(c) that the treatment will be appropriate and effective in terms of the outcomes referred to in s 6(1) of the Act; and > > (d) treatment cannot be adequately given except under a treatment order; and > > (e) that the patient does not have decision making capacity.

1. In addition, the Tribunal must also be satisfied that:
   1. the application has been made by an approved medical practitioner - see s 48(1) of the Act.
   2. the application was made at least 10 days before the day during which the treatment order expired - see s 48(2) of the Act; and
   3. the application, in accordance with s 195 of the Act, was accompanied by the relevant documents - see s 48(3) of the Act.
2. At the hearing, the Tribunal was satisfied that:
   1. Dr SD is an approved medical practitioner;
   2. the application was made at least 10 days before the day during which the treatment order expired;
   3. the application is in accordance with s 195 of the Act and was accompanied by the relevant documents; and
   4. copies of the application have been provided to all parties as required under s 48(4) of the Act.
3. Further, in determining whether to exercise a discretion to renew a treatment order under s 48 of the Act, the Tribunal is required to be mindful of the objects of the Act provided for in s 12:

12. Objects of Act > > The objects of this Act are as follows: > > (a) to provide for the assessment and treatment of persons with mental illnesses; > > (b) to provide for appropriate oversight and safeguards in relation to such assessment and treatment; > > (c) to give everyone involved with such assessment and treatment clear direction as to their rights and responsibilities; > > (d) to provide for such assessment and treatment to be given in the least restrictive setting consistent with clinical need, legal and judicial constraints, public safety and patient health, safety and welfare; > > (e) to promote voluntary over involuntary assessment and treatment and the making of free and informed assessment and treatment choices; > > (f) to provide for all incidental and ancillary matters.

4. Finally, in exercising its responsibilities under the Act, the Tribunal must have regard to the mental health service delivery principles set out in Sch 1 of the Act. The principles set out in Sch 1 are as follows:

SCHEDULE 1 - Mental health service delivery principles > > The mental health service delivery principles are as follows: > > (a) to respect, observe and promote the inherent rights, liberty, dignity, autonomy and self-respect of persons with mental illness; > > (b) to interfere with or restrict the rights of persons with mental illness in the least restrictive way and to the least extent consistent with the protection of those persons, the protection of the public and the proper delivery of the relevant service; > > (c) to provide a service that is comprehensive, accessible, inclusive, equitable and free from stigma; > > (d) to be sensitive and responsive to individual needs (whether as to culture, language, age, religion, gender or other factors); > > (e) to emphasise and value promotion, prevention and early detection and intervention; > > (f) to seek to bring about the best therapeutic outcomes and promote patient recovery; > > (g) to provide services that are consistent with patient treatment plans; > > (h) to recognise the difficulty, importance and value of the role played by families, and support persons, of persons with mental illness; > > (i) to recognise, observe and promote the rights, welfare and safety of the children and other dependants of persons with mental illness; > > (j) to promote the ability of persons with mental illness to make their own choices; > > (k) to involve persons receiving services, and where appropriate their families and support persons, in decision-making; > > (l) to recognise families, and support persons, of persons with mental illness as partners, with mental health service providers, in the provision of their treatment and care to the extent that this is appropriate and consistent with their own wishes; > > (m) to respect the wishes of persons receiving services, and the wishes of their families and support persons, to the maximum extent consistent with the health and safety of those persons and the safety of others; > > (n) to promote and enable persons with mental illness to live, work and participate in their own community; > > (o) to operate so as to raise community awareness and understanding of mental illness and to foster community-wide respect for the inherent rights, liberty, dignity, autonomy and self-respect of persons with mental illness; > > (p) to be accountable; > > (q) to recognise and be responsive to national and international clinical, technical and human rights trends, developments and advances. > > (r) to ensure that persons receiving mental health services have their medical and other health needs, including any alcohol and other addiction problems, recognised and responded to; > > (s) to ensure that the best interests of children and young persons are recognised and promoted as a primary consideration, including receiving services separately from adults, whenever possible; > > (t) to ensure that the needs, wellbeing and safety of children, and other dependants, of persons receiving mental health services are recognised and protected; > > (u) to ensure that staff working in mental health services have access to the support, supervision and appropriate training, including cultural diversity training, required to maintain quality, safety and a highly skilled workforce; > > (v) to provide a mental health service that - > > (i) is easily accessible, and safe; and > > (ii) provides persons with mental illness with timely treatment, care and support that is high quality and based on contemporary best-practice principles; and > > (iii) promotes recovery in the least restrictive manner that is consistent with the needs of persons with mental illness; > > (w) to ensure that people who require mental health care and treatment have timely referrals, and access to specialist mental health services, when appropriate.

1. Dr SD's evidence was presented orally at hearing and through the application for renewal of treatment order dated 14 April 2025, the treatment plan of the same date and a copy of KD's current treatment order.
2. Through the application Dr SD opined:
   1. KD has an established diagnosis of schizophrenia with a differential diagnosis of delusional disorder. KD's index admission was in 2017.
   2. Dr SD assessed KD's current presentation to be in keeping with delusional disorder.
   3. KD has had three admissions to mental health inpatient units in southern Tasmania and admissions to mental health inpatient units in Victoria and was treated under a community treatment order in 2018 and 2019 prior to moving to Tasmania.
   4. KD has required treatment and management of her mental illness as an involuntary patient since 2021 with a period of voluntary treatment in 2023 before coming to the attention of mental health services due to concerns from her family.
   5. KD has presented in the past with persecutory delusions about people spreading lies and malicious rumours about her, and Capgras delusions about her mother and brother being replaced by imposters.
3. Turning to the treatment criteria:

1. The definition of mental illness in the Act is:

4. Meaning of mental illness > > (1) For the purposes of this Act - > > (a) a person is taken to have a mental illness if he or she experiences, temporarily, repeatedly or continually - > > (i) a serious impairment of thought (which may include delusions); or > > (ii) a serious impairment of mood, volition, perception or cognition; and > > (b) nothing prevents the serious or permanent physiological, biochemical or psychological effects of alcohol use or drug-taking from being regarded as an indication that a person has a mental illness.

2. KD is diagnosed with schizophrenia with a differential diagnosis of delusional disorder. Dr SD opined that:

On my assessment [KD] presented as guarded and suspicious. She continues to believe that strangers and neighbours have been spreading malicious and vicious lies about her. She also hears these lies spread on the radio, on television and when she is in the supermarket. She is unwilling to discuss what these lies are about and she states she would never repeat the language that is used on her. She has paranoid beliefs that the people who speak about her in public have intentions to harm her and as a result she feels unsafe when she is outside the home and spends minimal amounts of time outside and only if required. > > She has some ideations about her mother having been taken over by an imposter but is now reassured because her mother could answer some questions about her life and other relatives have also confirmed her identity. She denies any other difficulties at home.

3. We have accepted Dr SD's evidence and are satisfied KD has a mental illness as defined by s 4 of the Act and that criterion s 40(a) is met.

Section 40(b) Without the treatment, the mental illness will, or is likely to, seriously harm the person's health or safety or the safety of other persons.

1. The issue for us to decide is whether we can be satisfied that without treatment, KD's mental illness will, or is likely to, seriously harm her health and safety or the safety of others. This criterion was the subject of interpretation by Blow CJ (as he then was) in B v Mental Health Tribunal [2020] TASSC 10 at 14:

For the purposes of the Act, the word 'likely' means "something more than a remote or theoretical possibility ... something that might well happen".

2. We accept the evidence of Dr SD and are satisfied that without treatment KD's mental state is likely to deteriorate resulting in serious harm to her health with a deterioration in her mental state and serious harm to her safety. Dr SD reported to the Tribunal that KD has placed herself at risk by climbing onto the roof to remove tiles and nails in response to paranoid delusions.
3. We also accept that as a consequence of a deterioration in KD's mental state there are risks of serious harm to the safety of others. Dr SD reported that when unwell in the past KD has experienced Capgras delusions and has questioned her mother's identity as she believed her mother to be an imposter. Dr SD gave evidence that KD has also been verbally aggressive towards her mother.
4. We are satisfied criterion s 40(b) is met.

Section 40(c) The treatment will be appropriate and effective

1. We must be satisfied that the treatment proposed will be appropriate and effective in terms of the outcomes referred to in s 6(1):

6. Meaning of treatment > > (1) For the purposes of this Act, treatment is the professional intervention necessary to - > > (a) prevent or remedy mental illness; or > > (b) manage and alleviate, where possible, the ill effects of mental illness; or > > (c) reduce the risks that persons with mental illness may, on that account, pose to themselves or others; or > > (d) monitor or evaluate a person's mental state.

2. Dr SD outlined that KD is currently living in the community with regular case management and reviews by the treating doctors. Dr SD reports that KD is treated with Olanzapine antipsychotic depot medication IMI 300 mg every 4 weeks for the management of her symptoms and for risk mitigation of her psychotic illness.
3. Dr SD further reported that this treatment regime had decreased the intensity of KD's symptoms, that KD believed there was a reduction in the number of people spreading rumours and lies about her and that this had led to an improvement in her quality of life allowing her to live with and support her elderly mother.
4. Dr SD told us he plans to augment KD's current treatment with the introduction of an antidepressant medication to reduce KD's level of anxiety around her psychotic symptoms.
5. On the evidence before us we are satisfied the treatment prescribed for the treatment of KD's mental illness is appropriate and has been effective in reducing the intensity of her delusions and improved her quality of life. We are satisfied that criterion s 40(c) is met.

Section 40(d) The treatment cannot be adequately given except under a treatment order

1. It was clear from the evidence of both Dr SD and from KD herself that she does not accept that she has a mental illness, that she only accepts medications because she is on an order and subsequently, without an order being in place, it is highly improbable KD would be subject to any treatment for mental illness.
2. KT told the Tribunal she has case managed KD since January 2025. They meet at the Olanzapine Clinic once a month for the administration of KD's depot antipsychotic medication and speak on the phone each fortnight in between the clinic visits. KT said that most conversations are general in nature (about how KD spends her time each week). KD talks to KT about side effects she is experiencing from the antipsychotic medication such as tiredness, sleeping long hours and blurred vision. KT said that KD was assessed by an optometrist and had stronger glasses prescribed, but still experiences blurred vision. KD has also reported a restless leg. These side effects have been reported to Dr SD.
3. KT told the Tribunal that KD tells her she does not have a mental illness and that she is being wrongly treated with medication and has been wrongly admitted to hospital for the treatment of a mental illness in the past. KT said that KD does not resist the depot medication on the day of administration but has stated that if the order was not in place she would not accept the medication.
4. Further, as noted below, we accepted the professional opinion of Dr SD that KD currently lacks decision making capacity to provide informed consent, and as such, an order is required for ongoing treatment.
5. We are satisfied criterion s 40(d) is met.

Section 40 (e) The person does not have decision making capacity.

an adult is taken to have the capacity to make a decision about his or her own assessment or treatment (decision-making capacity) unless a person or body considering that capacity under this Act is satisfied that - > > (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 the application for renewal and at hearing, Dr SD reported that KD has an enduring disorder of the mind, namely a psychotic illness with associated delusions.
3. Dr SD further reported that KD does not believe she has a mental illness, nor believes she needs treatment with medication. Dr SD states that KD believes the delusions she experiences to be true experiences. Dr SD said KD's mental illness impacts her perception of reality and the delusional structure (people spreading lies about her) is a disturbance of reality impacting her capacity to think through her daily activities. Dr SD said KD's mental illness impairs her mind and affects her day-to-day capacity to make decisions.
4. Dr SD told us that KD's mental illness has an impact on her ability to understand the symptoms she experiences and weigh the risks of whether she needs to take medication to treat the illness.
5. KD told us that she rejects the application for renewal of the treatment order and that there was false information in the application. KD told us she did not have a mental illness or delusional disorder. KD told us that she:

Has had two admissions not three to a mental health unit in [southern Tasmania]. There was a community treatment order in 2018 and 2019 in Victoria and the fourth treatment in Victoria was in 2017. The admissions in Victoria and admissions in [southern Tasmania] in October 2024 were due to the unknown people in the medical team respectively filling out paper to force me into hospital. The admission in [southern Tasmania] in December 2021 was due to my daughter phoning up 000 because she thought I didn't recognise my mother.

6. KD told the Tribunal that these forced admissions to hospital were for "financial gain". She also said that she "had no doubt now that the elderly lady she lives with" had verified herself and was her mother. KD said she hardly watches television or listens to the radio now because she used to hear her neighbours spreading vicious and malicious lies about her on the radio and television. KD said she still occasionally hears some of her neighbours spreading vicious and malicious lies about her when she is at home in the garden or the neighbours are in the garden and she is inside. She also said she hears other "abusers" spreading malicious and defamatory information about her when she is at medical appointments or is out shopping. KD said Dr SD was not there to hear this and therefore cannot dismiss her experience as a delusional disorder.
7. KD told us she has never had a mental illness and is not a risk to herself or others. She said that climbing on the roof to find out what the scratching sound was did not constitute mental illness. KD said that the arrangement of her mother living with her was never in jeopardy and she only asked her mother to live with her brother in October 2021 until she was able to verify her mother's identity properly. KD said she and her mother enjoy living together and that she has never had verbal aggression towards her mother "even when I was unsure of her". She told us, "I only get angry at times when abusers spreading malicious and vicious" lies of a defamatory nature are attacking her.
8. We accepted Dr SD's evidence that KD presented with persecutory delusions and that her current presentation is in keeping with her diagnosis of delusional disorder. This was apparent on KD's evidence at hearing. We are satisfied that KD is unable to make treatment decisions because of an impairment of, or disturbance in, the functioning of the mind or brain and is unable to understand and, use and weigh information to make treatment decisions. We were satisfied criterion s 40(e) is met.

1. We found that KD has a mental illness and because of the symptoms of her illness is unable to make her own treatment decisions. We are satisfied that a treatment order is necessary to ensure her mental illness is treated.
2. Accordingly, we were satisfied that we should renew the treatment order and on the evidence that we should also vary the order. Dr SD applied for antipsychotic, antidepressant and anticholinergic medications to be authorised under the order. He also applied for urine testing to be authorised under the order. The Tribunal varied the order by adding antidepressant medications as this class of medication was not authorised under the current order, and we removed benzodiazepine medications as this class of medication was no longer being prescribed. We also added authorisation for urine testing should it be clinically indicated. The order was renewed for a period of six months, unless discharged sooner.

1. The Tribunal determines that the treatment order is varied and renewed from the date of expiry of the current order, 7 May 2025. The order will remain in place for a further six months, until 6 November 2025, unless the order is discharged sooner.