager, primary nurse or another member of the treating team, the complaints liaison officer or patient representative in the hospital, your doctor or psychiatrist or the Director of Psychiatry at the mental health service. You can also complain directly to the Health Services Commissioner or the Chief Psychiatrist. If you need help with your complaint, you can ask someone you trust to assist you. This might be a member of the treating team, a friend, a family member, a lawyer or a community visitor. IMPORTANT CONTACTS The organisations you can contact for assistance and more information are described below. The service will provide you with their contact details. • Community Visitors are people who visit mental health services at least once a month to inquire into the adequacy of services and facilities for the treatment and care of patients, investigate complaints and report on their inquiries and investigations. r. 9 -- 58 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 58 • The Mental Health Legal Centre is an independent legal service which specialises in mental health legal issues. It may be able to arrange representation for you at Mental Health Review Board hearings or about other legal matters. • Victoria Legal Aid provides free legal advice about a range of issues, legal assistance if you cannot afford a private solicitor and may be able to assist with legal representation at Mental Health Review Board hearings. • The Public Advocate assists, advises and advocates for people with serious complaints about mental health and disability services and treatment. • The Chief Psychiatrist is a senior departmental official appointed under the Mental Health Act, with special responsibilities in relation to people receiving mental health services. These include the power to investigate complaints and other matters and to take necessary action. • The Health Service Commissioner is an independent commissioner who investigates and helps to resolve complaints by health care consumers about health services, including mental health services. The Commissioner can help patients access their health information. • The Ombudsman investigates complaints about government departments. • The Mental Health Review Board is an independent tribunal that hears appeals from involuntary patients, hospital order patients and security patients who want to be discharged from their involuntary treatment status. It also automatically reviews these patients. You can also ask your case manager or any member of staff about other local organisations and support groups which may be able to help you. __________________'. ═══════════════ r. 9 -- 59 of 60 -- Victorian Legislation and Parliamentary Documents S.R. No. 157/2004 Mental Health (Statements) Regulations 2004 59 ENDNOTES 1 Reg. 3: S.R. No. 120/1998 as amended by S.R. Nos 45/2001, 111/2003 and 149/2004. Endnotes -- 60 of 60 --