Community Mental Health Workers

Information for Community Mental Health Workers

In the following document a person who is receiving involuntary treatment for mental illness is referred to as ‘patient’. In some sectors people receiving services are also referred to as consumer or client. The Mental Health Review Tribunal uses the term ‘patient’ in keeping with the language in the Mental Health Act 2000.

What is the Mental Health Review Tribunal?

The Mental Health Review Tribunal (MHRT) is an independent statutory authority established under the Mental Health Act 2000 as a key statutory safeguard for the rights of individuals subject to involuntary treatment under the Act.

One of the guiding principles of the Mental Health Act 2000 is the right of the patient to have their voice heard. In earlier times one particular concern was that the patient’s voice was often not heard over the opinions of family members and others.

What does independence mean?

The Tribunal is independent of the Minister for Health and Queensland Health, including being independent of the hospital or health service where the person is receiving involuntary treatment. It is also unconnected with the Director of Mental Health, or the Mental Health Court or any other Tribunals that may be making decisions about the person.

What does the Tribunal do?

The Tribunal conducts review hearings and makes decisions regarding:
• Involuntary Treatment Orders
• Forensic Orders
• Fitness for Trial
• Electroconvulsive Therapy
• Limited Community Treatment
• Confidentiality Orders
• Examination Orders
• Attendance Notices
• Considers requests to observe hearings
• Forensic Patient Information Orders

These decisions are reached with regard to the legislative requirements and having heard information and submissions from each of the parties to the review and expert opinion from witnesses.

How does the Tribunal work?

The general principles for administration of the Act apply to the Tribunal in addition to some specific principles:

• Natural justice
• Informality
• Least restriction on rights and liberty
• Respect for privacy and confidentiality
• Refer to ‘A guide to the rights of patients attending a Tribunal hearing’.

What does natural justice mean in practice?

• A person must be given notice of a hearing
• Where the patient is present, he or she must be made aware of the contents of any written material to be considered by the Tribunal. A patient must be informed of the documentation upon which the Tribunal intends to rely in making their decision.
• A person must have an opportunity to present his or her case
• The hearing must be impartial (no prejudgement; unbiased decision makers)
• The Tribunal may only take into account those matters that are relevant and are required (under the Act) to be considered in respect of the decision at hand. The consideration of irrelevant matters or matters outside the Tribunal’s jurisdiction is a breach of the natural justice principles.

What does informality mean in practice?

Tribunal members are encouraged to dress less formally for a hearing, use round table seating configurations where possible, warm friendly greeting styles, first name address style (with agreement from the patient) and plain language communication. Informality is also promoted through less emphasis on a formal order of proceedings.

Who can attend the hearing?

• The patient
• Their allied person (if they have one). The allied person’s role is to help the patient represent his or her view, wishes and interests (Refer to ‘A guide to Allied Persons and the Tribunal’)
• The patient’s lawyer or an agent
• A Representative of the Attorney-General (for Forensic Order review or Fitness for Trial review)
• Members of the treating team – psychiatrist, case manager, and other members of the treating team eg Indigenous Mental Health Worker. The treating team attends as a witness to give their report and respond to questions about the treatment criteria and treatment issues
• If the patient wants another person to be with them at the hearing (eg a relative who is not the allied person or a support worker), that person can attend at the discretion of the Tribunal panel on the day
• A person can assist the patient to represent their views, wishes and interests at the discretion of the Tribunal panel on the day
• The Tribunal can request other people to attend to assist the Tribunal.

What are the Treatment Criteria that the Tribunal will consider for a person on an Involuntary Treatment Order?

• Whether the person has a mental illness that requires immediate treatment
• Whether the treatment is readily available at an Authorised Mental Health Service
• Whether there is a risk that because of the person’s mental illness the person may cause harm to him or herself or to someone else; or suffer serious mental or physical deterioration;
• That there is no less restrictive way for the person to receive treatment;
• Whether the person lacks capacity to consent to treatment or is unreasonably refusing treatment;
• Refer to A Guide to Involuntary Treatment Order Reviews

For a person on a Forensic Order the Tribunal will also consider:

• Each offence leading to the patient becoming a forensic patient
• Whether the person would represent an unacceptable risk to their own safety or the safety of others if taken off the forensic order
• Whether limited community treatment (LCT) is appropriate so the person can undertake some or all of their treatment or rehabilitation in the community
• Refer to A Guide to Forensic Patient Information Orders

For an Electroconvulsive Therapy (ECT) application the Tribunal must consider and decide:

• That the person does not have the capacity to give informed consent to the ECT
• That ECT is the most appropriate treatment in the circumstances
• Refer to A Guide to Electroconvulsive Therapy Applications

NOTE: The Tribunal does not review treatment. Any issues raised in the hearing regarding treatment must be referred back to the treating team. The patient may obtain a second opinion from another clinician if they wish.

What happens at a hearing?

• There may be some discussion outside the hearing room to establish who will be attending the hearing
• Everybody is brought into the hearing room together
• Everyone is introduced, and their reason for being there is explained
• The reason for the hearing is explained and the process that will occur is explained
• The Tribunal will check whether the patient has seen the clinical report and has understood what is written
• If not, there should be a short adjournment to enable the report to be explained to the patient
• The Tribunal panel ask questions of the patient and the treating team
• The allied person may speak on behalf of the patient, or in addition to the patient to help the patient represent his or her views, wishes and interests
• In circumstances where the Tribunal gives a support worker permission to attend the hearing the worker may also help the patient represent his or her views, wishes and interests or may be asked questions by the Tribunal panel
• When everyone has made their comments, the panel will ask the participants to leave the room.
• They will then ask the participants to come back into the room and give their decision. They will usually give some explanation of the decision
• A written decision is sent by mail within a few days of the hearing

What information does the Tribunal require?

• How the patient feels about being on the involuntary treatment order and their treatment
• Comments on the doctor’s report
• Supports in the patient’s life
• How the patient’s life is going and strategies to deal with stress
• Where the patient is living and if this accommodation is suitable
• How the patient occupies his or her time
• What progress the patient feels they’ve made

What is the role of the Support Worker in supporting a patient through the hearing process?

At the patient’s request a paid support worker can be invited to attend the hearing. However permission to attend is at the discretion of the Tribunal panel on the day.

The support worker can assist the patient throughout the hearing process in a variety of ways including:

• Encouraging the patient to attend the hearing as the hearing is about them and their life and it is important for the person to tell the Tribunal what is happening in their life so the Tribunal has all the relevant information to make their decision.
• Assisting the patient to prepare for their hearing by watching the Tribunal’s DVD, assisting them to decide what they would like to say, helping them to fill out the Self Report Form.
• Providing relevant information to the treating team regarding information on the patient’s life such as supports, living situation, use of time etc, which may be included in the clinical report and thus provide a current comprehensive view of the patient’s life.
• Discussing with the patient what support they would like on the day
– transport support to get to the hearing but not go into the hearing room
– support to tell the Tribunal how things are going
– as a familiar face in the hearing room i.e. just sitting beside them
• Assisting the patient in sourcing an appropriate advocate or act as an advocate, however, it should be clear to the patient and the Tribunal what role you are playing.
• Assisting the patient to represent their views, wishes and interests at the discretion of the Tribunal panel on the day
• When invited into the hearing room by the Presiding member the patient should clearly state that they would like the support worker to attend the hearing.
• If it is difficult for the patient to convey this message on the day they can write a letter to give to the Presiding member and request their support worker be permitted to attend the hearing. It is useful to outline in this letter the reasons the patient would like their worker to attend and the role the worker will be taking. The Tribunal considers this request when deciding who to allow into a hearing. The Tribunal may decide to not allow a support worker to attend if they believe that this would not be in the patient’s best interest or believe that the patient is not comfortable in having the support worker attend. During a hearing confidential information is discussed and therefore the Tribunal needs to be confident that the patient is at ease with the support worker being privy to this information.
• Any person in attendance at a hearing can be asked questions by the Tribunal. It is important to discuss this issue with the patient prior to the hearing so that both the patient and worker are prepared should this situation arise.
• After the hearing the worker can discuss the decision with the patient. If the patient did not get the desired result plans can then be put in place to act on the Tribunal’s decision and work on what the patient would like to achieve in the future.

If you require more information please contact the Tribunal on

Phone: (07) 3235 9059
Freecall: 1800 006 478
Facsimile: (07) 3234 1540
Website: www.mhrt.qld.gov.au
Email: enquiry@mhrt.qld.gov.au

You can also download a printable PDF of this document for reference here.