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.

5. 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. Within the application, Dr BFT details that against a background of an industrious work history and high functioning, for the past 10 - 15 years NBG has had a history of persecutory delusional ideation. In 2018, NBG was admitted to hospital for approximately 6 months following a near fatal assault against his wife. At that time, he was diagnosed with late onset schizophrenia.
2. NBG was managed within the private system, until 2022 when his psychotic symptoms increased in intensity and required involuntary treatment.
3. In more recent times, NBG's diagnosis has been revised to delusional disorder.

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. At hearing, Dr BFT provided evidence that NBG has a diagnosis of a delusional disorder. NBG exhibited a fixed delusion/delusional belief that there is a video which portrays him performing a "lewd act" which he believes has been widely disseminated amongst the community. Therefore, NBG holds the belief that everyone is judging him for the content, inclusive of strangers.
3. As a consequence of holding the belief, NBG has become socially withdrawn.
4. When invited by the Tribunal to provide his views in relation to the criteria, NBG expressed disagreement with the diagnosis given by Dr BFT and previous clinicians.
5. Given the definition of mental illness in the Act, and despite the reported views of NBG to the contrary, the Tribunal is satisfied that NBG has a mental illness, namely a delusional disorder. The only medical evidence put before the Tribunal was the evidence of Dr BFT. Accordingly, we are satisfied this treatment criterion 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 was whether we could be satisfied that without treatment, NBG's mental illness will, or is likely to, seriously harm his 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:

Section 40(b) is concerned with what is "likely". When that word is used in legislation, it can have various meanings. It can mean "more probable than not" or "more than a 50% chance". It can refer to something that might well happen. It can refer to a possibility that is more than a remote or theoretical possibility. The meaning of the word has been considered in a great many cases. See, for example, Boughey v The Queen (1986) 161 CLR 10; Tillmanns Butcheries Pty Ltd v Australasian Meat Industry Employees' Union [1979] FCA 85; (1979) 42 FLR 331 at 339; Cream Holdings Ltd v Banerjee [2003] EWCA Civ 103; [2003] 3 WLR 999. Much depends on the legislative context. It is significant that the principal purpose or object of s 40(b) is the protection of mentally ill persons and others from risks of harm. Having regard to the purpose and context of the provision, I consider that "likely" should be given a wide interpretation. It should not be interpreted as meaning "more probable than not". It must be interpreted as meaning something more than a remote or theoretical possibility. I think it should be interpreted as referring to something that might well happen. Having regard to the evidence that I have referred to, I consider that it was open to the Tribunal to conclude that, without treatment, the appellant's mental illness was "likely" to result in her killing herself.

2. At hearing, Dr BFT outlined that due to the delusion, NBG's distress has resulted in agitation which escalated to physical violence. Without treatment, NBG's behaviour will escalate.
3. We accept Dr BFT's unchallenged evidence that without treatment NBG's mental illness would be likely to seriously harm the safety of others. We are satisfied on the evidence presented, that without treatment, it is likely that NBG's mental health would decline, and he would be at increased risk of serious harm to others.
4. The Tribunal is satisfied this criterion in 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. Within the application and at hearing, Dr BFT described that the medication had been effective, and his mental state had not deteriorated when he remained on treatment. The medication prescribed to NBG at the time of the hearing was two mg of Risperidone which is an anti-psychotic medication.
3. During the hearing, NBG's wife, BNG, detailed the concerns about the effectiveness of the medication - "it needs to be investigated". She was concerned about the side effects. She felt that he would benefit from psychological input which he has not had access to. Dr BFT concurred that medication should not be viewed in isolation but a multi-disciplinary approach.
4. We accept the evidence of Dr BFT that the treatment proposed in the application is appropriate and effective for NBG as defined in the Act. We are satisfied the criterion is met.

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

NBG has poor insight into his illness and the need for treatment. Without a treatment order, NBG is unlikely to remain adherent to his medications.

2. At hearing, Dr BFT expanded on this statement. He referred to the medical history of NBG, stating previously without an order, there was a period of non-compliance, less adherence with the medication regime which ultimately resulted in NBG's hospitalisation.
3. BNG, whilst acknowledging history of self-reduction of his prescribed medication, reported that he is currently compliant with the prescribed regime and requests his medication on a daily basis.
4. Without a treatment order in place, we were satisfied that NBG would not continue to take medication, and therefore that treatment cannot be adequately given to him except as an involuntary patient under the authority of a treatment order. We were satisfied this criterion was 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. Within the application, Dr BFT outlined that due to the delusional disorder, NBG lacks insight into his illness and need for treatment. Further NBG is unable to understand his illness or the role of his medications prescribed to treat the illness. He has been assessed as not having the ability to weigh up the consequences of choices regarding his treatment. Consequently, NBG sees no value in his prescribed antipsychotic medications and believes that they are slowly poisoning him.
3. At hearing, Dr BFT reiterated these opinions: that NBG dismisses the need for medication ultimately indicating an inability to use or weigh the information necessary for making decisions around his treatment. Ultimately, NBG is unable to consider the risks or benefits associated with treatment versus non-treatment nor does he recognise the potential risk of not receiving treatment.
4. Within his assessment of NBG, despite Dr BFT's attempt to explain his medical diagnosis/assessment, NBG disagreed, maintaining the delusion of the existence of a video where he is performing a "lewd act" being distributed to the wider community and that NBG would "rather gather evidence to support the delusion". In the opinion of Dr BFT, the delusion affects NBG's ability to understand information relevant to his treatment decision.
5. Upon consideration of all the evidence, we are satisfied that due to NBG's delusional thinking surrounding the video as outlined in paragraph 18 & 37, he was unable to understand information relevant to his mental illness. We are also satisfied that NBG is unable to use or weigh the information.
6. We are satisfied that NBG does not have decision making capacity and this criterion is satisfied.

1. As outlined, following hearing, the Tribunal was satisfied that all of the treatment criteria in s 40 were met and determined that a treatment order should be renewed.
2. The treatment order is renewed from the date of expiry of the current order, being 30 July 2025 and will remain in place for a further twelve months, until 29 July 2026 unless the order is discharged sooner.