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Program Management Circulars Index <
Protocol for the supervision and treatment of people subject to non-custodial
supervision orders between Forensicare and area mental health services
- March 2007
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Key message
Area mental health services have primary responsibility for providing
treatment and case management to people who live in their area and are
subject to non-custodial supervision orders that have been made on the
grounds of mental illness.
Forensicare has primary responsibility for supervising people on non-custodial
supervision orders that have been made on the grounds of mental illness.
Purpose and scope
This protocol defines the respective roles and responsibilities of the
authorised psychiatrists and other clinicians of the Victorian Institute
of Forensic Mental Health (‘Forensicare’) and area mental health
services concerning the treatment and management of people subject to
non-custodial supervision orders (NCSO) made on the grounds of mental
illness.
This protocol only applies to people on NCSOs that have been made on
the basis of mental illness. It does not apply to clients of disability
services or other service sectors who may be made subject to NCSOs.
Background
Public mental health services in Victoria are provided through area
mental health services (AMHS). AMHS have primary responsibility for the
management of persons who meet eligibility criteria who reside in their
area. This includes persons on NCSOs under the Crimes (Mental Impairment
and Unfitness to be Tried) Act 1997 (‘the CMIA’).
Non-custodial supervision orders
A NCSO is a supervision order made by a court that allows the person
to live in the community while receiving treatment or services for their
mental disorder. The person is required to receive that treatment subject
to the conditions of the order.
There are two ways that a person can be made subject to a NCSO:
- A court may make a NCSO if a person is found to be unfit to stand
trial or not guilty of an offence because of mental impairment.
- A court may vary a person’s custodial supervision order (CSO)
to a NCSO.
Most people being considered for a NCSO will already be receiving mental
health services from an AMHS. It is expected that the relevant AMHS will
continue to provide services when the person is placed on a NCSO. Where
a person is not currently registered with an AMHS, the relevant AMHS will
be determined by reference to the person’s usual or most recent place
of residence.
There will be occasions where a person being considered for a NCSO will
be receiving treatment from a private psychiatrist or general practitioner.
This arrangement may continue after a NCSO has been made. A person being
treated by a private practitioner may also be case managed by an AMHSA
NCSO is a supervision order made by a court that allows the person to
live in where clinically indicated. Any reference in this protocol to
a function or obligation of the authorised psychiatrist of a treating
AMHS concerning a person on a NCSO will also apply to a private practitioner
where the practitioner has primary responsibility for providing treatment
and care to a person on a NCSO.
Individual service agreements
Forensicare, AMHS service providers and private practitioners are required
to enter into individual service agreements concerning the supervision,
treatment and management of individual people subject to NCSOs.
- Individual service agreements must be negotiated as soon as practicable
following the making of a NCSO. An agreement must be explicit about
the roles and responsibilities of all service providers who are partners
in the supervision, treatment and management of people subject to a
NCSO.
- These agreements will incorporate the requirements of this protocol
and the publication Non-custodial supervision order – policy
and procedure manual (Department of Human Services, March 007).
- They will also include specific provisions tailored to meet the needs
of the person. These will have regard to the person’s treatment
plan, any conditions imposed by the court (see below), the person’s
medical and psychiatric history, their family and social circumstances,
any special needs, risk assessments and available services.
- Individual service agreements must include provisions for periodic
review, revision as required and dispute resolution.
Terms and conditions of orders
The terms and conditions of NCSOs are set by the court and vary from
case to case. The NCSO will indicate:
- The supervisor of the NCSO. Each person on a NCSO must be subject
to supervision. The courts generally appoint the authorised psychiatrist
of Forensicare as the supervisor of NCSOs made on the grounds of mental
illness.
- Requirements for treatment and management. NCSOs typically refer to
treatment being carried out by the nominee of the authorised psychiatrist
of Forensicare (as the supervisor). The authorised psychiatrist of the
relevant AMHS will be nominated to provide treatment subject to the
order.
- A direction to comply with the lawful directions of the supervisor,
the nominee and the case manager.
- The place of residence and any requirements if the person wishes to
change their place of residence.
- Additional conditions to meet the needs of the individual person,
for example, that the person abstain from illicit drug use and to submit
to drug screening as and when required by the nominee of the supervisor
(that is, the authorised psychiatrist of the AMHS) or the person’s
case manager.
- A requirement that the person does not leave the State of Victoria
without the permission of the supervisor of the NCSO.
Treatment planning and management
Report to court when a person is first declared liable to supervision
Section 41(1) of the CMIA requires that when a person is first declared
liable to be on a NSCO, a clinical report including a suggested treatment
or other plan for managing the person’s condition must be provided
to the court within 30 days of the declaration.
- The authorised psychiatrist of Forensicare is responsible for preparing
the clinical report within the required timelines in consultation with
the authorised psychiatrist of the treating AMHS.
- The authorised psychiatrist of Forensicare will usually require a
clinician from Forensicare to personally examine the person.
- The authorised psychiatrist of Forensicare is responsible for lodging
the report with the court.
Treatment planning
Once a NCSO is made, the initial treatment plan that was outlined in the
report to the court must be further developed into a comprehensive treatment
and management plan.
- The authorised psychiatrist of the relevant AMHS will prepare, review
on a regular basis and revise as required a treatment and management
plan in consultation with the authorised psychiatrist of Forensicare.
The plan will include arrangements in the event of a relapse or crisis.
Supervision
Each person on a NCSO must be subject to supervision. This is an active
role that will always include monitoring the treatment a person receives.
The authorised psychiatrist of Forensicare is nominated as the supervisor
of mental health NCSOs in all but exceptional circumstances.
- The authorised psychiatrist of Forensicare is responsible for monitoring
the treatment and management of the person subject to the NCSO.
- The authorised psychiatrist of the AMHS is responsible to provide
quarterly clinical reports to the authorised psychiatrist of Forensicare
concerning the treatment, management (including risk management) and
progress of a person on a NCSO in support of the supervision role. The
authorised psychiatrist of Forensicare may vary the frequency of the
report at his or her discretion.
- The authorised psychiatrist of the AMHS is responsible to notify the
authorised psychiatrist of Forensicare about any issues of concern relating
to the person without delay in support of the supervision role.
- The authorised psychiatrist of Forensicare may, in consultation with
the authorised psychiatrist of the AMHS and the Chief Psychiatrist,
vary the nominee or take over treatment and case management.
- Where there is a dispute regarding responsibility for treatment and
case management, either the authorised psychiatrist of Forensicare or
the AMHS may refer the matter to the Chief Psychiatrist. The Chief Psychiatrist
will seek to facilitate a resolution of the dispute.
Ongoing treatment
The AMHS will provide treatment and case management in accordance with
the treatment and management plan and relevant policies and protocols.
- The authorised psychiatrist of the AMHS is responsible for providing
treatment and case management in accordance with the person's treatment
and management plan (as periodically revised) and relevant policies
and protocols. This role will include conducting regular reviews, managing
compliance with the conditions of the NCSO and identifying and managing
any risks factors.
Inpatient admission
A person subject to a NCSO may be admitted as an inpatient on a voluntary
basis or as an involuntary patient under the Mental Health Act 1986
without affecting their status on the NCSO. Admission will, in all but
exceptional circumstances, be to the inpatient unit of the AMHS.
- The authorised psychiatrist of the AMHS must notify the authorised
psychiatrist of Forensicare as soon as practicable regarding an admission.
- Following discharge, the authorised psychiatrist of the AMHS must
provide a report to the authorised psychiatrist of Forensicare outlining
the patient's progress during the admission and any relevant discharge
planning.
Involuntary treatment
A person on a NCSO can be recommended and placed on an involuntary treatment
order (ITO) under the Mental Health Act without affecting their status
on the NCSO. A person on a NCSO can also be placed on a community treatment
order (CTO). In these circumstances the NCSO and the ITO or CTO will operate
concurrently.
- The authorised psychiatrist of the AMHS must notify the authorised
psychiatrist of Forensicare as soon as practicable whenever a person
on a NCSO is made an involuntary patient.
Annual report
A clinical report about the person's progress must be sent to the court
each year. It must include an updated plan for managing the person's illness
or condition.
- The authorised psychiatrist of Forensicare is responsible for preparing
and lodging the annual report within required timelines. This will be
based on an examination conducted by a delegate of the authorised psychiatrist
of Forensicare and the quarterly clinical reports provided by the authorised
psychiatrist of the AMHS (see above).
Non-compliance with a NCSO
Person who has breached conditions of NCSO and is a serious risk
The CMIA has specific provisions for the apprehension and admission of
a person on a NCSO where the person has breached the conditions of their
order and poses a risk of serious danger to themselves or others. Admission
will usually be to the inpatient unit of the AMHS. Admission to the Thomas
Embling Hospital campus of Forensicare will only occur where a person
cannot be managed safely or appropriately in the AMHS's in-patient unit.
Following apprehension, an application must be made to the court within
48 hours to vary the NCSO to a custodial supervision order.
- The authorised psychiatrist of the AMHS is responsible for ensuring
the authorised psychiatrist of Forensicare and the Chief Psychiatrist
are notified about a person breaching the conditions of their NCSO or
where the person may pose a serious danger to themselves or others,
without delay.
- The authorised psychiatrists of Forensicare and the AMHS, in consultation
with the Chief Psychiatrist, will determine how to manage the situation.
This will include decisions about how and when the person will be apprehended
under the CMIA and the most appropriate inpatient service for the admission.
- If a person poses an imminent serious danger and the authorised psychiatrist
of Forensicare or the Chief Psychiatrist cannot be contacted within
a reasonable period, the authorised psychiatrist of the AMHS should
arrange for the person to be apprehended as a matter of urgency. The
authorised psychiatrist of Forensicare and the Chief Psychiatrist should
be consulted as soon as practicable.
- The authorised psychiatrist of Forensicare will liaise with the Department
of Human Services to make an application to the appropriate court.
Person who has breached conditions of NCSO
The CMIA has provisions for a court to review the case of a person who
has not complied with the conditions of their NCSO, but is not posing
a serious danger to themselves or others
- The authorised psychiatrists of Forensicare and the AMHS will together
determine how to manage the situation.
- The authorised psychiatrist of Forensicare will liaise with the Department
of Human Services to make an application to the appropriate court.
Reports
In addition to the reports described above, reports are required whenever
a person is to return to court for a review, variation or revocation hearing
concerning their NCSO.
- The authorised psychiatrist of the AMHS is responsible for preparing
a report on the treatment and progress of the person for each court
hearing in consultation with the authorised psychiatrist of Forensicare.
He or she will also be required to be available to give evidence at
any hearing.
- The case manager from the AMHS will also be required to provide a
report and be available to give evidence.
- The Department of Human Services or Forensicare will notify the authorised
psychiatrist of the AMHS when reports are required.
- The authorised psychiatrist of Forensicare will provide advice and
assistance with these responsibilities.
- The authorised psychiatrist of Forensicare may prepare a separate
report for the court.
- The authorised psychiatrist of Forensicare will liaise with the authorised
psychiatrist of the AMHS and the Department of Human Services to provide
this evidence to the appropriate court.
Local policies and procedures
Mental health service management should ensure that procedures are developed
and implemented to enable staff to appropriately manage the clinical and
legal issues associated with people who are subject to NCSOs.
- Procedures must be consistent with this protocol, the publication
Non-custodial supervision order - policy and procedure manual (Department
of Human Services, March 007) and the requirements of the Crimes (Mental
Impairment and Unfitness to be Tried) Act and the Mental Health Act.
Role of the Chief Psychiatrist
The Chief Psychiatrist has a broad monitoring role in relation to all
forensic patients as well as a number of specific functions under the
CMIA.
- The authorised psychiatrists of Forensicare and the AMHS are responsible
to support the Chief Psychiatrist to carry out these roles. This includes
informing the Chief Psychiatrist of issues of concern relating to the
treatment and management of people on NCSOs.
Further information
Further information can be obtained from the Chief Psychiatrist on 9096
7571 or 1300 767 99 (toll free).
The publication Non-custodial supervision order - policy and procedure
manual (Department of Human Services, March 007) is available at
www.health.vic.gov.au/mentalhealth.
Electronic copies of the CMIA and the Mental Health Act can be viewed
or downloaded from the legislation and parliamentary documents website
at www.dms.dpc.vic.gov.au
About program management circulars
The information in this program management circular is intended as general
information and not as legal advice. Staff should develop a working knowledge
of the relevant provisions in the CMIA and the Mental Health Act. If staff
have queries about their obligations under these acts, they should seek
independent legal advice.
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