XGY [2025] VMHT 9 (6 May 2025)

You were said to have obtained an intervention order against a neighbour which was of two years duration. The Tribunal was not given details about the paranoid thinking that led to you obtaining this intervention order, but the legal member noted you were the protected person, and you were granted an order of longer than usual duration by the judicial officer presiding over that hearing.

The treating team referred to an alleged assault against your mother. However, your mother denied this occurred and as a result that material was redacted from your files. Despite this, it appeared in the report and in the more recent discharge summary which was provided to the Tribunal. Given your mother had denied these events had occurred and that this material had been redacted from your file, this was not material the legal member was comfortable relying on.

You denied ever reporting hearing voices or references from the television. Historically as well as recently, you have called members of the treating team 'crazy' for saying things like this about you. This was reported as you experiencing significant paranoia about the treating team. You have also acted aggressively in response to compulsory treatment in the past. The legal member did not consider behaviour designed to challenge and resist compulsory treatment as necessarily indicative of mental illness.

When you were admitted to hospital in 2020 you were found in your home with the lights off and blinds drawn. The information before the Tribunal indicated you had not been attending to your cleaning and did not have fresh food in the house. This occurred during the COVID-19 pandemic. The report stated you were tangential and paranoid when admitted to hospital, but no examples were provided. Many people did not function as they ordinarily would have during the pandemic. Given the context weight was not placed on this evidence.

In 2024 when you were hospitalised you were deemed to be polite but guarded and irritable when discussing mental health. You did not agree you had a mental illness. You were said to have 'themes of religion and persecution' but with no examples provided. You were concerned about bacteria in the air from other co-consumers who had not showered which is not necessarily a significant disturbance of thought. You were resistant to treatment, but you were not responding to internal stimuli and had no suicidal or homicidal ideation. You were angry about being forced to have medications which you said impacted your memory and quality of life. Some time into your admission you became less aggressive and more compliant which was attributed to your symptoms being managed by antipsychotic medications, though antipsychotic medications are notoriously sedating, which may have explained the change in your behaviour. This is particularly so when your admission was triggered by a failure to have your depot injection which resulted in you being brought into hospital by police, as opposed to being found to be actively psychotic. Other than being concerned about bacteria and being angry about being in hospital and forced to have treatment, there did not appear to be any signs of a decline in your mental health at that time. Despite this, the treating team's report says that you experienced a 'psychotic relapse'.

During the hearing CM said you neglected yourself leading up to your last admission and had lost a lot of weight. You told the Tribunal that CM was crazy and that you had to go on a diet to lose weight because your GP recommended it.

You have experienced significant trauma during your life. According to the report, you migrated to Australia from another country as a refugee. Your brother, who was a teenager at the time, was abducted by soldiers and you never saw him again. Within a few years of arriving in Australia, your marriage ended leaving you with the care of three children on your own. You experienced family violence within that marriage. You suffered orthopaedic injuries in the 1980's which led to you being the recipient of a Disability Support Pension. You lost a son to suicide. Despite all this you remained independent, raised your children, and you were active in your community, attending English classes, local groups and church. An exception to this was during the pandemic, as noted above.

You speak English as a second language and require an interpreter. You adamantly deny saying things included in the report and other documents that the treating team say are symptoms of mental illness. The legal member was concerned that historically you have been recorded as saying things where it is not clear that you had the benefit of an interpreter. The legal member also noted FM raised concerns about the interpreting services during the hearing. FM told the Tribunal several times that what was being said was being misinterpreted. Your hearing had already been adjourned multiple times, and you did not want the Tribunal to adjourn it again. It was difficult to have confidence in the standard of interpretation following this which meant it was hard to be satisfied that you were able to properly respond to what the treating team said in the hearing. In one notable example you told the Tribunal you were not talking to yourself when CM attended your home to conduct an assessment, and this was confirmed by your daughter. As it turns out, CM was talking about a different experience, but something was clearly lost in translation. On this point, CM told the Tribunal you were talking to yourself for hours when no-one else was in the home. But it was impossible to know if you were directing what you were saying to CM who, by his own account, was standing outside your home for an extended period of time, or yourself, or if you were just talking to someone on the telephone. There was no mention of an interpreter present so what you were, in fact, saying was also unknown. You denied ever talking to yourself.

In the more recent discharge summary, it was evident the hospital had listened your repeated requests for an interpreter, and one was present throughout all of the reviews. According to the discharge summary it was anticipated that you would require interpreters for your community clinic reviews which would 'significantly improve engagement with clinicians'. It would appear from this document that it had not been a habit of community clinicians to review you with an interpreter present.

The Tribunal was invited to conclude that multiple previous admissions to hospital was evidence that you experienced a mental illness. The details of those admissions are scarce but the fact that there were many can be relied on. Having said that, past diagnosis of mental health is not necessarily evidence of a current mental illness.

Much of the evidence relied on to establish you experience a mental illness in the hearing consisted of vague and broad statements about symptoms you were experiencing such as 'paranoid thinking' but with no examples provided. Likewise, much of the evidence that you had a mental illness consisted of accounts of your failing to adhere to treatment. Again, this is not necessarily indicative of a mental illness.

It is impossible in the time frame allotted to hearings to critically examine all of the evidence provided. It is customary for the Tribunal to rely on the report prepared by the treating team and part of the medical file with the knowledge that it is not a complete account of your history and that some of it may be in dispute. However, given the vague and broad descriptions of symptoms above, lack of context around your experiences of those symptoms, and without clear evidence that your behaviours have been assessed through a cultural, gender and trauma lens and/or with the benefit of an interpreter, the legal member was uncomfortable making a determination that you had a mental illness as defined by the Act.

This minority decision should not be read as the legal member drawing a conclusion that you do not experience, or have not, experienced mental illness. Your lawyer, Dan, told the Tribunal you identify with having some form of mental illness at times. The minority decision is just the legal member's assessment that the material before the Tribunal at the time of the hearing was not of sufficient probity to rely upon to reach a conclusion about mental illness given the seriousness of the decision the Tribunal is being asked to make.

Because the legal member was not satisfied that you have mental illness, she was not required to consider the remaining criteria. The remaining reasons are therefore a record of the majority decision which reflects the views of the psychiatrist and community members.

(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?

The treating team's report outlined a long and significant history of hospitalisations as well as compulsory and voluntary treatment in the community. The treating team identified that when you are not treated with antipsychotic medication your mental health deteriorates, and this has been a pattern over time. At times this results in you being hospitalised which you find very distressing. When you are experiencing symptoms of your mental illness you become angry, irritable, paranoid, suspicious and you isolate yourself. You stop engaging in your favourite activities and you spend significant periods of time isolated in your home without fresh food and living in squalor. At one point whilst travelling overseas you were reported as being homeless. You become overly worried about your children, even turning up at their workplaces and homes uninvited because you are worried harm will come to them. You have also threatened to harm clinicians when unwell, kicking and biting them.

For these reasons a majority of the Tribunal was satisfied that because of your mental illness you need treatment now to prevent a serious deterioration to your mental health, physical health and to prevent serious harm to yourself and others.

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

A majority of the Tribunal was satisfied you would continue to receive immediate treatment if it confirmed your treatment order. This treatment includes but is not limited to psychiatric reviews, monitoring of your mental state, case management and the administration of psychotropic medications.

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

The treating team told the Tribunal you do not accept that you experience a mental illness that requires the treatment they are recommending. For this reason, according to your treating team you resist taking medication and you have ceased medications in the past as soon as you are not compelled to take them. This has led at times to periods of hospitalisation which you find very distressing. Dan told the Tribunal you do not agree that you need the treatment recommended by the treating team because you are not a risk to yourself or anyone else.

The Tribunal heard that if you were making your own decisions about your treatment you would like to see your GP on a regular basis because you have a good relationship with him, and you trust him.

You told the Tribunal you took medications when your GP recommended you do so. You stopped taking this medication when your GP told you this was okay. CM told the Tribunal that within a month of stopping the medications you relapsed and were hospitalised again. He said that that each time you relapse it takes longer and longer to for you to recover. You denied you relapsed at all.

Taking into account your long history of hospital admissions and the pattern of ceasing medication and relapses, and given you do not accept you need treatment and would not accept treatment in the absence of a compulsory treatment order, the majority of the Tribunal was satisfied that there is no less restrictive means than a treatment order that would enable you to receive immediate treatment.

Given the Tribunal decided that all of the compulsory treatment criteria applied to you the Tribunal confirmed a treatment order.

As your hearing was about your application to have your order revoked the Tribunal did not have to make a decision about how long your order should last. The Act sets the duration of your order as the amount of time remaining on your order at the time of the hearing. This means the duration of your order is unchanged and it will expire on 15 May 2025.

Your treatment order cannot extend beyond 15 May 2025_._ Your treating doctor must revoke your treatment order at any time if they believe the treatment criteria no longer apply.

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.