Mental Health Act 2013 (Tas); ss 4, 6, 7, 12, 15, 37, 38, 39, 40, 50, 52, 53, 195, Sch 1, Sch 4.

S v Mental Health Tribunal [2016] TASSC 34

B v Mental Health Tribunal [2020] TASSC 10

CMB v Mental Health Tribunal [2021] TASFC 4

The decision has been anonymised for the purpose of publication

1. LE is a 77 year old woman living in Southern Tasmania, with no previous history of treatment for mental illness, who lives with her former partner, XE, and they have two adult sons, ME and TE.
2. LE was referred to Older Persons Mental Health Service (OPMHS) in February 2025 due to concerns about changes in her mental health around October and November 2024.
3. On 29 April 2025 the applicant, Dr JO, assessed LE against the treatment criteria set out in s 40 of the Mental Health Act 2013 (Tas), (the Act), and found she met the treatment criteria. A second psychiatrist, Dr DM, assessed LE on 30 April 2025 and also found she met the criteria.
4. On 1 May 2025 the Tasmanian Civil and Administrative Tribunal (the Tribunal) received an application for treatment order from Dr JO for LE pursuant to s 37(4) of the Act.
5. The application for treatment order stated:

[LE] is an intelligent, retired teacher, academic and astrologer, living [in Southern Tasmania] with her ex-partner [XE]. She was referred to the older persons mental health service by police and her family in Feb 2025 due to uncharacteristic changes in her mental state commencing around November 2024. [LE] does not have a history of psychiatric illness, although her father lived with bi-polar (sic) affective disorder which required hospitalisation.

Recent concerns include disinhibition, irritability, disorganisation, increased activity, increased quantity of thought and speech with tangential and over-inclusiveness, insomnia with late night email writing and disregard of a restraint order initiated by her ex-neighbour... with whom [LE] had held a romantic interest. Despite clear explanation of the restraint order by police, [LE] continued to contact [her ex-neighbour] and is anticipated to receive a court summons for 50-60 breaches.

[LE] initially received support in the community from [Dr BD] (OPMHS psychiatrist), however ongoing community concerns with financial and reputational risk alongside intolerance and reluctance to take treatment led to her voluntary admission to [a hospital in Tasmania] [on 01 April 2025]. Alongside psychiatric concerns, [LE] has experienced marked weight loss (>15kg) and increasing frailty, falls and reliance on [XE] for activities of daily living. Her blood tests demonstrate a recurrence of auto-immune condition, she has recently met with the rheumatology team (15/4/2025) and is awaiting further medical investigation.

[LE] has experienced physical and psychological stressors contributing to her illness episode including: a trip to [a town in New South Wales] where she contracted a viral illness. She has performed considerable work editing and publishing her mother's memoirs, and her father's home in [ a suburb in Southern Tasmania] was recently sold - which was an emotional time and led to [LE] receiving an inheritance of approximately $350K.

[LE's] family have been concerned with [LE's] spending, estimating she has spent approximately $130K in 8 weeks and an enduring power of attorney has been enacted which has led to considerable distress for [LE] and an unfortunate conflict with her sons [TE and ME].

Some of [LE's] financial decisions including paying her hairdresser... to paint her house (owned by [TE] who is not supportive of this process) and donations to her friends and online acquaintances.

In late 2024, [LE] left the home unexpectedly, drove to [a city in Tasmania] and was involved in a car accident. She was disorganized and required assistance from her sister and then had difficulty paying for her hotel stay. While there are no concerns for active cognitive impairment, [LE] experienced delirium in early 2024 during an episode of community acquired pneumonia and, with increasing age, is cognitive [sic] vulnerable and has experienced a late in life mood disorder.

1. On 1 May 2025 a single member of the Tribunal made an interim treatment order under s 38 of the Act in relation to LE in the following terms:

This Interim Treatment Order: > > (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 treatment of the patient:

2. 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
3. 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.
4. Standard medical and/or blood, and/or urine and/or radiological and medical imaging tests, as clinically indicated and as directed by the treating team.
5. Adult Community Mental Health Services (ACMHS) appointments (inclusive of home visits as arranged when being treated in the community).

1. The hearing for treatment order was convened on 9 May 2025 by a three member panel of the Tribunal. Upon the conclusion of the hearing the Tribunal was satisfied the treatment criteria in s 40 of the Act was made out and that it was appropriate to make a treatment order authorising treatment as an involuntary patient. The treatment order was made for six months in the same terms as the interim treatment order.

1. The hearing for the application for treatment order was held on 9 May 2025 from the Tribunal hearing rooms by video link and in person. The applicant, Dr JO, LE, ME and TE attended the hearing by video link. LE's advocate, Ashley Brown from Advocacy Tasmania, also attended by video link. XE attended the hearing in person.
2. The Tribunal had before it the application for treatment order, the interim treatment order, the treatment plan dated 1 May 2025 and other accompanying documents. Neither LE nor her advocate provided any documents or written submissions, nor did LE seek to rely upon any expert opinion outside of the opinions of the treating team.
3. At the conclusion of the hearing the Tribunal made a treatment order in the terms sought by the applicant and the same terms as the interim treatment order. The treatment order was made for six months from the day of the hearing, to expire on 8 November 2025.
4. On 27 May 2025 the Tribunal received a written request for a statement of reasons for the Tribunal's decisions on LE's behalf from her advocate Ms Brown, as per Sc 4, Pt 6, cl 1 of the Act. These are the reasons as requested.

Under s 39(1) of the Act, 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 the 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) of the Act appear to have been met with respect to the treatment plan.

As per s 39(1)(b) of the Act, the Tribunal can be satisfied that a treatment order should be made where the application has fulfilled the requirements under s 37, as follows:

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).

The Tribunal must also be satisfied the person the subject of the application meets the treatment criteria set out in s 40 of the Act:

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.

As noted above, the Tribunal has to be satisfied a treatment plan has been made in order to make a treatment order. Section 50 of the Act states a treatment plan is 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) of the Act prescribes that the Tribunal must be satisfied that the requirements of section 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, the Tribunal needs to be alive to the objects of the Act in s 12:

12. Objects of the 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 its responsibilities under the Act, the Tribunal must refer to the mental health service delivery principles set out in Sch 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 > > 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 (whether as to culture, language, age, religion, gender or other factors); > > (e) to emphasise and value promotion, prevention and early detection and intervention; > > (f) to seek to bring about the best therapeutic outcomes 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, 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 choices; > > (k) to involve persons receiving services, and where appropriate their families 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; > > (q) to recognise and be responsive to national and international clinical, technical and human rights trends, developments and advances. > > (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. We were satisfied that the applicant was an approved medical practitioner and the requirements of s 37(4) of the Act were met - i.e.:
   • LE had been assessed by the applicant and one other approved medical practitioner, separately, within the preceding seven days; and
   • The applicant and the other approved medical practitioner were both satisfied from their respective assessments that LE met the treatment criteria; and
   • The application was brought in accordance with s 195 of the Act; and
   • The applicant had given a copy of the application to the patient and placed a copy of it on the patient's clinical record.
2. The Tribunal was also satisfied that a treatment plan had been prepared in accordance with s 53(2) of the Act.

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. Dr JO gave evidence LE had started to experience changes in her mental health toward the end of 2024, with increased energy and activity and reduced need for sleep. Dr JO also gave evidence that LE had also recently experienced a number of stressful events. These events include the sale of her father's house, travel to Northern New South Wales to meet with the production team making a dramatisation about her mother's life, and her own work on a book about her mother.
3. Dr JO went on to state LE had also experienced a number of physical stressors, describing that LE had a history of autoimmune myositis, and that this had re-occurred.
4. Dr JO stated that the most concerning aspect of LE's presentation in the lead up to hospitalisation was some uncharacteristic behaviour, including making unwanted contact and romantic overtures toward a neighbour who had been clear, through her lawyers, that she did not want any romantic contact with LE, which led to an interim restraint order being issued and LE breached it multiple times. Despite police becoming involved and making it clear any further breach of the order would amount to a criminal act, LE continued to breach the order.
5. Dr JO told the Tribunal of concerns raised by the community psychiatrist that LE was experiencing a manic or hypomanic presentation, with "erotomanic" beliefs, "increased goal directed activity" and engaging in an uncharacteristic amount of electronic communication, late night emails and postings on social media. Dr JO went on to state that LE also spent about $130,000 from her $350,000 inheritance in a manner that amounted to a lack of financial restraint.
6. Dr JO reported that LE was admitted to hospital on 1 April 2025 and the treating team considered that perhaps she was experiencing an episode mania caused by organic factors, but testing has ruled this out and the treating team formed the view that her presentation was a result of mental illness. He went on to state LE exhibited symptoms of mental illness. He said she was circumstantial, with pressured speech and thought, and that this fluctuated depending upon how much sleep she was getting. He also stated she had lost 18 kilograms in weight in the lead up to her admission to hospital and continued to experience insomnia and was disinhibited in her speech and behaviour.
7. Dr JO stated he believed LE was experiencing a first episode manic episode and having erotic and psychotic beliefs, with a hypomanic presentation that had been persisting for some months. He stated LE had a family history of bipolarity, with her father diagnosed and hospitalised with bipolar disorder, and the treating felt that LE was likely experiencing a late onset of a bipolar disorder.
8. LE gave evidence at the hearing. She stated she had been "freaked out" by a lot of stressful things that had happened to her, including the sudden death of her step mother, the sale of her family home, a trip to Northern New South Wales in regard to a dramatisation of a book she had written, a visit to a writers' festival, a car accident, and the application for restraint order taken against her by the woman she was in love with.
9. LE indicated that she was having difficulty accepting the diagnosis of possible bipolar disorder but that she was "not entirely closed off to the diagnosis".
10. The Tribunal asked LE whether she thought that the issues between her and her neighbour could be part of mental illness. LE responded to say "if falling in love is a mental illness, then without a doubt". She went on to state that her neighbour had sought a restraint order against her previously and had done this "when she starts feeling things" and indicated this was a course of conduct her neighbour had engaged in previously.
11. Ms Brown submitted that LE was still coming to terms with her diagnosis but did not specifically state whether or not LE agreed with the diagnosis.
12. LE, ME and TE individually gave evidence to the Tribunal and each expressed concern about LE's mental state and agreed with Dr JO's assessment.
13. Having heard the evidence from both Dr JO and LE and her family, and taking Ms Brown's submissions into consideration, the Tribunal were satisfied that LE was experiencing a serious impairment of thought and a serious impairment of mood and that this amounted to mental illness. We were satisfied that the treating team had ruled out any organic causes of the symptoms LE had been experiencing. Dr JO's evidence satisfied us that LE had been experiencing a first episode manic episode that may have been indicative of a late onset bipolar disorder.
14. The Tribunal is satisfied that this criterion is met.

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

1. This criterion requires the Tribunal to be satisfied that without treatment the patient's mental illness will, or is likely to, seriously harm the patient's health and safety or the safety of others. 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) is 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 [2020] TASSC 10 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. Dr JO gave evidence that without treatment LE would be likely to continue to breach the restraint order that was made against her, leading to police involvement and criminal charges being laid against her. He also identified financial risks associated with ongoing illness, referring to her recent overspending and the relationship harm that has caused within her family. He stated that ongoing egocentricity, irritability and impulsivity associated with her illness would likely contribute to stress in her relationships between family and friends and her broader community resulting in the loss of her social supports.
5. Neither LE nor Ms Brown addressed the Tribunal as to risk and we were satisfied by Dr JO's uncontested evidence that without treatment LE's illness would likely cause serious harm to her health and safety. Those risks include risk of overspending, deterioration in her physical health through weight loss and risk to LE's familial and community relationships, leading to social isolation and breaches of restraint order with further interaction with police and criminal charges.
6. The Tribunal is satisfied that this criterion is met.

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

1. The Tribunal must be satisfied that the outcome of the proposed treatment is appropriate and effective in terms of the meaning of treatment set out 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. As noted above, in S v Mental Health Tribunal Blow CJ commented upon this criterion, noting the threshold for satisfaction of this criterion is "fairly low". He went on to say:

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).

3. Dr JO gave evidence that LE had not received any ongoing psychiatric medications since she has been in hospital as she preferred natural medicines to the medication and treatment offered by the treating team. He went on to say that there was no evidence base to support these treatments as being helpful in resolving LE's manic symptoms, but that the treating team had been supportive of her going out for acupuncture and using homeopathic medicines.
4. Dr JO stated that the treating team felt that they had "reached an impasse" despite psychoeducation and the support of family and friends. He stated that the introduction of a number of psychiatric medications would assist LE, and had suggested a mood stabiliser and an antipsychotic. He stated LE took an antipsychotic for a day but ceased it, despite it being helpful in aiding her sleep, out of concern it contained lactulose.
5. Dr JO indicated that outside that single occasion the treating team had not been able to administer any medication to LE and had taken a careful approach to medications in accordance with LE's wishes, seeking to treat her in the least restrictive manner.
6. Dr JO stated the treating team proposed a low dose of the antipsychotic paliperidone 3mg nocte, and a mood stabiliser, such as lithium. He said that this combination of medications is standard treatment and there is a significant evidence base that indicates this is the best treatment for bipolar disorder.
7. Dr JO went on to say that the treating team expected that, once LE starts taking the medications prescribed to her there was a very good likelihood she would start to improve, with better sleep and physiological and mental health, clarity of mind and increased recall, and that she would develop a better appreciation of her illness, and better understand the risks associated with it and the benefits of treatment.
8. Dr JO gave evidence that the treating team also sought an antidepressant in the event LE went into a post manic depressive phase, a benzodiazepine to assist with any side effects and sleep, and an anticholinergic in the event LE were to develop side effects from the antipsychotic.
9. LE, ME and TE gave evidence in support of the treatment proposed by Dr JO and expressed the view, individually, that they felt that remaining in hospital and accepting treatment offered by the treating team was in LE's best interests.
10. Neither LE nor her advocate addressed the Tribunal as to the appropriateness or effectiveness of the proposed treatment.
11. The Tribunal accepted Dr JO's evidence that there was no evidence to support the appropriateness or effectiveness in LE's chosen therapies that these would aid in resolving LE's symptoms of her mental illness. We were satisfied that the proposed treatment was evidence based and therefore likely to remedy LE's illness, manage and alleviate the ill effects of her illness and reduce the risks her illness posed to herself or others.
12. The Tribunal is satisfied that this criterion is met.

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

1. Dr JO gave evidence that LE had an unconventional belief system when it comes to heath care, preferring homeopathy and complementary and alternative medicines, and has not been able to recognise the concerns raised by others with regard to her experience of mental illness. Dr JO described LE as being "quite dismissive and superficial" in her engagement with mental health services, and that she believed her behaviour to be normal in the context of the life stressors she had experienced. He stated LE had made it clear she would not consider western "allopathic treatments" despite conversations he had had with her about their effectiveness in treating her symptoms.
2. LE stated at the beginning of the hearing that she had decided she would accept the treatment offered by the treating team, and that she had needed time to think about it. Dr JO indicated that he found that to be a positive step but was concerned that such a recent acceptance of medications and treatment was fluctuant, and that LE had two nights previously stated to staff it was her intention to leave the hospital and expressed displeasure at having to attend the Tribunal and possibly be placed under a treatment order. Dr JO also stated that a friend of LE's had attended the hospital the day before the hearing, stating that she was there to assist LE to leave hospital and take her to stay with an alternative practitioner.
3. Dr JO also stated that LE had made it very clear to the treating team she would not take any antipsychotic medication offered to her as it would be incompatible with her homeopathic remedies. He also said LE was opposed to taking the mood stabiliser Lithium due to her father's experience with this medication causing him oversedation.
4. LE reiterated what she had said earlier in the hearing, that she was content to proceed with the recommended treatment, that she did not want a fight, but that she was "in a state of disbelief". She went on to state she had not believed she would ever experience a bipolar disorder and that her objections to treatment had come from a lack of understanding, and felt she needed "some serious psychoeducation".
5. LE stated that she had difficulty accepting her diagnosis and that despite Dr JO having given her material explaining the diagnosis, she had felt that not all the symptoms the material described applied to her. She stated that she did not know what the proposed medications would do for her but that she wanted to "go with the flow". She stated that, while she came to hospital voluntarily, she had begun to feel she had been "ambushed" but accepted she did need to be admitted because she needed respite and stated that the admission assisted her in getting over her cataract surgery and gave her the opportunity to be looked after.
6. As with previous criteria, LE, ME and TE gave evidence in support of Dr JO's position and expressed the view that a treatment order was appropriate for LE.
7. LE's advocate, Ms Brown, made submissions that LE was content to stay in hospital but wanted to be treated as a voluntary patient and that since coming into hospital LE has "started to come to terms" with her diagnosis and proposed treatment.
8. The Tribunal accepted LE's evidence and her advocates submission that she was starting to come to terms with her diagnosis but we were not satisfied that she would engage with the treatment offered by the treating team. We preferred Dr JO's evidence that LE's acceptance of treatment was "fluctuant". We accepted his undisputed evidence that, despite repeated attempts to engage LE, she had refused treatment instead preferring complementary therapies, and had very recently sought the assistance of a friend to help her leave the hospital. We were satisfied that without a treatment order LE would be disinclined to engage in treatment and would likely leave the hospital and therefore could not be treated except under a treatment order.
9. The Tribunal was also satisfied that, for reasons expressed below, LE lacked decision-making capacity.
10. The Tribunal is satisfied that this criterion is met.

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. Dr JO gave evidence regarding LE's decision-making capacity. He stated that her ability to retain and to use and weigh information has been impaired by thought disorder associated with her mental illness. He stated that she claimed not to have had conversations on specific dates with the treating team about her diagnosis and was not always able to grasp information her family had tried to convey to her.
3. Dr JO stated that LE's understanding of her illness, need for treatment and treatment in hospital was fluctuant, and that she could not understand the concerns raised by others about the risks she faces if not treated.
4. Dr JO expressed concern that LE has not been able to recognise that she is experiencing hypomania and that this is an illness that was causing dysfunction in her life, and that she was very reluctant to accept psychiatric treatment, treatment the treating team anticipate would resolve her distress and the distress of others around her.
5. As noted above, LE stated she was in a state of disbelief that she could be experiencing a bipolar disorder and was still coming to terms with what that meant, and indicated she did not recall having received psychoeducation and that she did not yet understand the nature of her illness.
6. LE's advocate made submissions that LE wished to be a voluntary patient and wanted more "intensive therapies" to help her understand the nature of her condition as she has found the diagnosis confronting and felt she had had very little education in regard to her diagnosis.
7. Based on the evidence presented the Tribunal were of the view that, while LE had started to come to terms with her diagnosis, she lacked decision-making capacity. Despite LE's evidence, reiterated by her advocate, that she would engage with the treating team and accept the treatment they had been trying to administer her, we were satisfied that the symptoms of her mental illness were preventing her from being able to understand or retain information provided to her by the treating team, and that she was unable to use or weigh this information to make decisions about her assessment and treatment for mental illness.
8. The Tribunal is satisfied that this criterion is met.

1. It is worth noting that the Tribunal was satisfied that the treating team had complied with the objects of the Act. Specifically, we were satisfied the treating team had gone to significant effort to treat LE in the least restrictive manner through providing psychoeducation to LE in an attempt to assist her to make treatment decisions for herself, and had also facilitated LE to continue with her preferred therapies. We were satisfied that the application for treatment order was made after all other options had been exhausted.

1. The Tribunal found that the criteria set out in s40 of the Act were met and on 9 May 2025 made a treatment order in the terms sought by the treating team. The order was made for six months and expires on 8 November 2025 unless discharged sooner.