1. The patient is to take the following medication (depending on clinical indication):

1. Antipsychotic medication 2. Mood stabilising medication 3. Benzodiazepine medication 4. Anti-cholinergic medication for treatment of any extrapyramidal side effects from taking antipsychotic medication

Medications may be administered orally and/or by intra-muscular injection and/or by depot injection as prescribed by a treating psychiatrist within clinical guidelines, with dosages adjusted according to clinical response and tolerability.

2. Standard medical and/or blood, and/or urine tests and/or diagnostic radiological and medical imaging tests, as clinically indicated and as directed by the treating team.
3. Adult Community Mental Health Service (ACMHS) appointments (inclusive of home visits as arranged when being treated in the community).
4. The terms of the treatment order renewed on an interim basis made on 17 July 2025 were identical to that original treatment order.

1. Following the determination of the application, orders were made at the hearing on 21 August 2025.
2. On behalf of MDG, Ms Olsson submitted a written request for reasons for our orders on 28 August 2025. These are our reasons as requested.

1. The hearing was conducted by audio-visual link between Adult Community Mental Health Services North (ACMHSN) and the Tribunal in Hobart. MDG attended the hearing by telephone. MDG was represented by Ms Olsson, who appeared from ACMHSN. Dr GT, Dr KQ and BC (a case manager), all members of the treating team, also attended the hearing from ACMHSN.
2. The Tribunal had before it materials relevant to the original application for treatment order, the application and a further report prepared by Dr KQ dated 28 July 2025.
3. Ms Olsson had made contact with the Tribunal registry indicating that she intended to refer at the hearing to the previous TASCAT case of TI (Application for Treatment Order) [2022] TASCAT 31, in particular [57].
4. During the course of the hearing, MDG interrupted the evidence of Dr GT. He was unable to listen to the evidence without expressing it to be 'lies'. He advised the Tribunal "I am actually recording this call as well as I have done others". The hearing was stood down for MDG to speak with Ms Olsson, his solicitor, about his continued participation. When the matter resumed, Ms Olsson advised that MDG would not be participating in the hearing any further. The hearing then continued without MDG in attendance.

Section 48 of the Act provides for the renewal of a treatment order and what the Tribunal must be satisfied of before making an order to renew a treatment order.

48. Renewal of treatment order > > (1) The Tribunal may renew a treatment order on the application of any approved medical practitioner (the applicant). > > (2) An application must be made at least 10 days before the day during which the treatment order is due to expire, and is invalid if it is not. > > (3) An application is to be in accordance with section 195 and be accompanied by - > > (a) a copy of the treatment order; and > > (b) particulars of any recommended change in treatment; and > > (ba) particulars of any recommended change to the treatment setting; and > > (c) a statement by the applicant affirming that (and explaining how) the patient continues to meet the treatment criteria and is expected to continue to meet those criteria for the period of renewal. > > (4) An applicant for the renewal of a treatment order - > > (a) is to give a copy of the application to the patient (together with a statement of rights in a form approved by the President of the Tribunal); and > > (b) is - > > (i) to give a copy of the application to the treating medical practitioner (if it is someone other than the applicant); and > > (ii) to give a copy of the application to the CCP; and > > (iii) if the patient is in, or is expected to be in, an approved facility, to give a copy of the application to the controlling authority of that facility; and > > (c) is to place a copy of the application (and accompanying documentation) on the patient's clinical record. > > (5) The Tribunal is to determine an application as soon as practicable after it is made and must do so by way of a hearing. > > (6) To avoid doubt, a treatment order may only be renewed if it is still in effect. > > (7) A treatment order in respect of a person may only be renewed if the Tribunal is satisfied that - > > (a) the applicant has complied with subsection (4) ; and > > (b) the person meets the treatment criteria. > > (8) Under this section, a treatment order may be renewed for - > > (a) if it has not previously been renewed, a period not exceeding 6 months; or > > (b) in any other case, a period not exceeding 12 months. > > (9) On renewing a treatment order, the Tribunal is to - > > (a) give notice of the renewal to the patient (together with a statement of rights in a form approved by the President of the Tribunal); and > > (b) give notice of the renewal to - > > (i) the applicant; and > > (ii) the treating medical practitioner (if it is someone other than the applicant); and > > (iii) if the patient is in, or is expected to be in, an approved facility, the controlling authority of that facility; and > > (iv) the CCP. > > (10) A notice under subsection (9) is to specify the period of renewal.

The Tribunal must be satisfied the person meets the treatment criteria in order to renew a treatment order. The treatment criteria are defined in s 40 of the Act:

40. Treatment criteria > > The treatment criteria in relation to a person are - > > (a) the person has a mental illness; and > > (b) without treatment, the mental illness will, or is likely to, seriously harm - > > (i) the person's health or safety; or > > (ii) the safety of other persons; and > > (c) the treatment will be appropriate and effective in terms of the outcomes referred to in section 6(1); and > > (d) the treatment cannot be adequately given except under a treatment order; and > > (e) the person does not have decision-making capacity.

Further, in determining whether to exercise a discretion to renew a treatment order under s 48, or make any other order, 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.

The Tribunal is mindful also of the rights of patients, as outlined in the Act. Section 15A of the Act sets out the rights of patients, as follows:

15A. Rights of patients > > (1) Each person receiving an assessment or treatment under this Act has the following rights: > > (a) the right to receive the assessment, or treatment, under this Act in accordance with the mental health service delivery principles; > > (b) the right to have any restriction on, or interference with, the person's dignity, rights and freedoms to be limited as much as possible when taking into account the person's health and safety and the safety of others; > > (c) the right to promote, and make prominent, the person's decision-making capacity, and to respect the person's wishes, to the maximum extent possible when taking into account the person's health and safety and the safety of others; > > (d) the right to be given clear, accurate and timely information about - > > (i) the person's rights as a patient; and > > (ii) the person's diagnosis and treatment. > > (2) In addition to the rights under subsection (1) , a person who is a forensic patient, or involuntary patient, also has the following rights while admitted to an approved facility: > > (a) the right to be detained in a manner that is appropriate in respect of the patient's assessment, treatment or care requirements; > > (b) the right to be given clear and timely information about the rules, and conditions, governing the patient's conduct in the relevant approved facility, including any relevant context in respect of a change in those rules or conditions while the patient is at the relevant approved facility; > > (c) the right to have access to current information about local, national and world events; > > (d) the right to ask for a leave of absence from the relevant approved facility; > > (e) the right to seek legal advice and have contact with, including the right to correspond privately with, Official Visitors and the patient's representatives and support persons; > > (f) the right to be provided with general health care; > > (g) the right not to be unreasonably deprived of any necessary physical or communication aids; > > (h) the right - > > (i) to wear suitable clothing of the patient's own, if appropriate in the relevant approved facility; or > > (ii) to be provided with basic clean clothing that is appropriate to the climate and the patient's size; > > (i) the right to be provided with - > > (i) food that is adequate to maintain the health and wellbeing of the patient; and > > (ii) a diet that has reasonable variation; and > > (iii) special dietary food, if the Chief Psychiatrist is satisfied that it is necessary for medical reasons, the patient's religious beliefs or the patient's dietary practices; > > (j) the right to adequate toilet and sanitary arrangements; > > (k) the right to adequate light and ventilation; > > (l) the right - > > (i) to practise a religion, or custom, in accordance with the patient's religious or cultural beliefs; and > > (ii) if consistent with the management and security requirements of the relevant approved facility - > > (A) to join with other patients in practising the religion or custom; and > > (B) to possess such articles as are reasonably necessary for the practice of the religion or custom; > > (m) the right to ask for, and receive, such reasonable help from the staff of the relevant approved facility so as to enable the patient to enjoy the rights specified in this section.

In exercising its responsibilities under the Act, the Tribunal must also have regard to the mental health service delivery principles set out in Schedule 1 of the Act (s 15: see B v Mental Health Tribunal [2020] TASSC 10 at [39] and CMB v Mental Health Tribunal [2021] TASFC 4 at [31]). The principles set out in Schedule 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.

1. Section 10 of the TASCAT Act outlines the main objectives of the Tribunal:

10. Main objectives of Tribunal > > (1) The main objectives of the Tribunal in dealing with matters within its jurisdiction are - > > (a) in the exercise of its jurisdiction, to promote the best principles of public administration, including - > > (i) independence in decision-making; and > > (ii) natural justice and procedural fairness; and > > (iii) high-quality, consistent decision-making; and > > (iv) transparency and accountability in the performance and exercise of statutory functions, powers and duties; and > > (b) to be accessible by being easy to find and easy to access, and to be responsive to parties, especially people with greater needs for assistance than others; and > > (c) to ensure that applications, referrals, reviews and appeals are processed and resolved as quickly as possible while achieving a just outcome, including by resolving disputes through high-quality processes and the use of alternative dispute resolution processes, or compulsory conferences, wherever appropriate; and > > (d) to keep costs to parties involved in proceedings before the Tribunal to a minimum insofar as is just and appropriate; and > > (e) to use straightforward language and procedures (including, insofar as is reasonably practicable and appropriate, by using simple and standardised forms); and > > (f) to act with as little formality and technicality as possible, including by informing itself in the manner that the Tribunal thinks fit; and > > (g) to be flexible in the way in which the Tribunal conducts its business and to adjust its procedures to best fit the circumstances of a particular case or a particular jurisdiction. > > (2) In furtherance of the Tribunal's main objectives, the Tribunal should, in relation to the conferral and exercise of the Tribunal's jurisdiction, consult from time to time with the agencies, organisations or bodies that it thinks appropriate.

1. As outlined in the applicable legislation summarised above, the Tribunal must be satisfied of a number of procedural matters before turning to the issue of whether the patient meets the treatment criteria.

1. The documents filed in the proceedings by the applicant indicated that each of the procedural matters had been satisfied. It appeared to the Tribunal that:
   1. the applicant is an approved medical practitioner as defined in s 138 of the Act (for the purpose of s 48(1));
   2. the application was:
      1. made at least 10 days before the day on which the treatment order expires, noting that to "make" the application, the applicant is to file the application with the Tribunal;
      2. made on the approved form;
      3. the information referred to in s 48(3) accompanied the application made to the Tribunal, as required;
      4. included a statement by the applicant explaining how, in his view, the patient satisfied the treatment criteria;
      5. copies of the application, together with a statement of rights was provided by the applicant to the patient, and any other required person, and a copy placed on his clinical records (s 48(4)).

1. The applicant's documentary evidence was contained primarily in the application for renewal completed by Dr GT dated 7 July 2025 and the report by Dr KQ dated 28 July 2025.

1. Dr GT, the applicant, stated at hearing that unfortunately, following MDG's discharge from hospital, after the episode leading to the three-week hospital admission in January, the community treating team had not been able to have a face-to-face review with MDG. There was one attempt at this in March 2025 in which Dr KQ briefly met with MDG but at that time, Dr KQ formed the view that MDG needed a bit more time in a contained environment in respect to his then current episode. He explained that the readmission paperwork was completed but that MDG has not been able to be located since then.

1. The application provides that Dr GT had formed the view that the treatment criteria had been met, based on two reviews conducted by Dr GT with MDG by telephone, with the application addressing each criterion individually.

1. In the application, in summary, Dr GT stated MDG met the s 40 treatment criteria in that:
   1. MDG has received a diagnosis of an acute psychotic episode. Dr GT said this:

is likely to be a late-onset First Episode Psychosis in context of ongoing psychotic symptoms. There have been some definitive affective symptoms noted as well, however, we have unfortunately not been able to review [MDG] face-to-face to further ascertain these.

1. Relevant to whether there is a risk of serious harm to self or others if MDG is not treated, Dr GT stated in his application that MDG's risk of deterioration in mental health remains chronically elevated given he is unable to be located and has been non-compliant with medication. Dr GT explained that MDG's:

current mental state reveals ongoing psychosis with delusions of grandeur believing his is a prophet and that he receives messages from a Higher Power. He has significant paranoid and persecutory delusions, in particular towards healthcare workers, and emergency services workers. He has made specific threats of harms to the police officer involved with his case prior to his admission. He has also made threats towards certain staff members of OPMHS and paramedics in the context of his paranoia.

1. As to whether the treatment is appropriate and effective for MDG, Dr GT stated in his application that treatment is proposed to be through OPMHS [Older Persons Mental Health Services] or at [an approved facility] if requiring admission. He explained that the current treatment prescribed is Risperidone 2mg daily but following a readmission, it is proposed that MDG would be commenced on a long-acting injectable antipsychotic medication to ensure compliance. He explained the side effects of the medication, although the Tribunal understood this to be the possible side effects, not the actual side effects given MDG was not receiving the medication. Future treatment would also include:
   • readmission with a view to optimising medication and containment of risk.
   • Standard blood tests for metabolic screening.
   • Urine tests to detect drugs or "inter current infection"
   • ECG to evaluate for cardiac complications of treatment
   • Radiological imagining if appropriate

As to why the future treatment would be appropriate and effective, Dr GT says:

... Commencing on a LAI [long acting injectable] antipsychotic medication will ensure compliance and improvement in mental state and the risks associated with it.

1. Relevant to whether treatment could be given to MDG without a treatment order, Dr GT says that MDG refuses to take any ongoing medications and has essentially been off treatment since discharge from the hospital. He also explained that MDG refuses face-to-face contact as he "does not wish to associate himself with the OPMHS team as he believes they serve an agenda of their own". He also said MDG does not believe that he has a mental illness.

1. And relevant to whether the patient has decision making capacity, Dr GT said:

[MDG] explained multiple times about his diagnosis but he remains certain that he does not have any mental illness and is unable to fully understand information provided to him due to his current mental state.

[MDG] has been explained multiple times about the need for ongoing treatment but unfortunately he is unable to retain that information.

[MDG] does not believe that his current actions are due to a mental illness. He remains adamant that this is his baseline and that he is stressed because of the admission in January 2024.

[MDG] is briefly able to understand information but unfortunately due to hsi [sic] current mental state, he does not believe it and his communication is mostly around the paranoia he has with healthcare workers and the medications being prescribed.

1. As noted above, the Tribunal had been provided with a report by Dr KQ, a consultant with the treating team, dated 28 July 2025. Dr KQ explained that attempts to arrange a direct review had been made, since the Tribunal's direction to make such attempts on 17 July 2025. MDG continued to decline this but did agree to a phone review, which was conducted with his current case manager, BC, on 24 July 2025. He said the "phone assessment was lengthy, with significant circumstantiality and difficult to follow history and limited ability to direct the same."

1. By way of background, Dr KQ described MDG's admission in January to have related to symptoms including grandiose, persecutory and religious delusions, thought disorder, thought insertion, broadcasting and increased stream of thought, behaviour influenced by delusional beliefs, impact to insight and judgement, as well as elevated mood, disinhibition, overfamiliarity and drive, amongst other symptoms. Noted concerns at the time related to irritability, marital breakdown, court/legal requirements, engagement with his general practitioner and concerns as to driving. He was treated with oral antipsychotic medication and noted to gradually improve, including reduction in intensity of delusions, impact upon behaviours, engagement and overall reduction in irritability and abnormal elevated drive. Dr KQ summarised that a "significant change in [MDG's] mental state" was noted.

1. Dr KQ provided an extract from his notes following a review on 12 March 2025. He noted his impression was a "mixed picture in [MDG] with certainly strong psychotic elements to his presentation which also have pronounced affective aspect in addition". MDG had reported he had ceased medication 2 weeks prior to the review but Dr KQ suspected non-compliance had been longer noting the relapse in severity of symptoms. Dr KQ formed the view that treatment and management was "unlikely to succeed in the outpatient setting" and noting the high risks of misadventure, and repercussions financially, legally, physically and psychiatrically, Dr KQ determined at that time that readmission was required. Dr KQ explained that since then, MDG has become increasingly "caustic and antagonistic towards many members of the mental health service, police, paramedics and his general practitioner."

1. Dr KQ referred then to notes taken by Dr GT at his review on 7 July 2025 in which he noted that MDG had ongoing psychotic symptoms in the nature of paranoid and persecutory delusions towards healthcare workers and the police and made threats towards them during the review, resulting in him having elevated risk.

1. As to the review of 24 July 2025, Dr KQ reported that MDG expressed the view that the purpose of the order was for him to be admitted to a psychiatric facility and "injected with poison". He made clear his belief that medications would and could destroy his body. Regarding his admission in January, MDG reported this had followed assessment for his licence and deception was used to admit him. MDG believed the reason was purely to fill beds on the ward and employ staff. In exploring aspects of his psychosis, MDG gave an "unclear rambling" focused on his ex-wife, the police and health and other professionals in a persecutory fashion, with a significant aspect being held with delusional intensity. Dr KQ gave examples of MDG believing he had a connection with a higher power, providing him with certain abilities of perception, healing or prediction.

1. Dr KQ went on to then specifically address the s 40 treatment criteria in his report. Which can be summarised as follows:

1. MDG appears, from history and assessment of Dr KQ and others, to have a psychotic disorder, evident from disturbed behaviour, formal thought disorder, delusions and impact on function over several months;
2. MDG has demonstrated benefit whilst receiving treatment and relapse of psychosis when antipsychotics were ceased, this being highly likely to continue and likely to aggravate the duration and likelihood of severity into the future;
3. MDG was initially treated with widely recognised antipsychotic medication (risperidone and olanzapine) initially and had had a notable decline in mental state since ceasing the medications, indicating effectiveness if taken as prescribed;
4. MDG has disengaged with mental health services other than by phone, despite multiple options for engagement being provided to him. Any engagement is only possible under a treatment order; and
5. MDG has impairment in decision making related directly to his ongoing psychosis. He disagrees with his diagnosis likely directly due to his delusions. Retention of information is poor, as is his ability to weigh information. MDG does not appear to understand the role of treatment in this condition.

1. Dr KQ conceded that MDG's psychosis was less severe than his pre-admission state but observed it appeared to be fluctuating between his review and Dr GT's earlier in July. It remained the case, however, in the doctor's view, that psychosis was still present.

1. Dr GT gave evidence on behalf of the treating team at the hearing, which was consistent with the application he submitted, as detailed at [19] - [21] above. In addition to those matters, Dr GT further explained that MDG has mentioned multiple times that he is a prophet, receiving messages from a higher power. The team were "okay" with this, however, on the last review, MDG stated that if he finds the person or the police or paramedics that were involved with a situation with his ex-wife, he was going to harm them. He said that he has the names of the detectives and police and that he would "beat them with his own bare hands". The team took this seriously and considered there was a change in his mental state as he had not mentioned anything of that nature before. MDG has also made overt comments about members of the service (which the Tribunal takes to mean the community mental health service) necessitating the team to ensure that certain members of staff are not present when he has appointments (even if he does not attend) so as not to "aggravate" things for MDG. Dr GT said that MDG advised him many times he would not take any medication. He explained there has been many attempts to discuss this with MDG as to whether there was a medication he would prefer but that MDG has said there is no medication he would take because all of this has been misconstrued and "made up" by the mental health service.

1. Finally, as to decision making capacity, Dr GT said that MDG has a "fair degree of thought disorder" and that MDG gets quite angry and agitated when talking about what led to his admission as he believes he was admitted to the hospital under false pretences and that this was all an elaborate lie made up by the doctors. The team believe that his ability to weigh the risks and benefits of ongoing management is quite poor secondary to the ongoing mental illness, and this prevents him from absorbing this information. Dr GT said that the team obtained some collateral from MDG's son who said that when MDG was taking medication, it was a lot easier to have discussions with him and easier for him to absorb information without interrupting or being argumentative. The team considered this objective evidence of the effectiveness of the treatment.

1. Upon questioning from the panel as to whether aggression has been observed, Dr GT explained it has not because the team have not met with MDG face to face since the brief review by Dr KQ in March as MDG left his home and has not been located by the police since. Dr GT also further explained the need for a mood stabiliser. He said that although this was labelled a first episode psychosis during the hospital admission, each subsequent review has revealed a mood component. The mood stabilisers would be used to flatten the highs and lows of the mood component and maintain MDG at his baseline.

1. Ms Olsson questioned Dr GT as to what information the team have to inform them as to his baseline. Dr GT explained they have had multiple conversations with MDG's son to establish this. MDG's son mentioned that, at his baseline, his father is a "strong opinioned gentleman", quite black and white, but is able to have a reasonable conversation. He can listen even if he doesn't agree, without being constantly argumentative. MDG's son advised that the idea of him being a prophet has been mentioned time and again, possibly for the past five to eight years. However, it wasn't this intense and he was generally able to keep it to himself, but it has now become more overt.

1. In response to a question from Ms Olsson about whether any testing had been done to rule out organic causes, Dr GT said that MDG had two CT scans (one in December, just prior to his presentation and one in February) and an MRI during his admission, which revealed nothing untoward that might be contributing to this episode.

1. Dr KQ also gave evidence, which was consistent with his report of 28 July 2025. Dr KQ had conducted the most recent review of MDG, albeit it was again by telephone. Dr KQ had also conducted the face to face review in March at which it was determined that MDG required a further hospital admission as he was quite active, driven, irritable and persecuted. Dr KQ explained that the need for diagnostic clarity arises from the significant limitations of only having contact with MDG by telephone. Dr KQ noted that whilst MDG was relating quite a lot of "relatively bizarre material" at the review on 24 July 2025, the active threats and aggression wasn't so much part of that call as had been observed by Dr GT during the previous review. He described MDG as fluctuating.

1. Dr KQ explained that the treating team applied for the renewal, even in the context of limited engagement as the risks were significant. He said that given the risks, the team felt it would be unethical not to apply for a renewal.

1. Dr KQ was of the view that treatment cannot be given unless under a treatment order and that MDG lacks understanding of why he came into hospital and what the risks were at that time. This was related to his very strongly held beliefs, some of which could be overvalued ideas but others appear as delusional in quality. Dr KG's view is that his behaviours are influenced directly by these ideas. He said there was a very "obvious and notable change" when MDG was off the medication. He said there is no doubt there is mental illness but where diagnostic clarity is required is in respect to the mood component versus psychosis.

1. Upon questioning from the Tribunal as to how MDG first came to the attention of the mental health service, Dr KQ said that it was a referral from his general practitioner regarding concerns around his driving and his mental state, and his wife at the time had been calling the police. There had been some legal proceedings coming about that and MDG had been becoming quite paranoid about the dealings of his wife and police as well so there were "a few things going on". He said that MDG was transported to hospital after having some difficulty getting him to come in, and this is where MDG references a lot of the deception about how he was placed initially in hospital. He was quite elevated at the time and, Dr KQ opined his memories are quite crowded. Dr KQ was not able to clarify the circumstances in respect to the issue with MDG's ex-wife prior to admission as he said the team had been given different stories about that from MDG and from family and the situation was unclear.

1. Regarding the issue of whether there are any other contributing factors, Dr KQ opined that given his time in hospital and the severity of his symptoms of thought disorder, delusions and altered behaviour, this was beyond what you might expect to see with a paranoid personality disorder, noting also this has been going on for months now.

1. Dr KQ was asked by Ms Olsson if KQ would expect to have seen MDG come into contact with services by now, given he has been untreated since his discharge from hospital. Dr KQ said you would expect that but there are many hypotheticals. He said there are many people in the community with low grade residual psychotic symptoms who are untreated and rarely come to the attention of mental health services but who are still at a greater risk than the general population for a relapse of psychosis or an increase in severity of symptoms. He said it is impossible to tell what the person's risks are when the only contact had is by phone. Dr KQ said that a significant concern has been the making of threats to police or family or paramedics. Dr KQ later clarified it was more in the nature of derogatory comments about family but threats to police being related to this. This has made the treating team anxious about disengaging too early simply due to failure to access that person.

1. Ms Olsson continued her line of questioning, asking if Dr KQ whether he would expect for MDG to deteriorate further or whether he would plateau to somewhat of a baseline. Dr KQ answered that one can only work with statistics, rather than with any certainty. He said that once a person has had a relapse, or they have had a lengthy duration of any of the major mental illnesses, they are at increased risk of having that occur again. He said that there is certainly evidence to show that this has not been an episode that has been successfully treated.

1. BC, the case manager, also gave evidence. She relayed information provided by MDG's son to give context to MDG's deeply ingrained distrust with government services. Around twenty years ago, MDG had allegedly witnessed a police officer push a man down a flight of stairs, which was denied by police in court. This incident was extremely pivotal in establishing MDG's distrust and paranoia of government and health services. She said also that the circumstances around MDG being taken to the emergency department were "probably a little bit clunky", explaining that MDG was under the impression he was going for an assessment to get his licence back but he was admitted involuntarily. Further, regarding the suggestion that he fled his home, the situation is that the police broke into his home to conduct a welfare check and the front door was broken. The home is provided through Housing Tasmania and the door has not yet been repaired. BC also spoke of collateral from MDG's son that MDG speaks in a way that can be alarming to other people and may be interpreted as threatening but that MDG never has an intention of causing harm to anybody. She said that she has reservations about whether he has any actual plans or intention of carrying out any acts of harm but that it is clear that he has some beliefs and ideas that exist outside of social norms.

1. Upon questioning from the Tribunal about whether his use of provocative language and the words he uses could speak to a lack of insight about his behaviour, BC said that he could be unaware of how the language he uses can be perceived, or he could be aware of it and using it as a way to get his point across.

1. Dr KQ then said there is a spectrum where MDG will exaggerate or say things for effect but there are other statements beyond this which reflect underlying beliefs that are inconsistent with reality. Dr KQ said there is a range and that is where his discussion is around MDG's premorbid personality influencing his presentation. Dr KQ said the key is the severity of the presentation when he came to hospital, which was beyond what would be expected of someone with a vulnerable personality and who is angry about coming into contact with the mental health system.

1. Upon further questioning from the Tribunal, to summarise the assessments, Dr KQ confirmed that when he was observed in hospital, MDG met the criteria for psychosis. When Dr KQ himself spoke with MDG, there was evidence of delusional beliefs and psychosis. Dr GT also confirmed that there was evidence of psychotic symptoms when he spoke with him by telephone.

1. At the hearing, Ms Olsson said that she has extensive instructions to dispute what is in the written documentation and things said at this hearing and previous hearings. She said certainly, the vast majority of evidence is disputed by MDG. She said ultimately, her submission is that the Tribunal cannot be satisfied that all five of the treatment criteria are met and the Tribunal should dismiss the application to renew the treatment order. Ms Olsson's submissions included:
   1. MDG does not agree that he has a mental illness.
   2. As to whether the treatment is appropriate and effective, Ms Olsson sought to rely on the decision of the Tribunal in TI (Application for Treatment Order) [2022] TASCAT 31. Ms Olsson said that in that decision, the Tribunal stated at [54], that in considering whether treatment is appropriate, the Tribunal can consider factors that extend beyond the clinical efficacy of potential treatment and consider things such as a the distress that is caused by treatment and the proportionality of the harm of treatment in comparison to the harm that its seeking to remedy. She quoted from the decision at [57]:

where there was clear evidence that the efficacy of treatment was so low, or non-existent, in comparison to the actual, not predicted, harm being dealt to the patient by the existence of the coercive order itself.

1. Ms Olsson noted that in the case of TI, they did not find the situation existed but submitted that this case can be distinguished from the circumstances of that case. She submitted that MDG's case is unique in that the coercive nature of the treatment order and the ongoing threat or possibility of being readmitted to hospital has caused him to take quite extreme measures to disengage from all services which is causing a greater harm to his general health and well-being. MDG would no longer seek medical attention if he was unwell in any way. He would not call the police or an ambulance if he was in danger for fear of being taken back to hospital and readmitted to a mental health facility. He instructs he has become socially isolated and is not able to participate in any activities with his children. He has either seven or eight children, with three of those children of dependent age and who were living with him prior to his admission to hospital and subsequent itinerancy. She said he now does not have much involvement with his children, other than by phone, and is not able to support them financially because he is not working, which came about at a similar time to his admission.

1. Finally, she said that he had been living in his home until the police broke the door when attempting to execute the failure to comply [being authorisation to readmit the patient under s 47 of the Act] and MDG has been unable to return because it is still boarded up. She said this was the result of the perseverance of mental health services in trying to return him to hospital. Finally, she said that MDG feels that a readmission to an approved facility would be catastrophic to his wellbeing. Ms Olsson's submission is that the actual harm being dealt to MDG by the existence of the treatment order outweighs the efficacy of the treatment because in this case, he is not receiving any benefit.
2. Ms Olsson said it would have to be conceded that MDG could not be treated without being under a treatment order, although it is possible that without the threat of being returned to hospital, he may engage with the service. She said given that he is still speaking with the team be telephone, he has not disengaged entirely.
3. As to decision making capacity, Ms Olsson said the evidence is that MDG has a personality that might predispose him to coming across as abrasive or being quite a disagreeable person. He was upfront about his views and this openness demonstrates that he does have some insight into his views. MDG has a long-standing preference against medication and that is evidenced by his decision not to receive the COVID vaccine. She said that his views abut the mental health service may appear as persecutory but in Ms Olsson's submission that is to an extent a reasonably held belief. She said MDG had never had involvement with the service and his point of view is that the quality of his life has deteriorated significantly. The link that can be drawn between that engagement and his situation is now clear. His decision not to engage is based on his personal beliefs and his experience having now interacted with the service.

1. Ms Olsson concluded that even if the Tribunal were to be satisfied that all of the criteria had been met, it would be appropriate to exercise the Tribunal's discretion not to make a treatment order as it would be inconsistent with the objectives of the Act, the rights of patients under s 15A and the service delivery principles.

1. The Tribunal took the whole of the evidence before it into account, as well as the submissions made by Ms Olsson on behalf of MDG.

1. In making its decision the Tribunal found the medical evidence presented by the treating team persuasive. In considering all the evidence available the Tribunal was satisfied the evidence addressed all of the treatment criteria and the evidence of Dr GT and Dr KQ was compelling.

1. The Tribunal was satisfied that:
   1. The applicant was an approved medical practitioner; and
   2. The application for renewal was made on 9 July 2025 which was at least 10 days before the day during which the treatment order was to expire namely 23 July 2025;
   3. The application was in accordance with s 195 of the Act and was acco4mpanied by the relevant documents; and
   4. Copies of the application had been provided to all parties as required under s 48(4) of the Act.

1. The Tribunal accepted the evidence of Dr GT and Dr KQ in relation to the question of whether MDG had a mental illness. The evidence was that the treating team had "no doubt" there is a mental illness, albeit there is a need for diagnostic clarity to consider the issue of the observed mood component in the context of the psychosis.

1. MDG does not accept that he has a mental illness and asserts this is his baseline. His solicitor suggested in submissions that MDG's personality was such that his views may be perceived as persecutory, whereas there is some reasonable basis for MDG to have those strongly held beliefs.
2. Given the evidence before the Tribunal of psychosis before and during the hospital admission in January 2025, observations of continuing psychosis by Dr KQ in March and on 24 July 2025 and of Dr GT on two other occasions in July, the Tribunal was satisfied that MDG had a mental illness within the meaning of s 4, in the form of a psychotic illness, with a mood component also under consideration.
3. The Tribunal was satisfied the treatment criterion was met.

s 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 Tribunal received evidence of a significant risk of harm to both MDG and to others without treatment. That is, the treating team has observed a relapse of MDG's psychosis since his discharge from hospital and discontinuance of medication. Dr KQ explained that this relapse would 'aggravate' the duration and severity of future relapses. The Tribunal was also advised that MDG had made threats of harm to specific police officers and to mental health service staff, as well as more generally to police and paramedics involved in a situation relating to his ex-wife.
2. Through his solicitor, the Tribunal heard of a risk to MDG's family relationships, in that prior to his admission, some of his children resided with him, which is no longer the case, and that MDG is no longer able to work. This was put the Tribunal as a consequence of the existence of the treatment order and the intention of mental health services to readmit him to hospital. Evidence from the treating team was that there was a breakdown of MDG's marital relationship prior to his hospital admission, which involved police and an undefined "legal process" and that there had been an issue with his driver's licence such that he was not able to work.
3. The threshold for satisfaction of this criterion is fairly low. The Tribunal is of the view that a medical practitioner need not be satisfied of any risk to other persons, nor of any risk to the safety of the patient. It was sufficient if the practitioner was satisfied that, without treatment, the mental illness was likely to seriously harm the person's health, which of course includes the person's mental health. (See S v Mental Health Tribunal [2016] TASSC 34.

1. The Tribunal found that, without treatment, MDG's mental illness was likely to cause serious harm to his mental health and there would be a risk of serious harm to others given the threats made to police and mental health services staff.

1. The Tribunal was satisfied the treatment criterion was met.

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

1. The evidence before the Tribunal was that MDG is prescribed an antipsychotic medication, risperidone. In hospital, he had been receiving risperidone and olanzapine and was noted to have gradually improved, with an observed reduction in intensity of delusions, impact upon behaviours, engagement and overall reduction in irritability and abnormal elevated drive. Upon ceasing these medications, MDG "notably declined in his mental state", which clearly indicated the medications were effective and appropriate when taken as prescribed.

1. The Tribunal was advised that the proposed future treatment for MDG involved a readmission to hospital to optimise psychotropic medication and contain risks. There would also be medical investigations (such as standard blood tests, urine tests, ECT and imaging). Given the non-compliance with treatment, the team also consider a long acting injectable antipsychotic medication would be required.

1. Through his solicitor, MDG submitted that this was a case of the treatment order doing more harm than good. MDG had effectively fled his home out of fear of being returned to hospital and had become isolated from his family and disconnected from any services. He felt that being readmitted to hospital would be catastrophic to his well-being.

1. The Tribunal considered the previous Tribunal decision referred to by Ms Olsson and agrees with the position that there may be circumstances in which the Tribunal would consider whether treatment under a coercive treatment order would cause more harm to the patient than benefit. As was decided in that case, that might be the case where the efficacy of the treatment was so low, or non-existent, in comparison to the actual harm being caused by the existence of the coercive order. That is not the case in this instance. The benefit of the medication proposed by the treating team was demonstrated by the improvement in MDG's mental state in hospital when he was medicated. Dr KQ explained this improvement was to the point that he was able to be discharged to return to his home and be treated in the community.

1. The Tribunal considered the impact of the treatment order on MDG's well-being, as submitted by Ms Olsson, and acknowledges the distress to MDG in his fear of being re-admitted to hospital and also being treated with medication he considers to be poison. Evidence before the Tribunal was that some of the impacts on MDG's life, as described by Ms Olsson, were evident before the treatment order was in place and that other factors in MDG's distress are the direct result of the illness itself. If the illness is treated, MDG's delusions will be less intense or will resolve, as demonstrated during his hospital admission in January, and when that occurs his distress will also be reduced.

1. For the purposes of s 40(c) treatment would be 'appropriate and effective' if it was treatment directed towards the management of the ill effects of mental illness, or even just the monitoring of a person's mental state. The threshold for satisfaction of the criterion is fairly low. (See S v Mental Health Tribunal [2016] TASSC 34.

1. The treatment is clearly within the ambit of the definition of treatment under s 6 of the Act. The Tribunal was satisfied on the evidence the treatment was appropriate and effective treatment for MDG's mental illness.

1. The Tribunal was satisfied the treatment criterion was met.

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

1. The Tribunal found MDG lacked insight into his mental illness and treatment. The Tribunal found that as a direct result of the symptoms of his illness, including persecutory delusions, he was lacking in decision making capacity to understand the nature of his illness, including the reasons for his admission to [an approved facility], or to use and weigh the risks verses benefits of treatment verses non treatment. As a result, MDG does not believe he has a mental illness, nor that he requires treatment for the illness.

1. MDG has made it clear to the treating team, and to the Tribunal, through submissions from his solicitor, that he does not believe that he has mental illness. That being the case, it is highly unlikely that he would accept treatment as prescribed if he were not under an order.

1. The Tribunal found that treatment cannot be adequately given to MDG except under a treatment order.

1. The Tribunal was satisfied the treatment criterion was met.

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

1. The Tribunal accepted the expert opinion of Dr GT provided in the application regarding MDG's lack of decision making capacity as a result of his current mental state. Dr GT was of the view that he was unable to fully understand information provided to him about his diagnosis, unable to retain information that had been explained multiple times and unable to use and weigh information. Dr GT elaborated further that during his two reviews by telephone with Dr GT, MDG has consistently shown ongoing signs of psychosis with a mood component. Dr GT also said that MDG displayed a "fair degree of thought disorder" such that he was unable to have a reasonable discussion. Dr KQ gave further evidence as to capacity, stating that MDG's disagreement with his diagnosis or treatment was directly attributable to his expressed delusions.

1. The Tribunal was satisfied that the assessment of MDG's decision making capacity was evidence based and consistent with all of the information available to the treating team in respect to MDG.

1. The Tribunal found that, MDG is affected by the symptoms of his psychotic illness, particularly persecutory delusions, which impact his ability to understand the symptoms as part of his illness, or the reasons for his involvement with mental health services. The Tribunal accepts also that MDG is unable to retain the information given to him regarding his diagnosis or treatment. He is therefore not able to use the available information, about the benefits or risks of treatment versus non treatment to make treatment decisions. Due to his strongly held view that he has been persecuted, MDG is unable to apply information provided to him about the need for his treatment and in this way, is not able to use and weigh the information.

1. The Tribunal was satisfied the treatment criterion was met.

1. Having determined that each of the treatment criteria had been met, the Tribunal then considered the terms of the current order and the application for renewal of it and whether to exercise the discretion to renew the order.
2. Having weighed the risks of MDG not being treated, against his fear of being treated, the Tribunal determined that the treatment order would be renewed in respect of MDG for a period of 6 months commencing 23 July 2025 until 22 January 2026.
3. No variation was made to the order, so the terms of the renewal of treatment order were the same as what is specified at paragraph [9] above.