Mental health decisions
Before a doctor can treat you for a mental illness, they must obtain your consent. You can only give or refuse consent if you have decision making ability.
If you lose the ability to make this decision and you don’t have an Advance health directive (AHD) , your doctor must seek a decision from your substitute decision-maker or place you on an order under the Mental Health Act 2016.
If there is no one in your life available or suitable to act as your substitute decision-maker, the Queensland Civil and Administrative Tribunal (QCAT) can appoint us to make decisions about your mental health treatment and care as your guardian.
We can also make decisions about your mental health treatment and care if you have appointed us as your attorney under an Enduring power of attorney (EPOA) or AHD.
We will not make a decision about your mental health treatment and care as a Statutory Health Attorney of last resort.
What principles guide our decision-making?
Our decisions are guided by the Guardianship and Administration Act 2000 and our Structured Decision-Making Framework . These principles ensure that:
- Your human rights are respected
- Your views, wishes and preferences are considered as much as possible
- You are involved in the decision-making process to the greatest extent possible
- Decisions are made in a way that promotes and safeguards your rights, interests and opportunities in the least restrictive way.
What information do we need to make a decision?
When making a mental health decision for you, we ask your treating doctor to provide us with a range of information. This includes:
- What your views, wishes and preferences are and if you agree with the treatment
- Information in relation to what treatment and care they are proposing
- What are the alternative treatment options available
- What are the risks and benefits to you.
What is treatment in a ‘less restrictive way’?
Under the Mental Health Act 2016, treatment must be provided in a way that is the least restrictive of your rights.
Your authorised doctor must obtain consent for your treatment from the first available option in the following order of priority:
- A relevant direction in your advance health directive
- Your guardian
- Your attorney (appointed under an EPOA or AHD)
- Your statutory health attorney.
When might a ‘less restrictive way’ not apply?
1. If you’re an inpatient under an advance health directive or with consent of a guardian or attorney
If you’ve been an inpatient for 14 days or more under an advance health directive or with the consent of a guardian or attorney, your authorised doctor must review your treatment and care.
They will decide:
- Whether you should remain as an inpatient or if community treatment is more appropriate
- If you remain an inpatient, whether treatment should continue under your AHD or with the consent of your guardian or attorney or under a treatment authority.
In making this decision, your doctor must consider:
- Your treatment needs
- Your views, wishes and preferences.
2. If you’re an inpatient with consent of a statutory health attorney
The Chief Psychiatrist recommends that authorised doctors consider using a treatment authority instead of relying on consent from a statutory health attorney. This is because:
- Patients do not choose their statutory health attorney
- Treatment authorities provide procedural safeguards and review mechanisms under the Mental Health Act 2016.
This decision should be made on a case-by-case basis.
If you’re treated as an inpatient with the consent of a statutory health attorney, your doctor must review your treatment 14 days after admission. They will then decide:
- Whether you should remain as an inpatient or if community treatment is more appropriate
- If you remain an inpatient, whether treatment should continue under an AHD, with the consent of a guardian or attorney or under a treatment authority.
In making this decision, your doctor must consider your:
- Treatment needs
- Views, wishes and preferences.
What happens if involuntary treatment is needed?
In some cases, there may be no ‘less restrictive way’ to provide mental health treatment and care.
If this happens, your authorised doctor can make a treatment authority, allowing you to be treated involuntarily, if the treatment criteria apply to you, meaning:
- You have a mental illness
- You lack ability to consent to treatment
- Without involuntary treatment, or continued involuntary treatment, you are likely to:
- Experience imminent serious harm to yourself or others, or
- Suffer serious mental or physical deterioration.
- There is no less restrictive way for you to receive treatment and care.
Will you be treated in the community or as an inpatient?
If you’re treated under a treatment authority, your authorised doctor must provide your treatment in the community.
However, inpatient treatment may be required if your doctor believes one or more of the following cannot be reasonably met in the community:
- Your treatment and care needs
- Your safety and welfare
- The safety of others.
This principle also applies if you’re being treated under an advance health directive or with the consent of a guardian or attorney.
How are treatment authorities assessed and revoked?
Authorised doctors must assess a treatment authority at least every three months to determine whether:
- The treatment criteria still apply, or
- There is a less restrictive way to provide treatment.
If the criteria no longer apply or a less restrictive way is available, the doctor must revoke the treatment authority.
More information
Consent to mental health treatment and care policy
Application for mental health treatment consent form
Chief Psychiatrist policies, forms, flowcharts and resources