Second psychiatric opinions

Second psychiatric opinions – who can seek one?

An entitled patient can seek a second psychiatric opinion at any time.

An entitled patient is a person who is subject to a Temporary Treatment Order or Treatment Order, a security patient or a forensic patient.

At the request of an entitled patient, any person may seek a second psychiatric opinion. Guardians, parents of entitled patients under 16 years of age and the Secretary to the Department of Health & Human Services, if the entitled patient is the subject of a family reunification order or a care by Secretary order, may also seek a second psychiatric opinion.

Second psychiatric opinions – who can provide one?

A second psychiatric opinion under the Mental Health Act 2014 can be sought from any psychiatrist. For example:

• another psychiatrist at the entitled patient's treating designated mental health service
• a psychiatrist from a different designated mental health service
• a private psychiatrist
• the Second Psychiatric Opinion Service.

Where a second psychiatric opinion is requested under the Mental Health Act 2014, the authorised psychiatrist must ensure that reasonable steps are taken to assist an entitled patient to obtain a second opinion. This includes assistance to decide the most appropriate psychiatrist to provide the second psychiatric opinion. This will be decided by the patient's circumstances in each case including, the purpose for which the opinion is sought, the diagnosis, the urgency of the request and the patient's financial circumstances.

For example a private psychiatrist (who will require payment to provide an opinion) may possess specialist expertise relevant to the patient's treatment or be able to provide an opinion more quickly than a psychiatrist employed at a designated mental health service or the Second Psychiatric Opinion Service. Refer to the Second Psychiatric Opinion Service website for their eligibility criteria.

Role of second opinion psychiatrist

The second opinion psychiatrist reviews the treatment provided to an entitledpatient and may recommend changes they consider appropriate.

In relation to patients on Temporary Treatment Orders or Treatment Orders and security patients, the second opinion psychiatrist will also provide an opinion about whether the treatment criteria apply.

The second opinion psychiatrist will:

• examine the entitled patient in person or remotely via video conferencing
• access any relevant heath information that is held by the designated mental health service treating the entitled patient
• consult the authorised psychiatrist and any other staff of the designated mental health service about the entitled patient's treatment.

In deciding to recommend any changes to the treatment, the second opinion psychiatrist must have regard to:

• the entitled patient's views and preferences about treatment, any beneficial alternative treatment and the reasons for these views and preferences including any recovery outcomes the patient would like to achieve
• the views and preferences of the entitled patient in their advance statement
• the views of the nominated person
• the views of a guardian
• the views of a carer if the psychiatrist is satisfied the recommended changes will directly affect the carer and the care relationship
• the views of a parent of an entitled patient under 16 years
• the views of the Secretary to the Department of Health & Human Services, if the entitled patient is the subject of a family reunification order or care by Secretary order.

Staff of a designated mental health service must provide a psychiatrist giving a second psychiatric opinion any reasonable assistance that the psychiatrist requires in order to perform or exercise their functions or powers.

The second opinion psychiatrist must provide a written report to the patient, the authorised psychiatrist, the nominated person and other specified people, including the carer where the second opinion will directly affect the carer and the care relationship.

Second psychiatric opinion report – who can receive a copy?

The second opinion psychiatrist must ensure reasonable steps are taken to provide a copy of the report to the entitled patient and the following people (as applicable):

• the person who requested the second psychiatric opinion
• the nominated person
• a guardian
• a carer if the psychiatrist is satisfied the opinion will directly affect the carer and the care relationship
• a parent if the entitled patient is under 16 years
• the Secretary to the Department of Health & Human Services, if the entitled patient is the subject of a family reunification order or care by Secretary order.

Role of the authorised psychiatrist

The authorised psychiatrist must consider any second psychiatricopinion report provided and may make changes to the entitled patient's treatmentbased on the recommendations.

Where the second psychiatric opinion report expresses an opinionthat the criteria do not apply to the entitled patient, the authorisedpsychiatrist must:

• examine the entitled patient as soon as practicable and
• determine whether the criteria for the relevant Order apply to the entitled patient.

If the authorised psychiatrist determines that the criteria for an Order to which the entitled patient is subject do apply, the authorised psychiatrist must:

• give the entitled patient the reasons for their determination and
• advise the entitled patient that they have a right to apply to the Mental Health Tribunal for revocation of the Order.

If the second opinion psychiatrist’s report recommends changes to the entitled patient's treatment, the authorised psychiatrist must:

• review the entitled patient’s treatment and
• decide whether to adopt any of the recommendations made in the report.

If the authorised psychiatrist decides to adopt any of the recommendations made in the second opinion report, the authorised psychiatrist must revise the treatment of the entitled patient.

If the authorised psychiatrist decides to adopt none or to adopt only some of the recommendations made in the second opinion psychiatrist’s report, the authorised psychiatrist must:

• give their reasons to the entitled patient for adopting none or only some of the recommendations and provide an explanation of the reasons and
• advise the entitled patient that they have a right to apply to the Chief Psychiatrist for a review of their treatment.

Review by the Chief Psychiatrist

An entitled patient (or any of the persons listed above who can seek a second psychiatric opinion) may apply to the Chief Psychiatrist for a review of the entitled patient's treatment if the authorised psychiatrist does not adopt any or all of the recommendations contained in a second psychiatric opinion report.

Staff of a designated mental health service must provide an entitled patient with reasonable assistance to make an application to the Chief Psychiatrist to review their treatment.

The Chief Psychiatrist must review the treatment of an entitled patient within 10 business days of receiving an application from an entitled patient.

In conducting a review of the treatment of an entitled patient, the Chief Psychiatrist may:

• examine the entitled patient
• access any heath information that is held by the designated mental health service treating the entitled patient
• consult the authorised psychiatrist and any other staff of the designated mental health service about the entitled patient's treatment.

When deciding whether to recommend changes to treatment, the Chief Psychiatrist may take into account the views of the following people:

• the entitled patient, including:
  • the patient’s views and preferences about treatment, any beneficial alternative treatment and the reasons for these views and preferences including any recovery outcomes the patient would like to achieve
  • views and preferences expressed by the patient in their advance statement
• the nominated person
• a guardian
• a carer if the recommended changes will directly affect the carer and the care relationship
• a parent of an entitled patient under 16 years
• the Secretary to the Department of Health & Human Services, if the entitled patient is the subject of a family reunification order or a care by Secretary order.

The Chief Psychiatrist may recommend changes to the treatment and can direct an authorised psychiatrist to make changes to the entitled patient’s treatment if necessary.

The Chief Psychiatrist must ensure that reasonable steps are taken to notify in writing the following persons of the outcome of their review:

• the entitled patient
• any person who applied for the review
• the authorised psychiatrist
• the nominated person
• the guardian
• the carer if the Chief Psychiatrist is satisfied that the recommended changes will directly affect the carer and the care relationship
• a parent of an entitled patient under 16 years
• the Secretary to the Department of Health & Human Services, if the entitled patient is the subject of a family reunification order or a care by Secretary order.