Local Patient Identifier
FAMILY NAME
MHT 3
Report on Compulsory Treatment
GIVEN NAMES
DATE OF BIRTH
Mental Health Statewide UR Number
SEX
Place patient identification label (if available)
Patient’s name:
Address:
Date of Temporary Treatment Order:
Date of current Treatment Order. From:
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 (or similar) 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 current social circumstances including:
accommodation, employment, financial details, current social stressors, relevant
family and developmental history (include any childhood diagnoses and traumatic
events), interests, activities, abilities and skills.
Report on Compulsory Treatment
Part One: Background information about the patient
MHT 3
July 2014
1.3 Detail any alcohol or substance use issues (refer to rating tools if applicable).
Page 1 of 7
Local Patient Identifier
FAMILY NAME
MHT 3
Report on Compulsory Treatment
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 Relevant legal matters (such as VCAT orders, court orders and police/forensic
matters. List historic and current matters).
1.7 How long has the current treating team been treating the patient?
Part Two: Criteria for Compulsory Treatment
Section 5(a) – 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.
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.
Report on Compulsory Treatment
Under the Mental Health Act 2014 a person can only be treated as a compulsory patient if they
satisfy all of the criteria in section 5.
MHT 3
July 2014
2.3 Describe the patient’s psychiatric history (in chronological 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.
Page 2 of 7
Local Patient Identifier
FAMILY NAME
MHT 3
Report on Compulsory Treatment
GIVEN NAMES
DATE OF BIRTH
Mental Health Statewide UR Number
SEX
Place patient identification label (if available)
2.4 If the patient is an inpatient, detail the circumstances and referral leading to the
patient’s current admission.
2.5
Does the patient have a significant disturbance of thought (form or
content)?
Does the patient have a significant disturbance of mood?
Does the patient have a significant disturbance of perception?
Does the patient have a significant disturbance of memory?
2.6 If you answered ‘Yes’ to any of the questions at 2.5, 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).
2.7
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 himself/herself?
Does the patient need immediate treatment to prevent serious harm
to another person?
2.9 Have these matters been discussed with the patient? What views has the patient
expressed?
Page 3 of 7
MHT 3
July 2014
2.8 If you answered ‘Yes’ to any of the questions at 2.7, 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.
Report on Compulsory Treatment
Section 5(b) – because the person has mental illness, the person needs immediate treatment to
prevent serious deterioration in the person's mental or physical health or serious harm to the
person or to another person.
Local Patient Identifier
FAMILY NAME
MHT 3
Report on Compulsory Treatment
GIVEN NAMES
DATE OF BIRTH
Mental Health Statewide UR Number
SEX
Place patient identification label (if available)
Section 5(c) – the immediate treatment will be provided to the person if the person is subject to
a 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.
2.10 What immediate treatment does the patient require?
2.11 How does the (proposed) Treatment Order facilitate this treatment? Explain the
purpose, method and duration of the immediate treatment.
2.12 Describe the beneficial and adverse effects of the patient’s treatment and provide
details of how any side effects are being addressed.
This criterion involves an assessment of whether the patient can receive treatment voluntarily
rather than compulsorily. This criterion is not about treatment setting (i.e. inpatient or
community), which is addressed below.
2.13 Provide details of key relationships, social connections and other services (e.g.
Mental Health Community Support Services, general practitioner, private psychiatrist,
carer, family, friend/s, guardian, nominated person) involved and the patient’s
acceptance of the involvement of these in their care, treatment and support.
2.14 Has the patient expressed any views about voluntary treatment? Are the
patient’s current actions compatible with those views?
Report on Compulsory Treatment
Section 5(d) – there is no less restrictive means reasonably available to enable the person to
receive the immediate treatment.
MHT 3
July 2014
2.15 Why does the treating team believe less restrictive treatment is not reasonable at
present?
Page 4 of 7
Local Patient Identifier
FAMILY NAME
MHT 3
Report on Compulsory Treatment
GIVEN NAMES
DATE OF BIRTH
Mental Health Statewide UR Number
SEX
Place patient identification label (if available)
2.16 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 (or similar) covering the relevant matters (please attach and
direct the Tribunal to the relevant parts). However, you must answer questions 3.4 and 3.5
about the duration and category of Treatment Order being sought.
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.
3.4 What is the proposed treatment setting of the Treatment Order? Give details as to
why community/inpatient treatment is necessary. If inpatient treatment is proposed,
give details regarding plans to progress the patient to discharge (via community
treatment or voluntary treatment).
3.5 What is the proposed duration of the Treatment Order? Give details as to why the
duration is proposed.
Report on Compulsory Treatment
3.3 If there are any alternatives to the current treatment plan being considered or
other proposed treatment, please provide details.
MHT 3
July 2014
3.6 Any other relevant information not covered in Parts One to Three.
Part Four: Carer, family, nominated person’s views
Page 5 of 7
Local Patient Identifier
FAMILY NAME
MHT 3
Report on Compulsory Treatment
GIVEN NAMES
DATE OF BIRTH
Mental Health Statewide UR Number
SEX
Place patient identification label (if available)
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.
4.2 Has the patient’s diagnosis been discussed with the patient’s carer/
family/ nominated person?
4.3 If the patient’s carer/ family/ nominated person (on behalf of the patient) has
expressed views about the patient’s treatment and/or Treatment Order, please
provide details (including whether these views can be complied with).
MHT 3
July 2014
Report on Compulsory Treatment
Page 6 of 7
Local Patient Identifier
FAMILY NAME
MHT 3
Report on Compulsory Treatment
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.
Print name:
Authorised psychiatrist/ delegate
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:
Report on Compulsory Treatment
Signed:
MHT 3
July 2014
Last updated: July 2014
Page 7 of 7