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ACT CIVIL & ADMINISTRATIVE TRIBUNAL IN THE MATTER OF ED (Mental Health) [2017] ACAT 84 MH 248/2017 Catchwords: MENTAL HEALTH – authorisation of short-term involuntary detention for immediate treatment, care or support – statutory preconditions for initial detention by a doctor for 3 days – Tribunal order extending the period of involuntary detention for a period not longer than an additional 11 days – Tribunal review of involuntary detention under section 85 of the Mental Health Act – relevant conditions and when they must apply for exercise of discretionary power Legislation cited: ACT Civil and Administrative Tribunal Act 2008 s 60 Mental Health Act 2015 ss 9, 10, 11, 80, 81, 82, 83, 84, 85, 91 Cases cited: George v Rockett (1990) 170 CLR 104 McKinnon v Secretary, Department of Treasury (2006) 228 CLR 423 Tribunal: Presidential Member G McCarthy Date of Orders: 31 July 2017 Date of Reasons for Decision: 18 October 2017

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ACT CIVIL & ADMINISTRATIVE TRIBUNAL

IN THE MATTER OF ED (Mental Health) [2017] ACAT 84

MH 248/2017

Catchwords: MENTAL HEALTH – authorisation of short-term involuntary detention for immediate treatment, care or support – statutory preconditions for initial detention by a doctor for 3 days – Tribunal order extending the period of involuntary detention for a period not longer than an additional 11 days – Tribunal review of involuntary detention under section 85 of the Mental Health Act – relevant conditions and when they must apply for exercise of discretionary power

Legislation cited: ACT Civil and Administrative Tribunal Act 2008 s 60Mental Health Act 2015 ss 9, 10, 11, 80, 81, 82, 83, 84, 85, 91

Cases cited: George v Rockett (1990) 170 CLR 104McKinnon v Secretary, Department of Treasury (2006) 228 CLR 423

Tribunal: Presidential Member G McCarthy

Date of Orders: 31 July 2017Date of Reasons for Decision: 18 October 2017

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AUSTRALIAN CAPITAL TERRITORY )CIVIL & ADMINISTRATIVE TRIBUNAL ) MH 248/2017

IN THE MATTER OF ED

TRIBUNAL: Presidential Member G McCarthy

DATE: 31 July 2017

ORDER

The Tribunal orders that:

1. The order made on 27 July 2017 is confirmed.

………Signed………………..Presidential Member G McCarthy

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REASONS FOR DECISION

1. On 24 July 2017, a doctor at the Canberra Hospital Adult Mental Health Unit

(AMHU) authorised involuntary detention and involuntary treatment, care and

support for a person (referred to in these reasons as ‘ED’1) for a period not

exceeding three days pursuant to section 85(1) of the Mental Health Act 2015

(the Act). The involuntary detention commenced at 10:45am on 24 July 2017.

2. On 27 July 2017, ED’s treating psychiatrist2 applied to the Tribunal for ED’s

involuntary detention to be extended for a further period not longer than 11 days

pursuant to section 85(2) of the Act. On the same day, the Tribunal made an

order authorising ED’s detention for a further period of up to 11 days to expire

at 10:45am on 7 August 2017.

3. By this means, ED’s involuntary detention was authorised for up to 14 days in

total from when it commenced on 24 July 2017.

4. On Friday, 28 July 2017, ED applied to the Tribunal under section 85(4) of the

Act for review of his involuntary detention.

5. Under section 85(4) of the Act, that Tribunal was required to conduct its review

within two working days after the day the application for an extension of the

period of detention was made.

6. On Monday, 31 July 2017, I conducted a hearing at the AMHU to review ED’s

involuntary detention. Under section 85(6) of the Act, I was permitted to

consider ED’s application for review of his involuntary detention without

holding a hearing. However, in this case, I elected to hold a hearing. I did so

primarily because I did not know the basis upon which ED had applied for

review. To conduct a hearing was also an expedient and practical means of

enabling ED to put his case.

1 The initials ‘ED’ are not the person’s initials.2 The Tribunal understands that ED’s treating psychiatrist holds a

delegation from the Chief Psychiatrist under section 200 of the Act to exercise the Chief Psychiatrist’s functions under the Act.

2

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7. ED attended the hearing and was represented by his solicitor, Ms A Banks.

ED’s two treating psychiatrists and ED’s mother also attended the hearing. At

the conclusion of the hearing, I confirmed the Tribunal’s order made on 27 July

2017 and gave oral reasons for doing so.

8. On 14 August 2017, ED applied for a statement of reasons for the Tribunal’s

order made on 31 July 2017.

9. Section 60 of the ACT Civil and Administrative Tribunal Act 2008 (the ACAT

Act) provides a procedure regarding provision of a statement of reasons. It

states:

60 Statement of reasons(1) This section applies if—

(a) the tribunal makes an order on an application; and(b) within 14 days after the day the order is made, a party asks for a

statement of reasons for the making of the order.(2) The tribunal must give the party a written statement of reasons or a

transcript of an oral statement of reasons for the making of the order.(3) The statement of reasons must set out—

(a) any principles of law relied on by the tribunal; and(b) the way in which the tribunal applied the principles of law to the

facts.Note For what must be included in a statement of reasons, see the Legislation Act, s 179.

(4) This section does not apply to an order under section 53 (Interim orders) or an order of a procedural nature.

10. Under section 60(2) of the ACAT Act, I could have provided ED with a

transcript of the reasons I gave on 31 July 2017. However, I have elected

instead to provide ED with the following written statement of reasons drawn

from the transcript.

Statutory framework

11. Chapter 6 of the Act, comprising sections 80-92, deals with emergency

detention and what may or must occur prior to and during involuntary detention.

The sections are heavily interrelated and must therefore be read together.

Relevant to this case, section 85 provides for authorisation of involuntary

detention but is dependent on sections 80, 81 and 84 for its operation.

3

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12. Section 85 of the Act provides:

85 Authorisation of involuntary detention(1) A doctor may authorise the involuntary detention and treatment, care or support of a person at an approved mental health facility for a period not exceeding 3 days if—

(a) the doctor has conducted an initial examination of the person under section 84 and, on the basis of that examination and any other information the doctor is given, has reasonable grounds for believing that—(i) the person requires immediate treatment, care or support;

and(ii) the person has refused to receive that treatment, care or

support; and(iii) detention is necessary for the person’s health or safety,

social or financial wellbeing, or for the protection of someone else or the public; and

(iv) adequate treatment, care or support cannot be provided in a less restrictive environment; and

(b) another doctor has also examined the person and, on the basis of that examination and any other information the doctor is given, also has reasonable grounds for believing the matters mentioned in paragraph (a) (i) to (iv).

(2) Before the end of the 3-day period of detention, the chief psychiatrist may apply to the ACAT to extend the period of detention if the chief psychiatrist believes on reasonable grounds that the person continues to meet the criteria mentioned in subsection (1) (a) (i) to (iv).(3) If an application is made under subsection (2), the ACAT may order that the period of detention be extended by the period, not longer than 11 days, stated in the order.(4) A person may apply to the ACAT for the review of involuntary detention under this section.(5) If an application is made under subsection (4), the ACAT must conduct the review within 2 working days after the day the application is made.(6) The ACAT may consider an application under subsection (2) or (4) without holding a hearing.

13. Numerous preconditions must be met before a doctor may, under section 85(1)

of the Act, “authorise the involuntary detention and treatment, care or support of

a person at an approved mental health facility”.

14. First, under section 85(1)(a), ‘the doctor’ – meaning as a matter of statutory

structure the doctor who proposes to authorise the involuntary detention and the

4

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treatment, care and support – must have conducted an initial examination of the

person under section 84 of the Act.

15. Section 84 “applies to a person (the subject person) detained at an approved

mental health facility under section 81.”3

16. Section 81 of the Act authorises detention of a person at an approved mental

health facility in two circumstances, as set out in sections 81(1) and 81(2).

Those subsections provide:

81 Detention at approved mental health facility(1) If a person is taken to an approved mental health facility under section 80 or the Crimes Act, section 309 (1) (a) (Assessment whether emergency detention required), the person in charge of the facility must detain the person at the facility.(2) If a doctor or mental health officer believes on reasonable grounds that a person attending an approved mental health facility (voluntarily or otherwise) is a person to whom section 80 (2) (a) to (e) applies, the doctor or mental health officer may detain the person at the facility.

17. ED was not taken to AMHU under section 80 of the Act (which deals with

apprehension of a person and taking the person to an approved mental health

facility) or section 309(1)(a) of the Crimes Act. Section 81(1) was therefore not

applicable.

18. ED was taken to AMHU because of concerns about his behaviour. Section 81(2)

therefore applied regarding his detention. It does not matter whether ED was

taken to AMHU “voluntarily or otherwise”. Either way, section 81(2) applies.

Several factors are of note.

19. First, detention is discretionary, arising from the word ‘may’ in section 81(2),

unlike detention under section 81(1) where detention is mandatory, arising from

the word ‘must’.

20. Second, in order for the person to be detained, the doctor or mental health

officer must believe on reasonable grounds that the person “is a person to whom

section 80(2)(a) – (e) applies”.

21. Section 80(2)(a) – (e) of the Act provides:3 Section 84(1)

5

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(2) A doctor or mental health officer may apprehend a person and take the person to an approved mental health facility if the doctor or mental health officer believes on reasonable grounds that—

(a) the person has a mental disorder or mental illness; and(b) either—

(i) the person requires immediate treatment, care or support; or

(ii) the person’s condition will deteriorate within 3 days to such an extent that the person would require immediate treatment, care or support; and

(c) the person has refused to receive that treatment, care or support; and

(d) detention is necessary for the person’s health or safety, social or financial wellbeing, or for the protection of someone else or the public; and

(e) adequate treatment, care or support cannot be provided in a less restrictive environment.

22. Third, by the pathway set out in sections 80(2)(a), 81(2) and 84, although not

stated in section 85(1), it becomes clear that a precondition of ED’s detention

under section 85 was that the doctor who authorised ED’s involuntary detention

and his treatment, care and support believed on reasonable grounds that ED had

a mental disorder4 or a mental illness.5

23. Being in the nature of emergency detention, section 80(2)(a) did not require a

diagnosis that ED had a mental disorder or mental illness. A belief “on

reasonable grounds” was sufficient. It is not the point if the doctor, on further

review or arising from later treatment, care and/or support, were later to

conclude that there are not, or are no longer, reasonable grounds for that belief.

A later revised view does not affect the lawfulness of a person’s detention at the

time he or she was detained, but it would trigger an obligation to release under

section 91 of the Act which provides:

91 Order for release(1) If a relevant entity is satisfied that the detention of a person under section 85 is no longer justified, the entity must, as soon as practicable, order the release of the person for the period of detention authorised under that subsection expires.

4 ‘mental disorder’ is defined in section 9 of the Act.5 ‘mental illness’ is defined in section 10 of the Act

6

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24. For a doctor to have ‘reasonable grounds for believing’ that the criteria under

section 85(1) are met differs from a doctor reasonably believing that the criteria

are met. The former is an objective test. The latter a subjective one. While a

doctor may assert that he or she has or had reasonable grounds for believing the

factual circumstances described in section 85(1)(a)(i) – (iv), that is not the test.

Whether there are reasonable grounds for a belief must be approached,

objectively, from the viewpoint of a reasonable decision maker.

25. In George v Rockett,6 the High Court (per Mason CJ, Brennan, Dean, Dawson,

Toohey, Gaudron and McHugh JJ) explained the significance of the phrasing as

follows:

When a statute prescribes that there must be "reasonable grounds" for a state of mind - including suspicion and belief - it requires the existence of facts which are sufficient to induce that state of mind in a reasonable person. … That requirement opens many administrative decisions to judicial review and precludes the arbitrary exercise of many statutory powers: see, for example, Attorney-General v Reynolds [1980] AC 637. Therefore it must appear to the issuing justice, not merely to the person seeking the search warrant, that reasonable grounds for the relevant suspicion and belief exist.7

26. In McKinnon v Secretary, Department of Treasury (McKinnon),8 the High

Court made similar observations on the question whether, on review by the

Administrative Appeals Tribunal, there were reasonable grounds for a claim that

disclosure of a document would be contrary to the public interest. The High

Court said:

10. This is an objective test. George v Rockett was concerned with Queensland legislation empowering the issue of a search warrant if there were reasonable grounds for suspecting that there was incriminating evidence in a house. The statutory formula, however, is widely used. The point of the objectivity of such a test, when it is necessary to consider whether a primary decision-maker had reasonable grounds for a given state of mind, is that the question is not whether the primary decision-maker thinks he or she has reasonable grounds.

11. To decide whether it was reasonably open to a decision-maker, on the evidence, to make a judgment such as … whether there are reasonable grounds for a claim that a course of action (such as disclosure of a

6 (1990) 170 CLR 1047 (1990) 170 CLR 104 at [8]8 [2006] HCA 45; (2006) 228 CLR 423

7

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document) would be contrary to the public interest, involves an evaluation of the known facts, circumstances and considerations which may bear rationally upon the issue in question. …

12. Where a claim, or an argument, or a conclusion or some other state of mind (such as suspicion, or belief, or satisfaction) involves an interplay of observation (of objective facts and circumstances), opinion, and judgment (which may involve an evaluation of matters such as reasonableness of conduct, or of the public interest), the question whether there are reasonable grounds for such a claim, or argument, or state of mind requires a consideration of all relevant matters and an assessment of the reasonableness of the claim, or argument, or state of mind having regard to all relevant considerations. It is not a hypothetical question. It is a question to be answered in the light of all the known circumstances. This applies to all relevant considerations whether they be matters of objective fact (as in the example given), or of opinion, or of argument. Until all relevant considerations, that is, all (known) considerations that could have a rational bearing upon the claim, or state of mind, or decision under review, are taken into account, it is impossible to form a just and fair judgment whether, objectively considered, there are reasonable grounds for the claim that the disclosure of the document would be contrary to the public interest. It is not enough for the Tribunal to ask whether there are facts, or opinions, or arguments that rationally bear upon that topic. All relevant matters must be taken into account; not for the purpose of deciding whether the Tribunal agrees with the Minister, but for the more limited purpose of deciding whether there are reasonable grounds for the claim which the Minister accepted.

12. Applying these statements of principle to section 85 of the Act, it is not to the

point that the doctor who conducted the initial examination of the person under

section 84 of the Act reasonably believes that the facts and circumstances

described in section 85(1)(a)(i) – (iv) are made out. Section 85(1)(a) requires the

existence of facts, objectively judged, which are sufficient to induce a state of

mind in a reasonable person (referenced to a reasonable and appropriately

skilled doctor) that the facts and circumstances described in section 85(1)(a)(i) –

(iv) exist and hence the criteria for involuntary detention are met.

13. Likewise, on review under section 85(4), the task of the Tribunal is to ascertain,

objectively, whether all the relevant facts and circumstances support that state

of mind in a reasonable person at the time of the review. The review is of the

person’s involuntary detention authorised by the doctor, whether that be during

the initial three days authorised by the doctor under section 85(1) or during an

extended period authorised by the Tribunal under section 85(3).

8

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14. On review, the Tribunal does not decide in the exercise of its discretion whether

involuntary detention should continue. That is always for the doctor to decide.

The Tribunal’s role is only to review whether the doctor has reasonable grounds

for his or her belief that the criteria in section 85(1)(a)(i) – (iv) continue to be

met. If so, involuntary detention may continue.9

15. The Tribunal’s role, on review, is to consider not just the facts put forward by

the doctor as to why – objectively judged – there are reasonable grounds for

why the criteria are met, but also anything that the subject person says. As

stated in McKinnon, the Tribunal is required to take into account all relevant

considerations. To adopt a phrase from McKinnon,10 the facts advanced by the

doctor “is not the end; it is the beginning” as to whether there are reasonable

grounds for the doctor believing that the facts and circumstances described in

section 85(1)(a)(i) – (iv) are made out.

16. Several further aspects of section 85 should be noted.

17. Save for the question of refusal in section 85(1)(a)(ii) which I deal with below,

section 85 is written in the present tense. At each stage, whether that be when

the doctor is considering whether to authorise involuntary detention and

treatment, care or support for a period not exceeding three days under section

85(1), or when applying for an extension of the period of detention under

section 85(2), or when responding to a person’s application to the Tribunal for

review of his or her involuntary detention, the doctor must be guided by

whether he or she has, or continues to have, reasonable grounds for believing

that the person meets the criteria described in section 85(1)(a)(i) - (iv).

18. This is an important consideration, given that Chapter 6 of the Act is about

emergency detention of a person who requires immediate treatment, care or

support and involuntary detention to facilitate that treatment, care or support. In

situations of this kind, circumstances can quickly change. The reasonable

9 This limited role of the Tribunal contrasts with its roles under section 58 and section 66 of the Act, where the Tribunal (itself) has to be satisfied of the matters described in those sections for the purpose of making a psychiatric treatment order or a community care order, respectively.

10 McKinnon v Secretary, Department of Treasury at [17]

9

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grounds for why a doctor authorised involuntary detention at a particular time

might cease to apply. For example, within a few days after a doctor has

authorised involuntary detention, it may become clear that “adequate treatment,

care or support [can] be provided in a less restrictive environment” such that the

criterion in section 85(1)(a)(iv) is no longer met.

19. The Tribunal is under the same obligation when conducting a review of

involuntary detention. The question is whether the facts and circumstances

described in section 85(1) are met at the time the review is conducted,

irrespective of whether the necessary facts and circumstances existed at the time

the doctor authorised initial detention under section 85(1) or at the time that the

Tribunal authorised an extension of the period of detention under section 85(3).

20. This need to consider the facts and circumstances at the time of the review

permits the Tribunal to revoke the authorisation without any suggestion that the

detention was not validly authorised at the time it was authorised or at the time

when the period of detention was extended. Circumstances can change.

21. Several other uncontroversial but important preconditions that must be met in

order for a doctor to authorise involuntary detention should be noted:

(a) the doctor must have conducted an initial examination of the person under

section 84;

(b) the reasonable grounds for the doctor believing that the criteria set out in

section 85(1)(a)(i) – (iv) are met must be based on the examination that

the doctor has conducted of the person and any other information given to

the doctor; and

(c) under section 85(1)(b) of the Act, another doctor must also have examined

the person and, on the basis of his or her examination and any other

information given to him or her, must also have reasonable grounds for

believing that the criteria set out in section 85(1)(a)(i) – (iv) are met. The

information given to the second doctor might be the same as the

information given to the doctor authorising the involuntary detention, but

it remains necessary that the second doctor has independently examined

10

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the person and has been given the information upon which that second

doctor’s belief on reasonable grounds is based.

22. Section 85(1)(b) of the Act applies for the purpose of authorising involuntary

detention of the person, but further examination by the initial authorising doctor

or a second doctor is not necessary for the purpose of applying for or obtaining

an extension of the period of detention. It is necessary only that the chief

psychiatrist (or his/her delegate) believes on reasonable grounds that the person

continues to meet the criteria in section 85(1)(a)(i) – (iv). The chief psychiatrist

or his/her delegate may or may not be the doctor who authorised the initial

involuntary detention or the second doctor who also examined the person for the

purposes of section 85(1)(b).

Section 85(1)(a) - mental illness

23. In this case, on the evidence, I was satisfied at the time of conducting my review

that the authorising doctor (and the other doctor who also examined ED) had,

and continued to have, reasonable grounds for believing that ED had a mental

illness. I reached that conclusion for several reasons.

24. First, ED had been taking high quantities of a prescribed drug,

dexamphetamine. A question arose as to whether ED’s delusions (which were

apparent to each doctor who observed ED) were caused by the drug. Section

11(j) of the Act provides that a person is not to be regarded as having a mental

disorder or mental illness only because the person takes or has taken alcohol or

any other drug. Withdrawal of dexamphetamine from ED (he being unable to

obtain it whilst detained at AMHU) was not causing his mental state to resolve

or improve. Rather, withdrawal of the drug was exposing the real possibility

that ED’s continuing delusions were because of a mental illness. The

dexamphetamine had been, in effect, masking the possibility of that underlying

mental illness.

25. Second, there were real concerns on the part of ED’s treating doctors, including

the doctor who had authorised ED’s detention, that ED was obtaining prescribed

dexamphetamine consequent upon a past but incorrect diagnosis of attention

deficit hyperactivity disorder (ADHD). The doctors were concerned that ED

11

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was taking dexamphetamine supposedly to support his mental wellbeing but not

by reference to a diagnosis they accepted. At hearing, the doctors were clear in

saying they had not made any determination about whether ED had or did not

have ADHD, nor did I make any finding about it. However, in the context of

emergency involuntary detention, a possible misdiagnosis of ADHD gave

reasonable grounds for the authorising doctor to believe that ED’s delusions

were because of a mental illness.

Section 85(1)(a)(i) - requires immediate treatment, care or support

26. Where ED presented with delusions and his mental circumstances were

unknown, it was clear that ED required immediate treatment, care or support.

There was, appropriately, no suggestion to the contrary from Ms Banks.

27. There is ambiguity as to whether the word ‘involuntary’ in the opening line of

section 85(1) applies only to the detention that a doctor may authorise or

extends to the “treatment, care or support” that a doctor may authorise. The

ambiguity is compounded by sections 85(2), (3) and (4), which:

(a) enable the chief psychiatrist (or his/her delegate) to apply to the Tribunal

for an extension of the period of detention;

(b) enable the Tribunal to extend the period; and

(c) enable the person to apply for review of his or her involuntary detention,

but are silent about review of the authorised treatment, care or support.

28. The ambiguity did not arise at the hearing of ED’s application for review of his

involuntary detention, and so I can express only a preliminary view that section

85(1) enables a doctor to authorise involuntary treatment, care or support. It

would be illogical that a doctor could involuntarily detain a person in an

approved mental health facility, and determine that the person requires

immediate treatment, care or support (that being a criterion for the person’s

involuntary detention), and yet not be able to provide that required immediate

treatment, care or support if the person chose not to receive it.

12

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29. That conclusion is supported by the words of section 85 which provide that the

involuntary detention arises in circumstances where the person has “refused to

receive” the treatment, care or support that the person “requires” immediately.

30. The absence of any power on the person’s part to apply for review of the

person’s treatment, care or support, or any power on the Tribunal’s part to

review that treatment, care or support, is consistent with the general principle in

the Act that it is for treating doctors, not the Tribunal, to decide the kind of

treatment, care or support that a person should receive.11

Section 85(1)(a)(ii) - refusal of treatment, care or support

31. Ms Banks submitted that ED was not refusing treatment, care or support and

therefore that criterion in section 85(1)(a)(ii) was not met. I rejected the

submission.

32. First, section 85(1)(a)(i), (iii) and (iv) are written in the present tense unlike

section 85(1)(a)(ii) which requires the doctor to have reasonable grounds for

believing that the person (and ED in this case) “has refused” to receive the

immediate treatment, care or support that he requires.

33. The word ‘that’ in section 85(1)(a)(ii) contemplates that the refusal has to be of

the treatment, care or support that the person requires. It follows that if the

treatment, care or support were to change, the person would need an opportunity

to accept the changed treatment, care or support, and to have refused it, before

section 85(1)(a)(ii) is met. However in this case, the treatment, care or support

that ED required had not changed and he had refused it.

34. ‘Treatment, care or support’ is written disjunctively in section 85(1)(a)(i), (ii)

and (iv). It follows that the refusal can be of any of the treatment, care or

support that the person requires. It is not to the point that the person is not

refusing one aspect of their treatment, for example his or her medication/s, if the

person is refusing another aspect of the required treatment, care or support.

Relevant to this case, part of the care and/or support that ED immediately

required was hospitalisation in order for the doctors to explore further their

11 See for example, sections 57, 59(2) and (3), 67(2) and (3)

13

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provisional diagnosis of his mental illness. On any view, ED had refused, and

was refusing, to stay at AMHU voluntarily.

35. Section 85(1) is silent as to when the refusal needs to have occurred, but in my

view it needs to have occurred at a time relevant to the need for detention. That

might be at a time that led to the person being taken to an approved mental

health facility under section 80(2) of the Act or at any later time but not a time

prior. The refusal cannot be historic.

Section 85(1)(a)(iii) - detention is necessary

36. Whilst refusal of treatment, care or support need not be ongoing for the

purposes of section 85(1)(a)(ii), the absence of ongoing refusal can be relevant

to whether “detention is necessary” or is no longer necessary. However all the

circumstances need to be taken into account. If a person is taking his or her

medications voluntarily and hospitalisation is not otherwise required, detention

might no longer be necessary for the person’s health. However there are other

prescribed reasons for why detention may still be necessary, namely the

person’s safety, social or financial well-being or for the protection of someone

else or the public.

37. These other reasons did not need to be explored at the hearing of ED’s

application because there were reasonable grounds for why detention was

necessary for his health, namely the doctors needed to continue exploring ED’s

medical circumstances in order to ascertain the treatment, care and support he

required. Detention was necessary because ED made clear that he did not accept

that there was anything untoward about his mental health and that he wished to

leave AMHU, hence his application for review.

Section 85(1)(a)(iv) - adequate treatment in a less restrictive environment

38. Whether the final criterion is met depends heavily upon the facts and

circumstances in each case. In many cases, whether this criterion is made out

will depend on whether there is a viable alternative to hospitalisation in order

for the person to receive immediate treatment, care or support. The treatment,

care or support does not need to be to a standard or of a kind that can be

provided in hospital. It needs only to be ‘adequate’.

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39. In this case, the reasonable grounds for why the doctor who authorised ED’s

involuntary detention believed that adequate treatment, care or support could

not be provided in a less restrictive environment mirrored the grounds for why

detention was necessary. At the hearing, ED stated his denial of any mental

illness and did not suggest any other place or manner by which he could receive

treatment, care or support. Rather he denied the need for any treatment, care or

support. If free to leave AMHU, he would have done so and, in all probability,

would have returned (if he could) to taking high doses of dexamphetamine

without any regard to whether they were needed.

40. Through a combination of circumstances, ED came to the attention of mental

health doctors who, fortunately for ED, recognised that his mental health needed

to be addressed. Once his mental state is better understood, the question of

ongoing treatment (voluntary or otherwise) can be considered. However those

issues did not arise in the context of ED’s involuntary detention under section

85, which entailed emergency detention pending doctors being able to make

diagnoses and assessments of ED’s mental health by reference to which they

could determine long-term treatment of ED.

Section 85(1)(b) - another doctor

41. I have noted at paragraph 36(c) above, the requirement for another doctor to

have examined the person and also to have reasonable grounds for believing

that the matters mentioned in section 85(1)(a)(i) – (iv) are met. In circumstances

where there needs to be reasonable grounds for the second doctor’s belief,

objectively judged, the grounds will in most if not all cases be the same

grounds. However, it remains necessary that a second doctor has examined the

person and has the requisite belief. In this case, on the evidence presented, I was

satisfied that another doctor had examined ED and had the requisite belief.

Conclusion

42. For these reasons, I confirmed the order extending the period of ED’s detention.

………………………………..Presidential Member G McCarthy

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HEARING DETAILS

FILE NUMBER: MH 248/2017

PARTIES, APPLICANT: ED (pseudonym)

PARTIES, RESPONDENT: Chief Psychiatrist

COUNSEL APPEARING, APPLICANT Ms Adele Banks

COUNSEL APPEARING, RESPONDENT N/A

SOLICITORS FOR APPLICANT Legal Aid ACT

SOLICITORS FOR RESPONDENT N/A

TRIBUNAL MEMBERS: Presidential Member G McCarthy

DATE OF HEARING: 31 July 2017

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