Variation of treatment order - Application for benzodiazepine medication

- Variation of order to include benzodiazepine medication- Tribunal discretion to vary treatment order.

Mental Health Act 2013 (Tas); ss 6, 12,15A, 40,41 181(2), Sch 1.

The decision has been anonymised for the purpose of publication

1. TQ (the patient) is a 53-year-old man who lives in Northern Tasmania. TQ has a long established diagnosis of chronic paranoid schizophrenia and substance use disorder.
2. On 18 September 2015, TQ was made subject to a treatment order under s 39 of the Mental Health Act 2013 (Tas) (the Act), following an application made to the Mental Health Tribunal (as it was then known).
3. On 6 March 2025, a three-member panel conducted a 180 day rereview of the order under s 181 of the Act. The Tribunal affirmed the treatment order in the following terms:

(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:

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

   1. Antipsychotic medication

   2. Anticholinergic medication for treatment of any extrapyramidal side effects from taking antipsychotic medication

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 radiological 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).
3. On 4 July 2025, the Tribunal received an application to vary the treatment order from Dr NC to include benzodiazepine medication. Dr NC application stated that the reason for the variation was as follows:

Currently withdrawing from substances. Agitated and disinhibited in context of his psychotic illness.

4. Dr NC indicated in the application that TQ had been consulted on the date of the application but noted:

At the time of application [TQ] is not able to understand or articulate his views on medication changes.

181 (2) The Tribunal may vary a treatment order at any time -

(a) on its own motion; or

(b) on the application of any approved medical practitioner; or

(c) on the application of any person with the necessary standing.

181 (2A) The Tribunal may vary a treatment order whether or not it has conducted a review under this section.

2. Section 41 provides for the form and content of a treatment order:

Section 41 Form and content of treatment order > > (1) To be valid, a treatment order must - > > (a) be in a form approved by the President of the Tribunal; and > > (b) be correctly completed. > > (2) A treatment order is taken to be correctly completed if it - > > ...

(a) specifies the treatment, or types of treatment, authorised under the order; and

...

(5) A treatment order may, without compromising its validity, specify or provide for any other matters, incidental to the treatment of the person in respect of whom the order is made, that the Tribunal considers necessary or desirable in the circumstances.

1. I must also consider the right of patients contained in s 15A of the Act. The rights relevant to this matter are as follows:

15A. Rights of patients > > (1) Each person receiving an assessment or treatment under this Act has the following rights: > > (a) the right to receive the assessment, or treatment, under this Act in accordance with the mental health service delivery principles; > > (b) the right to have any restriction on, or interference with, the person's dignity, rights and freedoms to be limited as much as possible when taking into account the person's health and safety and the safety of others; > > (c) the right to promote, and make prominent, the person's decision-making capacity, and to respect the person's wishes, to the maximum extent possible when taking into account the person's health and safety and the safety of others; > > ...

2. Finally, in exercising responsibilities under the Act, I must refer to the mental health service delivery principles set out in Sch 1 of the Act. The relevant principles are as follows:

SCHEDULE 1 - Mental health service delivery principles > > 1. 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; > > ... > > (f) to seek to bring about the best therapeutic outcomes, including the use of evidence-based care, and promote patient recovery; > > (g) to provide services that are consistent with patient treatment plans; > > ... > > (j) to promote the ability of persons with mental illness to make their own decisions, including decisions about the person's assessment, treatment and recovery that involve a degree of risk; > > (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; > > ... > > (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; > > ... > > (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; > > ...

3. As a single member of the Tribunal, in chambers, on 7 July 2025 at 9:11 am, I determined the application for variation of TQ's treatment order and authorised benzodiazepine medication.
4. On 16 July 2025, the patient's direct legal representative, Mr Kumar, submitted a written request for a statement of reasons regarding the determination for variation of treatment order made 7 July 2025 at 9:11 am. These are the reasons as requested.

1. At the time the application for variation of treatment order was filed with the Tribunal, TQ was an involuntary patient at an approved hospital.
2. In the application to vary the treatment order, Dr NC sought authorisation to administer benzodiazepine medication, citing TQ's substance withdrawal, agitation, and disinhibition in the context of his psychotic illness.
3. There are no prescriptive criteria for the Tribunal to consider when varying a treatment order under the Act. However, the tribunal clearly cannot vary the order in a way which goes beyond the bounds of the treatment criteria set out in s 40 of the Act.
4. Accordingly, I considered if the treatment will be appropriate and effective in terms of the outcomes referred to in s 6(1) which are as follows:

(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.

....

1. The evidence before me was that TQ was displaying agitated and disinhibited behaviour in the contact of his psychotic illness. The use of benzodiazepine medication in situations where a patient is experiencing agitation in the context of acute psychosis is in keeping with the recommendations of the Royal Australian and New Zealand College of Psychiatrists (Professional Practice Guideline 5).
2. I am satisfied that benzodiazepine medication meets the definition of treatment. It is professional intervention necessary to manage and alleviate, where possible, the ill effects of TQ's mental illness. Although I note TQ's diagnosis of substance use disorder and the potential for benzodiazepine dependence, I was satisfied that any such risk can be appropriately managed in the context of TQ's inpatient admission. I am satisfied that the treatment is appropriate and effective.
3. I am also satisfied that the variation of the treatment order to include benzodiazepine medication is in keeping with the mental health service delivery principles, including 'to seek to bring about the best therapeutic outcomes, including the use of evidence-based care, and promote patient recovery' and to promote and enable persons with mental illness to live, work and participate in their own community. This was on the basis that alleviation of TQ's symptoms would allow for him to be treated less restrictively and promote his recovery.
4. Dr NC indicated that at the time of making the application that TQ was not able to 'understand or articulate his views on medication changes'. Accordingly, I did not have any evidence before me which indicated TQ's wishes with respect to the medication at that time.
5. One of the objects of the Act as set out in s 12(a) is to provide for the treatment of persons with mental illness. The provision of benzodiazepine medication in the circumstances allows for the management and alleviation of the ill effects of TQ's mental illness. I am satisfied that the variation of the treatment order would allow for TQ to receive treatment that would alleviate any distress he was experiencing due to his agitation.

1. The treatment order was varied in the terms requested by the applicant on 7 July 2025 at 9:11 am. The order will expire on 7 September 2025 at 11:45 am unless discharged sooner or renewed.