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 can be times when you become unwell do not have decision-making capacity, or you refuse help. This can present a risk of harm to yourself or the community.
In these situations, a psychiatric treatment order (PTO) may be made.
Understanding a psychiatric treatment order
A PTO is a type of mental health order, made by the ACT Civil and Administrative Tribunal (ACAT), when you have been identified as requiring treatment and care for your mental illness.
It is made to enable you to receive the assessment, treatment, care or support you need, when you don’t have the ability to seek it yourself or are refusing to do so. This means treatment, care or support can be given without your consent.
When can an order can be made
An order will only be made if, based on an assessment, you have a mental illness and either do not have decision-making capacity and you refuse treatment, care, and support or you have decision-making capacity but do not consent to treatment, care, and support and you are likely to seriously harm yourself or someone else.
It may also be made if your physical or mental health is getting worse, or is likely to get worse to the extent that it outweighs your right to give consent.
A PTO will be made if:
- treatment, care, and support are likely to improve your mental illness or stop it from getting worse
- and where treatment, care, and support cannot be given to you in a way that involves less restriction on your freedom of choice and movement.
Application for an order
The Chief Psychiatrist or their delegate can apply to the tribunal for a PTO. The delegate is usually your treating psychiatrist who will provide information about your mental illness and why the application is being made. Your psychiatrist should also attach a copy of your proposed treatment plan with the application.
The treatment plan will include information about what treatment, care or support is recommended, why and how it will help. These application forms can be found on the ACAT website.
How an order is made
After receiving an application, ACAT will hold a hearing to decide whether a PTO should be made. They will give you at least 3 days written notice of the hearing.
The hearing is a formal meeting, and you will be invited to attend. The tribunal encourages your attendance as your views and wishes are important. You can bring support people with you and have a lawyer to represent your interests.
Your views and those of your carer, guardian or nominated person can be put forward, both verbally and in writing. The tribunal is also provided with information from your treating team.
Hearings are held in private, which means that only people who you want to be present will be able to attend. Hearings may be in person, via video or by teleconference.
Who is consulted
If a PTO has been made for you, the psychiatrist will consult with you and discuss your opinions about:
- where treatment, care or support will be given
- whether you should stay in a mental health facility for treatment
- and the types of treatment you might be given.
You might want to talk to the psychiatrist about:
- what treatment is being considered
- why where and when the treatment, care and support will take place
- the treatment, care or support that has worked for you in the past, and the types of treatment, care or support you want, what you don’t want and why.
While your opinions and views will always be considered, your treatment plan will need to accommodate your clinical needs, and the treatment given and/or the location may be different to what you request. Your psychiatrist may also talk to:
- your parents, or the people who have parental responsibility, if you are a child
- your nominated person if you have one
- your guardian if you have one
- the person who holds power of attorney for you if you have one
- your health attorney if you have one
- the Director General of 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.
The psychiatrist will give a copy of your treatment plan to you, as well as:
- your parents, or the people who have parental responsibility (if you are a child)
- ACAT
- the Public Advocate
- your nominated person if you have one
- your guardian if you have one
- the person who holds power of attorney for you if you have one, and your health attorney if you have one.
What happens after an order is made
If a PTO has been made for you, the Chief Psychiatrist or their delegate is responsible for your treatment, care, and support. The delegate can be a psychiatrist in the community, at the hospital or at another mental health facility.
The psychiatrist needs to decide:
- what treatment, care or support you will be given and includes making sure that the treatment is explained to you
- whether you need to stay at an approved mental health facility such as a hospital to receive treatment, care, and support. If so, the treatment plan must say if you can be given leave
- or if you are receiving your treatment, care and support in the community, where you need to go to receive treatment and when you need to go there. This may be for counselling, to attend a group program, or to collect medication.
These decisions will be made within 5 working days of the order being made and are used to form your treatment plan. A copy of your plan will be given to you in writing.
Duration of an order
Under the Act, any compulsory treatment must be for the shortest time possible. An order can be made for any period up to 6 months, but it is usually shorter.
The PTO will be reviewed before it expires. It can also be reviewed sooner if your treating team believes the order is no longer needed or if you ask for a review. A hearing needs to be held if you, your representative or ACAT nitiated the review. The tribunal will review the order within 72 hours. This will usually occur without holding a hearing.
When the tribunal reviews an order, it can:
- confirm the order as it is
- change the order
- cancel the order
- make additional orders
- or make an assessment order, requiring you to undergo a mental health assessment to decide what further treatment, care and support is needed.
Limits on communication
As part of your order, 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, and support. You will be told the reasons for the limitation, what the limitations are and how long they will be in place. The maximum is 7 days at a time.
Leave
If you are subject to a PTO and your treatment plan requires you to stay at an approved mental health facility, you have the right to apply for leave.
Leave is time spent outside a facility that has been agreed on between you and your treating team. Leave is designed to enhance recovery and help you return to your usual life in the community. Your treatment plan should state whether you are entitled to entitled to leave and if not, why.
The specific type, length and other conditions of leave are decided on a case-by-case basis, when leave is requested.
The Chief Psychiatrist or your treating doctor can also cancel your leave. If leave is cancelled, you will be invited to return to the facility voluntarily. If you do not have approved leave or fail to return from approved leave then a mental health officer, doctor, authorised ambulance officer or police officer can apprehend you and take you to a relevant facility.
Not complying
If you do not comply with the terms of your order, for example you refuse or fail to attend for treatment, you will be contacted by a member of your treating team to discuss why. A verbal warning will be issued in the first instance and, if you still fail to comply with your order, a written warning will be delivered to you.
If you continue to refuse treatment after the written warning your treating team will seek approval from the Chief Psychiatrist to ask for support from police to locate and apprehend you and to transport or detain you at an approved mental health facility so that treatment can be provided.
Restriction order
A restriction order is a type of mental health order that can be added to a PTO for a maximum of 3 months and can tell you where you must live or where you must stay and can also state any people you must not see or talk to, places you must not go or things you must not do.
ACAT is responsible for reviewing applications and can make the order if it is needed to keep you, someone else, or the public safe, and if treatment, care, and support cannot be given in a way that involves less restriction of your freedom of choice and movement.