Mental Health (Forms) Regulations 2004

Mental Health (Forms) Regulations 2004

S.R. No. 149/2004

table of provisions

RegulationPage

1.Objective

2.Authorising provision

3.Commencement

4.Principal Regulations

5.Involuntary Patients

6.New regulation 6A inserted

6A.Involuntary treatment orders

7.Application forms for licenses

8.Schedule 1 substituted

SCHEDULE 1—Form of Request for a Person to Receive Involuntary Treatment

9.Schedule 2 substituted

SCHEDULE 2—Form of Recommendation for a Person to receive Involuntary Treatment

10.Schedule 3 substituted

SCHEDULE 3

Form 1—Particulars of Use of Restraint

Form 2—Particulars of Use of Sedation

11.Schedule 4 substituted

SCHEDULE 4—Form of Authority to Transport Involuntary Patient

12.Schedule 6 substituted

SCHEDULE 6—Involuntary Treatment Order

13.Schedule 21 substituted

SCHEDULE 21—Electroconvulsive Therapy Return

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ENDNOTES

S.R. No. 149/2004

Mental Health (Forms) Regulations 2004

statutory rules 2004

S.R. No. 149/2004

Mental Health (Forms) Regulations 2004

Mental Health Act 1986

S.R. No. 149/2004

Mental Health (Forms) Regulations 2004

Mental Health (Forms) Regulations 2004

S.R. No. 149/2004

Mental Health (Forms) Regulations 2004

The Governor in Council makes the following Regulations:

Dated: 30 November 2004

Responsible Minister:

BRONWYN PIKE

Minister for Health

diane casey

Clerk of the Executive Council

1.Objective

The objective of these Regulations is to amend the Mental Health Regulations 1998.

2.Authorising provision

These Regulations are made under section 142 of the Mental Health Act 1986.

3.Commencement

These Regulations come into operation on 6December 2004.

4.Principal Regulations

In these Regulations the Mental Health Regulations 1998[1] are called the Principal Regulations.

5.Involuntary Patients

r. 5

(1)For the heading to Part 2 of the Principal Regulations substitute—

"Part 2—Involuntary Patients".

(2)Insert the following heading to regulation 5 of the Principal Regulations—

"Initiation of involuntary treatment".

(3)For regulation 5(1) of the Principal Regulations, substitute—

"(1)For the purposes of section 9(1)(a) of the Act, a request to initiate involuntary treatment must be in the form of Schedule1.".

(4)In regulation 5(3) of the Principal Regulations for "9(7), 9(7A)," substitute "9B(4),".

(5)In regulation 5(4) of the Principal Regulations, for "9(7A)(c) of the Act," substitute "9A(1)(c) of the Act,".

(6)In regulations 5(5), (6) and (7) of the Principal Regulations, for "section 9(8) of the Act," substitute "section 7 of the Act,".

(7)In regulation 5(6)(b) of the Principal Regulations, for "that the person be admitted to and detained in the approved mental health service" substitute "that the person receive involuntary treatment from an approved mental health service".

6.New regulation 6A inserted

After regulation 6 of the Principal Regulations, insert—

"6A.Involuntary treatment orders

For the purposes of sections 12 and 12AA of the Act, an involuntary treatment order must be in the form of Schedule 6.".

7.Application forms for licenses

r. 6

In regulation 11(1) of the Principal Regulations, for "For the purposes of section 77(2)(a) and (b)" substitute "For the purposes of section 77(2)(b)".

8.Schedule 1 substituted

For Schedule 1 to the Principal Regulations substitute—

"SCHEDULE 1

Form of Request for a Person to Receive Involuntary Treatment

Mental Health Act 1986

Section 9

Mental Health Regulations 1998

Regulation 5(1) Schedule 1

REQUEST

FOR PERSON TO RECEIVE INVOLUNTARY TREATMENT FROM
AN APPROVED MENTAL HEALTH SERVICE

TO THE *ADMITTING REGISTERED MEDICAL PRACTITIONER/ MENTAL HEALTH PRACTITIONER

Please make an involuntary treatment order for:

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of
person who should be made subject to an
Involuntary Treatment Order

of:

address of person who should be made subject to an involuntary treatment order

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of
person making the request

of:

address of person making the request

Signed: Date://

AUTHORISATION (Optional)

I authorise:

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of other
person authorised by the person making the request

of:

address of other person authorised by the person making the request

To take the abovenamed person to an appropriate approved mental health service.

To arrange for a mental health practitioner to assess the person.

(please cross  one option only.)

Signed:Date: //

signature of person making the request

* delete as necessary

r. 8

______".

9.Schedule 2 substituted

r. 9

For Schedule 2 to the Principal Regulations substitute—

"SCHEDULE 2

Form of Recommendation for a Person to receive Involuntary Treatment

Mental Health Act 1986

Section 9

Mental Health Regulations 1998

Regulation 5(2) Schedule 2

RECOMMENDATION

FOR PERSON TO RECEIVE INVOLUNTARY TREATMENT FROM AN APPROVED MENTAL HEALTH SERVICE

PART A

TO THE *ADMITTING REGISTERED MEDICAL PRACTITIONER/ MENTAL HEALTH PRACTITIONER

Please make an involuntary treatment order for:

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of person
who should be made subject to an involuntary
treatment order

of:

address of person who should be made subject to an involuntary treatment order

(1)I am a registered medical practitioner.

(2)I personally examined the abovenamed person:

on theday of20at*am/pm.

(3)It is my opinion that all the following criteria in section 8(1) of the Mental Health Act 1986 apply to the person:

(a)the person appears to be mentally ill (a person is mentally ill if he or she has a mental illness, being a medical condition that is characterised by a significant disturbance of thought, mood, perception or memory); and

(b)the person's mental illness requires immediate treatment and that treatment can be obtained by the person being subject to an involuntary treatment order; and

(c)because of the person's mental illness, involuntary treatment of the person is necessary for his or her health or safety (whether to prevent a deterioration in the person's physical or mental condition or otherwise) or for the protection of members of the public; and

(d)the person has refused or is unable to consent to the necessary treatment for the mental illness; and

(e)the person cannot receive adequate treatment for the mental illness in a manner less restrictive of his or her freedom of decision and action.

(4)I do not consider the person to be mentally ill by reason only of any one or more of the exclusion criteria listed in section 8(2) of the Mental Health Act 1986.

(5)I base my opinion on the following facts.

Facts personally observed by me on examination to support this recommendation:

r. 9

Facts communicated to me by another person to support this recommendation:

* delete as necessary

PART B

TO BE COMPLETED WHERE NO FACTS ARE PERSONALLY OBSERVED

(6)As no facts were personally observed by me to support this recommendation, the following facts were communicated directly to me *in person/in writing/by telephone/by electronic communication by:

Dr.

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of
other registered medical practitioner

of:

address of other registered medical practitioner

doctor's telephone number:

who examined the person on the day of 20

(being a period not more than 28 days prior to today's date)

Facts communicated to me by other examining registered medical practitioner:

PART C

SIGNATURE

(7)I consider that an involuntary treatment order should be made for the abovenamed person.

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of
recommending registered medical practitioner

Signed: Date: / /

signature of recommending registered medical practitioner

Qualifications:

Address:

Telephone no:

* delete as necessary

______".

10.Schedule 3 substituted

r. 10

For Schedule 3 to the Principal Regulations substitute—

'SCHEDULE 3

Form 1—Particulars of Use of Restraint

Mental Health Act 1986

Section 9B

Mental Health Regulations 1998

Regulation 5(3) Schedule 3 Form 1

RESTRAINT

FOR THE PURPOSES OF SAFELY TRANSPORTING A PERSON TO AN APPROVED MENTAL HEALTH SERVICE

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of
person restrained for safe transport

of:

address of person restrained for the purposes of safe transport

(1)I am a "prescribed person" within the meaning of section 7 of the Mental Health Act 1986—a "prescribed person" is a member of the police force, an ambulance officer or a:

Registered medical practitioner

Registered nurse

Registered psychologist

Social worker

Occupational therapist—

—employed, appointed or engaged to provide care and treatment to persons with a mental disorder in an approved mental health service, a State child and adolescent psychiatry service, any premises licensed under section 75 of the Act, a hospital admitting or caring for persons with a mental disorder, a mental health service of a community health centre, a psychiatric outpatient clinic or a community mental health service.

(2)The abovenamed person is:

subject to a request (Schedule 1) and recommendation (Schedule 2).

r. 10

subject to a request (Schedule 1) and authority to transport (Schedule4).

subject to an involuntary treatment order (Schedule 6) and is to be taken to an approved mental health service under section 12(6) or section 12AC(4)(b) of the Mental Health Act 1986.

a patient absent without leave from an approved mental health service.

(Please cross  one option only.)

(3)I applied the following restraint/s to the abovenamed person to enable her/him to be taken safely to an approved mental health service:

(Specify the type of restraint applied and the reason, each time restraint is used.)

(a)Restraint: Reason applied:

Date: Time applied: *am/pmTime removed: *am/pm.

(b)Restraint: Reason applied:

Date: Time applied: *am/pmTime removed: *am/pm.

(c)Restraint: Reason applied:

Date: Time applied: *am/pmTime removed: *am/pm.

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of prescribed person

employed by:

* Victoria Police / Ambulance Service (MAS/RAV)/mental health service/ other (please specify)

of:

business address of prescribed person

Signed: Designation: Date: / /

* delete as necessary

r. 10

______

Form 2—Particulars of Use of Sedation

Mental Health Act 1986

Section 9B

Mental Health Regulations 1998

Regulation 5(3) Schedule 3 Form 2

SEDATION

FOR THE PURPOSES OF SAFELY TRANSPORTING A PERSON TO AN APPROVED MENTAL HEALTH SERVICE

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of
person sedated for safe transport

of:

address of person sedated for the purposes of safe transport

(1)I am a "prescribed registered medical practitioner" within the meaning of section7 of the Mental Health Act 1986.

(2)The abovenamed person is:

subject to a request (Schedule 1) and recommendation (Schedule 2).

r. 10

subject to an involuntary treatment order (Schedule 6) and is to be taken to an approved mental health service under section 12(6) or section 12AC(4)(b) of the Mental Health Act 1986.

a patient absent without leave from an approved mental health service.

(Please cross  one option only.)

(3)The person has refused or is unable to consent to sedation. I consider that it is necessary to sedate the person so that the person can be taken safely to an approved mental health service. The reasons for my decision are:

(4)The following sedation is to be administered to the person:

Drug: Dose:

Route (IM, IV, Oral): Frequency:

(5)I administered the sedation myself at the following time/s: *am/pm

I direct the following "authorised person" to administer the sedation in the prescribed form:

(Please cross  one option only.)

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of
authorised person

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of
prescribed registered medical practitioner

of:

address of prescribed registered medical practitioner

Signed: Qualifications: Date: / /

TO BE COMPLETED AS NECESSARY BY AUTHORISED PERSON

(1)I am an "authorised person" within the meaning of section 7 of the Mental Health Act 1986—an "authorised person" is a registered medical practitioner or a registered nurse.

(2)I administered the following sedation as prescribed by the abovenamed medical practitioner:

Drug: Dose:

Route (IM, IV, Oral): Time (1): *am/pm Time (2): *am/pm

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of
authorised person

of:

address of authorised person

Signed: Qualifications: Date: / /

* delete as necessary

r. 10

______'.

11.Schedule 4 substituted

r. 11

For Schedule 4 to the Principal Regulations substitute—

'SCHEDULE 4

Form of Authority to Transport Involuntary Patient

Mental Health Act 1986

Section 9A

Mental Health Regulations 1998

Regulation 5(4) Schedule 4

AUTHORITY TO TRANSPORT WITHOUT RECOMMENDATION

TO THE ADMITTING REGISTERED MEDICAL PRACTITIONER

Please examine:

GIVEN NAME/SNAME (BLOCK LETTERS) of person

of:

address of person

for the purpose of making a recommendation under section 9 of the Mental Health Act 1986.

(1)I am a "mental health practitioner" within the meaning of section 7 of the Mental Health Act 1986.

(2)I have observed a completed request relating to the abovenamed person.

(3)A recommendation has not been completed because a registered medical practitioner was not available within a reasonable period to consider making a recommendation, despite all reasonable steps having been taken to secure the attendance of one.

(4)It is my opinion that all the following criteria in section 8(1) of the Mental Health Act 1986 apply to the person:

(a)the person appears to be mentally ill (a person is mentally ill if he or she has a mental illness, being a medical condition that is characterised by a significant disturbance of thought, mood, perception or memory); and

(b)the person's mental illness requires immediate treatment and that treatment can be obtained by the person being subject to an involuntary treatment order; and

(d)the person has refused or is unable to consent to the necessary treatment for the mental illness; and

(e)the person cannot receive adequate treatment for the mental illness in a manner less restrictive of his or her freedom of decision and action.

(5)I do not consider the person to be mentally ill by reason only of any one or more of the exclusion criteria listed in section 8(2) of the Mental Health Act 1986.

(6)I base my opinion on the following facts personally observed by me on examination:

(7)I consider that the person should be taken to an approved mental health service for examination by a registered medical practitioner for the purpose of making a recommendation under section 9 of the Mental Health Act 1986.

GIVEN NAME/SNAME (BLOCK LETTERS) of mental health practitioner

Signed: Date: / / Time: *am/pm

Employed by: Designation:

approved mental health service

* delete as necessary

r. 11

______'.

12.Schedule 6 substituted

r. 12

For Schedule 6 to the Principal Regulations, substitute—

"SCHEDULE 6

Involuntary Treatment Order

Mental Health Act 1986

Sections 12 and 12AA

Mental Health Regulations 1998

Regulation 6A Schedule 6

INVOLUNTARY TREATMENT ORDER

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of
person subject to Involuntary Treatment Order

of:

address of person subject to Involuntary Treatment Order

To be completed by registered medical practitioner/mental health practitioner

(1)I am a registered medical practitioner employed by the approved
mental health service.

The abovenamed person has been taken to the approved mental health service.

I am a mental health practitioner within the meaning of section 7 of the Mental Health Act 1986.

I have been requested to assess the abovenamed person.

(please cross  one option only.)

(2)I have sighted a completed request and recommendation relating to the person.

(3)I hereby make an involuntary treatment order for the person on:

the day of 20 at *am/pm.

(4)The approved mental health service is:

name of approved mental health service

GIVEN NAME/SFAMILY NAME (BLOCK LETTERS) of
*registered medical practitioner/mental health practitioner

Signed: Designation:

Address: Telephone no:

* delete as necessary

r. 12

______".

13.Schedule 21 substituted

r. 13

For Schedule 21 to the Principal Regulations substitute—

"SCHEDULE 21

Electroconvulsive Therapy Return

Mental Health Act 1986 / TO THE CHIEF PSYCHIATRISTSCHEDULE 21
Section 80
Mental Health Regulations 1998
Regulation 13
ELECTROCONVULSIVE THERAPYRETURN / From: Date: /
*approved mental health service / licensed premises
Referring service (if applicable): ......

Licensed premises/approved mental health services must submit a return every month—including a 'nil return' when no electroconvulsive therapy is performed in a given month.
Start a new page for each day. A page records electroconvulsive therapy performed on one day only.
Complete separate pages for patients from other 'referring services'. One page for each referring service.
Individual pages should be compiled to form the monthly return to the Chief Psychiatrist.
Information should be recorded using the code letter in brackets where applicable.

/ Name of doctoradministering ECT: ......
Name of anaesthetist: ......
Mental Health Statewide Patient Number
or
Private Hospital UR Number / Sex
(M)
or
(F) / Date of birth / Country of birth / Program type
(A)Adult
(G)Aged
(K)CAMHS
(S)Specialist
(P)Private / Legal status
(I)nvoluntary
(H)ospital Order
(S)ecurity
(F)orensic
(N)o Status or
Informal / Treatment type
(B)ilateral
(U)nilateral
(BF)Bilateral
Bifrontal
(BT)Bilateral
Bitemporal / Treatment phase
(A)cute
(C)ontinuation
(M)aintenance / Status
(I)npatient
(O)utpatient / Consent type
(P) Patient
(A) Authorised
Psychiatrist
(PA) Patient &
Authorised Psychiatrist / Principal diagnosis to be treated by ECT
(Use ICD Code No)
I submit this return of electroconvulsive therapy performed at these premises as part of the monthly return to the Chief Psychiatrist.
......
Given NamesFamily Name (BLOCK LETTERS) of person
completing this return
Signed: ...... Designation: ...... / ......
Given NamesFamily Name (BLOCK LETTERS) of *delegated/authorised psychiatrist/ECT Director/Occupier of licensed premises
Signed: ...... Designation: ...... Date: ....
*delete as necessary

______".

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S.R. No. 149/2004

Mental Health (Forms) Regulations 2004

ENDNOTES

Endnotes

[1] Reg. 4: S.R. No. 120/1998 as amended by S.R. Nos 45/2001 and 111/2003.