|Title:||Further Opinions Under the Mental Health Act 2014|
|Document ID:||Operational Directive OD 0637/15|
|Date of issue:||Tuesday, 22 December 2015|
|Description:||This operational directive is to outline the principles and processes regarding the request and provision of further opinions under the Mental Health Act 2014. There have been some ammendments since it was previously approved.|
|Legal requirements:||Mental Health Act 2014
|Applicable to:||Psychiatrists, Mental Health Staff, Nurses, Psychologists, Social Workers, Occupational Therapists, Care Co-ordinators|
|Framework:||Mental Health Policy Framework|
|Period of effect:||from 30 November 2015 to 30 November 2020|
|Review date:||30 November 2016|
|Authorised by:||Dr David Russell-Weiz, Director General, Department of Health, 22-Dec-2015|
|Print version:||View print version|
Further Opinions Under the Mental Health Act 2014
The purpose of this document is to outline the principles and processes regarding the request and provision of further opinions under the Mental Health Act 2014 (MHA 2014).
This document refers to further opinions regarding the treatment of an involuntary patient or a mentally impaired accused patient under the MHA 2014. Further opinions under the MHA 2014 also include those relating to a continuation of a community treatment order.
The MHA 2014 recognises that further opinions are an important patient right, and safeguards this right by stating that when either a patient, the person who is authorised by law to consent on the patient’s behalf, the patient’s carer, close family member or nominated person is dissatisfied with treatment provided to a patient under an involuntary treatment order or a mentally impaired accused patient, they may request a further opinion.
Involuntary community patients may also request a further opinion on whether it is appropriate for the supervising psychiatrist to continue a community treatment order by making a continuation order. However, this does not include whether the length of the treatment period specified in the order is appropriate (MHA 2014, section 121(5)).
The MHA 2014 requires that the patient’s psychiatrist or the Chief Psychiatrist obtain the further opinion as soon as practicable after receiving the request.
Principles for Further Opinions
Stakeholders, including patients and carers, were consulted in the development of the model for further opinions. The provision of further opinions is to be based on the following principles:
The process for the request and provision of a further opinion is a non-restrictive approach, which allows the person requesting the further opinion a choice in how they would like this opinion obtained.
The further opinion can be conducted using audio-visual communication in both metropolitan and non-metro areas to provide flexibility and choice. The psychiatrist providing the further opinion and the patient do not need to be in each other’s physical presence but must be able to see and hear each other. When using audio-visual means, a health professional is to be in the room with the patient during the examination.
The process for the request and provision of a further opinion is to follow the steps below.
A further opinion can be requested by a carer, close family member, nominated person or legal representative (section 182). The patient may object to this request, in which case the further opinion does not occur.(MHA 2014 section182 (4(a)).
Further opinions are to be conducted in a way that considers the patient’s cultural needs. If the patient is Aboriginal, to the extent that it is practicable and appropriate, treatment is to be provided in collaboration with Aboriginal Mental Health workers and significant members of the patient’s community. Therefore, they are to be included in the process of obtaining a further opinion (MHA 2014, section 189 and Principle 7 Charter of Mental Health Care Principles).
Where a patient requests a specific psychiatrist, there is to be a reasonable attempt to meet this request. However, it must be acknowledged that practical issues may prevent the provision of the further opinion by the named psychiatrist and in this instance an alternative option will be sought.
Continuation of Community Treatment Orders
The same process applies as per the steps noted above, however community patients must request the further opinion in writing. The Further Opinion Template (attached) can be completed with the patient by a member of the treating team and given to the treating psychiatrist (MHA 2014, section 121(5)).
Refusal of request for an additional further opinion per episode of care
Where a further opinion has already been provided, a request for an additional further opinion may be made. The further opinion should be obtained as outlined above. The patient’s psychiatrist or the Chief Psychiatrist may make a decision that, having regard to the guidelines published under section 547(1)(d), the additional request is not warranted. In this instance the psychiatrist, or Chief Psychiatrist, must, as soon as practicable, file a record of the decision and the reasons for it and provide a copy to the patient, the person requesting the additional opinion (if not the patient), and the Chief Psychiatrist (MHA 2014 section 183 (2) and (5)).
See attached Further Opinions Flowchart.
Timeframes for Further Opinions
Timeframes are required to manage expectations of patients and carers when requesting a further opinion. These timeframes have been set by the Chief Psychiatrist and Area Health Service Chief Executives.
The Further Opinion Template is to be used by WA Health services to ensure clear communication, consistency and accountability with regard to the process. Further Opinion Template is attached.
The form contains both the request and the further opinion written report.
The Further Opinion Template is to be filed in the medical record and a copy given to the patient, or person requesting the further opinion (MHA 2014 section.182 (8) and (9)).
Reasons for refusal of request for a further opinionare to be documented in the medical record and a copy given to the patient, the person requesting the further opinion if not the patient, and the Chief Psychiatrist. A template will be available on the Office of the Chief Psychiatrist website for refusal of a request for an additional opinion.
Evaluation and Monitoring
Data on the volume of requests for further opinions, and the responsiveness to these, needs to be maintained. This data will allow for review of the model and to evaluate the equity of distribution across health services.
Data collection is to include:
Dr David Russell-Weiz
This circular last updated: Thursday, 24 December 2015 at 11:39am