PTZ [2025] VMHT 5 (1 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:

• Least restriction - mental health and wellbeing services are to be provided to a person living with mental illness with the least possible restriction on their rights, dignity and autonomy with the aim of promoting their recovery and full participation in the community. Your views and preference were an important consideration in this regard because you wanted to be a voluntary patient and seek treatment through the private mental health system rather than the public system.
• Dignity of risk - a person receiving mental health and wellbeing services has the right to take reasonable risks in order to achieve personal growth, self-esteem and overall quality of life.

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 and to the Tribunal, they also provided some documents extracted from your file. You provided some written materials as well, including a letter and a letter from your counsellor. 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 wish to be treated with autonomy and fairly as a voluntary patient with the support of a team of mental health professionals from private practice.

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.

Your lawyer, Claudia, said you agree you have a mental illness called bipolar affective disorder.

You told us when you are unwell you become manic and do ridiculous things.

The report says you have a medical condition called bipolar affective disorder with depressive and manic episodes, that you have been receiving treatment for this illness since 2005 and have had multiple admissions to hospital since that time.

The report indicates that your most recent admissions to hospital were in December 2024 and February 2025 because you had a relapse of your symptoms of mania having stopped taking any medication. Your symptoms included difficulty sleeping, disorganised thinking, including pressured speech and racing thoughts, an elevated mood with increasing irritability which led to disorganised behaviour.

Both CM and TD said your mental state improved significantly after you received medication in hospital.

The Tribunal accepted the evidence before it, including your views, and was satisfied that you have experienced a significant disturbance of your thought and mood. At the time you were treated in hospital your symptoms included being irritable, and pressured speech.

(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?

Claudia said you agree you need treatment to prevent serious deterioration in your mental health, but you reject any suggestion that treatment is needed because you engage in risk taking behaviour.

You agreed that at the time of your hospital admission in February there was a fire in your apartment, however you explained that the fire was due to a malfunction in the air conditioner and was not caused by you.

The report said you need treatment now to prevent a relapse of your manic symptoms and to prevent serious harm to yourself and others.

The report states that when you have been off medication you have become highly disorganised in your thought and behaviour, prone to dangerous risk-taking and disinhibited behaviour, and become labile and distressed in mood. The report indicates that in the past, you have been uncharacteristically hostile and verbally aggressive towards others.

CM said you need medication called lithium, a mood stabiliser, now because it is effective in treating your bipolar disorder symptoms and preventing depressive and manic relapses.

The Tribunal accepted the information provided by your treating team and decided that you need to continue to have immediate treatment to prevent a serious deterioration in your mental health. The Tribunal was not satisfied there was enough evidence on the day of the hearing to support a finding that you need immediate treatment to prevent serious harm to yourself and others.

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

As you had received treatment up to the time of the hearing, the Tribunal was satisfied that if a Treatment Order was made you would continue to receive treatment, including lithium medication to help stabilise your mood and flupentixol, a long-acting injectable anti-psychotic medication.

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

Claudia said you have a strong preference to be taken off a treatment order and you have a clear plan for voluntary treatment from the private mental health sector. Claudia said you also have many supports in the community, including NDIS support workers and a strong network of friends who are supporting you to continue to receive treatment.

In your written statement you asked the Tribunal to consider your plan for voluntary treatment based on a fair assessment, ethical practice and least restrictive treatment principles. You said your plan includes support from a private treating team comprised of a psychiatrist, your psychologist, your counsellor, your GP and a social worker. You stated you receive strong support from your NDIS case manager who you meet twice weekly. You said your private psychiatrist has agreed to provide treatment for you provided you are not on a treatment order. You said you have been seeing your psychologist for about five years. You provided a letter from your counsellor who confirmed that she had an initial consultation with you in March and you have arranged to have ongoing consultations.

During the hearing you said your relationship with the public mental health treating team is not working because they do not treat you holistically. Instead, they only want to treat you with medicine. You said they don't listen to you and there is no trust on both sides.

You said you love having the long-acting injectable medication, that it acts like a buffer because sometimes you forget to take the pills. You said it feels like a new beginning being on this medication because it is working well and keeping you calm without side effects. You said you have some reservations about continuing to take the lithium tablets because it has made you feel sick in the past. However, you said you will listen to the advice of your private psychiatrist regarding the lithium and any recommended medication. You said if you started to feel unwell you would seek help from your NDIS case manager because you trust him.

The report states that in the past when you have been a voluntary patient you have stopped taking any medication and stopped engaging with the treating team because you have not agreed that you have a mental illness or need treatment. The report indicates that this has resulted in a relapse of bipolar disorder symptoms and the need for compulsory treatment in hospital.

TD said the treating team support your transition to care from a private team, but they would need to be able to engage with the team to ensure an effective handover.

CM said that lithium is the most effective medication to treat your symptoms, and he is concerned that if you are a voluntary patient, you will stop taking the medication which will cause another relapse. He said this happened recently when you were taken off a treatment order by the Tribunal. CM said it is very early days in your recovery for you to be considered for voluntary treatment having had two hospital admissions recently after significant relapses.

The Tribunal acknowledged the treating team's concerns, that based on recent history of voluntary treatment outlined in the report you may not receive immediate treatment as a voluntary patient and that you may make decisions that involve a degree of risk. However, the mental health principles under the Act require that persons should receive treatment in the least restrictive way possible with voluntary treatment preferred; that your views and preferences should be respected, and that you should be allowed to make decisions that involve a degree of risk. Given your current mental state, your change of view about the current medication, your plan for treatment from private mental health services and the support you receive from NDIS, the Tribunal was satisfied that you would continue to receive the immediate treatment you needed as a voluntary patient.

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.