Mental Health Act forms
These forms can be used by clinicians and members of the public for mental health orders and information included in the Mental Health Act 2015 (the Act).
You can also refer to definitions of terms used in the Act.
| Chapter | Section | Section name | Name of form | Form no. |
|---|---|---|---|---|
| 3 | 19 | Nominated person | Nominated Person - Appointment [PDF 24kB] | 15156 |
| 3 | 26 | Entering into Advance Agreement | Advance Agreement [PDF 52kB] | 15299 |
| 3 | 27 | Making Advance Consent Direction | Advance consent direction [PDF 36kB] | 15303 |
| 3 | 30 | Effect of advance agreement and advance consent direction on guardian with authority to give consent for treatment, care or support | Consent to Mental Health Treatment, Care or Support by the Guardian [PDF 119kB] | 15211 |
| 4 | 33 | Applications by people with mental disorder or mental illness-assessment order | ACAT Assessment Order Application Form [DOCX 49kB] | AF2016-30 |
| 4 | 34 | Applications by other people-assessment order | ACAT Assessment Order Application Form [DOCX 49kB] | AF2016-30 |
| 4 | 35 | Applications by referring officers-assessment order | ACAT Assessment Order Application Form [DOCX 49kB] | AF2016-30 |
| 5 | 51 | Application for mental health orders | Application form for psychiatric treatment order, community care order or restriction Order [DOCX 60kB] | AF2016-28 |
| 5 | 62 | Role of chief psychiatrist-PTO | PTO treatment plan and location determination [PDF 56kB] | 10348 |
| 5 | 64 | Action if psychiatric treatment order no longer appropriate-no longer person in relation to whom ACAT could make order | Notice of revocation for PTO or RO [PDF 27kB] | 15161 |
| 5 | 64(1)(b)(i) | Action if Psychiatric Treatment Order no longer appropriate: | Written notice to the carer and/or nominated person [PDF 27kB] | 15140 |
5 | 64(1)(b)(i) | Action if a Restriction Order in conjunction with a Psychiatric Treatment Order is no longer appropriate | Written notice to the carer and/or nominated person [PDF 27kB] | 151405 |
| 5 | 65 | Powers in relation to a PTO | Seclusion [PDF 20kB] | 50010 |
| 5 | 65 | Powers in relation to a PTO | Seclusion and confinement observations [PDF 87kB] | 604215 |
| 5 | 70(2) | Role of community care coordinator | Community forensic community care order-care plan-care coordinator's determination [PDF 23kB] | 65463 |
| 5 | 70(3) | Role of community care coordinator | Application for leave from a facility [PDF 18kB] | 15179 |
| 5 | 72(1)(b)(i) | Action if Community Care Order no longer appropriate | Written notice to the carer and/or Nominated person [PDF 27kB] | 15140 |
| 5 | 72(1)(b)(i) | Action if a Restriction Order in conjunction with a Community Care Order is no longer appropriate | Written notice to the carer and/or Nominated person [PDF 27kB] | 15140 |
| 5 | 72(4) | Action if CCO no longer appropriate | Application for revocation [PDF 42kB] | 15162 |
| 5 | 72(4) | Action if CCO no longer appropriate | Notice of intent to revoke FTPO, CCO or FCCO [PDF 27kB] | 15160 |
| 5 | 73(5) | Powers in relation to CCO | Seclusion [PDF 20kB] | 50010 |
| 5 | 73(5) | Powers in relation to CCO | Seclusion or confinement observations [PDF 87kB] | 60421 |
| 5 | 73(5) | Powers in relation to CCO | Mechanical physical restraint or forcible giving of medicine form [PDF 21kB] | 35249 |
| 5 | 77(2)b | Contravention of mental health order | Contravention of mental health order - written warning [PDF 71kB] | 15172 |
| 5 | 77(2)c | Contravention of mental health order | Notification of contravention and authorisation to require a person to be detained [PDF 22kB] | 15165 |
| 5 | 78(4) | Contravention of mental health order-absconding from facility | Unauthorised leave from an inpatient facility-risk assessment [PDF 1.13MB] | 35257 |
| 5 | 78(4) | Contravention of mental health order-absconding from facility | Notification of return from unauthorised leave [PDF 25kB] | 10256 |
| 6 | 83 | Statement of action taken | Statement of action taken - apprehension by an authorised ambulance or police officer [PDF 193kB] | 20264 |
| 6 | 83 | Statement of action taken | Statement of action taken - apprehension by a doctor or mental health officer [PDF 193kB] | 20263 |
| 6 | 84 | Initial examination at approved mental health facility | Failure to conduct initial examination [PDF 42kB] | 15155 |
| 6 | 85 | Authorisation of involuntary detention | Authorisation or notification of involuntary detention [PDF 144kB] | 20250 |
| 6 | 85(2) | Authorisation of involuntary detention | Application for a Further Period of Involuntary Detention [DOC 46kB] - not exceeding 11 days | 15151 |
| 6 | 88 | Treatment during detention | Seclusion [PDF 20kB] | 50010 |
| 6 | 88 | Treatment during detention | Seclusion or confinement observations [PDF 87kB] | 60421 |
| 6 | 88 | Treatment during detention | Mechanical physical restraint or forcible giving of medicine form [PDF 21kB] | 35249 |
| 6 | 91 | Order for release | Release from Involuntary Detention [PDF 25kB] | 15166 |
| 7 | 94 | Applications for forensic mental health orders - detainees | ACAT Application for a Forensic Mental Health Order [DOC 46kB] | AF2016-32 |
| 7 | 103 | Role of chief psychiatrist-forensic psychiatric treatment order | FPTO Treatment Plan and Location Determination [PDF 56kB] | 65464 |
| 7 | 103(2)a | Role of chief psychiatrist-forensic psychiatric treatment order | Leave whilst in detention-Forensic Mental Health orders [PDF 23kB] | 15177 |
| 7 | 105(4) | Action if forensic psychiatric treatment order no longer appropriate-no longer person to whom ACAT can make order | Application for Revocation [PDF 42kB] | 15162 |
| 7 | 105(1)(b) | Action if Forensic Psychiatric Treatment Order no longer appropriate | Written notice to the carer and/or Nominated person [PDF 27kB] | 15140 |
| 7 | 106(4) | Action if Forensic Psychiatric Treatment Order no longer appropriate to detain person | Written notice to the carer and/or Nominated person [PDF 27kB] | 15140 |
| 7 | 107 | Powers in relation to a FPTO | Seclusion [PDF 20kB] | 50010 |
| 7 | 107 | Powers in relation to a FPTO | Seclusion/confinement observations [PDF 87kB] | 60421 |
| 7 | 107 | Powers in relation to a FPTO |
| 35249 |
| 7 | 107(2)d | Powers in relation to a FPTO | Leave whilst in detention-Forensic Mental Health orders [PDF 23kB] | 15177 |
| 7 | 110(2) | Role of care coordinator-forensic community care order | Community/Forensic Community Care Order-Care Plan-Care Coordinator's Determination [PDF 23kB] | 65463 |
| 7 | 112(4) | Action if forensic community care order no longer appropriate- no longer person to whom ACAT could make order | Application for Revocation [PDF 42kB] | 15162 |
| 7 | 105(1)(b) | Action if Forensic Psychiatric Treatment Order no longer appropriate | Written notice to the carer and/or Nominated person [PDF 27kB] | 15140 |
| 7 | 106(1)(b) | Action if Forensic Psychiatric Treatment Order no longer appropriate to detain person | Written notice to the carer and/or Nominated person [PDF 27kB] | 15140 |
| 7 | 107 | Powers in relation to a FPTO | Seclusion [PDF 20kB] | 50010 |
| 7 | 107 | Powers in relation to a FPTO | Seclusion/confinement observations [PDF 87kB] | 60421 |
| 7 | 107 | Powers in relation to a FPTO | Mechanical, Physical Restraint, or Forcible Giving of Medication Form [PDF 21kB] | 35249 |
| 7 | 107(2)d | Powers in relation to a FPTO | Leave whilst in detention-Forensic Mental Health orders [PDF 23kB] | 15177 |
| 7 | 110(2) | Role of care coordinator-forensic community care order | Community/Forensic Community Care Order-Care Plan-Care Coordinator's Determination [PDF 23kB] | 65463 |
| 7 | 112(4) | Action if forensic community care order no longer appropriate- no longer person to whom ACAT could make order | Application for Revocation [PDF 42kB] | 15162 |
| 7 | 105(1)(b) | Action if Forensic Psychiatric Treatment Order no longer appropriate | Written notice to the carer and/or Nominated person [PDF 27kB] | 15140 |
| 7 | 106(1)(b) | Action if Forensic Psychiatric Treatment Order no longer appropriate to detain person | Written notice to the carer and/or Nominated person [PDF 27kB] | 15140 |
| 7 | 112(1)(b) | Action if Forensic Community Care Order is no longer appropriate | Written notice to the carer and/or Nominated person [PDF 27kB] | 15140 |
| 7 | 113(1)(b) | Action if Forensic Community Care Order no longer appropriate to detain person | Written notice to the carer and/or Nominated person [PDF 27kB] | 15140 |
| 7 | 113(4) | Action if forensic community care order no longer appropriate- no longer necessary to detain | Application for Revocation [PDF 42kB] | 15162 |
| 7 | 114 | Powers in relation to FCCO | Seclusion [PDF 20kB] | 50010 |
| 7 | 114 | Powers in relation to FCCO | Seclusion/confinement observations [PDF 87kB] | 60421 |
| 7 | 114 | Powers in relation to FCCO | Mechanical, Physical Restraint, or Forcible Giving of Medication Form [PDF 21kB] | 35249 |
| 7 | 120 (1)a | Revocation of leave | Revocation of leave-forensic mental health orders [PDF 23kB] | 15176 |
| 7 | 120(6) | Revocation of leave granted by ACAT | FMHO-Notification of Detention [PDF 26kB] | 15150 |
| 7 | 121 | Grant of leave for person detained by relevant official | Leave whilst in detention-Forensic Mental Health orders [PDF 23kB] | 15177 |
| 7 | 122 | Leave in emergency or special circumstances | Leave in emergency or special circumstances-FMHO [PDF 27kB] | 15178 |
| 7 | 123(2) | Revocation of leave granted by relevant official | Revocation of leave-forensic mental health orders [PDF 23kB] | 15176 |
| 7 | 123(6) | Revocation of leave granted by relevant official | FMHO-Notification of Detention [PDF 26kB] | 15150 |
| 7 | 124(4) | Contravention of forensic mental health order | Wanted Person from a Secure Mental Health Facility [PDF 48kB] | 15150 |
| 7 | 136 | Transfer to mental health facility | Request to Transfer a Detainee from a Place of Detention or Correctional Centre to DMHU [PDF 27kB] | 36525 |
| 8 | 144A(3) | Transfer of custody if person admitted to secure mental health facility | Request to Transfer a Detainee from a Place of Detention or Correctional Centre to DMHU [PDF 27kB] | 36525 |
| 8 | 144A (5) | Transfer of custody if person admitted to secure mental health facility | Request to Transfer a Detainee from a Place of Detention or Correctional Centre to DMHU [PDF 27kB] | 36525 |
| 8 | 144A(7) | Transfer of custody if person admitted to secure mental health facility | Notification of Admission to DMHU [PDF 31kB] | 20269 |
| 8 | 144A | Transfer of custody if person admitted to secure mental health facility | Transfer to from DMHU Security and Escort Risk assessment [PDF 28kB] | 36526 |
| 8 | 144B | Taking person to appear before court | Transfer of custody between a place of detention or correctional centre and DMHU or DMHU and Court [PDF 71kB] | 20274 |
| 8 | 144C | Release etc on change of status of person | Notification of Action following release from court ordered custody [PDF 31kB] | 20272 |
| 8 | 144D | Power to apprehend if person escapes from secure mental health facility | Correctional Escapee from DMHU - Risk Assessment [PDF 32kB] | 36501 |
| 8 | 144E | Transfer to mental health facility | Transfer from AMC [PDF 34kB] | 15255 |
| 9 | 148 | Administration of Electroconvulsive Therapy - Adult with decision-making capacity | Electroconvulsive Therapy Consent and Prescription form [PDF 55kB] | 15290 |
| 9 | 149 | Administration of Electroconvulsive Therapy - Adult with decision-making capacity | Electroconvulsive Therapy Consent and Prescription form [PDF 55kB] | 15290 |
| 9 | 152 | Administration of Electroconvulsive Therapy - Young person without decision-making capacity | Electroconvulsive Therapy Consent and Prescription form [PDF 55kB] | 15290 |
| 9 | 153 | Application for electroconvulsive therapy order | ACAT Electroconvulsive Therapy (ECT)-Application Form [DOCX 59kB] | AF2016-33 |
| 9 | 165 | Doctor must record electroconvulsive therapy | ECT Treatment Record [PDF 88kB] | 50005 |