HSB [2025] VMHT 7 (14 March 2025)

The Tribunal made a community treatment order with a duration of 26 Weeks expiring on 13/08/2025.

After the hearing your treating team requested a written explanation of the Tribunal's decision. A copy of this statement of reasons will be given to your treating team as well as to you and your legal representative. While the statement of reasons was requested by your treating team, because it concerns you it is addressed to you.

This hearing was held because you were on a temporary treatment order due to end on 17/02/2025. The Tribunal had to have a hearing before the temporary treatment order expired to decide whether or not to make a treatment order.

2. The law the Tribunal had to apply to make a decision

To make this decision the Tribunal had to consider whether the compulsory treatment criteria applied to you. The compulsory treatment criteria are listed in the Mental Health and Wellbeing Act 2022 ('the Act') and are attached.

Under the Act the Tribunal must give proper consideration to the mental health and wellbeing principles ('principles'). Based on the information provided in your hearing and our understanding of your circumstances, the Tribunal identified the following principles were particularly relevant to its decision:

• Dignity and autonomy - you are willing to have treatment for your mental health and you accept medication has been helpful.
• Least restriction - you are very opposed to remaining in hospital but are willing to continue treatment in the community.
• Supported decision making - you have not made an advance statement of preferences about your treatment preferences.
• Dignity of risk- there is some risk that you could again become unwell if you leave hospital but there is a tolerable level of risk provided you continue treatment in the community.
• Cultural safety - you are an indigenous woman with connections in two different states.

The Tribunal must also give proper consideration to your rights under the Charter of Human Rights and Responsibilities Act 2006 ('the Charter'). Compulsory treatment engages and limits a number of human rights protected under the Charter including privacy, liberty, freedom from medical treatment without consent, and where a person is being treated in hospital, freedom of movement. To give proper consideration to your rights protected under the Charter, and whether limits on them are reasonable, the Tribunal must thoroughly examine three things:

• whether the compulsory treatment criteria apply to you;
• if it is making or confirming a treatment order, whether you can be treated in the community; and
• if authorised to do so, how long the treatment order should last.

3. Overview of the information provided to the Tribunal at the hearing

As you know your treating team prepared a report for your hearing that they gave to you and to the Tribunal, they also provided some documents extracted from your file. You read a statement you had prepared prior to the hearing as well. Both you and your treating team spoke to and answered questions from the Tribunal in the hearing. Your legal representative also made submissions on your behalf. This statement of reasons does not summarise all that information, but the next section refers to the information the Tribunal relied on to make its decision and explains why.

The Tribunal must have regard to your views and preferences. From what you told the Tribunal and the materials we read you accept that you have a mental health issue that needs treatment but you very much want to have the treatment in the community rather than remain in hospital. You are now in a good headspace and you acknowledge that your drug use has had a detrimental impact on your life and your mental health so you are now committed to not using any illicit substances. This time you were placed on an assessment order when you were put on bail by the Court, and you did not abscond from treatment as stated in the Report. A housing service has arranged accommodation for you when you leave hospital as you are unable to return to your previous Office of Housing accommodation. You are in a priority group for new State provided housing and hope to have new permanent accommodation in the next three to six months. Your mother recently passed away when you were in custody, but you hope to re-establish contact with your sister now that you are not using substances, as she has a young family. You want to keep taking the medication that has been prescribed for your mental health because it helps to keep you stable. You were willing to have treatment arranged by a particular community health service , but then the hospital became involved and you were admitted to hospital. You are currently on bail. When you were previously in custody it was because a person had accused you of offences that have not been proved, and this person has also previously made false allegations against you.

Your lawyer made submissions that you are now wanting to make a new start and turn your life around. You agree that you have a mental health condition for which you are willing to have treatment on a voluntary basis. A specialist service has arranged temporary accommodation for you, initially at a hotel and this is available now. There are also multiple additional services in place to support you. You are not a risk to yourself or anyone else and you strongly deny the allegation in the report that you were carrying a knife in public. You have also never received any financial compensation for past abuse. You have made many positive changes in your life. You have found being in hospital frustrating and traumatic but despite this you have complied with all recommended treatment. You are willing to continue to follow all recommendations from your treating team.

4. The Tribunal's decision about the compulsory treatment criteria

The following summarises what the Tribunal decided in relation to the four questions that need to be answered under the compulsory treatment criteria.

Your Report said that you have experienced mental illness which at times has involved a significant disturbance of thought, mood and perception. You experienced very significant trauma in your earlier life including abuse in foster care, sexual assaults, and multiple miscarriages, which have affected your mental health in adulthood. You have had over 40 admissions to hospital for mental health treatment. You have had multiple periods of incarceration since the early 2000's . This current admission to hospital came about after you absconded from a previous hospital admission (although it is noted that you dispute this). At times you have experienced distressing psychotic symptoms however this has not been observed during the current admission, although you have been guarded about this in discussions. On admission your mood was elevated and at times agitated, but this had settled with the reinstatement of anti-psychotic medication.

This information was reiterated by AP during the hearing, who whilst he has not been your treating psychiatrist for the current admission, has treated you in previous admissions.

As noted above, you told the Tribunal you accept you have a mental illness and are willing to continue with recommended treatment and your lawyer r confirmed that this criterion for treatment was not disputed. The Tribunal was therefore satisfied that you have mental illness, characterised as a significant disturbance of thought, mood and perception.

(b) Does your mental illness mean you need to be treated now, to try and prevent your mental health or physical health seriously deteriorating; or to prevent serious harm to you or someone else?

Your Report said you needed immediate treatment to prevent a serious deterioration in your mental health, and to prevent serious harm to you and to others. In the past there has been significant self-harm and you have needed many admissions to hospital for treatment since first experiencing symptoms many years ago. Your treating team believe you are at risk of harm from misadventure and potentially from others, and you have had a long history of being incarcerated for various criminal offences. You damaged your previous Office of Housing accommodation by burning it , so you are now homeless. Over many years you have suffered many serious traumatic life experiences which have affected your mental health. You have had multiple previous serious suicide attempts and have put yourself in significant danger when you have been acutely unwell, for example running into traffic. In addition, when unwell your self-care deteriorates including you having inadequate oral intake and not having wounds attended to, which means your physical health is also at risk. Your use of substances has impacted significantly on your mental health, and during the current admission you had a medical episode after using methamphetamine.

It was apparent to the Tribunal that when you have not been receiving consistent mental health treatment and support you have quickly required admission to hospital for necessary treatment to be reinstated, and for necessary supports to be put in place. You have repeatedly suffered harm from misadventure and from others, and have had many interactions with the criminal justice system, all of which were at least partly a result of inadequately treated mental illness. Your vulnerability to using substances increases the risks to your mental and physical health. Whilst you told the Tribunal you had not used substances for the last three months, you recently had a medical episode in hospital after using methamphetamine. When the Tribunal raised this with you, you said you had forgotten about this.

For these reasons the Tribunal was satisfied that you need immediate treatment to prevent a serious deterioration in your mental and physical health, and to prevent serious harm to you. The Tribunal considered there was insufficient detailed evidence to be satisfied that you pose a risk of serious harm to another person.

(c) Will you receive immediate treatment if you are on a treatment order?

Your report said that your treatment plan includes mood stabilising and antipsychotic medication, and you will continue to receive medication as part of your treatment if you are on a treatment order.

Your treatment plan currently is for an admission to an extended care unit for rehabilitation once a bed becomes available. AP said you may need to be discharged from hospital and have treatment in the community whilst waiting for a bed in the extended care unit. This is discussed further below.

(d) Is there a less restrictive means than a treatment order that would enable you to receive immediate treatment?

Your lawyer submitted that you could be treated less restrictively, as a voluntary patient, as you are willing to continue to follow the advice of your treating team. You also told the Tribunal you are willing to continue treatment and will accept the recommendations of the doctors about what treatment you should have.

Whilst the Tribunal acknowledges you have good intentions to continue treatment, there was considerable clear evidence that when you have not been on a treatment order in the past you have not had consistent mental health treatment. You have also previously been lost to follow up many times after being discharged from hospital, and it has only been when you have either been readmitted to hospital or in custody that mental health services were able to engage you and ensure you received treatment with medication and other necessary psychosocial supports. On this basis the Tribunal was satisfied that, at the time of the hearing, there was no less restrictive way for you to receive necessary mental health treatment than a treatment order.

Given the Tribunal decided that all of the compulsory treatment criteria applied to you the Tribunal made a treatment order.

As noted above, your treating team have a plan for you to be admitted to an extended care unit for further treatment with a rehabilitation focus.

However, an inpatient treatment order places the greatest limits on your rights protected under the Charter. For this reason, the Act says that the Tribunal can only make an inpatient treatment order if it is satisfied that a person cannot be treated in the community.

Your treating team said they were seeking an inpatient treatment order so that you can be admitted to an extended care unit with a rehabilitation focus once a bed is available. This level of treatment is not available from a community mental health service. This would include engagement with alcohol and drug supports, occupational therapy, social work and psychology input, with an eventual discharge to National Disability Insurance Scheme (NDIS) supported accommodation, all in a safe and structured care setting.

You were very opposed to the plan for long term treatment in an inpatient setting. You said you had turned your life around and had made a commitment to abstain from substance use and that you would be very willing to continue treatment with a community mental health service.

Whilst your treating team's long-term plan appeared to represent optimum treatment, the mental health and wellbeing principles provide that decisions about a person's treatment and care must be provided with the least possible restriction of a person's rights, dignity and autonomy, and that their views and preferences should be key determinants of the nature of recovery and participation. The principles also provide that a person has the right to take reasonable risks to achieve personal growth, self-esteem and overall quality of life.

Placing due weight on these principles and your commitment to continue treatment once discharged from hospital, the Tribunal decided you should be given a further opportunity to have treatment in the community rather than in hospital and made a community treatment order.

The Act sets a maximum duration of six months for treatment orders. Your treating team requested a treatment order to run for six months.

The Tribunal decided to make an order for this six-month period, as you will very likely require ongoing intensive mental health treatment indefinitely. You have many significant barriers to achieving recovery and will need extensive ongoing psychosocial rehabilitation and support for an extended period of time.

Presiding member, on behalf of the Tribunal division.

Further information: Patients have the right to apply to the Tribunal at any time to have the Treatment Order revoked if they believe the treatment criteria no longer apply. Contact the Tribunal on 9032 3200 or toll free on 1800 242 703 (country callers only) or by email mht@mht.vic.gov.au for more information.

Parties have the right apply to the Victorian Civil and Administrative Tribunal (VCAT) for a review of the Tribunal's decision within 20 business days after either the Tribunal's determination or receiving a statement of reasons (whichever is the later). Contact VCAT on 1300 018 228 or by email humanrights@vcat.vic.gov.au for more information.

A 'party' is the person who is the subject of the hearing (the patient), their treating psychiatrist and any party joined by the Tribunal.

Mental Health and Wellbeing Act 2022 (Vic)

Section 4 Meaning of mental illness in this Act

(1) Mental illness is a medical condition that is characterised by a significant disturbance of thought, mood, perception or memory.

(2) A person is not to be considered to have mental illness by reason only of any one or more of the following -

(a) that the person expresses or refuses or fails to express a particular political opinion or belief;

(b) that the person expresses or refuses or fails to express a particular religious opinion or belief;

(c) that the person expresses or refuses or fails to express a particular philosophy;

(d) that the person expresses or refuses or fails to express a particular sexual preference, gender identity or sexual orientation;

(e) that the person engages in or refuses or fails to engage in a particular political activity;

(f) that the person engages in or refuses or fails to engage in a particular religious activity;

(g) that the person has engaged in a certain pattern of sexual behaviour;

(h) that the person engages in conduct that is contrary to community standards of acceptable conduct;

(i) that the person engages in illegal conduct;

(j) that the person engages in antisocial behaviour;

(k) that the person is intellectually disabled;

(l) that the person uses drugs or alcohol;

(m) that the person has a particular economic or social status or is a member of a particular cultural or racial group;

(n) that the person is or has previously been involved in family conflict;

(o) that the person is experiencing or has experienced psychological distress;

(p) that the person has previously been diagnosed with, or treated for, mental illness.

(3) Subsection (2)(l) does not prevent the serious temporary or permanent physiological, biochemical or psychological effects of using drugs or alcohol from being regarded as an indication that a person has mental illness.

The compulsory treatment criteria for a person to be made subject to a temporary treatment order or treatment order are that -

(a) the person has mental illness; and

(b) because the person has mental illness, the person needs immediate treatment to prevent -

(i) serious deterioration in the person's mental or physical health; or

(ii) serious harm to the person or to another person; and

(c) if the person is made subject to a temporary treatment order or treatment order, the immediate treatment will be provided to the person; and

(d) there are no less restrictive means reasonably available to enable the person to receive the immediate treatment.

(1) A person receives treatment for mental illness if professional skill is used -

(a) to remedy or alleviate the person's mental illness; or

(b) to alleviate the symptoms and reduce the ill effects of the person's mental illness.

(2) Treatment includes electroconvulsive treatment and neurosurgery.

(4) To avoid doubt, treatment means treatment for mental illness.