Mental illness

Forensic patients are people who are either:

• subject to supervision orders (supervision orders last for an indefinite time, and can be custodial or non-custodial);
• on remand under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 (Vic) (‘CMIUT Act’);
• ordered under the Crimes Act 1914 (Cth) (‘Crimes Act (Cth)’) to be detained in safe custody in prison or in a hospital for a specified period (‘Commonwealth forensic patients’).

An IMSO authorises the Victorian Institute of Forensic Mental Health (‘Forensicare’) to place a patient in intensive monitored supervision in a supervision unit located at premises where Forensicare provides secure services to security patients, forensic patients or treatment patients and limits the patient’s contact with others for a period not exceeding 28 days (s 577).

The Mental Health Tribunal makes an IMSO.

The IMSO criteria are that:

• the patient poses an unacceptable risk of seriously endangering the safety of another person; and
• the risk is ongoing; and
• the patient requires an immediate period of supervision in a supervision unit that limits contact with others to mitigate the risk; and
• all less restrictive options have been tried to mitigate the risk and have been found to be ineffective; and
• the patient is able to receive treatment or therapeutic interventions in a supervision unit (s 578).

The Mental Health Tribunal must have regard to the patient’s views and preferences about the treatment or therapeutic interventions including any recovery outcomes they would like to achieve, the patient’s advance statement of preferences, the views of the nominated support person, guardian or carer (if satisfied the making of the order will directly affect the carer and care relationship), the likely impact on the patient and any past experience of trauma, and the patient’s culture, beliefs, values and personal characteristics.

An IMSO application must be accompanied by:

• a report by the authorised psychiatrist setting out the reasons why the authorised psychiatrist is satisfied that each element of the IMSO criteria apply, attaching any supporting evidence, and specifying the date on which the authorised psychiatrist last examined the patient;
• a supervision plan to support the mental health and wellbeing of the patient detailing the proposed treatment and other therapeutic interventions to be provided during the IMSO, measures proposed for reducing the risk posed by the patient to transition from IMSO to the hospital environment; and
• any anticipated harmful effects of being subject to the IMSO and the actions to be taken to reduce those harmful effects (s 582).

An IMSO authorises Forensicare to place a patient in intensive monitored supervision in a supervision unit and limit the patient’s contact with others. The authorised psychiatrist must still consider the safety of others and act to prevent possible harm, confine the patient in the least restrictive way possible and act to advance the patient’s supervision plan. An authorised psychiatrist can set the conditions of an IMSO – permitting patients to move outside the supervision unit or having contact with other persons (s 583).

A patient on an IMSO must be provided with facilities and supplies that meet their needs and maintain their dignity and reflect their interests (subject to any safety requirements) and reduce the effects of isolation and be permitted to spend a reasonable period of time outdoors every day (s 585).

The Mental Health Tribunal must determine the duration of an IMSO. The duration cannot be longer than 28 days after the day on which the order is made (beginning on and including the day the order is made). An IMSO must end if a patient no longer poses an unacceptable risk or if the criteria no longer apply. The patient, nominated support person, guardian and carer (see above) must be notified of the revocation.

Forensicare must establish a clinical committee to provide weekly reports to the Chief Psychiatrist and to conduct reviews. Reports must review the progress of a patient’s treatment or therapeutic intervention having regard to the patient’s supervision plan and the progress towards the patient no longer being subject to an IMSO (s 586).

After an IMSO ends, the clinical committee must conduct a review to determine the effectiveness of the patient’s supervision plan and the experience of the patient while subject to an IMSO. Patients or their nominee, IMHA, nominated support persons or guardians must be invited to make submissions and provide information in the review. The committee’s written report must be provided to the Institute and the Chief Psychiatrist.

A registered medical practitioner or registered nurse must clinically review the patient as frequently as is appropriate having regard to the patient’s condition but not less than every 15 minutes. If it’s not practicable to conduct reviews so frequently, the authorised psychiatrist must be notified. The authorised psychiatrist must examine the patient as frequently as the authorised psychiatrist considers appropriate but not less than every 24 hours or if not practicable, ensure that another registered medical practitioner does (s 587).

Sections 571 and 572 of the MHWA deal with forensic patients and the criteria and process around being taken to another designated mental health service and applying to the MHT for review of such a decision. (See Chapter 8.3: Disability and criminal justice.)