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Forensic psychiatric treatment order

Most people with a mental illness willingly and actively seek help and can make decisions about what kind of treatment, care or support they want. There may however be times when you become unwell as a result of your mental illness and cannot make those decisions, or you refuse help, despite there being a risk of harm to yourself or the community.

If in addition to this you are detained in a correctional facility, at a place of detention or are serving a community-based sentence, on parole, or a court has found you to be ‘unfit to plead’ or ‘mentally impaired’ a forensic psychiatric treatment order (FPTO) may be made.

Understanding a forensic psychiatric treatment order

The order is made by the ACT Civil and Administrative Tribunal (ACAT) when you require treatment and care for your mental illness and you are either:

  • detained in a correctional facility or another place of detention
  • serving a community-based sentence
  • on parole
  • found by a court to be ‘unfit to plead’ or ‘mentally impaired’ under the Crimes Act 1900 (ACT) or the Crimes Act 1914 (Commonwealth).

A FPTO is made to enable you to receive the assessment, treatment, care or support you need but are refusing to do so. This means treatment, care or support can be given without your consent.

When an order can be made

The Chief Psychiatrist can apply to ACAT for an order. The application must include a proposed plan for treatment, care, and support. The tribunal can make an order if:

  • you have a mental illness, and because of your mental illness you are doing or are likely to do serious harm to yourself of someone else
  • your physical or mental health is getting worse, or is likely to get worse and because of your mental illness, you are seriously endangering or are likely to seriously endanger public safety
  • treatment, care, and support are likely to reduce the risk of harm to yourself or others, or improve your condition
  • The tribunal is satisfied that a mental health order should not be made instead and treatment, care, or support cannot be given in a way that involves less restriction on your freedom of choice and movement.

The tribunal does not need to consider decision-making capacity to make an order.

How an order is made

Before making an order, there will be a hearing. The hearing is a formal meeting, and you will be invited to attend. You can bring support people with you and have a lawyer. Information from your treating team, as well as your views and those of your carer, nominated person or family can be put forward, both verbally and in writing.

In making a order, ACAT will consider:

  • the proposed plan for treatment, care, or support
  • your views and wishes
  • what your advance agreement or advance consent direction says if you have these
  • the opinions are of those who care for you day to day
  • the opinions are of those at the hearing
  • the opinions are of the affected person if there is one
  • the opinions are of each person consulted whether any restrictions placed on you should be the minimum required
  • any other options for treatment, care or support that are available, including the aim of that treatment, its benefits and whether it is likely to be upsetting, cause discomfort or side effects
  • any other medical history.

If you were referred to the tribunal by a court under the Crimes Act 1900 or the Crimes Act 1914, they will consider:

  • the nature and circumstances of the alleged offence
  • the effect that your mental illness may have on your behaviour in the future and whether, if you were not detained, your safety or the safety of others would be at risk
  • the views of the Victim of Crimes Commissioner if there is a registered affected person, and/or anything else under the law.

Who is consulted

Before making an order, ACAT will try to talk to:

  • your parents, or the people who have parental responsibility if you are a child
  • your guardian if you have one
  • the person who holds power of attorney for you if you have one
  • your nominated person if you have one
  • your health attorney if you have one
  • the Chief Psychiatrist if they are likely to be responsible for providing treatment, care, or support
  • the Director General Corrections if you are a detainee, on bail or parole
  • the Children and Young People’s Director General, if you are a child who is a detainee or on bail.

What happens if an order is made

Your treating team will decide on your specific treatment, care, or support. An order will state information such as:

  • the approved mental health facility that you will stay at
  • that you must undergo treatment, care or support, counselling, training, or a therapeutic or rehabilitation program
  • that limits may be imposed on your communication
  • where you must live or be detained and where you can go and who you can see

If an order has been made for you, the Chief Psychiatrist or their delegate is responsible for your treatment, care, and support. The psychiatrist must decide:

  • whether you need to stay at an approved mental health facility, such as a hospital to receive treatment, care, or support
  • when and where you will receive treatment, care, or support, if you are living in the community
  • what treatment, care and support you will be given and ensure that it does not cause undue stress
  • where you must live if the order does not already state this.

The psychiatrist will, where possible, consult with you to make these decisions. They may also talk to the same people that ACAT consulted. These decisions will be made within 5 working days of the order being made and this information will be given to you in writing.

Before any treatment, care or support is given, it will be explained to you in a way that you understand.

Duration of an order

An order can only be made for up to 3 months at a time. However, if you have already had an FPTO 4 times - 3 month orders in a row - the tribunal can make an order for up to 12 months.

If your psychiatrist believes that you no longer need an order they will tell the tribunal and the order will be reviewed.

Limits on communication

As part of a FPTO, limits can be placed on who you are able to communicate with. The limitation must be consistent with the order, necessary and reasonable and must not reduce the effectiveness of your treatment, care, or support.

You will be told the reasons for the limitation, what the limitations are and how long they will be in place. There is a maximum limit of 7 days at a time.

Leave

If you are on an order and required to stay at an approved mental health facility you have the right to apply for leave.

Leave refers to a period of time outside a facility that has been agreed on between you and your treating team.

The authority who determined that you need to stay in an approved mental health facility, the tribunal or the Chief Psychiatrist, can give you permission to leave in certain situations if you apply for it.

Before granting leave, the tribunal or the Chief Psychiatrist must:

  • seek agreement from the Director General Corrections if you are a detainee or Children and Young People’s Director General if you are a young detainee
  • be satisfied that no serious concerns have been raised following this consultation
  • be satisfied that your safety, and the safety of others will not be seriously endangered

The tribunal or the Chief Psychiatrist can also cancel your leave. They can do this if they have concerns about the safety of yourself or others, or if you break a condition of your leave.

If leave is cancelled then a mental health officer, doctor, authorised ambulance officer or police officer can apprehend and take you to a relevant facility.