This report is made as—
(tick whichever is appropriate)
□ a certificate of the opinion of an authorised medical officer after examination of a person under the Mental Health Act 2007, section 27(1)(a),
□ advice by a medical practitioner to an authorised medical officer under the Mental Health Act 2007, section 27(1)(b) or (c).
OR, if it is not reasonably practicable for an authorised medical officer of a mental health facility or other medical practitioner to personally examine a person or observe the person’s condition for the purpose of determining, under the Mental Health Act 2007, section 27, whether the person is a mentally ill person or a mentally disordered person—
This report is made as—
(tick whichever is appropriate)
□ a certificate of the opinion of a medical practitioner after examination of a person using an audio visual link in accordance with the Mental Health Act 2007, section 27A(1)(a),
□ a certificate of the opinion of an accredited person authorised by the medical superintendent of [name of mental health facility] to personally examine a person in accordance with the Mental Health Act 2007, section 27A(1)(b)(i),
□ a certificate of the opinion of an accredited person authorised by the medical superintendent of [name of mental health facility] to examine a person using an audio visual link in accordance with the Mental Health Act 2007, section 27A(1)(b)(ii).
Note 1—
For examinations under the Mental Health Act 2007, section 27A, an accredited person and a medical practitioner who is not a psychiatrist must, if it is reasonably practicable to do so, seek the advice of a psychiatrist before making a determination as to whether the person is a mentally ill person or a mentally disordered person. See the Mental Health Act 2007, section 27A(4).
Note 2—
A medical practitioner must not carry out an examination or observation using an audio visual link unless the medical practitioner is satisfied that the examination or observation may be carried out by audio visual link with sufficient skill and care to form the required opinion about the person. See the Mental Health Act 2007, section 27A(3).
I, the undersigned, a registered medical practitioner/an accredited person on [date and time] examined by audio visual link/personally examined [patient’s name] a person detained at [name of mental health facility].
I also certify the following (whichever is appropriate)—
(a) on [date and time] [name of second examiner], as referred to in the Mental Health Act 2007, section 27(1)(b), examined by audio visual link/personally examined the patient,
(b) on [date and time] [name of third examiner], as referred to in the Mental Health Act 2007, section 27(1)(c), examined by audio visual link/personally examined the patient,
(c) on [date and time] [name of examiner], as referred to in the Mental Health Act 2007, section 27A, examined by audio visual link/personally examined the patient.
In my opinion, [patient’s name]—
(tick the 1 box that is appropriate)
□ is not a mentally ill or mentally disordered person,
□ is a mentally ill person,
□ is a mentally disordered person.
The basis for my opinion is as follows—
Reported behaviour of the patient
[list behaviours]
Observations by me of the patient
[list observations]
Conclusion
[insert conclusion]
(This report may be continued on a separate page, if necessary)
Name of registered medical practitioner/accredited person—
Qualifications as a psychiatrist, if applicable—
[Signature]
[Date]
Note—
This report is for the use of a legal tribunal and therefore should not be written in technical medical language.
Notice of proceedings before Mental Health Review Tribunal
Dear .........................
I wish to advise you that [patient’s name] is at present a patient at this mental health facility under the provisions of the Mental Health Act 2007.
On [date] at approximately [time] the Mental Health Review Tribunal will hold an inquiry at [location] to consider whether or not further detention for the purpose of treatment is warranted.
You are invited to attend this inquiry. With the permission of the patient and the Tribunal, any person at all may represent the patient. However, the patient will be legally represented unless the patient decides that the person does not want to be. Should it be necessary, a competent interpreter will be available to assist.
If the Tribunal considers further detention is warranted, the Tribunal will also consider whether or not the patient is able to manage the patient’s affairs. If the Tribunal considers that the patient is able to do so, then the patient will continue to do so. If the Tribunal is not satisfied that the patient can manage the patient’s affairs, then an order will be made that the NSW Trustee and Guardian manage the patient’s affairs.
If the patient does not agree that the patient’s affairs should be managed by the NSW Trustee and Guardian, the patient may appeal to the Supreme Court or the Civil and Administrative Tribunal.
If you have any questions, please feel free to discuss them with the patient’s doctor or social worker. Contact may be made by telephoning [telephone number].
Yours faithfully,
[Authorised medical officer]
[Date]
Form 3 Appeal by patient against refusal to discharge
Electroconvulsive therapy (ECT) is recommended if alternative forms of treatment have either not worked well or would work too slowly to be effective.
The following will happen during ECT treatment—
(a) You will be given a brief general anaesthetic. This involves giving medications to ensure that you are asleep during the procedure and to relax the muscles. The anaesthetist will normally give the anaesthetic by an intravenous injection.
(b) While you are anaesthetised, another medical practitioner will use a medical apparatus designed to pass a controlled electrical current through your head for a few seconds. The intention is to affect those parts of your brain related to emotion and thought.
(c) While the current is passing, the anaesthetic is intended to prevent you from feeling anything and to prevent your body from moving more than slightly.
(d) An acute course of treatment with ECT may be given 2 or 3 times a week with the goal of improving symptoms.
(e) An acute course of treatment will generally involve between 6 and 12 treatments, but on some occasions, more treatments will be required. Any queries you have in relation to the number of treatments you may need may be raised with your doctor.
(f) Some people need to have more ECT after an acute course to prevent symptoms from returning. This is called continuation or maintenance ECT, and is usually given less frequently (usually every 1–4 weeks). It may be given over several weeks or months, or sometimes longer if needed.
Possible benefits of treatment
Benefits depend on your symptoms and may vary between people. Relief may be obtained from the symptoms of a variety of mental health disorders including depression, bipolar disorder and schizophrenia.
Possible alternative treatments
Other treatments may also be considered for your condition. A full disclosure of appropriate alternative treatments must be provided to you. Any questions you have in relation to this information may be discussed with your doctor.
Possible complications of treatment
Immediately after ECT most people have a short period of confusion due to the treatment and the anaesthetic. This usually resolves rapidly. Some people notice difficulties with their memory of new information or events occurring during ECT treatment. Some people may also experience memory loss for events which occurred before they started ECT. The degree of memory loss varies between people and is more likely to affect memories for events closer in time to the ECT course. This usually gets better over time, but for some, the loss of some past memories may be permanent.
Other thinking abilities may also be affected by ECT. These effects usually resolve within a month of receiving the last acute ECT treatment.
Some people experience a headache, nausea, or muscle soreness on awakening after the treatment. Your blood pressure and heart rate often increase during the treatment, and sometimes medication is given by the anaesthetist to manage this. Uncommon side effects that may occur during the procedure include abnormal heart rhythms and problems with breathing related to the anaesthetic. Very rare complications include injuries to bones, muscles or teeth from movement. This is very rare because medication is given to relax your muscles, and a mouth guard is used to protect your teeth.
Consent to treatment
This treatment cannot be carried out without your consent (see Part 2 below), unless you are an involuntary patient at the mental health facility. If you are an involuntary patient, the treatment can only be carried out in accordance with an order made by the Mental Health Review Tribunal.
Before giving this consent you may ask your doctor any questions relating to the techniques or procedures to be followed.
You may also withdraw your consent and discontinue this treatment AT ANY TIME.
Persons under 16
People under 16 may provide consent for ECT, but the consent must be reviewed at a Mental Health Review Tribunal hearing.
Legal and medical advice
You have the right to get legal advice and medical advice before you give your consent. The LawAccess NSW telephone number is 1300 888 529.
Disclosure of financial relationship
All medical officers involved in the delivery of your ECT treatment receive financial compensation for their work.
Part 2 Consent to electro convulsive therapy
I, [name in full], consent to being treated with electro convulsive therapy.
I ACKNOWLEDGE that I have read/have had read to me Part 1 of this Form, and that I understand the information it contains.
I UNDERSTAND that I am free at any time to change my mind and withdraw from the course of treatment if I so desire.
[Signature]
[Date]
Part 3 Consent to electro convulsive therapy for involuntary patients
I, [name in full], consent to being treated with electro convulsive therapy.
I ACKNOWLEDGE that I have read/have had read to me Part 1 of this Form, and that I understand the information it contains.
I UNDERSTAND that I am free at any time to change my mind and withdraw from the course of treatment if I so desire.
I UNDERSTAND that my consent will be reviewed by the Mental Health Review Tribunal.
[Signature]
[Date]
Interpreter (if applicable)
[Name]
[Signature]
[Date]
[EmployeeID/Provider number]
Certification by witness*
I certify that all matters dealt with in this Form have been orally explained to the person in relation to whom treatment is proposed and have been explained in a language with which that person is familiar.
[Signature]
[Date]
*The witness must be a person observing the consent process other than the medical officers recommending ECT.
The Mental Health Review Tribunal will be hearing matters in relation to [name of patient].
The hearing will take place at [time] on [date] at [address].
You are required—
(Tick 1 box only)
□ to attend the hearing as a witness
□ to attend the hearing and produce the following documents—
............................................................
............................................................
You are entitled to receive reasonable costs, including any loss of earnings incurred through compliance with this summons.
Should you fail or refuse to comply with this summons, properly served, you may be guilty of an offence under the Mental Health Act 2007.
If you are required to attend the hearing only to produce documents, it is sufficient compliance with this summons if those documents are delivered to [place] at [address] on or before [date].
[Signature]
[President/Deputy President] of the Mental Health Review Tribunal
I, [name], do swear that I will well and truly advise and assist, without fear or favour, affection or ill will, the Supreme Court of New South Wales as an assessor in any matter coming before that Court pursuant to the provisions of the Mental Health Act 2007.