Chief Psychiatrist policies
This page includes information about the following Chief Psychiatrist policies.
| Policy | Treatment criteria, assessment of capacity, less restrictive way and advance health directives (PDF 487 kB) | |
| Policy | Treatment authorities (PDF 327 kB) |
These policies are mandatory for all authorised mental health services (AMHSs). An authorised doctor, authorised mental health practitioner, AMHS administrator, or other person performing a function or exercising a power under the Mental Health Act 2016 must comply with these policies.
You can also find additional fact sheets, forms, clinical notes and resources that are available for these policies under the relevant subtopics on this page.
What is capacity to consent to be treated
Capacity is the ability of a person to give informed consent to a particular treatment at a particular time. Capacity can fluctuate over time or a person might have the capacity to consent to some aspects of their treatment and care but not to others.
It is a principle of the Mental Health Act 2016 that a person is presumed to have capacity to make decisions about their own treatment and care. A person may have capacity to consent to be treated even though the person decides not to receive treatment.
Additionally, the Mental Health Act 2016 promotes supported decision making, so if a person is able to understand information and make a decision with the assistance of another person, then the person is deemed to have capacity to make decisions about their own treatment.
If after an assessment, an authorised doctor determines that the person does not have capacity to consent to be treated, a treatment authority may be required to ensure the person receives the necessary treatment and care for their mental illness.
The 'less restrictive way'
The Mental Health Act 2016 promotes the use of a ‘less restrictive way’ for a person to receive treatment and care for mental illness.
This means that where a person lacks capacity to consent to mental health treatment, service providers must consider alternatives to involuntary treatment and care, particularly through the use of advance health directives and substitute decision making if a person’s treatment and care needs can be met using these options.
The Less restrictive way guidelines (PDF 6273 kB) are available to assist clinicians in understanding the meaning, and use, of the less restrictive way.
The guidelines include resources that can inform good practice, and address some of the practical issues experienced by clinicians in supporting less restrictive options.
Advance health directives
In line with recovery-oriented practice, advance health directives allow individuals to provide consent for future mental health care, and to document their views, wishes and preferences about future mental health treatment should they become unwell and lack the capacity to make decisions.
In Queensland, an advance health directive is an enduring document. Advanced health directives can also be used for directions for other matters outside mental health treatment, such as a patient's physical health.
When a patient gives an advance health directive to an AMHS, staff at the AMHS must ensure it is valid and must upload it to the patient's health record on CIMHA.
Patients can read our brochure or guide about making an advance health directive to learn more.
| Guide and form | Advance health directives for mental health (PDF 1748 kB) | |
| Brochure | Advance health directives (PDF 2500 kB) |
Watch the advance health directives video on Vimeo for more information.
Fact sheets and forms
The Guide to Advance Health Directives, Enduring Powers of Attorney, Guardians and Administrators (PDF 253 kB) summarises the provisions of the Powers of Attorney Act 1998 and the Guardianship and Administration Act 2000 of most relevance to clinicians providing treatment to patients with a mental illness.
AMHSs should use the Advance health directives and enduring powers of attorney (PDF 829 kB) checklist and guide to make sure you're following the correct process.
Substitute decision makers
A substitute decision maker is appointed by a person, at a time when they have capacity, to provide substitute decision making and consent in times when they lack capacity.
A substitute decision maker may include the following.
- Appointed guardian
- Person appointed under an Enduring Power of Attorney
- Statutory Health Attorney
The types of decisions that can be made by a substitute decision maker will be dependent on the type of appointment but may include consent to treatment, community and housing support decisions or financial decisions.
Learn more about what a substitute decision maker is on the Queensland Government website.
Forms, checklists and guides for capacity and decision making
For adults
Capacity assessment
Use the Capacity assessment for adults form (PDF 290 kB) to document an adult patient's capacity to consent. Read the Capacity assessment for mental health treatment – adults (PDF 442 kB) form guidance and help using the form.
Decision making
Use the Decision making for adults - Mental health treatment and care flowchart (PDF 442 kB) to follow the correct process for assessing a person's decision making capacity.
For children and minors
Capacity assessment
Use the Capacity assessment for child and youth form (PDF 355 kB) to document a patient's capacity to consent if they're under 18. Read the Capacity assessment for mental health treatment – Child and youth guide (PDF 443 kB) to learn about the Gillick competency and assessing a minor's capacity to consent.
Decision making
Use the Decision making for child and youth - Mental health treatment and care flowchart (PDF 279 kB).
You can also use the Decision maker information checklist - Child and youth (PDF 241 kB) to record a child or minor's capacity to consent. The Guide for the Decision maker information checklist - Child and youth (PDF 350 kB) has more information and guidance on how to use the checklist and assess a minor's capacity to consent.
There are also other considerations for treatment and care of children and minors including parental consent that authorised mental health services must comply with.
Treatment authorities
If a person is not able to consent to treatment of their mental illness, and there is no less restrictive way available, it may be necessary for an authorised doctor to make a treatment authority to authorise involuntary treatment for the person.
When a treatment authority is made, the authorised doctor must determine whether the patient is to receive treatment as an inpatient of a mental health unit or in the community, for example as an outpatient of a community based mental health unit.
The community category is the default category for treatment authorities unless the person’s treatment and care needs cannot be met in the community.
As a key safeguard, patients have their treatment authority regularly reviewed by the Mental Health Review Tribunal.
The Tribunal’s role is to review the appropriateness of the treatment authority and decide whether to confirm (continue) or revoke (end) the authority.
The Tribunal may also decide to change the category of the authority (inpatient or community) or change community treatment arrangements or other conditions which may be applied to the authority.
Fact sheets, forms and resources
Read the Treatment authorities fact sheet (PDF 85 kB) to learn more about when and how to make a treatment authority.
The following forms and clinical notes can be used for patients under a treatment authority.
Some of these forms won't open in your browser. If you experience an error, right-click on the hyperlink instead and select 'save link as.' Otherwise, you can change your browser settings to automatically open PDF documents using Adobe Reader.
| Clinical Note | Involuntary patient and voluntary high risk patient summary (PDF 377 kB) | |
| Form | Order or authority amendment (PDF 1152 kB) | |
| Form | Limited community treatment access and return (PDF 589 kB) | |
Other treatment orders
The majority of people receiving involuntary treatment and care under the Mental Health Act 2016 are on a treatment authority.
However, where a person with a mental illness, or an intellectual or cognitive disability, is charged with committing an offence, the Act enables them to be diverted from the criminal justice system if they are found to have been of unsound mind at the time of the alleged offence, or they are unfit for trial.
In these circumstances, involuntary treatment and/or care may be provided to a person under a treatment support order or forensic order.