Tasmanian Civil and Administrative Tribunal Act 2020, s 98.

B v Mental Health Tribunal [2020] TASSC 10;

CMB v Mental Health Tribunal [2021] TASFC 4;

S v Mental Health Tribunal [2016] TASSC 34.

Mr Toby MacGregor, Tasmanian Legal Aid, as Separate Representative

The decision has been anonymised for the purpose of publication

1. INQ (the patient) is a 19-year-old woman.
2. At the time of the application and hearing, INQ was an involuntary patient at [an approved facility].
3. On 5 September 2025, Dr BF (the applicant) filed with the Tasmanian Civil and Administrative Tribunal (the Tribunal) an application for a treatment order for the patient pursuant to s 37 of the Mental Health Act 2013 (the Act). In his application, Dr BF provided the following circumstantial overview:

19 year old female, previously known to paediatric services with a single admission in Feb 2022 for management of physical symptoms of an eating disorder. It is docimented (sic) that patient missusing (sic) substances and had an emerging borderline personality disorder. > > No past admission to the psychiatry wards > > she is single unemployed woman, and has no dependent homeless, currently staying with her father and his partner. > > Collateral from her mother(she works as a social worker for RHH) > > [The Patient] moved out from home when she was 14. She mixed up with the wrong peer group in high school and started doing drugs. She came home only when she was in a crisis... > > Current presentation: > > She was brought in by PACER when her father called 000 due to her altered behaviour. She earlier it (sic) the day before presentation she presented to Sexual Assault Unit to report that she was sexually assaulted, the clinician there found her to be odd. > > Patient was brought under a DFA with SASS concerned for psychosis, delusions, with patient thinking her parents were replaced by paedophile, she had bizarre thoughts and stated that her boyfriend raped her. Her father suspected she had used some substances. > > On Assessment while in ED: [the Patient] was grossly thought disordered, and was erratic in her behaviour and had bizarre thoughts about the events leading to this presentation. She stated that her father was raped when she rang, also thought that her father laced her drink with some substances. her affect was labile and fatuous, she was actively hallucinating but did not want to elaborate about her hallucinations.

4. Dr BF sought an interim treatment order pursuant to s 38 of the Act. On 5 September 2025, a single Member of the Tribunal made an interim treatment order, effective until 3:13pm on 5 September 2025, in relation to the patient in the following terms:

• (A) is authority for the patient to be admitted to and if necessary detained in an approved facility for the purposes of receiving treatment;
• (B) authorises a combination of treatment settings and the admission or readmission of the patient to those settings, including treatment in the community; and
• (C) authorises the following:

1. The patient is to take the following medication (depending on clinical indication): 1. Antipsychotic medication 2. Mood stabilising medication 3. Antidepressant medication 4. Benzodiazepine medication 5. Anticholinergic 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.

1. 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.
2. Adult Community Mental Health Service (ACMHS) appointments (inclusive of home visits as arranged when being treated in the community.
3. On 5 September 2025, a single member of the Tribunal made an order under s 98 of the Tasmanian Civil and Administration Act 2020 for INQ to be separately represented in relation to the application for treatment order. Brief reasons for that decision were provided. In summary, it was INQ's first involuntary admission for the treatment of a mental illness and noting her age and social demographics, she would benefit from the assistance of a separate representative to go through the documentation, provide her with advice regarding the legislation underlying the application and interim treatment order, and support her through the hearing process.
4. A Notice of Hearing was issued by the Tribunal advising that a hearing to determine the application for a treatment order would be held on 12 September 2025 before a three-member panel of the Tribunal.
5. The hearing proceeded as scheduled on 12 September 2025 and a treatment order was made. Brief oral reasons for the decision were given at the hearing.
6. Following the hearing, INQ submitted a written request for reasons for the orders made on 12 September 2025. These are our reasons.

1. The hearing was conducted by audio-visual link between the Tribunal Members and [an approved facility]. INQ attended the hearing from [an approved facility]. Dr QL attended the hearing from [an approved facility] on behalf of the applicant and the Patient's treating team, together with a nurse. Mr McGregor, the separate representative, attended the hearing from the Tribunal's premises in Hobart.
2. The application and associated supporting documentation were filed by the applicant and the patient's treating team prior to the hearing. No documentary evidence or submissions were provided by the patient.

Section 39 of the Act provides the Tribunal with authority to make a treatment order:

39. Determination of application for treatment order > > (1) The Tribunal may make a treatment order in respect of a person if, and only if, it is satisfied that - > > (a) an approved medical practitioner has applied for a treatment order in respect of the person; and > > (b) the requirements of section 37 have been met in respect of the application; and > > (c) the person meets the treatment criteria; and > > (d) a treatment plan has been prepared for the person; and > > (e) the requirements of section 53(2) appear to have been met with respect to the treatment plan. > > ...

Pursuant to s 39(1)(b), the Tribunal can be satisfied that a treatment order should be made where the application has fulfilled the requirements under s 37:

37. Application for treatment order > > (1) Any approved medical practitioner may apply to the Tribunal for a treatment order in respect of a person. > > (2) The application may be made whether or not the person is subject to an assessment order. > > (3) If the person is subject to an assessment order, the application should only be made if - > > (a) the applicant has assessed the person under the authority of the assessment order; and > > (b) the applicant is satisfied from the assessment that the person meets the treatment criteria. > > (4) If the person is not subject to an assessment order, the application should only be made if - > > (a) the person has been assessed by the applicant and one other approved medical practitioner, separately, within the preceding 7 days; and > > (b) the applicant and the other approved medical practitioner are both satisfied from their respective assessments that the person meets the treatment criteria. > > (5) The application in relation to a person is to be in accordance with section 195 and be accompanied by - > > (a) a statement by the applicant affirming that (and explaining how) the person meets the treatment criteria; and > > (b) . . . . . . . . > > (c) an indication as to whether an interim treatment order is needed; and > > (d) if the person is subject to an assessment order, a copy of that order. > > (6) The applicant is to - > > (a) give a copy of the application to the person (together with a statement of rights in a form approved by the President of the Tribunal); and > > (b) place a copy of the application (and accompanying documentation) on the person's clinical record (ensuring that such a clinical record is created if one does not already exist).

Further, we must be satisfied that the person the subject of the application meets the treatment criteria provided under s 40:

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.

We note that in relation to the requirement for a treatment plan, a treatment plan is defined under s 50 of the Act as an instrument which outlines the treatment the patient is to receive and in accordance with s 52, must be in a form approved by the Chief Civil Psychiatrist. Section 39(1)(e) prescribes that the Tribunal must be satisfied that the requirements of s 53(2) appear to have been met in relation to a treatment plan:

53. Preparation of treatment plan > > (2) In preparing a treatment plan, a medical practitioner - > > (a) is to consult the patient; and > > (b) may, after consulting the patient, consult such other persons as the medical practitioner thinks fit in the circumstances.

Further, in determining whether to make a treatment order pursuant to s 39, we need to be cognisant of the objects of the Act 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.

Finally, in exercising our responsibilities under the Act, we must refer 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]). Schedule 1 provides:

SCHEDULE 1 - Mental health service delivery principles > > 1. 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 including, but not limited to - > > (i) needs relating to culture, language, age, religion, gender, gender identity, sexual preference, sexuality or other personal factors; and > > (ii) in relation to patients who are Aboriginal persons or Torres Strait Islanders, that there is a recognition of and response to their distinct cultural and identity needs; and > > (iii) needs that require recognition of and response to relevant cultural and identity needs generally; and needs related to trauma-informed care; > > (e) to emphasise and value promotion, prevention and early detection and intervention; > > (f) to seek to bring about the best therapeutic outcomes, including the use of evidence-based care, 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, carers, children 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 decisions, including decisions about the person's assessment, treatment and recovery that involve a degree of risk; > > (k) to involve persons receiving services, and where appropriate their families, carers, children 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 and to have robust clinical governance and quality and safety processes; > > (q) to recognise and be responsive to national and international clinical, technical and human rights trends, developments and advances and meet the requirements to national accreditation; > > (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. In accordance with the provisions outlined above, we must be satisfied of a series of what are essentially important procedural matters prior to determining whether the patient meets the treatment criteria.
2. The documents filed by the applicant and the patient's treating team lead us to conclude that the procedural matters had been satisfied, specifically:

(a) the applicant is an approved medical practitioner pursuant to s 138 of the Act (s 39(1)(a));

(b) in circumstances where the patient is subject to an assessment order, the applicant has assessed the patient under the authority of the assessment order and is satisfied that the patient meets the treatment criteria (s 37(3)); and

(c) the application was: made on the approved form; included a statement by the applicant explaining how the patient satisfied the treatment criteria; indicated that an interim treatment order was required; accompanied with an assessment order; copies of the application together with a statement of rights were provided by the applicant to the patient; a copy had been placed on the patient's clinical records; and the applicant had made a note on the patient's clinical records of those actions (s 37(5),(6)); and

(d) a treatment plan has been prepared for the patient, such plan having been prepared by Dr QL dated 9 September 2025, and that the patient was consulted in the course of preparing the plan (s 39(1)(d)(e) and s 53(2)), albeit the doctor noted she had no insight into her mental state and just wanted to leave the hospital.

1. We now turn to an examination of the evidence and submissions as to whether the patient meets the treatment criteria.

The person has a mental illness pursuant to s 40(a)

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. In Dr BF's application for the order, he opined that the patient was suffering from a psychotic episode. He went on:

mostly Drug induced psychosis as collateral from both parents indicates on going substance use and on and off psychosis and fluctuation in her mood. and behaviour over the years. > > She may have a primary psychotic illness that was missed due to living away from the family home and the repetitive nature of her psychotic episodes. this may need further monitoring and mental health follow up to be confirmed. > > Currently: > > She is thought disordered, > > She is mood disordered. > > She has auditory hallucinations. > > She has paranoid delusions whith (sic) believes that her father laced her drink and may have sexually abused her in the past. > > She has delusions of misidentification: believes both her parents has (sic) different names and identities.

3. At the hearing, Dr QL said that INQ was quite paranoid when at home, mostly about the family. She said that INQ believes that her stepmother, her mother and her father are all actors, that she herself has many children, one of whom she keeps in touch with but the others have been taken away and also that her parents have taken out her eggs (which have been "transformed" into multiple children). Dr QL stated that INQ was presenting with psychotic symptoms only, no affective symptoms. She also said that INQ's urine drug screen had been negative for substance use and the patient said she had not been using substances while living with her father.
4. At the hearing, the patient did not wish to speak to this criteria. Mr MacGregor said that INQ had expressed to him that she did not wish to comment on the medical evidence or the incidents leading to the admission.
5. There is no evidential onus of proof on an applicant for a treatment order, or any other form of order sought by an applicant to be made by the Tribunal under the Act. Rather, in light of the protective nature of the jurisdiction being exercised, a commonsense approach to evidence should be taken. The approved medical practitioner as applicant, or other member of a patient's treating team supporting an application, must present evidence and information sufficient to enable the Tribunal to conclude, having taken account of the nature of the order requested and the consequences which might flow to the patient, that on the balance of probabilities each criterion required to enable an order to be made has been met.
6. Dr BF, in his written application and Dr QL at hearing, provided cogent evidence which explains why the view has been formed that the patient has a mental illness in the form of a psychosis. There was no dispute as to whether there was a mental illness. The Tribunal are satisfied to the requisite standard upon the evidence and information provided by the treating team, that the criterion in s 40(a) of the Act is met. That is, the patient has a mental illness as defined by the Act.

Without treatment, the mental illness will, or is likely to, seriously harm the person's health or safety; or the safety of other persons pursuant to s 40(b)

1. The issue for us to decide on this criterion was whether we could be satisfied that without treatment, the patient's mental illness will, or is likely to, seriously harm the patient's health and safety. This criterion has been the subject of interpretation by his Honour Blow CJ in two matters.
2. In S v Mental Health Tribunal [2016] TASSC 34, his Honour said at [22]:

The thresholds for the satisfaction of the criteria in s 40(b) and (c) are fairly low. To be satisfied as to (b), a medical practitioner need not be satisfied of any risk to other persons, nor of any risk to the safety of the patient. It is sufficient if the practitioner is satisfied that, without treatment, the mental illness is likely to seriously harm the person's health, which of course includes the person's mental health.

3. Subsequently, his Honour provided additional comments as to the interpretation of this criterion in the matter of B v Mental Health Tribunal (supra) 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.

4. In the application, Dr BF set out the risks to the patient if she were not treated as follows:

She is at risk of misadventure considering age and sex and homelessness while mentally disordered. > > Risk of further decline in mental state if goes untreated. > > Risk of harming others as reported to have anger issues in the past > > Risk of neglect and as episodically homeless with no contact with her parents.

5. At hearing, Dr QL spoke further to the risk of harm to INQ if she were untreated, explaining that her mental and physical health would deteriorate without treatment noting she was quite "dishevelled and disorganised" when she came in. She also noted there appeared to have been cognitive decline due to her decline into psychosis over a long period of time. Dr QL also mentioned that some members of INQ's family were quite fearful of her given past behaviours.
6. The patient did not wish to put anything forward regarding risk, nor did Mr MacGregor.
7. We are satisfied that the evidence indicates that without treatment the patient's mental and physical health is likely to further deteriorate, placing her at risk of serious harm in the context of her disorganised thought content and behaviours.

The treatment will be appropriate and effective in terms of the outcomes referred to in s 6(1) pursuant to s 40(c)

1. In determining whether to exercise the discretion to make a treatment order, we must be satisfied that the outcome of the proposed treatment is appropriate and effective with regard to the meaning of "treatment" in s 6(1) of the Act:

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. In the matter of S v Mental Health Tribunal (supra), his Honour Blow CJ provided commentary as to the interpretation of this criterion at [22] - [23]:

The thresholds for the satisfaction of the criteria in s 40(b) and (c) are fairly low...

Although s 40(c) uses the words "the treatment will be appropriate and effective", it is clear that the legislation is intended to apply to mentally ill individuals whose symptoms cannot be treated or ameliorated in any way. For the purposes of s 40(c) treatment will be "appropriate and effective" if it is treatment directed towards the management of the ill effects of mental illness, or even just the monitoring of a person's mental state: s 6(1)(b) and (d).

1. In the application, Dr BF outlines the current treatment to include antipsychotic medication (Olanzapine) and benzodiazepine medication (Diazepam), in an acute inpatient unit setting. Future treatment will involve titrating the current medication to clinical response, monitoring the response and further testing for a possible primary psychotic illness. Dr BF described this as evidence-based treatment for a recurrent psychotic illness with ongoing substance use. Dr BF stated the following expected outcomes:
   • - Improvement in mood, agitation and overall behaviour.
   • - Prevent further psychotic relapses.
   • - Support around maintaining sobriety.
2. At the hearing, Dr QL said that INQ was doing much better since she had been treated and contained in hospital. For example, whereas in the past she was constantly interrupting discussions around treatment, she was becoming more able to engage in those discussions. Dr QL also confirmed that a social worker had been involved with INQ's case. Dr QL also said that INQ had been more able to sleep, had been more cognisant and more organised in her thinking after having treatment. She said that the treating team were continuing to investigate whether there is any organic cause for her symptoms.
3. Mr MacGregor submitted that INQ had communicated to him that she does not believe that the current medication is working well for her and that she would like to change from Olanzapine to Clonazepam, explaining that she has had Clonazepam in the past and it has "worked for her".
4. As to that issue, Dr QL stated that Clonazepam cannot replace Olanzapine as Olanzapine is an antipsychotic medication. The Tribunal notes that Olanzapine is generally used for psychotic and mood disorders, whereas Clonazepam is a benzodiazepine medication, generally used for seizures and anxiety including panic and muscle spasms.
5. Mr MacGregor also said that INQ is happy to stay in hospital until she "finds a safe place to go", albeit she is not happy about how some of the nursing staff speak to her, or that there is a camera in the hospital. She has expressed that she would rather not have leave from the hospital with her parents. The patient herself shared with the Tribunal that she is just interested to know if she can go out on leave and if so, whether she can go out by herself.
6. We accepted the evidence as to the professional opinions of Dr BF and Dr QL that the treatment proposed in the application and being administered was appropriate and effective for the patient as defined in the Act and that such treatment would be within accepted treatment guidelines. The prescribed medications are directed towards the management of the ill effects of the patient's mental illness, which currently can only be managed in an approved facility with discharge to community management in due course. The Tribunal noted also that whilst Mr MacGregor put forward the patient's views, he accepted that this criterion was met if the treatment is to continue but with continued psychoeducation. This criterion is satisfied.

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

1. In the application for the treatment order, Dr BF provided the following opinion in relation to this criterion:

[The patient] has no capacity or insight around her current illness and is a risk of flight leaving her current living status with her father. It is very difficult to ensure compliance with any medication while in community with current mental status.

2. Dr QL, at the hearing, said that INQ cannot be treated without a treatment order because she does not understand that she has a mental health condition and needs to be in hospital and needs treatment.
3. Having accepted the evidence of the treating team that the patient is not yet able to understand her mental health condition and weigh information in respect to it, or the need to stay in hospital to receive treatment for it, we are satisfied that the required treatment cannot be currently given without the imposition of a treatment order. The patient is currently unable to give informed consent or be managed other than under a treatment order. We are satisfied that this criterion is made out by the evidence.

The person does not have decision-making capacity pursuant to s 40(e)

1. The Act defines 'decision-making capacity' in s 7:

7. Capacity of adults and children to make decisions about their own assessment and treatment > > (1) For the purposes of this Act, 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. In his application, Dr BF opined a view that the patient lacked decision making capacity, due to "significant disturbance in mood and thought characterised by elevated mood, paranoid delusions and bizarre delusions". He said further:

[The patient] has limited insight into her condition or situation that she is currently in. She does not understand the nature of the problem, course of events leading to admission and the rationale for treatment or management in the hospital. > > She is not able to retain information despite several attempts to engage in therapeutic conversation about the nature of the current mental state, rationale for the treatment and in-patient management. > > [The patient] is unable to weigh or balance the information provided to her about her diagnosis, treatment and risks associated with not having treatment. > > She does not have any issues in communicating her decision.

3. At the hearing, Dr QL stated that the most recent mental state examination had been two days prior to the hearing and was conducted with a consultant on the treating team. She explained further that INQ has been observed to be quite vague, quite perplexed and distracted. She opined that INQ is unable to retain or register information. She would ask the same question repeatedly and was focused only on going out of the hospital for a cigarette. She said that INQ was not able to communicate a decision in respect to treatment due to her ongoing symptoms of psychosis. For example, most of the time, her answers to the treating team's questions were "no comment". She was not able to be engaged. Dr QL opined that INQ is preoccupied and has both poverty of speech and poverty of thought. She also said that INQ was continuing to experience delusional misidentification in respect to her parents.
4. The Tribunal noted that at the beginning of the hearing, INQ stated to the Tribunal that her father was using a fake name and that her mother's name was [a renowned Hollywood actress's name] and that her mother was also using a fake name.
5. Mr MacGregor advised he did not take issue with any of the treatment criteria being met at that time.
6. The Tribunal received clear evidence that the patient's capacity to make treatment decisions was impacted by the symptoms of her psychotic illness, including poverty of thought, poverty of speech and delusions. As a result, she is unable to understand or use and weigh information in respect to her treatment decisions, or retain information or communicate information respect to those decisions. We accept the evidence of the treating team that the patient does not have decision making capacity, as defined by the Act, to make decisions as to the assessment and treatment of her mental health. This criterion is satisfied.

1. We are satisfied that the patient meets the treatment criteria. We are also satisfied that the other procedural matters have been met with as outlined under s 39 of the Act (see [18] above). Accordingly, we can proceed to decide whether to exercise the discretion to make a treatment order for the patient. We note that in exercising our discretion we need to consider the objects of the Act (in s 12) and the mental health delivery principles (in Sch 1).
2. We have concluded that the patient has a mental illness in the form of a psychosis. At present, we hold the view that the patient requires a treatment order to ensure that her mental illness is both treated and that she is kept under observation for the purpose of management of the illness. We deduced that INQ is currently incapable of making autonomous decisions about the treatment she requires for her mental illness. In expressing this view, we are guided by the analysis of Pearce J in CMB v Mental Health Tribunal (supra) at [31]:

Patients are to be subject to the least restriction, but only as far as is consistent with public safety and patient health, safety and welfare. Moreover, the submission that the terms of the legislation favour "patient autonomy" carry little weight when, at the relevant time, the patient is incapable of making an autonomous decision. In my view it is for the Tribunal to weigh the various, sometimes competing, considerations and to reach the appropriate balance.

3. We are satisfied that a treatment order should be made for the patient in the terms sought by the applicant for a period of six months, noting that unless the order is discharged sooner, it will be reviewed by the Tribunal within 60 days. We also note that without further involvement of the Tribunal, in the event that an approved medical practitioner assesses the patient as no longer meeting the treatment criteria provided in s 40 of the Act, then subject to s 49(3), the practitioner must discharge the treatment order we have made (s 49(2)) and has the authority to do so (s 49(1)(a)).

1. The treatment order, in the terms requested by the applicant, was issued on 12 September 2025 at 10.58am. The substantive provisions of the order were in identical terms to the interim treatment order made by the Tribunal on 5 September 2025 (see [4] above). The order was issued on the approved form and complied with the requirements under s 41 of the Act. The order will expire on 11 March 2026 unless discharged sooner, or renewed. The order has not been replicated in its entirety in these reasons to ensure that the identity of the patient is not disclosed as mandated by cl 11 of Pt 2 to Sch 4 of the Act.