Mental Health and Wellbeing Act 2022 (Victoria) – Comprehensive Study Notes

Note: These notes reflect content from the provided transcript and are organized to resemble a detailed study guide. LaTeX is used for all numerical values and durations.

Purpose and Objectives of the MHWA 2022

The Act provides a legislative framework for:
- the assessment of persons who appear to have a mental illness
- treatment of those with a mental illness
- initiation of Compulsory Treatment and making Compulsory Treatment Orders
- establishment of the Mental Health Tribunal
Objectives include:
- protecting the rights of persons receiving treatment
- enabling support persons to participate in decision-making
- recognising the role of carers
Additional aims:
- promote voluntary treatment over compulsory treatment
- minimise the use and duration of compulsory treatment
- ensure treatment provided is in the least restrictive manner
- set criteria for treatment orders and provide a duration for them
- support recovery‑orientated practice

Principles of the MHWA 2022 (Section 15)

Dignity and Autonomy
Diversity of Care
Least Restrictive
Supported Decision Making
Family and Carer’s involvement
Lived experience
Health Needs
Dignity of Risk
Wellbeing of Young People
Diversity Principle
Gender Safety
Cultural Safety
Wellbeing of Dependents

What does NOT constitute a mental illness

Political beliefs
Religious beliefs
Philosophical beliefs
Sexual preference, gender identity or sexual orientation
Engaging in or refusing to engage in a particular political activity
A pattern of sexual behaviour
Behaviour contrary to community standards of acceptable conduct
Illegal conduct
Antisocial behaviour

What does NOT constitute a mental illness (additional examples)

Intellectual disability
Substance use (drugs or alcohol)
Economic or social status or a member of a particular racial or social group
Involvement in family conflict
Psychological distress
Prior diagnosis or treatment for a mental illness

Assessment Orders (Chapter 4; Section 142)

Compulsory assessment criteria require that:
- (a) the person appears to have mental illness
- (b) because the person appears to have mental illness, the person appears to need immediate treatment to prevent:
- (i) serious deterioration in mental or physical health; or
- (ii) serious harm to the person or to another person
- (c) if the person is made subject to an assessment order, the person can be assessed
- (d) there are no less restrictive means reasonably available to enable the person to be assessed
These criteria establish the threshold for compulsory assessment.

Admission Process – Assessment Orders (Community vs Inpatient)

Assessment Order options:
- Community Assessment Order
- Inpatient Assessment Order
Enforcement driven by a Psychiatrist:
- Determines whether compulsory assessment criteria are met
Post-assessment outcomes:
- Individual may be discharged if criteria are not met
- If criteria are still not met, the order may be extended
- Or placed on a Temporary Treatment Order (TTO)
The process emphasizes
- a likelihood of immediate assessment and potential treatment
- clear pathways for discharge, extension, or transition to a treatment order

The Assessment Order Form (MHWA 101)

Local identifiers on the form include:
- Local Patient Identifier
- FAMILY NAME (block letters)
- GIVEN NAMES
- DATE OF BIRTH
- SEX
- GENDER
- Mental Health Statewide UR Number
Completion requirements:
- The form must be completed by a Registered Medical Practitioner or an Authorised Mental Health Practitioner
- Must be completed as soon as practicable after examination, but not more than 24\ \text{hours} after examination
Examination and purpose:
- Examiners must explain the purpose of the examination to the person
Contents and declarations:
- Sections 1–9 cover practitioner identity, examination date/time, assessment criteria (section 142), and decisions
- The practitioner must indicate whether the assessment can occur in the community or inpatient setting:
- Community Assessment Order
- Inpatient Assessment Order
- Designated Mental Health Service responsible for assessment
- Date and time the Assessment Order is made
- Duration details:
- A Community Assessment Order is for 24\ \text{hours} unless extended or revoked
- An Inpatient Assessment Order is the earlier of either 24\ \text{hours} after receipt at the service or 72\ \text{hours} after the order is made, unless extended or revoked
Signatures and validation:
- Signature of the practitioner
- Name, designation, address, and telephone
Additional form detail:
- Footer: ROLLS AUSTRALIA 1300600 192
- Original-designated mental health service and Copy-patient indicators
- MHWA 101

Admission Process – Treatment Orders (Chapter 4; CTO/ITO)

CTOs and ITOs require criteria similar to assessment orders and address immediate treatment needs when less restrictive means are not available
CT0: Community Treatment Order
ITO: Inpatient Treatment Order
CT0 and ITO specifics must be stated, including duration, and the setting in which treatment will occur

Temporary Treatment Orders (TTOs) – Chapter 4

The Authorised Psychiatrist is responsible for issuing a TTO
Considerations for issuing a TTO include:
- The person’s views and preferences about their mental illness and recovery
- Any views/preferences in an Advance Statement
- The views of the person’s Nominated Person, guardian, or carer
- The views of the person’s parent(s) if the person is under 16
- The views of the Secretary to the Department of Human Services if under a Custody or Guardianship Order
A TTO enables treatment either in the community or at a designated mental health service
A TTO can only be made if the Authorised Psychiatrist has examined the person and is satisfied that treatment criteria apply
The Mental Health Tribunal must conduct a hearing within 28\ \text{days}

Temporary Treatment Orders – Tribunal and Beyond (Chapter 4)

The Mental Health Tribunal can:
- Discharge the person from the order
- Confirm the individual remains subject to a treatment order (CTO or ITO)
- If in the community, arrange for the person to be taken to a designated mental health service (ITO)
The Tribunal must state whether the order is a CTO or ITO and specify the duration

Rights and Advance Statements

Statement of Rights (Chapter 2):
- Any person under the MHWA 2022 must be given a statement of rights
- Form of statement of rights and steps to ensure the person understands it
- The statement must be explained and given to:
- Support persons
- Guardian
- Carer
- Parent
Advance Statement of Preferences (Chapter 2):
- Sets out the person’s preferences regarding treatment, care, and support if they become unwell
- Can specify:
- Preferences for treatment
- Preferences relating to care and support (including communication and decision-making)
- Preferences about who may receive information
- Name and contact details of Nominated Support Person or Advocate
- Name and contact details of a person/organisation to be informed if the person is a patient

Nominated Person (Chapter 2)

Role:
- Advocate for the patient’s views and preferences
- Support the patient to participate in decisions
- Advocate for appropriate supports to assist communication and participation in decision-making
- Help the patient understand and communicate their views, preferences, and decisions
- Receive information on behalf of the patient
- Support the patient to exercise their rights
Appointment and validity:
- Appointed in writing
- Must be accepted by the nominated person
- Must be formally revoked when necessary
- They cannot make decisions on behalf of the patient
(Notes from transcript): MHWA 101 forms related to nominations may appear in documentation

Capacity and Consent (Chapter 3)

Presumption of capacity: the person is presumed to have the capacity to give informed consent
Informed consent must be sought before giving treatment
Informed consent may not be necessary if the person seeking consent reasonably believes the person does not have capacity
Informed consent criteria:
- The person has capacity
- The person has been given adequate information to make an informed decision
- The person has been given a reasonable opportunity to decide
- The consent is given freely
- The person has not withdrawn consent (or indicated an intention to withdraw)
Capacity criteria for the person:
- Understand the information
- Remember the information
- Weigh up the information
- Communicate a decision

Crisis Response (Chapter 5)

Leadership:
- Crisis Response should be led by a Health Professional where possible
- If a health professional cannot lead, they should advise those responding
Apply MHWA principles and a least restrictive approach
Must involve an Authorized Person during crisis response
Authorized Persons may include:
- Police officer
- Protective services officer
- Member of a prescribed class of persons
Powers during crisis:
- May take a person into care and control if they believe the person appears to have a mental illness and, due to the illness, it is necessary to take the person into care and control to prevent imminent and serious harm to the person or to others
- The person is not expected to exercise clinical judgment in determining mental illness
Aftercare: arrange for the person to be examined as soon as practicable

Mental Health Tribunal – Chapter 7

Functions include:
- Hear and determine whether a Treatment Order should be made
- Applications to revoke a Temporary Treatment Order
- Applications relating to transfer of a patient to another mental health service for assessment or court assessment, or treatment of a TTO patient or Treatment patient
- Applications to perform Electroconvulsive Therapy (ECT)
- Applications for security patients

Connections, Implications, and Practical Considerations

Ethical and human rights considerations:
- Balancing autonomy and dignity with safety and well-being
- Emphasis on least restrictive approaches and recovery-orientated practice
- Involvement of family, carers, and nominated persons in decision-making
Practical implications for practice:
- Need to understand and apply Section 142 criteria for assessment orders
- Proficiency in completing MHWA 101 assessment forms accurately
- Processes for community vs inpatient assessments and treatment orders
- Clear roles for Nominated Persons and Advance Statements in care planning
- Understanding tribunal processes, timelines (e.g., 28\ \text{days} for TTO hearings), and outcomes
Real-world relevance:
- Application in clinical settings, emergency/crisis services, and inpatient units
- Coordination with designated mental health services and the Mental Health Tribunal
- Importance of culturally safe and gender-sensitive practice (as reflected in the principles)

Quick Reference: Key Durations and Dates (LaTeX)

Community Assessment Order duration: 24\ \text{hours}
Inpatient Assessment Order duration: the earlier of 24\ \text{hours} after receipt at service or 72\ \text{hours} after order is made
Tribunal hearing timeframe for TTO: 28\ \text{days}