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

1. The application advises that the patient has a diagnosis of delusional disorder with multiple Capgras delusions about her children and other family members. It is reported that she has been the subject of three mental health admissions to hospital. As for the current admission, the applicant states as follows:

[UQP] appears to be presenting with worsening psychosis with disturbance in her thoughts and disturbance in her mood on the background diagnosis of delusional disorder. She has a disturbance in her thoughts, paranoid towards her family members, that they are against her in their efforts for her to receive help and misidentifies other family members as her children and has an ongoing belief that family members have been swapped with doubles. She is presenting with a disturbance in her mood with an inability to maintain her mood state.

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

1. The next criterion 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. As summarised in the matter of TI (Application for Treatment Order) [2022] TASCAT 31 at [38] - [39], this criterion has been the subject of interpretation by Blow CJ in two matters:

First, 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. > > 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.

2. The applicant addressed this criterion as follows:

Without immediate treatment under a treatment order, there is a risk to the self through misadventure and further deterioration. There is a risk that her relationships could lead to her losing custody of her child. There would be a potential increase in direct self-risk if this were to occur. There is a potential inadvertent risk to others due to the belief that others have been swapped.

3. This evidence satisfies me that without treatment the mental illness is likely to seriously harm the patient's health or safety, or the safety of others.

1. A further criterion of which I must be satisfied in order to exercise the discretion to make an ITO is that the treatment proposed will be appropriate and effective in terms of the outcomes referred to in 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. Comments in obiter as to the intention of this legislative criterion were made by Blow CJ 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 applicant proposed the patient required treatment as an inpatient at an approved facility until discharge, and then with the community mental health team. The administration of antipsychotic, benzodiazepine and anticholinergic medications was proposed, and had commenced pursuant to s 55 of the Act. Standard diagnostic testing was also proposed along with psychoeducation and supportive psychotherapy. The applicant described the treatment proposed as appropriate and effective as:

Current treatment is evidence based treatment for psychosis, and there has been past improvement and stability of [UQP]'s mental state when taking these prescribed treatments.

4. I was satisfied on the evidence that the treatment was directed towards the management of the ill effects of the patient's mental illness and the monitoring of her mental state. This criterion is met.

1. The next criterion requires me to be satisfied that the treatment cannot adequately be given except under a treatment order.
2. The applicant addressed this criterion in the application:

[UQP] lacks insight into her mental health issues and her capacity to take decisions for his (sic) treatments appears to be affected by this acute relapse. There is no less restrictive and safe way to manage his (sic) current presentation except under the mental health act (sic).

3. Further in the application the applicant states:

If [UQP] was made a voluntary patient, she would leave the hospital as she does not believe she is unwell and does not wish to take prescribed medications, she has recently attempted to leave the ward.

4. When read in conjunction with the applicant's assessment of the patient's current decision-making capacity (see below), I am satisfied that this criterion is met.

1. Further, I must be satisfied that the patient currently 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).

1. In the assessment of the applicant, the patient is presenting with disturbance in her thoughts and perceptions, which is directly impacting her decision-making capacity regarding treatment and her current behaviour and choices. He describes the patient as being unable to use or weigh information pertaining to her mental illness and treatment due to her fluctuating psychotic symptoms.
2. Understandably given the nature of an ITO application, there was no contradictory professional evidence before me in relation to the professional opinion of the applicant as to the patient's decision-making capacity. I am satisfied on the evidence provided by the applicant, that this criterion is currently satisfied.
3. I note the applicant ticked the box 'yes' next to the question 'does the patient have decision making capacity?', however I find this was an oversight and the no box was meant to be ticked based on the written information provided.

1. To proceed to make an ITO I also need to be satisfied that the Tribunal cannot immediately determine the application. To do so, amongst other things, 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 of the application.
2. This matter most certainly could not be dealt with immediately by the Tribunal.

1. Finally, to be able to consider the making of an ITO, I must be satisfied that the delay involved with awaiting the outcome of a hearing before a three Member panel would, or is likely to, seriously harm the patients' health or safety or the safety of others. Put another way, what would occur if no ITO was made and the affirmed assessment order simply lapsed?
2. For the reason outlined earlier, I am satisfied that without treatment, there is currently a likely 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 exercise her right to self-discharge. I am satisfied on the evidence presented and summarised earlier in these reasons that there is a strong probability that the patient would indeed leave the inpatient setting and otherwise refuse treatment given her current mental state.
3. This criterion is met.

1. As indicated, I am satisfied that the patient meets the treatment criteria. Given I am satisfied of the other procedural matters that need to be addressed as outlined in s 38 of the Act, I could 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 account of the objects of the Act (s 12) and the mental health service delivery principles (Sch 1).
2. Whilst cognisant of the limitations associated with dealing with such applications on the papers, especially in relation to the ability to take account of the patient's views, I am satisfied however that taking account of all mandatory considerations, I should make the ITO in the terms requested by the applicant for the maximum period of 10 days.

1. The Tribunal made an interim order in the following terms to 20 September 2025 at 3:50pm:

(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. Benzodiazepine medication
   3. 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 urine tests and/or diagnostic radiological and medical imaging tests, as clinically indicated and as directed by the treating team.
   1. Adult Community Mental Health Service (ACMHS) appointments (inclusive of home visits as arranged when being treated in the community).