JJV [2025] VMHT 6 (4 April 2025)

This hearing was held because you applied to have your Treatment order revoked (cancelled). The Tribunal had to have a hearing to decide whether or not an order should remain in place.

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 told the Tribunal that it was very important to you to retain responsibility for your treatment decisions.
• Least restriction - you explained you wanted to continue with treatment and the order was not needed for this to happen. You pointed out that you have the support of your family as well as plans to regularly see your private psychologist and general practitioner (GP).
• Family and carers - we considered the views and support of your family in relation to your care and treatment and noted that they were supportive of you managing your health without the need for a treatment order.
• Dignity of risk - we considered the risks involved if you were to be responsible for your own treatment decisions, and whether such risks are reasonable considering the duty of care of the health service.

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.

The mental health service must give you access to any documents in its possession that are connected to the hearing at least two business days before the hearing. If the treating psychiatrist believes information in those documents may cause serious harm to you or another person, they can apply to the Tribunal to deny you access to those documents.

Your treating psychiatrist applied to deny you access to a certain document. The Tribunal conducted a preliminary hearing to decide whether you could see those documents. Your lawyer attended this hearing.

The Tribunal decided by a majority decision that the document should be withheld from you because disclosure of the information may cause serious harm to you or another person. The Tribunal explained this decision to you when you joined the hearing.

4. 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. 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 accepted you have a mental illness and require treatment to prevent a serious deterioration in your mental health. You also agreed that you would receive treatment, however you stated that this could be done as a voluntary patient.

The Tribunal must also have regard to the views of your carer. Your father told the Tribunal that he supported your wish to receive treatment as a voluntary patient.

5. 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.

You have a history of interaction with mental health services since 2017 and have had four hospital admissions since that date. Your latest admission was in October 2024, where you presented as depressed with paranoid, bizarre and persecutorial thoughts.

You did not contest this criterion and agreed that you experience a significant disturbance of thought and mood and stated that the anti-psychotic medication you were on currently on helps you.

The Tribunal was satisfied that you have a mental illness characterised by a significant disturbance of thought and mood.

(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?

The treating team shared their view that you require treatment to prevent a serious deterioration in your mental health, stating that you were in the early stages of your recovery and that they suspected that you have had an untreated psychosis for some time. They also stated that without immediate treatment there was a risk to you through self-isolation and self-harm, as well as a risk of harm to others, as you have previously had homicidal thoughts towards your parents.

Although you disputed that you have had any recent homicidal thoughts, you acknowledged the risks in relation to the serious deterioration in your mental health should you not continue treatment, and did not contest this criterion.

The Tribunal accepted the evidence provided by yourself and your treating team that you needed immediate treatment to prevent a serious deterioration in your mental health, and serious harm to you. For this reason, the Tribunal was also satisfied in relation to this criterion and did not need to make a conclusion as to whether there was a risk of harm to others.

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

At the time of the hearing the treating team was providing treatment in the form of medication and case management; accordingly, we were satisfied that you would receive immediate treatment if on a treatment order.

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

The treating team were concerned about the risks should you disengage with treatment as a voluntary patient. Although they acknowledged that you are doing well and have transitioned to a stable dose of oral medication over the last four weeks, they also stated that you have previously self-ceased medication in the community and that you are still in the early stages of your recovery. They further questioned whether you had insight into your psychosis and therefore whether you would stick to treatment as recommended. The treating team recommend that you have 12 months of anti-psychotic medication in total with support from the community team, and stated their view that a treatment order would be a protective factor in ensuring your adherence to your treatment.

Contrary to this, you stated that you would continue to take the prescribed dose of medication now that you have been able to successfully transition to oral medicine, acknowledging that the medication is helpful to get rid of bizarre thinking and to keep you well. You also clarified that you are comfortable with your mother's role in supervising you taking your tablets. You further advised that you have been stable in the community for four months, and have now engaged a psychologist in the community who you see weekly. You stated that you would continue to meet with the community team fortnightly and attend on your GP also should you become a voluntary patient. You have recommenced studies and have the support of your parents. Your father told the Tribunal that he supported your wish to be voluntary and that this might be an important and necessary step for your recovery.

You acknowledged that there was no practical difference between the treatment you would have being on a treatment order and following through with the plan as a voluntary patient. However, you explained it was important to you to make treatment decisions on your own free will. You stated that in a symbolic sense, becoming a voluntary patient would be an endorsement of you and you state that this makes a difference to your well-being, as you would have a different perception of the treatment if you felt that you were responsible for decision-making.

The Tribunal considered carefully the evidence as to risk identified by the treating team and the principles under the Act and ultimately agreed with you that there was a less restrictive means than a treatment order that would enable you to receive immediate treatment. The Tribunal was persuaded by your evidence that you would continue treatment and engagement with the treating team, as well as evidence of the supports you have in the community from your parents to assist you to engage and also to identify early warning signs of any potential relapse.

Consequently, the Tribunal was not satisfied in relation to this criterion.

Given the Tribunal was not satisfied all the compulsory treatment criteria applied to you the Tribunal revoked your treatment order.

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.