(i) respect the informed consent of the person to the person's assessment and treatment, care or support including consent as expressed in an advance consent direction; and

(ii) support and allow the person to make the person's own decisions; and

(iii) be provided in a way that considers and respects the preferences of the person, including those expressed in an advance agreement; and

(iv) promote a person's capacity to determine the person's recovery from mental disorder or mental illness; and

(v) seek to bring about the best therapeutic outcomes for the person and promote the person's recovery; and

(vi) be therapeutic or diagnostic in nature for the benefit of the person, and never administered as punishment or for the benefit of someone other than the person; and

(vii) be delivered in a way that takes account of, and continues to build on, evidence of effective assessment and treatment, care or support; and

(viii) be provided in a way that ensures that the person is aware of the person's rights; and

(ix) facilitate appropriate involvement of close relatives, close friends and carers in treatment, care or support decisions in partnership with medical professionals; and

(x) acknowledge the impact of mental disorder and mental illness on the close relatives, close friends and carers of people with a mental disorder or mental illness; and

(xi) recognise the experience and knowledge of close relatives, close friends and carers about a person's mental disorder or mental illness; and

(xii) promote inclusive practices in treatment, care or support to engage families and carers in responding to a person's mental disorder or mental illness; and

(xiii) promote a high standard of skill and training for the people providing treatment, care or support.

1. The Chief Psychiatrist thus has a complicated responsibility, in regard to a person who is a voluntary patient but subject to conditions of release which provide a role to the Chief Psychiatrist, in terms of what treatments can be offered or directions it should issue. These challenges will need to be grappled with more proactively than has occurred in the recent past.
2. The subject person also has a responsibility to ensure that when living in the community he takes actions and puts in place arrangements to minimise any risks he poses to community safety. These include at a minimum abstaining from unprescribed substances and pursuing those treatments and programs identified by himself or experts in the field as necessary for his continued recovery. Regrettably, he has not shown in recent months that he is willing and able to take those steps which we are satisfied are necessary to avoid a likely risk to public safety[16].
3. The current circumstances demonstrate that since release from custody there is somewhat of an impasse between the subject person and the health teams, as to what programs supports and treatments are needed, what should be undertaken, and who should arrange and pay for them.
4. This impasse will need to be resolved by the collaborative preparation of a care plan or its equivalent, prepared individually. Whatever the Tribunal finds to be an acceptable plan for the subject person on release from custody, that plan will need to be implemented, and the implementation and compliance will need to be measurable and reliably measured[17].

b) The nature and extent of the person's mental illness including the effect it is likely to have on the person's behaviour in the future

5. The subject person has an established history of a mental illness. Past diagnoses have included schizophrenia, mixed personality disorder, PTSD, associated anxiety and depression, and substance abuse disorder.
6. The most recent medical opinion (provided in [2023] while he was in custody) is that the subject person suffers from schizophrenia, which is currently well treated and not symptomatic[18]. The evidence before the Tribunal suggests the subject person's mental illness is currently well-treated by fortnightly depot, however review by a psychiatrist is overdue.
7. When the subject person is unwell, this mental illness can affect his behaviour to the extent that he has previously killed someone.
8. We note that the subject person has in the past been diagnosed with substance abuse disorder. This is not a part of his current diagnosis, although we also note that while in custody the subject person declined to undergo urinalysis testing on several occasions, and the recent breach which we have found proven suggest non-prescribed substance use is a current issue.[19]
   1. Risk to the subject person's health or safety, and whether the person would be likely to do serious harm to others, if released
9. While it is not expressly referred to in this factor, we have considered the risk to the subject person's health and safety if he were again detained in custody. Apart from the delay to his back surgery caused by further incarceration, the subject person was graphic in explaining his fear that he would not survive a further stint in custody.
10. We have also considered the risk to public safety that the subject person poses if released - and specifically whether that is so high a risk as to be described as a finding that he is "likely to do serious harm to others".
11. We are satisfied that the subject person has been using unprescribed substances since his release from custody, and possibly while in custody.
12. The VOCC made cogent submissions about the established role of substance abuse in contributing to criminal behaviour. In this specific case, the evidence before the Supreme Court in [date] was that a contributor to the subject person's mental impairment for his serious offending was his use of non-prescribed substances. The consistent medical opinion is that substance use has been destabilising for the subject person in the past.
13. A consideration of the recent offending history demonstrates the point.
14. According to the ACT Mental Health Tribunal report of November 2022, after being permitted to reside in the community in 2019, the subject person in 2022 began to miss or delay mental health appointments and urine drug screens, culminating in his arrest in May 2022 and his being charged with a serious offence of violence. When arrested by the police he was in possession of two drivers' licences which were not his, and a quantity of methamphetamine. He was subsequently convicted of these offences.
15. The Tribunal relies on the findings and evidence before the courts which identified that drug usage contributes to the subject person's risk of offending and deteriorating mental health.
16. The Tribunal is satisfied that if the subject person remains living in the community under current conditions of release, as underpinned by the current practical arrangements, the subject person is on an almost inevitable trajectory to further violent offences.

d) Views of the VOCC and registered affected person

17. We have noted above the views expressed by the VOCC in their written and oral submissions, and view previously expressed by the registered affected person.

18. The term nominated by the Supreme Court in [date] will expire on [nominated term].

1. For these reasons, on 3 August 2023, the Tribunal revoked the order for release from detention, and ordered that the subject person to be detained in custody until further order of the Tribunal.
2. The parties were notified of these orders decision by email on 3 August 2023. The Tribunal was later advised that as required by the orders, the subject person surrendered himself to the AMC and was re-admitted to custody by close of business that day.

[1] Transcript of sentencing 3 April 2023, page 44

[2] Section 182(3) of the MH Act provides that a review triggered by a notice of contravention of conditions of release need not be conducted by way of a hearing, however given the seriousness of the alleged contravention and possible consequences the Tribunal decided to proceed in that way in this case.

[3] Dr Appleton is the head of biochemistry and toxicology at the Queensland Medical Laboratory, and also head of toxicology for the Healius group of laboratories which includes Laverty Pathology.

[4] Transcript of Hearing on 1 August 2023, page 52, line 32ff

[6] Transcript of hearing on 1 August 2023, page 90, line 29

[7] Unless very dilute, which this sample was not. Transcript of hearing on 1 August 2023, page 58, line 17ff

[8] Transcript of hearing on 1 August 2023, page 87, line 16ff

[9] Transcript of hearing on 1 August 2023, page 78, line 42ff

[10] Transcript of Hearing on 1 August 2023, page 76, line 15ff and page 77, line 20ff

[11] Accepting the subject person's most favourable estimate as to timing

[12] Transcript of Hearing on 1 August 2023, page 100 ff

[13] Transcript of Hearing on 1 August 2023, pages 100, 105 and 106

[14] The subject person's family surmised that the subject person might have downplayed his need for additional supports, in order to meet an expectation that he presents as "well" to authorities.

[15] Transcript of Hearing on 1 August 2023, page 101 ff; and written submission dated 25 May 2023

[16] The Tribunal notes that at the sentencing hearing on 3 April 2023, his solicitor submitted (at page 45) that the subject person planned on attending his GP the day after release to obtain a mental health plan for psychologist appointments. This clearly did not happen, and instead the subject person criticises the mental health team for not arranging a psychologist.

[17] The Tribunal is concerned that there was insufficient rigour by the Chief Psychiatrist in reviewing the drug test results, in that the presence of dexamphetamine was detected in the pathology results for 11 July 2023 but this was not raised with ACAT as required under the MH Act. If release is ordered in the future a more rigorous approach to interpreting the results of drug testing must be undertaken. At the minimum, a clinician with knowledge of the subject person's prescription medication and the ability to interpret pathology results must be given this task.

[18] Report of FOCIS clinical psychologist to Tribunal, 22 May 2022

[19] Report of FOCIS forensic psychiatrist and clinical psychologist to Tribunal, 11 November 2022