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Week 4: Victorian Mental Health Act [2014]: Patient Journey

Scenario
Jason is a 20 year old male who resides in a shared accommodation living with friends who he met
through his university course. Jason works part time while financially supporting himself through his
studies. Jason has a history with the local mental health services. His parents have been supportive
of his care.

Jason has been finding it increasingly difficult to concentrate in class and has been easily distracted
by external stimuli. Jason has been increasing his use of marijuana and his friends report he has
become increasingly irritated with strange and erratic types of behaviour, poor attention and
concentration, and wearing his earphones most of the day. Jason’s friends report being worried
about him, as he has been missing classes, behaving “in an odd manner” and are not sure how to
help him.

Jason was found by the police yelling and swearing while no one else was present, expressing the
belief that people were following him, while being increasingly resistive and aggressive when police
tried to assist him, stating “they are coming” “they’re coming to get me”.

Police subsequently transported Jason to the emergency department under section 351 of the
Victorian MHA [2014] for review and assessment by the psychiatric registrar & Mental Health
Practitioner (Nurse).

1. What are four criteria for a compulsory assessment order or admission under
Section 29 of the Victorian MHA [2014]

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2. What relevant assessments should the nurse and psychiatric registrar / medical officer conduct
to help inform their decision?

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After completion of these assessments it is apparent that Jason fulfils the criteria for compulsory
(involuntary) admission, under (section 30) of the Victorian Mental Health Act 2014 the Mental
Health Nurse or psychiatric registrar can complete the;

1. ____________________________________________________

and the treatment setting the patient will be assessed in would be;

2. _____________________________________________________

Baseline tests are positive for marijuana use and his other results are NAD, with Jason remaining
fearful and agitated that “they are after me”, the psychiatric registrar phones the Mental Health unit
to ascertain if a bed is available.

Jason hears the doctor making the call and absconds from the emergency department.

3. Given the Assessment Order forms has been completed and he is missing, who do you
notify?

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4. How long do services have to find Jason before the Assessment Order expires?

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5. Jason is located making his way home and is found by the Police and returned to the
hospital and is admitted to the psychiatric ward later that afternoon as a compulsory
patient. What form should the admitting nurse in charge complete on Jason’s arrival to the
ward? What other relevant documents should the nurse check?

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What relevant documents should the admitting nurse provide to Jason following assessment?

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6. Jason continues to protest his innocence and remains insight less that he appears to have a
mental illness. He remains paranoid of others and is easily agitated.

Jason is examined in the morning by the consultant psychiatrist for his “assessment for an
Inpatient Temporary Treatment Order (TTO)” section 46. Discuss the psychiatrist’s role and section
46 of the MHA [2014].

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7. There are instances where the Authorised psychiatrist cannot decide if Jason fits all the
section 30 criteria and wishes to defer a decision about the Temporary Treatment Order.
What is the maximum time that a psychiatrist can defer their decision?

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8. How many times can this deferral occur before the psychiatrist must decide? ____________

9. After the interview with the consultant psychiatrist, Jason becomes aggressive and violent
toward staff upon hearing that he has to stay in hospital as a compulsory patient; he attempts to hit
the psychiatrist requiring staff intervention involving bodily restraint. (Section 115) Jason continues
to be abusive and threatening without any response to staff de-escalation techniques and
administered of PRN medications, Jason is physically escorted into the seclusion room (Section 111)
where Jason remains distressed and abusive. Jason is subsequently secluded.

Legally under the act, Jason must be provided with what during the period of seclusion?
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10. Under the act, (1) how often does the nurse need to review/observe Jason, (2) at what
intervals does the nurse need to arrange a medical examination?

1._____________________________________________________________________________

2. _____________________________________________________________________________

11. Discuss the safety interventions that need to be conducted by the nurse when placing
Jason in the seclusion room.

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12. Upon ceasing seclusion, the nurse debriefs Jason regarding his understanding of events
that led to his seclusion and restraint. Why is this important?

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13. What are Jason’s legal rights if he wishes to complain about his treatment and who can he
complain to?

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14. Jason demands an appeal form, section 114 to the Mental Health Tribunal (MHT), section
153. Explain the role and function of the MHT with regard to maintenance of Jason’s rights.

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15. Now that the consultant psychiatrist has decided to detain Jason on an Inpatient -
Temporary Treatment Order, there are needs for a Mental Health Tribunal hearing to decide on
Jason’s future treatment. How long can Jason remain on a Temporary Treatment Order before
having his appeal heard?

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16. On the day of the Mental Health Tribunal (MHT) hearing, the MHT decides that Jason
fulfils the section 30 criteria but decide that Jason does not need to remain an inpatient and can
be treated in the community. Is there a difference in the duration of time a patient can be treated
compulsorily in the inpatient unit compared to the community before attending another MHT
hearing?

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17. Jason is now ready to be discharged. The treating team decides that it would be important
that Jason receives ongoing community follow-up. What options are available in terms of his legal
status under the Mental Health Act?

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18. How can the treating team monitor and ensure compliance with treatment and care for Jason
once discharged? (Discuss Section 52(2))

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