KUT [2025] VMHT 8 (22 April 2025)

After the hearing you 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.

This hearing was held because your treating team applied for another treatment order. The Tribunal had to have a hearing 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
• Least restriction
• Supported decision making
• Family and carers
• Dignity of risk
• Diversity

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, they also provided some documents extracted from your file. You provided a written submission to the Tribunal. 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, we understood that you were a man in your forties and lived at home with your mother. You were adamant that you did not experience any form of mental illness. You had never had any symptoms that could be attributed to a mental illness. You believed that the treatment you had been provided had caused you harm, including causing you to have diabetes. You said that you had good engagement with the treating team and did not lack insight into your mental health as the treating team claimed.

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.

There was a significant difference of opinion between you and the treating team.

As noted above, it was your view that you do not have a mental illness. In your submission, you explained that your father, before he passed away, made false claims to the treating team that you had been hitting family members and damaging the family home.

You said you have physical health issues that mean you are unable to work. You have been bothered by the treating team since 2009.

When asked why you believed the treating team would falsely say that you had a mental illness, you said it was so they could make money. The more people on orders there were, the more money they make.

You said that all your family and friends know that you don't have a mental illness and the treating team's involvement was causing lots of family problems.

You are a religious person and are concerned that your religious beliefs and manner of worship, is misunderstood as a mental illness.

The treating team had a very different view. The report stated that you were diagnosed with schizophrenia in 2003 and had multiple inpatient admissions to treat your illness. Your last admission was in early 2023. The diagnosis had been made based on observing you and talking to your close family members.

The report said that when unwell you exhibited symptoms of a mental illness. These included: Increased agitation and being verbally aggressive to your mother and threatening violence; persecutory delusions, namely beliefs you will be harmed; hearing voices stating that God has told you not to take medication and not to waste time going to the toilet; and a fixation that the medication is harming you. When unwell you also had poor self-care. The treating team were also of the view that you experienced what are known as negative symptoms of mental illness, inactivity, lack of enjoyment in life (anhedonia) and apathy (lack of motivation).

The report described how at the time of your last admission to hospital you were floridly psychotic. That is, they observed symptoms of psychosis.

When there is such a difference of opinion the Tribunal must consider the evidence that has been provided to it by everyone. We also took into account that the law says that you are not to be considered to have a mental illness because you express a particular religious belief or because you engage in particular religious activity.

We do not accept that that the treating team would misdiagnose you for profit. We note the lengthy time you have been engaged with mental health services and the fact that a number of different people over an extensive period of time, have observed you to have the symptoms of a mental illness. We understand that this is hard for you to accept but we also observe that often people have no memory of their symptoms when they recover.

We were satisfied that you had a significant disturbance of thought, mood and perception and therefore did have a mental illness.

(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 report noted, and TD confirmed at the hearing, that you were admitted to hospital in early 2023 because you were experiencing symptoms of a mental illness. At the time you were admitted to hospital you had not been taking your medication for a month. The treating team observed that when you started taking medication again, your symptoms improved. The report also noted that since leaving hospital and having regular medication, your mental state has remained stable.

We were satisfied that you need immediate treatment to prevent a serious deterioration in your mental health and therefore this criterion was met.

The treating team also stated that when you become unwell you have been aggressive to your family. No details were provided as to the seriousness of any harm your family members experienced, or the form that aggression took, other than verbal abuse. Although verbal abuse can be distressing, based on the material that was provided to us, we were not satisfied that you needed immediate treatment to prevent serious harm to someone else.

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

You are currently receiving treatment in the form of anti-psychotic depot injection. We were satisfied this will continue if you were on a treatment order.

You also have an NDIS package but you are reluctant to engage their services.

The treating team had also considered an admission to PARC (prevention and recovery care) that may assist you to develop skills to live more independently.

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

You said you would prefer to stay away from the treating team. You did not want to take the medication because it caused diabetes, and it is not natural. If you had to receive treatment you would prefer to be treated with vitamins and herbs. You thought that the people who made decisions about your mental health treatment were bad people.

You were also concerned that the harmful drugs were going into your body that God created. You believed all psychiatric drugs are one hundred per cent negative. You also said that you could not stand the needle as they hurt.

The treating team said that you had told them that you only attended appointments with them, and had the treatment, because you were on a treatment order.

We have given consideration to the principles, and we acknowledge that your dignity and autonomy is important and that you should be supported to exercise your rights. We understand that you find being subject to compulsory treatment is very distressing. We also appreciate that you feel that you are not being heard. In your written submission and when you spoke to us you made your views very clear.

You said that you found the treatment order very restrictive, and we note the principles require that treatment must be provided with the least restriction of your rights and with the aim of promoting your recovery. At the hearing we discussed with TD whether the treating team had taken into account the distress you experienced being on an order, when providing treatment. She indicated that the treating team had considered your distress at being on an order, but they were concerned about the serious risks if your mental illness was not treated. We also noted that prior to you admission in early 2023 the treating team had attempted to treat you more intensively in the community before admitting you to hospital as this was less restrictive.

The principles state you should be supported in making decisions about your treatment including services that are provided by NDIS and other treatments such as PARC. We were satisfied that the treating team was supporting you to make these decisions.

You live with your mother and she has been the subject of verbal abuse from you when you were unwell, she is to be supported in her role in decisions about your treatment and recovery.

The principles note you are entitled to the dignity of risk, that is you have the right to take reasonable risks. However, if you were to be wholly responsible for decisions about your treatment it appears that you would cease medication. The risk that you would suffer a relapse, based on what occurred when you stopped taking medication in the past is high, and in our view, not a reasonable risk.

You are a religious person, and the diversity principle requires that treatment you are provided should take into account your diverse needs. The treating team has not said, and we do not find, that the fact you are religious means you have a mental illness.

Due to the fact that you would not receive treatment for your mental illness if you were not on an order, we were satisfied that a less restrictive alternative to compulsory treatment was not available, and that this criterion was met.

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

There was no suggestion that your treatment could not be provided in the community and so the Tribunal 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 26 weeks. It appeared that at this stage you were not able to work together with the treating team as you did not trust them and thought they were bad people. You also did not see any need for any mental health treatment. For these reasons the Tribunal decided to make a 26-week order.

Twenty-six weeks is the longest this treatment order can last. Your treating doctor must revoke your treatment order at any time if they believe the treatment criteria no longer apply.

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.