1. The first mandatory criteria that must be satisfied before the Tribunal can exercise the discretion to make an ITO is that an Approved Medical Practitioner (AMP) has applied for a treatment order. I was provided confirmation by the registry that Dr KL is an AMP and his status as such is valid until 24 May 2027. He was the applicant for a treatment order for KKJH. This criterion is accordingly satisfied.

1. The requirements of s 37 of the Act must appear to be met. In this matter, an AMP is the applicant; the patient is a subject of an assessment order; the applicant assessed the patient under the authority of that order and was satisfied that the treatment criteria were met; the application was on an approved form and otherwise met the requirements of s 35 of the Act; and the applicant has advised that a copy of the application has been provided to the patient and placed on the patient's file. I am satisfied that the requirements outlined in s 37 have been met.

1. The fundamental role of the Tribunal in considering whether to make an ITO is deciding whether on the evidence available, the patient meets the treatment criteria as defined in s 40 of the Act.

1. While the application advises that KKJH does not have a past psychiatric history, the application reports that KKJH is experiencing a psychotic illness exhibited by paranoid beliefs, persecutory delusions, and erratic behaviours. The application states:

Recent history of erratic behaviour and significant paranoid beliefs linking her relationship breakup with the death of [redacted]. Reported to be running around in her pyjamas, talking to complete strangers about her fears of being murdered, beliefs that her phone is being tampered with by her ex-partner and her best friend.

2. This criterion is satisfied. The patient has a mental illness within the definition of s 4 of the Act.

1. Section 40(b) of the Act requires me to be satisfied that without treatment, the patient's mental illness will, or is likely to, seriously harm the patient's health or safety or the safety of other people.
2. This criterion has been the subject of interpretation by Blow CJ in two matters. In S v Mental Health Tribunal [2016] TASSC 34 at [22], his Honour held:

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. His Honour also provided 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.

the patient is severely frightened and highly stressed from her persecutory delusions and bizarre thinking. She is extremely vulnerable because of her paranoia. Further, [the patient's] mental health will deteriorate if immediate treatment is not commenced. > > Paranoid symptoms and elevated mood place the patient at risk of being exploited by others, and reputational damage.

5. I am satisfied on the evidence that without treatment the mental illness is likely to seriously harm the patient's health or safety or the safety of others.

Section 40(c) - Appropriate and effective treatment

1. A further criterion of which I must be satisfied in order to exercise a discretion to make an ITO is that the treatment proposed will be appropriate and effective in terms of the outcomes referred to in 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) assess a person's mental state. > > (2) However, this professional intervention does not extend to - > > (a) special psychiatric treatment; or > > (b) a termination of pregnancy; or > > (c) a procedure that could render a person permanently infertile; or > > (d) the removal, for transplantation, of human tissue that cannot thereafter be replaced by natural processes of growth or repair; or > > (e) general health care. > > (3) For the purposes of this Act, treatment does not include seclusion, chemical restraint, mechanical restraint or physical restraint.

2. Blow CJ made comments in obiter as to the intention of this legislative criterion in the matter of S v Mental Health Tribunal [2016] TASSC 34 at [23]:

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. The application details that KKJH is highly opposed to psychiatric treatment and was not accepting of regular anti-psychotic medication but that it is expected that treatment will resolve her psychotic symptoms and will result in an improvement from the symptoms of the mental illness.
4. The treatment plan states:

It is proposed to commence a trial of oral antipsychotic medication with consideration of switching to depo medication, given her lack of insight and strong opposition to receiving any treatment.

5. I was satisfied that the treatments directed towards the management of the ill effects of the patient's mental illness and the monitoring of her mental state, that this criterion is met.

Section 40(d) - The treatment requires an order

1. Section 40(d) requires that I be satisfied that treatment cannot adequately be given except under a treatment order. The applicant addressed this criterion detailing that the patient steadfastly refuses to accept any psychiatric treatment on a voluntary basis, the treatment plan completed by Dr KL states:

[the patient] does not accept that she has a mental illness and is strongly opposed to any psychiatric treatment.

2. Further the application outlines that KKJH has a lack of insight and strong opposition to receiving any treatment. Dr KL reports that because the patient is suffering from persecutory delusions, and bizarre and erratic behaviours, she is unable to recognise she is suffering from a mental illness
3. When read in conjunction with the applicant's assessment of the patient's current decision-making capacity as detailed following, taking into account the nature of the stated current delusions the patient is experiencing, and the reported history of non-compliance, I am satisfied this criterion is met.

1. Finally, I must be satisfied that the patient does not have decision making capacity as defined in s 7 of the Act:

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) For the purposes of this Act, a child is taken to have the capacity to make a decision about his or her own assessment or treatment (decision-making capacity) only if a person or body considering that capacity under this Act is satisfied that - > > (a) the child is sufficiently mature to make the decision; and > > (b) notwithstanding any impairment of, or disturbance in, the functioning of the child's mind or brain, the child is able to - > > (i) understand information relevant to the decision; and > > (ii) retain information relevant to the decision; and > > (iii) use or weigh information relevant to the decision; and > > (iv) communicate the decision (whether by speech, gesture or other means). > > (3) For the purposes of this section - > > (a) an adult or child may be taken to understand information relevant to a decision if it reasonably appears that he or she is able to understand an explanation of the nature and consequences of the decision given in a way that is appropriate to his or her circumstances (whether by words, signs or other means); and > > (b) an adult or child may be taken to be able to retain information relevant to a decision even if he or she may only be able to retain the information briefly. > > (4) In this section - > > information relevant to a decision includes information on the consequences of - > > (a) making the decision one way or the other; and > > (b) deferring the making of the decision; and > > (c) failing to make the decision.

2. The application reports that KKJH interprets her beliefs as true and reality based when in fact they are not, and they are a manifestation of her psychotic illness. The application details that KKJH is unable to weigh up the pros and cons of treatment and therefore is incapable of making an informed decision on her treatment. Dr KL describes the patient as being unable to use or weigh information pertaining to her mental illness and treatment which is caused by her bizarre and delusional beliefs which effect the functioning of the mind or brain, and she is therefore unable to recognise she is suffering from a mental illness.
3. Given the nature of the ITO application, there was no alternate medical evidence before me as to the patient's decision-making capacity other than that of the applicant. The assessment order made on admission for the patient by Dr BF on 13 January 2026 makes comments that the patient "has no insight, ongoing stress, unable to weigh risk". In addition, the application details KKJH is unable to recognise she is suffering from a mental illness.
4. While KKJH may not agree with her diagnosis, that is not in itself evidence of a lack of decision-making capacity.
5. In the decision of SI (60 Day Review Hearing) [2025] TASCAT 29, this Tribunal considered a patient's unwillingness to accept their diagnosis, and the threshold of a patient's capacity was considered at [149]-[151]:

...we agree that the threshold of capacity under the Act is a relatively low one. It only requires a person to be able to understand, retain and use or weigh the information and communicate a decision in the terms of the general nature, purpose and effect of the treatment. There is not a requirement that a person has a high level of understanding at a level similar to that of their treating team. > > With respect to capacity, we acknowledge that a lack of insight into the diagnosis alone is not sufficient to conclude that a person lacks decision-making capacity. Instead, a lack of capacity is a factual issue that can be relevant in evaluating a person's ability to understand, retain, and use or weigh the relevant information, which may support a determination of incapacity. > > However, we are challenged by the concept that a person who cannot recognise that they have a mental illness and recognise the symptoms of that illness due to an impairment in the function of their mind or brain can still have decision making capacity. This is because they cannot understand how the information is relevant to them and so cannot weigh up or use the information to reach a decision in the abstract.

6. Noting the comments in the assessment order as detailed at [33], when read in conjunction with the applicant's assessment of the patient's current decision-making capacity, taking account of the nature of the state of current persecutory delusions and paranoia, the patient is experiencing, I am satisfied this criterion is met.

1. To proceed to make an ITO, I also need to be satisfied that the Tribunal cannot immediately determine the application. To do so the Tribunal must list the application before a three-member panel and afford the parties procedural fairness such as providing reasonable notice of the hearing into the application.
2. In circumstances where the application was lodged at 12:32pm on 15 January 2026 and the assessment order was due to expire at 10:30am on 16 January 2026, this matter could not be dealt with immediately by the Tribunal.

1. Lastly, to be able to consider the making of an ITO, I must be satisfied that the delay experienced in waiting for the matter to be listed before a three member three-member panel would or is likely to seriously harm the patient's health or safety or the safety of others.
2. In support of the application for an ITO, Dr KL stated:

[the patient's] mental health will deteriorate if immediate treatment is not commenced. For that reason, and the reasons outlined earlier, I am satisfied that without treatment there is currently a likelihood of serious risk to the patient's health and safety, and the safety of others. If the assessment order were to lapse without an ITO in place, then the patient may discharge herself as she would be entitled to do.

3. I am satisfied on the evidence presented and referred to throughout these reasons that there is a compelling likelihood that KKJH would undoubtedly leave the inpatient setting and continue to refuse treatment given her current mental state because KKJH does not accept that she has a mental illness or that she requires any treatment. This criterion is met.

1. For the reasons outlined above, I am satisfied the patient meets the treatment criteria. I am further satisfied of the other procedural matters that need to be addressed as outlined in ss 37 and 38 of the Act to enable me to proceed to decide whether I should exercise my discretion to make the ITO or not sought by the applicant. In exercising my discretion, I am required to take into account the objects of the Act (s 12) and the Mental Health Service Delivery Principles Sch 1 and I have done so.
2. I am mindful of the constraints associated with dealing with such applications on the papers, specifically relating to the ability to consider the patient's views. However, in this matter it was apparent the patient was of the view that she was not experiencing a psychotic episode and would be opposed to the making of the order. Nonetheless, taking account of all the mandatory considerations, I am satisfied that it is appropriate for an ITO in the terms sought by the applicant to be ordered for the maximum period of ten days.

1. The Tribunal made an interim order in the following terms:

• (A) is the 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 at an approved inpatient facility (Royal Hobart Hospital, Launceston General Hospital, North West Regional Hospital, Millbrook Rise Centre and/or Roy Fagan Centre); and
• (C) authorises the following:

1. The patient is to take the following medication (depending on clinical indication):

(a) Antipsychotic medication > > (b) Mood stabilising > > (c) Antidepressant medication > > (d) Benzodiazepine medication > > (e) Anticholinergic medication for treatment of any extrapyramidal side effects from taking antipsychotic mediation.

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).