1. Section 7(1) presumes an adult to have decision-making capacity about his or her own assessment or treatment unless:

(a) he or she is unable to make the decision because of an impairment of, or disturbance in, the functioning of the mind or brain; and > > (b) he or she is unable to - > > (i) understand information relevant to the decision; or > > (ii) retain information relevant to the decision; or > > (iii) use or weigh information relevant to the decision; or > > (iv) communicate the decision (whether by speech, gesture or other means).

2. In applying s 7(1), we follow what the Tribunal said in SI (60 Day Review Hearing) [2025] TASCAT 29 at [149]-150]:

[149] Similarly we agree that the threshold of capacity under the Act is a relatively low one. It only requires a person to be able to understand, retain and use or weigh the information and communicate a decision in the terms of the general nature, purpose and effect of the treatment. There is not a requirement that a person has a high level of understanding at a level similar to that of their treating team. > > [150] With respect to capacity, we acknowledge that a lack of insight into the diagnosis alone is not sufficient to conclude that a person lacks decision-making capacity. Instead, a lack of capacity is a factual issue that can be relevant in evaluating a person's ability to understand, retain, and use or weigh the relevant information, which may support a determination of incapacity.

3. Dr SD gave evidence that the patient is preoccupied with her delusions, which derail conversations and lead to disorganised thoughts. He considered, and we accept, this to lead to an inability to adequately retain information relating to the patient's mental illness and her treatment. The applicant's written evidence suggests that the patient has had difficulty recognising and remembering members of her treating team, which suggests an impaired capacity to retain information.
4. Moreover, Dr SD opined, and we accept, that the patient's delusions and disorganised thought render her unable to adequately understand information relating to healthcare decisions and risks to her. Our observations during the hearing were that the patient was unable to focus on or address topics relating to her treatment, instead reverting to her delusions.
5. Dr SD also expressed concerns regarding whether the patient has a cognitive impairment, although he noted that no formal diagnosis (for example, of dementia) had been made. We mention this for completeness, as it is neither a formal diagnosis nor the basis of our findings as to the treatment criteria.
6. Ms Olsson submitted that the patient has decision-making capacity and that "bad decisions" or the patient's disagreeability towards her treating team did not amount to a lack of capacity. There is some force in the latter part of this submission. We accept that the patient's suicide attempt and her hostility towards her treating team do not, of themselves, amount to a lack of decision-making capacity. However, Dr SD's oral evidence and the applicant's written evidence about the patient's delusions and disorganised thoughts, and the doctors' conclusions relating to these, satisfy us that the patient does not have decision-making capacity.

1. We are satisfied of the formal requirements and that the patient meets the treatment criteria in s 40. However, that does not compel us to make a treatment order. The Tribunal retains a residual discretion whether to make an order. In exercising that discretion and in considering the treatment criteria, we have had regard to the Act's objects in s 12 and the 'mental health delivery principles' in Sch 1. In CMB v Mental Health Tribunal [2021] TASFC 4; 33 Tas R 306, Pearce J said at [31] (Wood and Geason JJ agreeing):

Patients are to be subject to the least restriction, but only as far as is consistent with public safety and patient health, safety and welfare. Moreover, the submission that the terms of the legislation favour "patient autonomy" carry little weight when, at the relevant time, the patient is incapable of making an autonomous decision. In my view it is for the Tribunal to weigh the various, sometimes competing, considerations and to reach the appropriate balance.

2. While we were satisfied that it was appropriate to make a treatment order, we were not satisfied that the order should authorise mood stabilising medication. We find that mood stabilising medication to be directed towards the possible secondary diagnoses, not the primary diagnosis of a psychotic disorder. Having regard to the uncertainty of the secondary or alternative diagnoses and the importance of interfering in the patient's rights in the least restrictive way, we are not satisfied that we should authorise mood stabilising medication.
3. Subject to the variation by removing mood stabilising medication, we are satisfied that a treatment order is consistent with the Act's objects and the mental health delivery principles.

1. We are satisfied that it is appropriate to make a treatment order. We made that order on the day of the hearing, being 16 May 2025. The order will expire on 15 November 2025 unless discharged sooner by an approved medical practitioner under the Act or renewed.