Local Patient Identifier
FAMILY NAME
MHT 4
Report on Court Secure
Treatment Order
GIVEN NAMES
DATE OF BIRTH
Mental Health Statewide UR Number
SEX
Place patient identification label (if available)
Patient’s name:
Address:
Date of Court Secure Treatment Order
From:
(section 94A Sentencing Act 1991)
To:
Consultant Psychiatrist:
Medical Officer:
Case Manager (or equivalent role):
Tribunal hearing date:
Please read the instructions and guidelines that the Tribunal has issued before
completing this report.
Are you making an application to withhold any documentation from the
patient that you will provide to the Tribunal?
If ‘Yes’, you need to complete a separate Application to deny access to documents
under section 191 of the Mental Health Act 2014.
Questions in Part One are designed to encourage multi-disciplinary input by case managers.
Please note: Part One questions may not have to be answered if the patient has a
comprehensive recovery plan covering the relevant matters (please attach and direct the
Tribunal to the relevant parts).
1.1 Cultural background (if the patient was not born in Australia, their year of arrival,
first language and level of English proficiency).
1.2 Give a summary of the patient’s social circumstances prior to being imprisoned
including: accommodation, employment, financial details, social stressors, relevant
family and developmental history (include any childhood diagnoses and traumatic
events), interests, activities, abilities and skills.
Report on Court Secure Treatment Order
Part One: Background information about the patient
MHT 4
July 2014
1.3 Detail any alcohol or substance use issues (refer to rating tools if applicable).
Page 1 of 6
Local Patient Identifier
FAMILY NAME
MHT 4
Report on Court Secure
Treatment Order
GIVEN NAMES
DATE OF BIRTH
Mental Health Statewide UR Number
SEX
Place patient identification label (if available)
1.4 Other relevant medical issues or relevant history.
1.5 List all current medications (psychotropic and general).
1.6 Patient’s placement prior to admission (include name of prison, whether on
remand or details of sentence, charges or convictions. Include other historic legal
matters).
Part Two: Criteria for security patient status
A person can only remain a security patient if they satisfy all of the criteria in section 94B(1)(c)
of the Sentencing Act 1991.
2.1 What is the patient’s current diagnosis?
2.2 Please give details as to the information regarding this diagnosis that has been
communicated to the patient.
2.3 Describe the patient’s psychiatric history (in chronological order). Detail the
circumstances leading to the patient’s Court Secure Treatment Order. (Consider the
pattern of the patient’s illness, pre-morbid mental state and functioning, initial
presentation/first episode, severity of relapse and precipitants, recovery and response
to treatment, disability.)
Does the patient have a significant disturbance of thought (form or
content)?
MHT 4
July 2014
2.4
Report on Court Secure Treatment Order
Section 94B(1)(c)(i) – the person has mental illness. Section 4 defines mental illness as a
medical condition that is characterised by a significant disturbance of thought, mood, perception
or memory.
Does the patient have a significant disturbance of mood?
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Local Patient Identifier
FAMILY NAME
MHT 4
Report on Court Secure
Treatment Order
GIVEN NAMES
DATE OF BIRTH
Mental Health Statewide UR Number
SEX
Place patient identification label (if available)
Does the patient have a significant disturbance of perception?
Does the patient have a significant disturbance of memory?
2.5 If you answered ‘Yes’ to any of the questions at 2.4, please provide details. Refer
to current mental state, current symptoms and symptoms that have responded to
treatment. You must include a summary of the evidence being relied upon (e.g. a
description of the content of delusional thoughts or the nature of auditory
hallucinations and when it was observed and/or any supporting assessments).
Section 94B(1)(c)(ii) – because the person has mental illness, the person needs treatment to
prevent serious deterioration in the person's mental or physical health or serious harm to the
person or to another person.
2.6
Does the patient need immediate treatment to prevent serious
deterioration in their mental health?
Does the patient need immediate treatment to prevent serious
deterioration in their physical health?
Does the patient need immediate treatment to prevent serious harm
to another person?
2.7 If you answered ‘Yes’ to any of the questions at 2.6, please provide details and the
evidence on which this assessment is based, including the source of that evidence and
how recently it was observed or occurred.
2.8 Have these matters been discussed with the patient? What views has the patient
expressed?
2.9 What immediate treatment does the patient require?
MHT 4
July 2014
Section 94B(1)(c)(iii) – the treatment will be provided to the person if the person is subject to a
Court Secure Treatment Order. Section 6 defines treatment as things done to the person in the
course of the exercise of professional skills to remedy the mental illness or to alleviate the
symptoms and reduce the ill effects of the mental illness.
Report on Court Secure Treatment Order
Does the patient need immediate treatment to prevent serious harm
to himself/herself?
Page 3 of 6
Local Patient Identifier
FAMILY NAME
MHT 4
Report on Court Secure
Treatment Order
GIVEN NAMES
DATE OF BIRTH
Mental Health Statewide UR Number
SEX
Place patient identification label (if available)
2.10 How does the Court Secure Treatment Order facilitate this treatment? Explain the
purpose, method and duration of the immediate treatment.
2.11 Describe the beneficial and adverse effects of the patient’s current treatment and
provide details of how any side effects are being addressed.
Section 94B(1)(c)(iv) – there is no less restrictive means reasonably available to enable the
person to receive the treatment.
This criterion involves an assessment of whether the patient can receive treatment voluntarily in
prison rather than compulsorily via a Court Secure Treatment Order.
2.12 Has the patient expressed any views about voluntary treatment? Are the
patient’s current actions compatible with those views?
2.14 Describe the changes or strategies that need to occur in order for the patient to
be able to be treated less restrictively. (This may include things that the patient needs
to do, supports that need to be put in place or strategies to address non-adherence.)
Part Three: Treatment and Recovery
Please note: Part Three questions may not have to be answered if the patient has a
comprehensive recovery plan covering the relevant matters (please attach and direct the
Tribunal to the relevant parts).
Report on Court Secure Treatment Order
2.13 Why does the treating team believe less restrictive treatment is not reasonable at
present?
MHT 4
July 2014
3.1 Describe how the patient has participated in the development of their recovery
plan (or equivalent plan) and/or how their wishes have been taken into account.
3.2 Describe the patient’s current stage of recovery and anticipated progress.
Page 4 of 6
Local Patient Identifier
FAMILY NAME
MHT 4
Report on Court Secure
Treatment Order
GIVEN NAMES
DATE OF BIRTH
Mental Health Statewide UR Number
SEX
Place patient identification label (if available)
3.3 If there are any alternatives to the current treatment plan being considered or
other proposed treatment, please provide details.
3.4 Any other relevant information not covered in Parts One to Three.
Part Four: Carer, family, nominated person’s views
4.1 If the patient is being supported by a carer, family, friend/s, guardian, or
nominated person, please list their names and relationship to the patient.
4.3 What is the role of the patient’s carer/ family/ nominated person in the patient’s
treatment plan (or equivalent plan)?
MHT 4
July 2014
4.4 If the patient’s carer/ family/ nominated person (on behalf of the patient) has
expressed views about the patient’s treatment, please provide details (including
whether these views can be complied with).
Report on Court Secure Treatment Order
4.2 Has the patient’s diagnosis been discussed with the patient’s carer/
family/ nominated person?
Page 5 of 6
Local Patient Identifier
FAMILY NAME
MHT 4
Report on Court Secure
Treatment Order
GIVEN NAMES
DATE OF BIRTH
Mental Health Statewide UR Number
SEX
Place patient identification label (if available)
Signed:
Print name:
Date:
Length of time you have known the patient:
Date you last reviewed the patient:
Date the patient was given a copy of this Report:
If more than one person has authored the Report, please list their names and positions below:
CONFIRMATION OF REPORT BY AUTHORISED PSYCHIATRIST
I have reviewed and confirm the accuracy of this report.
Authorised psychiatrist/ delegate
Print name:
Date:
Date you last reviewed the patient:
PATIENT RECEIPT OF REPORT
If possible, please ask the patient to sign below to indicate they have received and read this
Report.
Signed:
Date:
MHT 4
July 2014
Last updated: July 2014
Report on Court Secure Treatment Order
Signed:
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