HKQ [2008] NSWGT 1 (14 January 2008)

Guardianship - man with psychiatric disability in hospital - decisions need to be made about accommodation and dental care - man unable to make decisions or consent to treatment - no available family members to act as guardian or person responsible - Public Guardian appointed

1. These Reasons for Decision are for the orders of the Tribunal made on 14 January 2008 concerning Mr HKQ.

1. The Tribunal appointed the Public Guardian as Mr HKQ's guardian for a period of 12 months to make decisions on his behalf about his accommodation, health care and medical and dental treatment as set out in the Tribunal's Order.
2. The Tribunal consented to the withdrawal of the application for a financial management order.

1. This was an application for the appointment of a guardian and financial manager for Mr HKQ under the Guardianship Act 1987. Both parts of the application were dealt with at the same hearing.
2. The application, dated 13 June 2007, was received by the Tribunal on 13 June 2007.
3. The applicant is Ms LAB, Care Coordinator, a public hospital.

1. Before the Tribunal can make a guardianship order it must be satisfied that:
   1. Mr HKQ is a person with a disability within the meaning of the Guardianship Act;
   2. because of that disability/those disabilities, Mr HKQ is totally or partially incapable of managing his person; and
   3. there is a need for a guardianship order to be made in relation to Mr HKQ.
2. To make a financial management order the Tribunal must be satisfied that:
   1. Mr HKQ is not capable of managing his affairs;
   2. there is a need for another person to manage the affairs of Mr HKQ on his behalf; and
   3. it is in the best interests of Mr HKQ that a financial management order be made.

1. Throughout the course of the hearing the Tribunal used its best endeavours to bring the parties to a settlement. These endeavours were partially successful.

1. Mr HKQ is aged 53 years old who lives in supported accommodation with a disability support organisation providing accommodation for the psychiatrically disabled in Newcastle. He is currently a patient at a public hospital. Mr HKQ has schizophrenia. A guardianship order was made on 3 December 2002 which lapsed on 8 December 2003. Ms LAB, Care Co-Ordinator from the public hospital, lodged the application for guardianship as decisions need to be made about Mr HKQ's accommodation. The present accommodation provided by the disability organisation is not suitable in providing for Mr HKQ's care needs and behaviours. A group home operated by the disability support organisation is proposed for Mr HKQ. Mr HKQ has not objected to the move but does change his mind from time to time about where he wishes to live. Ms LAB is also of the view that a guardian could provide consent to dental treatment that Mr HKQ needs. Ms LAB suggests that the Public Guardian be appointed as Mr HKQ does not have any relatives that assist him.
2. Dr Z, JMO at the public hospital, provided a report to the Tribunal dated 4 December 2007. The doctor advised that Mr HKQ has shown increased aggression, behavioural problems and self neglect. He has a history of schizophrenia and is cognitively impaired. Dr Z stated:
3. "This is a chronic decline cognitive function which impairs his decision-making ability..hence we are applying for guardianship from the tribunal."
4. Dr Y, Career Medical Officer in Psychiatry at the public hospital, provided a report to the Tribunal dated 7 January 2008. The doctor advised that Mr HKQ has chronic schizophrenia and developmental delay. Mr HKQ has been on clopixol and ziprasadone. Further, Dr Y stated:
5. "A new accommodation will help stabilise his conditions...Although he has improved in his mental state, HKQ continued to have disorganised behaviour and irritability and has needed PRN chlorpromazine, quetiapine and midazolam to control his agitation and hallucinations. He is unable to make an informed consent. It is also not in his best interest to be discharged to his current accommodation."
6. Mr HKQ has had 42 admissions to a public hospital.
7. Ms X, Care Co-Ordinator with a Mental Health Service, provided a report to the Tribunal dated 11 January 2008. Ms X advised that:
8. "I believe that HKQ to have a severe disability and that he is not capable of making informed decisions about medical issues, financial and accommodation. HKQ currently has a great deal of support and guidance from the group but it is recently recognised that HKQ needs much more. He is now to be supported 24 hours. In my opinion the appointment of a Public Guardian is appropriate and necessary for HKQ."
9. Ms W, Welfare Worker on a Ward at the public hospital, provided a report dated 3 December 2007. Ms W advised that:
10. "I have known HKQ, as a patient of the hospital, for about seven years. During this time I have noticed the fluctuations in his presentation and feel that he is deteriorating, both physically and mentally...HKQ has remained adamant about living alone, and has stated his dissatisfaction to me many times during hospital stays about living in supported accommodation and continues to ask that I find a Department of Housing flat for him...HKQ's teeth also require urgent attention as they are obviously decayed..I feel that it is important that HKQ has a Public Guardian as he is not competent in making decisions relating to his own care and well being. HKQ's family is no longer able to assist him. Public Guardianship would ensure that he receives adequate medical, psychiatric and dental care, and very importantly that he does not become homeless."
11. A psychological assessment undertaken in March 2005 by Ms V, Psychologist at the public hospital, concluded that Mr HKQ has a mild intellectual disability.
12. Mr U, from a support organisation, advised that 24 hour supported accommodation is available upon Mr HKQ's discharge from hospital. Mr HKQ will be able to participate in living skills programs and have contact with Life Without Barriers.
13. Mr T from the disability support organisation provided a report. He advised that Mr HKQ's treating GP, Dr S, conducted an annual health assessment on 21 September 2007. Mr HKQ has refused his hypertension medication and it has been recommended that Mr HKQ undergo a sleep study.
14. Mr HKQ did not object to the appointment of a guardian for himself. Persons present at the hearing all supported the application for the appointment of a guardian for Mr HKQ.
15. There are no available family members or other persons that can be considered for appointment as Mr HKQ's guardian. There is no family member that can act as person responsible.
16. The Tribunal decided that Mr HKQ has a disability, namely a psychiatric condition and an intellectual disability, that partially affects his capacity to manage his person. There is a decision that needs to be made concerning Mr HKQ's accommodation when he is discharged from hospital. There is 24 hour supported accommodation that is available at the disability support organisation. Mr HKQ varies in his views as to where he wishes to live. Ms W indicated that Mr HKQ has said that at times he wishes to live independently. Due to Mr HKQ's present mental health condition he is unable to weigh up his accommodation options. The Tribunal decided that there is a need for another person to be appointed as Mr HKQ's guardian. Mr HKQ is taking psychotropic medication that he will continue to take while living in the community. Mr HKQ needs dental treatment which will be undertaken soon. Dr Y is of the view that Mr HKQ is unable to consent to his medication. There may be a need for further health investigations to be undertaken including a sleep study. The Tribunal decided to appoint a guardian for Mr HKQ. As there is no family member or other person that can be considered for appointment the Tribunal appointed the Office of the Public Guardian as Mr HKQ's guardian. The Public Guardian is to have the functions of accommodation, health care and medical and dental consents. As this is an initial order for guardianship the Tribunal decided to review the order in twelve months time.

1. On 20 March 1997 the Mental Health Review Tribunal made a Protected Estates Order appointing the Office of the Protective Commissioner as Mr HKQ's financial manager. The order is continuing. In view of the current order the Tribunal asked Ms LAB whether she wished to withdraw her application for financial management. Ms LAB requested that her application be withdrawn. The Tribunal consented to the application being withdrawn.

1. The Tribunal appointed the Public Guardian as Mr HKQ's guardian for a period of 12 months to make decisions on his behalf about his accommodation, health care and medical and dental treatment as set out in the Tribunal's Order.
2. The Tribunal consented to the withdrawal of the application for a financial management order.