Mental Health in Victoria: A presentation from Matthew Carroll, President, Mental Health Tribunal. The Mental Health Tribunal considers compulsory mental health treatment and treatment by electroconvulsive therapy (ECT). The Mental Health Act 2014 has operated for over 18 months. Mr. Carroll provided an overview of the work of the Tribunal, key features of the Act and emerging trends in its operation.

1. The Mental Health Act 2014 (Vic): Observations and
emerging issues from the first two years of operation
Matthew Carroll
President
Mental Health Tribunal
Russell Kennedy
Health Seminar
6 September 2016
Mental Health Tribunal

2. Issues to be covered
1. High level hearing data to illustrate the profile of
hearing triggers.
2. Some of the most significant and/or immediate
reforms, in particular the ECT framework, and
the Tribunal’s role in setting the duration of
Treatment Orders.
3. Some specific complexities.
4. Untapped potential.

3. Background: Principles
underpinning mental health reform
Recovery and community participation
Respect for preferences
Allowing choices involving a degree of risk
An holistic approach that recognises and responds
to the individual
Carers recognised, respected and involved in
decision making wherever possible.

4. Background: Functions of the MHT
The MHT makes orders:
• for compulsory treatment beyond an initial 28
day period, including setting the category and
duration of an order;
• permitting ECT for compulsory patients without
capacity to consent and young people under 18;
• approving neurosurgery for mental illness.
The Tribunal also has a ‘review’ jurisdiction in
relation to security patients.

5. The Broadbrush Picture
14/15 YTD 15/16
(31 March)
Projected
15/16
Hearings 6619 5639 7500
TOs made ITO: 2324
CTO: 2588
ITO: 1866
CTO: 2332
ITO: 2488
CTO: 3109
TOs
revoked
417 267 356
ECTOs
made
550 469 625
ECT app’s
refused
68 66 88

6. Triggers for TO Hearings
2014/15 YTD 2015/16
(30 March)
28 Day TTO
hearing
2902 (48%) 2306 (46%)
Application for
TO
1660 (28%) 1589 (31%)
Application for
TO revocation
831 (14%) 691 (14%)
Variation
hearing
581 (10%) 431 (9%)

7. Treatment Orders
Duration of Community Treatment Orders
15% (119)
38% (304)
1% (10)
46% (366) 1-13 weeks 14-26 weeks
27-39 weeks 40-52 weeks

8. Treatment Orders
Duration of Inpatient Treatment Orders
7% (42)
21% (124)
7% (41)
65% (391)
1-6 weeks
7-13 weeks
14-20 weeks
21-26 weeks

9. ECT Orders – Criteria
1. Does the patient have capacity to provide informed
consent?
Capacity and informed consent are elaborated on in s. 68-70
MH Act. The elements of capacity are :
• An ability to understand relevant information
• Able to remember relevant information
• An ability to use or weigh the information
• Able to communicate the decision s/he makes
In 2014/15 34% of the applications refused by the
Tribunal were on the basis of this criterion.

10. ECT Orders – Criteria
2. Whether in the circumstances there is no less restrictive
way for the patient to be treated.
Relevant considerations (s. 93 MH Act):
• Views and preferences of the patient
• Views of the nominated person and / or carer
• Likely consequences if not performed
• Second Psychiatric Opinion / second opinion
In 2014/15 61% of the applications refused by the Tribunal
were on the basis of this criterion.

11. ECT Applications - Timelines
ECT APPLICATIONS – TIME BETWEEN RECEIPT OF APPLICATION &
HEARING
20%
25%
22%
16%
13%
4%
same day
1 day
2 days
3 days
4 days
5 days

12. Issues of complexity
1. Access to information prior to Tribunal hearings
2. Recovery, relapse and the asymmetry of severity
3. Involvement of carers – generally and in situations of
conflict
4. Prospective v. retrospective tolerance of risk
5. Individuals with multiple and complex needs

13. Untapped Potential
1. Advance statements
2. Nominated persons
3. Second psychiatric opinions