|Title:||Emergency Psychiatric Treatment and Issues of Consent|
|Document ID:||Operational Directive OD 0244/09|
|Date of issue:||Wednesday, 2 December 2009|
|Status:||NO LONGER APPLICABLE|
|Description:||Guidance for clinicians giving Emergency Psychiatric Treatment under the Mental Health Act 1996 and the issue of consent.|
|Legal requirements:||Mental Health Act 1996
|Period of effect:||from 28 October 2009 to 28 October 2014|
|Review date:||28 October 2014|
|Authorised by:||Dr Peter Flett, Director General of Health, Department of Health, 02-Dec-2009|
|Print version:||View print version|
Emergency Psychiatric Treatment and Issues of Consent
Responsibilities of the Chief Psychiatrist for psychiatric care
The Mental Health Act 1996 (MHA) states that:
Consent to treatment (MHA, Part 5, Div 2)
A clinician must seek valid consent from a person before providing psychiatric treatment. Consent is valid if freely and voluntarily given and a failure to offer resistance to treatment does not of itself constitute consent to treatment.
Before consent is sought the patient must to be given a clear explanation of the proposed treatment including sufficient information such as warnings of risks and what is known or not known about the effects of the treatment. Essentially this is any information which will assist the patient in making a balanced judgement about whether or not to consent to the treatment. The extent of the information should be sufficient for a reasonable person in the patient’s position to regard as significant and include information that the person is likely to consider personally important. The information should be conveyed in a form that would enable the patient to readily understand the issues, including the use of information in other languages or the use of interpreters. Sufficient time should also be given to the patient to consider the information provided including whether to seek advice and assistance from other sources.
As a general rule a person can refuse treatment if they are:
Treatment may be provided to a person as part of the duty of care the health professional has for the person, however there may be issues of personal liability. Therefore, it is the view of the Chief Psychiatrist that Emergency Psychiatric Treatment (EPT), as it is within statutory legislation, is the preferred way of managing the issue of giving medication to behaviourally disturbed mental health patients who do not consent to treatment but at risk of harm to themselves or others. It is within statutory legislation and also results in the use of EPT being reported to and tracked/monitored by the Mental Health Review Board.
Emergency Psychiatric Treatment (EPT) (s.113)
EPT means psychiatric treatment that it is necessary to give to a person to save the person’s life, or to prevent the person from behaving in a way that can be expected to result in serious physical harm to the person or any other person.
EPT does not include psychosurgery.
Seclusion as described by s.116 of the MHA or any other intervention whereby a person is placed in a room from which they cannot leave of their own accord is not EPT.
Electroconvulsive Therapy (ECT) may be given as EPT if it meets the criteria in section 113 MHA
EPT may be given without any consent or approval that would be required for a voluntary patient or a referred person. However consent should always be sought and only if consent is not freely given or the patient is not capable of giving informed consent should treatment be given without consent or approval.
Duties of person giving emergency treatment
A person (usually the medical practitioner or nursing staff) who gives EPT, is to ensure no matter what the setting, (a clinic, GP’s surgery, emergency department, police lock-up, person’s home or a hospital) that a record is made of the treatment including:
A template EPT reporting form is available from the Resources and Publications page of the OCP website: www.chiefpsychiatrist.health.wa.gov.au.
Having completed a record of the treatment a copy must be forwarded to the Mental Health Review Board at GPO Box Y3063, East St George’s Terrace, PERTH WA 6832 or fax to 9219 3163. The MHRB maintain a database on EPT.
As ECT is usually a planned treatment the Chief Psychiatrist must be made aware when ECT is being provided as EPT. It would be preferable if the Office of the Chief Psychiatrist is informed before the treatment is given. The Chief Psychiatrist will also be provided with a report outlining the circumstances and reasons for the treatment.
Documentation of the EPT must also be placed on the patient’s medical record.
More detailed information about Emergency Psychiatric Treatment and Issues of Consent can be found in the Clinicians Guide to the Mental Health Act 1996 (Fourth Edition), available on the Chief Psychiatrist’s website: www.chiefpsychiatrist.health.wa.gov.au or a copy may be obtained by contacting the Office of the Chief Psychiatrist on 9222 4462. Dr Rowan Davidson is the Chief Psychiatrist.
Dr Peter Flett
This circular last updated: Wednesday, 2 December 2009 at 3:27pm